Based on the unique clinical correlates of two subtypes of childhood aggression (reactive and proactive), this study examined possible differential treatment effects for children with varying degrees of reactive or proactive aggression receiving one of two types of psychosocial treatment aimed at addressing these unique characteristics. Forty-seven affectively dysregulated children with oppositional defiant disorder (ODD) participated in the study. Results suggest a main effect for type of treatment, modest support for the moderating role of proactive aggression, and no support for reactive aggression as a moderator of treatment outcome. Implications for assessment and treatment of aggression are discussed. / Master of Science

Made available in DSpace on 2014-06-11T19:29:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-02Bitstream added on 2014-06-13T20:59:02Z : No. of bitstreams: 1 rodrigues_e_me_assis.pdf: 647512 bytes, checksum: b83921d06c32f071235ff7e6c9922082 (MD5) / O alcoolista sempre foi visto apenas através de seus sintomas, de sua dinâmica destrutiva e da sua doença, sem considerar a sua subjetividade. As propostas de atenção das políticas públicas são centradas na medicação, no alívio da sintomatologia clínica, restrita à abstinência e sem compreensão da relação psíquica sujeito/álcool. O presente trabalho propõe uma reflexão sobre uma proposta de atenção integral aos sujeitos alcoolistas, elegendo as oficinas terapêuticas como dispositivo de implementação de suas redes de contratualidade. Para tanto, recorremos à psicanálise, como fundamentação teórica e ao método intercessor, como dispositivo específico de produção de conhecimento, para compreender o alcoolista enquanto sujeito psíquico – e sua significação com o objeto droga – e social – como produto e produtor de suas relações sociais e afetivas. Esta metodologia permite considerar os desejos e necessidades dos sujeitos, suas decisões e soluções em relação aos problemas cotidianos; enquanto produtor de conhecimento, o seu papel de protagonista em sua vida, suas ações e na responsabilidade por seu tratamento e a possibilidade de transformação da realidade na qual se insere. Este estudo se baseia na análise de um sujeito alcoolista, acompanhado em uma instituição de saúde mental. Reflete sobre as oficinas como propostas terapêutica para os sujeitos alcoolistas, buscando construir um projeto de clínica-ampliada, que contemple ações em redes de contratualidade social, por meio das estratégias da Atenção Psicossocial / The alcoholic has long been seen only by their symptoms, their dynamics and their destructive disease, regardless of its subjective. The care guidelines proposed by public policies are focused on medication, on the relief of clinical symptoms, restricted to the abstinence and not taking into account the subject’s psychic relationship with alcohol. This paper proposes a discussion on a proposal for a comprehensive care to alcoholic subjects, which adopts the therapeutic workshops as an instrument to implement their contractuality network. Thus, we resort to the psychoanalysis as the theoretical foundation, and to the intercessor method as a specific directive of knowledge generation to understand the alcoholic as a psychic subject – its significance to the drug object – and social – as the product and the producer of its social and affective relations. This methodology allows us to consider the wishes and needs of the subjects, their decisions toward their everyday problems; as a generator of knowledge, their starring role in their own life, their actions and the responsibility for their treatment as well as the possibility of changing the reality of which they are part. This study is based on the analysis of an alcoholic subject, assisted in a mental health institution. It discusses the workshops as therapeutic proposals to treat the alcoholic subjects, aiming to develop a project of an extended-clinic which adopts actions in social contractualism networks, through strategies of Psychosocial Treatment

Orientador: Abilio da Costa Rosa / Banca: Sílvio Yasui / Banca: Sílvio José Benelli / Resumo: O alcoolista sempre foi visto apenas através de seus sintomas, de sua dinâmica destrutiva e da sua doença, sem considerar a sua subjetividade. As propostas de atenção das políticas públicas são centradas na medicação, no alívio da sintomatologia clínica, restrita à abstinência e sem compreensão da relação psíquica sujeito/álcool. O presente trabalho propõe uma reflexão sobre uma proposta de atenção integral aos sujeitos alcoolistas, elegendo as oficinas terapêuticas como dispositivo de implementação de suas redes de contratualidade. Para tanto, recorremos à psicanálise, como fundamentação teórica e ao método intercessor, como dispositivo específico de produção de conhecimento, para compreender o alcoolista enquanto sujeito psíquico - e sua significação com o objeto droga - e social - como produto e produtor de suas relações sociais e afetivas. Esta metodologia permite considerar os desejos e necessidades dos sujeitos, suas decisões e soluções em relação aos problemas cotidianos; enquanto produtor de conhecimento, o seu papel de protagonista em sua vida, suas ações e na responsabilidade por seu tratamento e a possibilidade de transformação da realidade na qual se insere. Este estudo se baseia