Emotional Side Effects Research Articles

Among healthy children, what toilet-training strategy is most effective and prevents fewer adverse events (stool withholding and dysfunctional voiding)?

Over the past 100 years, recommended toilet training (TT) methods have oscillated between the two most common TT methods used in North America – rigid adult-directed programs and child-oriented ones (1). In 1962, Brazelton (2) developed the ‘child readiness’ approach, which focused on gradual training and is child-oriented. Current TT guidelines developed by the Canadian Paediatric Society and the American Academy of Pediatrics include a child-oriented approach, not starting before 18 to 24 months of age, and beginning when the child displays interest (3,4). The Foxx and Azrin (FA) (5) method emerged in 1971 as a parent-oriented method that emphasized structured behavioural end point training aimed at eliciting a specific chain of independent events by quickly teaching the component skills of TT. These two methods differ with respect to goal development, end points and emphasis on the child’s self-esteem. Other methods include variations of operant conditioning and assisted infant TT (6,7). The goal of operant conditioning is to establish habits and proper behaviours through positive reinforcement with rewards (8). Assisted infant TT emphasizes simultaneous training of bowel and bladder control by the parent learning the infant’s elimination signals (6). This can begin at two to three weeks of age (9). This method has been criticized as the ‘parent training’ method because the parents must be trained to recognize their infant’s elimination cues. A systematic review was performed to determine which method of TT was best for healthy children. MEDLINE, EMBASE, ERIC, PsycINFO and Cinahl databases were searched using combinations and variations of the following terms – toilet or potty; and behaviour, learn, train or condition. While there are six noncomparative studies examining TT in a single cohort of children, only four comparative studies were included. Matson and Ollendick (10) randomly assigned 10 children (20 to 26 months of age) into one of the following groups – the FA method with an experienced trainer or the FA method conducted by mothers using a book to guide the TT process (10). The goal was to toilet train the children within five daily 4 h sessions. Four of five children in the former group were successfully trained within five sessions, while only one of five in the latter group was completely successful (one obtained partial success and the remaining three failed). All mothers reported that their child exhibited emotional side effects of the training, such as avoidance behaviour or temper tantrums. Candelora (11) randomly assigned 71 healthy children between 18 and 35 months of age to FA’s method of TT in less than one day or the child-oriented method outlined in Spock’s Baby and Child Care book (12). When comparing pretraining and post-training results, and pretraining and follow-up results, the FA method was found to be superior to Spock’s method. Using the FA method, the number of accidents per child per day was reduced by 3.17 from pretraining to follow-up, whereas the child-oriented Spock method resulted in a reduction of 1.89 accidents per child per day. The number of successes per child per day was increased by 3.37 from pretreatment to follow-up when using the FA method and 1.91 for children randomized to the Spock method. Taubman et al (13) randomly assigned 406 children, 17 to 19 months of age, to one of two TT groups – one group was given instructions to praise defecation in the diaper before TT and avoid negative terms to describe defecation, and the other group received no such direction. All parents trained their children using the child-oriented approach and determined when TT would commence. There was no difference in the number of children who developed stool toileting refusal, but duration of the refusal was significantly longer in the control group (7.3 versus 5.1 months). No significant differences were found between the groups in the incidence of stool withholding or hiding during defecation. TT was achieved at a significantly earlier age among those in the intervention group (40 versus 43 months). Bakker et al (14) conducted a retrospective study that collected data on 4332 primary school age children and compared children who did (n=928) and did not (n=3404) develop abnormal bladder control symptoms, such as daytime and/or night-time wetting, and urinary tract infections. Significantly more children in the control group had parental prompting during TT than those in the symptom group (68% versus 62%). Parents of the symptom group used significantly more rewards and punished behaviour than parents in the control group (53% versus 46%). Parents in the control group were significantly more likely to encourage the child to try again later (83% versus 67%). Parents in the symptom group were significantly more likely to make the child wait until voiding, encourage the child to push or strain, make special noises and open a tap.

Development of a Cancer Camp for Adult Spanish-Speaking Survivors: Lessons Learned from Camp Alegria

The serious psychosocial and emotional side effects of cancer and its treatment negatively affect the lives of breast cancer survivors. Camp Alegria, in 2005, was the first oncology camp offered to Latina breast cancer survivors. This 3-day camp (N = 58 women) provided a culturally and linguistically relevant program that empowered Spanish-speaking women diagnosed with breast cancer and gave them an opportunity to gain support from other cancer survivors facing similar challenges. Process evaluation results illustrate high satisfaction with the overall program, format, educational and recreational activities. This paper describes the camp development, experiences, and lessons learned.