na análise de um sujeito alcoolista, acompanhado em uma instituição de saúde mental. Reflete sobre as oficinas como propostas terapêutica para os sujeitos alcoolistas, buscando construir um projeto de clínica-ampliada, que contemple ações em redes de contratualidade social, por meio das estratégias da Atenção Psicossocial / Abstract: The alcoholic has long been seen only by their symptoms, their dynamics and their destructive disease, regardless of its subjective. The care guidelines proposed by public policies are focused on medication, on the relief of clinical symptoms, restricted to the abstinence and not taking into account the subject's psychic relationship with alcohol. This paper proposes a discussion on a proposal for a comprehensive care to alcoholic subjects, which adopts the therapeutic workshops as an instrument to implement their contractuality network. Thus, we resort to the psychoanalysis as the theoretical foundation, and to the intercessor method as a specific directive of knowledge generation to understand the alcoholic as a psychic subject - its significance to the drug object - and social - as the product and the producer of its social and affective relations. This methodology allows us to consider the wishes and needs of the subjects, their decisions toward their everyday problems; as a generator of knowledge, their starring role in their own life, their actions and the responsibility for their treatment as well as the possibility of changing the reality of which they are part. This study is based on the analysis of an alcoholic subject, assisted in a mental health institution. It discusses the workshops as therapeutic proposals to treat the alcoholic subjects, aiming to develop a project of an extended-clinic which adopts actions in social contractualism networks, through strategies of Psychosocial Treatment / Mestre

The goal of this study was to determine the bio-psychosocial treatment needs of dual diagnosis patients with depressive episodes and alcohol misuse. In order to achieve this goal, a qualitative research approach was adopted to gain a holistic understanding of dual diagnosis, as well as to explore and to describe the bio-psychosocial treatment needs of these individuals. This research study aimed to contribute towards solving a practical problem in practice by offering recommendations for a multidisciplinary team approach with regard to the treatment of patients diagnosed with depressive episodes and alcohol misuse in South African treatment centres. To this end, the collective case study design guided the research study. A two-stage sampling strategy was implemented in the study. Firstly, purposive sampling was used to identify potential participants, and it was followed up with, secondly, volunteer sampling to recruit 10 individuals with co-occurring depressive episodes and alcohol misuse from a private psychiatric clinic in Pretoria, which formed the research sample. Furthermore, a semi-structured one-on-one interview, guided by questions contained in an interview schedule, was used as a data collection method. The researcher implemented the qualitative data analysis process of Creswell (1998, in Schurink, Fouché & De Vos, 2011) to extrapolate themes and sub-themes from the raw data through thematic analysis. The trustworthiness of the data interpretation was confirmed through peer debriefing, member checking, as well as the assurance of confidentiality. An analysis of two different sources of data, namely the literature review and interviews, was used to answer the following research question: What are the bio-psychosocial treatment needs of dual diagnosis patients suffering from depressive episodes and alcohol misuse? The key findings indicated that persons suffering from a dual diagnosis of depressive episodes and alcohol misuse have idiosyncratic biological, psychological and social treatment needs. On a biological level it was found that patients with a dual diagnosis lead a less active and an unhealthy lifestyle and are therefore more prone to the development of chronic illnesses, such as hypertension and cardiovascular disease. It was also found that these individuals exhibit addictive behaviours apart from the alcohol misuse. With regard to psychological needs, the research found that dual diagnosis patients experience difficulties in expressing their needs and emotions to others. In this regard the research indicated that these individuals have poorly developed coping mechanisms and limited resources for gaining an improved sense of well-being. Identified areas in which these individuals may need assistance on a psychological level include: general coping mechanisms, communication skills, problem solving skills, and conflict management. With regard to violent and aggressive behaviour, it was found that these individuals are more likely to internalise their frustration and aggress towards themselves. On a social level it was found that individuals with a dual diagnosis of depressive episodes and alcohol misuse experience more relationship breakdown and less social support. Additionally, on a social level these individuals experience difficulties in coping in the workplace, as well as having problems with financial management. It is recommended that the multidisciplinary team participate in the development of psycho-educational groups that focus on the education of dual diagnosis patients regarding their needs on each level of functioning. Furthermore, it is recommended that effective clinical communication patterns are in place to prevent fragmented service delivery to individuals with a dual diagnosis. It is recommended that service delivery takes place in all forms of service delivery, including individual therapy, psycho-educational groups, group work activities, as well as family counselling. Further research could focus on the following: 1) Extending the research population to areas outside the Gauteng Province, or even South Africa, in order to determine if these findings can be generalised to all patients with a dual diagnosis of depressive episodes and alcohol misuse; 2) Conducting the research in public health care centres to determine if the findings of this study are also prevalent in lower socio-economic classes (taking into consideration that the present study was conducted at a private psychiatric clinic); 3) Repeating the study with different combinations of psychiatric illnesses, as well as substances of abuse, to determine if the conclusions drawn from this study can be made applicable to dual diagnosis in general, or only to dual diagnosis with depressive episodes and alcohol misuse in particular. / Dissertation (MSW)--University of Pretoria, 2014. / tm2015 / Social Work and Criminology / MSW / Unrestricted

Résumé en français Objectifs : Ce mémoire propose d’explorer l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques en répondant à trois questions : 1- Quels sont les facteurs influençant l’assiduité aux interventions psychosociales pour une clientèle atteinte de troubles psychotiques? 2- Sont-ils comparables aux facteurs influençant l’observance à la médication? 3- Quel est le taux d’abandon des interventions psychosociales et quels sont les facteurs qui font varier ce taux? Méthodes : Cette étude a permis de faire la synthèse des facteurs influençant l’observance à la médication à partir des revues systématiques publiées sur le sujet, et d’établir les facteurs influençant l’assiduité aux interventions psychosociales à partir des raisons d’abandon citées dans les essais cliniques randomisés publiés. Une méta-analyse a permis de combiner les essais cliniques rapportant les abandons et ainsi d’en établir un taux. Résultats : Nous avons répertorié 92 essais cliniques randomisés sur les interventions psychosociales avec les personnes atteintes de troubles psychotiques. De ce nombre, 43 ont permis de répertorier les raisons d’abandon. Les raisons d’abandon s’avèrent principalement liées à la maladie et liées à l’accessibilité, la continuité et la qualité des soins et services. Un taux d’abandon de 13% a été obtenu à partir de l’agrégation de 74 études dans la méta-analyse. Des facteurs faisant varier ce taux ont été identifiés. Conclusion : Plusieurs facteurs (personnels, lié aux traitements, sociaux) influençant l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques ont été identifiés. De plus, le faible taux d’abandon obtenu démontre bien la faisabilité clinique de ce type d’intervention. S’ajoutant à l’efficacité déjà bien démontrée de certaines modalités d’intervention psychosociales, le taux d’assiduité à ces mêmes modalités constitue un argument supplémentaire pour en assurer la disponibilité aux personnes atteintes d’un trouble psychotique. / Abstract Aims : This report suggest investigating the compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder by answering three questions : 1- What are factors influencing compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder? 2- Are they comparable to factors influencing compliance with pharmacological treatment? 3- What is the dropout rate of the psychosocial treatment and which are the factors which make vary this rate? Methods : A systematic review allowed to make the synthesis of factors influencing the compliance in the medication from the systematic reviews published on the subject and to establish factors influencing the compliance in the psychosocial treatment from the reasons of drop-out specified in the published randomized clinical trials. A meta-analysis allowed to combine clinical trials reporting drop-out and so to establish a rate. Results : We listed 92 clinical trials randomized on the psychosocial treatment among persons suffering from schizophrenia spectrum disorder , of this number 43 allowed to list the reasons of drop-out. The reasons of drop-out turn out mainly related to the disease and related to the accessibility, the continuity and the quality of the care and the services. A 13 % dropout rate was obtained from the aggregation of 74 studies in the meta-analysis. Factors making vary this rate were identified. Conclusions: Several factors which influence the compliance in the psychosocial treatment among persons suffering from schizophrenia spectrum disorders are identified. Furthermore, the low drop-out rate calculated demonstrates well the clinical feasibility of this type of treatment. Being added to the efficiency already well demonstrated by certain psychosocial modalities of treatnebt, the compliance rate in these same modalities establishes an additional argument to assure the availability among persons suffering from schizophrenia spectrum disorders.

Résumé en français Objectifs : Ce mémoire propose d’explorer l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques en répondant à trois questions : 1- Quels sont les facteurs influençant l’assiduité aux interventions psychosociales pour une clientèle atteinte de troubles psychotiques? 2- Sont-ils comparables aux facteurs influençant l’observance à la médication? 3- Quel est le taux d’abandon des interventions psychosociales et quels sont les facteurs qui font varier ce taux? Méthodes : Cette étude a permis de faire la synthèse des facteurs influençant l’observance à la médication à partir des revues systématiques publiées sur le sujet, et d’établir les facteurs influençant l’assiduité aux interventions psychosociales à partir des raisons d’abandon citées dans les essais cliniques randomisés publiés. Une méta-analyse a permis de combiner les essais cliniques rapportant les abandons et ainsi d’en établir un taux. Résultats : Nous avons répertorié 92 essais cliniques randomisés sur les interventions psychosociales avec les personnes atteintes de troubles psychotiques. De ce nombre, 43 ont permis de répertorier les raisons d’abandon. Les raisons d’abandon s’avèrent principalement liées à la maladie et liées à l’accessibilité, la continuité et la qualité des soins et services. Un taux d’abandon de 13% a été obtenu à partir de l’agrégation de 74 études dans la méta-analyse. Des facteurs faisant varier ce taux ont été identifiés. Conclusion : Plusieurs facteurs (personnels, lié aux traitements, sociaux) influençant l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques ont été identifiés. De plus, le faible taux d’abandon obtenu démontre bien la faisabilité clinique de ce type d’intervention. S’ajoutant à l’efficacité déjà bien démontrée de certaines modalités d’intervention psychosociales, le taux d’assiduité à ces mêmes modalités constitue un argument supplémentaire pour en assurer la disponibilité aux personnes atteintes d’un trouble psychotique. / Abstract Aims : This report suggest investigating the compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder by answering three questions : 1- What are factors influencing compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder? 2- Are they comparable to factors influencing compliance with pharmacological treatment? 3- What is the dropout rate of the psychosocial treatment and which are the factors which make vary this rate? Methods : A systematic review allowed to make the synthesis of factors influencing the compliance in the medication from the systematic reviews published on the subject and to establish factors influencing the compliance in the psychosocial treatment from the reasons of drop-out specified in the published randomized clinical trials. A meta-analysis allowed to combine clinical trials reporting drop-out and so to establish a rate. Results : We listed 92 clinical trials randomized on the psychosocial treatment among persons suffering from schizophrenia spectrum disorder , of this number 43 allowed to list the reasons of drop-out. The reasons of drop-out turn out mainly related to the disease and related to the accessibility, the continuity and the quality of the care and the services. A 13 % dropout rate was obtained from the aggregation of 74 studies in the meta-analysis. Factors making vary this rate were identified. Conclusions: Several factors which influence the compliance in the psychosocial treatment among persons suffering from schizophrenia spectrum disorders are identified. Furthermore, the low drop-out rate calculated demonstrates well the clinical feasibility of this type of treatment. Being added to the efficiency already well demonstrated by certain psychosocial modalities of treatnebt, the compliance rate in these same modalities establishes an additional argument to assure the availability among persons suffering from schizophrenia spectrum disorders.

Syftet med detta examensarbete var att undersöka hur behandlare inom olika professioner använt sig av hästunderstödd terapi, som en del av en terapeutisk behandling. Detta för att se om behandlarna kunde märka en förändring hos deltagaren. Examensarbetet baserades på kvalitativ metod där fyra telefonintervjuer genomförts med personer som arbetar med hästar i terapeutisk behandling. Resultaten visade att behandlarna upplevde att hästarna kunde hjälpa till med samspelet mellan behandlare och deltagare. Det framkom att behandlarna upplevde att det skedde genom ett icke-verbalt deltagande från hästen i samspel med behandlaren och den som deltog. Deltagarna fick en möjlighet att skapa mening med hjälp av vardagliga rutiner och strukturer. Del kunde känna tillit till andra, samt började våga skapa relationer med andra människor vilket gav en känsla av förhållande till samhället. Samtliga behandlare menade att det var svårt att avgöra vad som hade skapat en förändring. Gemensamt var behandlarnas upplevelse av en positiv förändring hos flertalet av deltagarna. / This bachelor thesis analyses the use of horse-assisted therapy amongst mental health practitioners within multiple sectors. The aim was to establish whether a change could be detected in participants. Adopting a qualitative approach the research was mainly conducted through four semi-structured interviews with equine-assisted therapy practitioners. The results show that the practitioners believe the horses improve the interactions between the practitioners and participants. The practitioners believe this improvement is due to the non-verbal participation of the horse in interface with the practitioner and participant and that the horses increase the participants’ trust in others as well as their confidence when establishing relationships with others. The participants gained an opportunity to create meaning within their lives through everyday routines, structures and feel a sense of context. Some of the practitioners struggled to identify what causes the change but recognised a positive change in the majority of participants.

Ce rapport de stage porte sur l’observance du traitement psychosocial chez des détenus fédéraux présentant un double diagnostic de schizophrénie et de trouble de la personnalité antisociale. Après une recension des écrits, le milieu de stage est présenté, ainsi que la méthodologie, trois études de cas et, enfin, une analyse de celles-ci. L’observance du traitement et les problématiques de santé mentale ici traitées sont exposées de façon descriptive, assez précise et critique. Suite à l’analyse des trois études de cas dans un centre correctionnel communautaire (SCC), il semble que la clientèle judiciarisée, schizophrène et antisociale ne reçoive pas des services entièrement adaptés à ses déficits au niveau des compétences sociales. De même, le personnel du SCC présente certaines lacunes face à l’intervention préconisée avec ces individus. Dans ce sens, il est noté que les intervenants sont généralement insuffisamment disponibles, formés et disposés à réellement envisager la réadaptation sociale du détenu tel que perçue dans ce stage. Souvent, les suivis étant discontinus, l’alliance thérapeutique peine à s’installer. Or ce n’est qu’en instaurant une relation de confiance qu’un travail clinique profitable peut subsister. En somme, avant d’être remis en liberté, il serait souhaitable que ces hommes reçoivent du soutien quant à l’acquisition des savoir-faire et savoir-être nécessaires à toute socialisation. / This report concerns the observance of the psychosocial treatment at federal prisoners presenting a double diagnosis of schizophrenia and antisocial personality disorder. After a literature’s review, the training course’s place is presented, as well as the methodology, three case studies and, finally, an analysis of these. The observance of the treatment and the problems of mental health here treaties are explained in a descriptive, rather precise and critical way. Further to the analysis of three case studies in a community correctional center (CSC), it seems that the delinquent, schizophrenic and antisocial clientele do not receive completely adapted services to its deficits at the level of the social skills. Also, the staff of the CSC presents certain gaps in front of the intervention recommended with these individuals. In this sense, it is noted that the employees are generally insufficiently available, trained and inclined to really envisage the social rehabilitation of the prisoner such as perceived in this training course. Often, follow-ups being intermittent, the therapeutic alliance has difficulty in settling down. Now only while establishing a reliable relation a profitable clinical work can remain. As a matter of fact, before being released, it would be desirable that these people receive from the support as for the acquisition of the know-how and the social skills necessary for any socialization.

Ce rapport de stage porte sur l’observance du traitement psychosocial chez des détenus fédéraux présentant un double diagnostic de schizophrénie et de trouble de la personnalité antisociale. Après une recension des écrits, le milieu de stage est présenté, ainsi que la méthodologie, trois études de cas et, enfin, une analyse de celles-ci. L’observance du traitement et les problématiques de santé mentale ici traitées sont exposées de façon descriptive, assez précise et critique. Suite à l’analyse des trois études de cas dans un centre correctionnel communautaire (SCC), il semble que la clientèle judiciarisée, schizophrène et antisociale ne reçoive pas des services entièrement adaptés à ses déficits au niveau des compétences sociales. De même, le personnel du SCC présente certaines lacunes face à l’intervention préconisée avec ces individus. Dans ce sens, il est noté que les intervenants sont généralement insuffisamment disponibles, formés et disposés à réellement envisager la réadaptation sociale du détenu tel que perçue dans ce stage. Souvent, les suivis étant discontinus, l’alliance thérapeutique peine à s’installer. Or ce n’est qu’en instaurant une relation de confiance qu’un travail clinique profitable peut subsister. En somme, avant d’être remis en liberté, il serait souhaitable que ces hommes reçoivent du soutien quant à l’acquisition des savoir-faire et savoir-être nécessaires à toute socialisation. / This report concerns the observance of the psychosocial treatment at federal prisoners presenting a double diagnosis of schizophrenia and antisocial personality disorder. After a literature’s review, the training course’s place is presented, as well as the methodology, three case studies and, finally, an analysis of these. The observance of the treatment and the problems of mental health here treaties are explained in a descriptive, rather precise and critical way. Further to the analysis of three case studies in a community correctional center (CSC), it seems that the delinquent, schizophrenic and antisocial clientele do not receive completely adapted services to its deficits at the level of the social skills. Also, the staff of the CSC presents certain gaps in front of the intervention recommended with these individuals. In this sense, it is noted that the employees are generally insufficiently available, trained and inclined to really envisage the social rehabilitation of the prisoner such as perceived in this training course. Often, follow-ups being intermittent, the therapeutic alliance has difficulty in settling down. Now only while establishing a reliable relation a profitable clinical work can remain. As a matter of fact, before being released, it would be desirable that these people receive from the support as for the acquisition of the know-how and the social skills necessary for any socialization.

Hästunderstödda insatser (HUI) är ett komplement till traditionella behandlingsmetoder inom det psykosociala fältet. HUI inkluderar både fysiska och psykiska moment. Syftet med arbetet är att belysa de professionellas uppfattningar om vilka faktorer i hästunderstödda insatser som anses vara verksamma och de professionellas erfarenheter av vilka målgrupper som insatserna är lämpade för. Resultatet grundar sig i en kvalitativ intervjustudie där två uppdragsgivare och tre uppdragstagare deltagit. Intervjuerna har analyserats och sammanfattats i teman efter olika faktorer och dess påverkan på ungdomarna. Det framkommer i arbetets resultat att det finns olika verksamma faktorer och dessa anses ha en positiv påverkan på ungdomarna. Vi fann även flera nya resultat som visar på de professionella upplever att ungdomarna blir motiverade och känner en positiv känsla när de ser ett direkt resultat av sitt arbete. Vidare kan HUI ge ungdomarna en chans till identitetsutveckling där de utvecklar en identitet kring hästarbetet samt kan de få en förståelse för verksamheten runt hästarna. Resultatet visar även att miljön i ett behandlingsarbete kan vara en bidragande faktor. Slutligen framkom det även att socialtjänstens förståelse kring behandlingsmetoden skulle kunna vara en utomterapeutisk faktor på samhällsnivå som påverkar ungdomarnas förändring.