The effectiveness and predictors of response to antipsychotic agents to treat impaired quality of life in schizophrenia: A 12-month naturalistic follow-up study with implications for confounding factors, antidepressants, anxiolytics, and mood stabilizers

Objective This study examined specific predictors of the efficacy of risperidone (RP), olanzapine (OL) and first-generation antipsychotic agents (FGAs), the role of confounding factors, and concomitant agents such as antidepressants, anxiolytics, and mood stabilizers in the treatment of health related quality of life (HRQL) impairment of schizophrenia patients. Method This was a community-based, open label, parallel group naturalistic study of 124 schizophrenia outpatients who received either RP, OL, FGA, or combined agents (CA). Evaluations were performed at baseline and 12 months later. They included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Positive and Negative Syndrome Scale (PANSS), the Distress Scale for Adverse Symptoms, and inventories for the assessment of distress severity, subjective tolerability, and self-efficacy. Results OL was found to be superior to RP, FGAs and CA in terms of quality of life. FGAs revealed greater therapeutic benefit than RP, which was more beneficial than combined therapy. Improvement in Q-LES-Q was revealed in patients who received antidepressants and anxiolytics, but not mood stabilizers, or anti-Parkinson drugs. This effect was independent of treatment groups and gender. Regression models revealed that changes in emotional distress and side effects were common predictors for HRQL changes across treatment groups. Specific predictors of HRQL efficacy included self-efficacy for OL, negative and positive symptoms for RP, dysphoric mood and positive symptoms, daily doses and self-efficacy for FGA treated patients. Conclusion These findings suggest that OL is beneficial in the treatment of HRQL impairment in schizophrenia compared with RP, FGAs and CA. Special attention should be paid to specific predictors of HRQL efficacy for each antipsychotic agent, and to concomitant treatment with antidepressants and anxiolytics.

Understanding Diabetes Medications From the Perspective of Patients With Type 2 Diabetes

The purpose of this qualitative study was to explore diabetes medication experiences of patients with type 2 diabetes. Study participants were recruited through newspaper advertisements and letters from primary and specialty clinics in Indianapolis, Indiana. The same professional facilitator conducted 18 focus groups (7 male, 11 female) at a Veteran Affairs facility in Indianapolis, Indiana. Participants were 138 socioeconomically diverse individuals with type 2 diabetes (68% female, 74% > or = 50 years old, 61% non-Hispanic Caucasian). Participants were on a variety of diabetes medication regimens (61% injectable insulin monotherapy or in combination with orals). Content analysis of focus group transcripts was used to establish themes. Three major themes emerged across the focus groups: (1) the inconvenience and inflexibility of the timing and frequency of administration of many diabetes treatments on participants' lives, (2) the desire to avoid injections and/or insulin therapy, and (3) the physical and emotional side effects of diabetes medications. Assuming equivalent effectiveness of 2 medications, participants would weigh the convenience and flexibility, route of administration, side effects, and cost of the medications to arrive at a treatment preference. Participants believed they currently had no opportunity to express their treatment preference to their health care provider. The best therapeutic option for a patient with type 2 diabetes will be one that is clinically effective and consistent with the patient's needs and preferences. The challenge for diabetes educators is to support patients in articulating and incorporating their needs and preferences into the treatment decision-making process.

Steroid-induced alterations of mood and behavior in children during treatment for acute lymphoblastic leukemia

Despite their therapeutic utility, children may experience emotional and behavioral side effects from steroids during treatment for leukemia. However, clinical manifestations and treatment options have rarely been described in the pediatric literature. The aim of this current paper is to address this knowledge gap via four brief case examples and a review of the literature. In addition, we review recent data to indicate how concurrent use of antifolates may place these children at particular risk for adverse psychological reactions.

Longitudinal assessment of coping abilities at exacerbation and stabilization in schizophrenia

Background Coping strategies play an important role in one's ability to adapt to stressful life conditions such as schizophrenia. To better understand the nature of various coping mechanisms at various stages in schizophrenia, this study examined task-, emotion-, and avoidance-oriented coping strategies and explored associated clinical factors at exacerbation and stabilization phases of the illness. Method Patients with schizophrenia were examined twice (at exacerbation phase, N = 237 and at stabilization phase, N = 148) with the Coping Inventory for Stressful Situations, and standardized measures of psychopathology and emotional distress severity, side effects, insight, self-constructs, social support, and quality of life. Multiple regression analysis was performed with coping strategies as dependent variables at exacerbation and stabilization including analysis of any change during the 16-month follow-up period. Results Analysis indicated that emotion coping strategies were used more at exacerbation than at stabilization phase. Regression analysis demonstrated emotional distress to be a strong predictor of emotion-oriented coping, with self-efficacy and social support being the best predictors of task and avoidance coping strategies, respectively. Individual changes in these variables also appear to be important predictors for fluctuations of these coping strategies over time. Severity of symptoms accounted for 3.5% and 5.5% to 9% of the total variance of emotion- and task-oriented coping strategies, respectively. Conclusions Emotion, task, and avoidance coping strategies and their predictors are influenced and may vary over the course of schizophrenia illness. Experienced emotional distress, self-efficacy, and social support are the best predictors of coping strategies both at exacerbation and stabilization phases of illness.

Do the emotional side-effects of hormonal contraceptives come from pharmacologic or psychological mechanisms?

Hormonal preparations have become one of the most popular methods used for controlling fertility. The literature over the last 40 years continues to reveal how their numerous side effects negatively impact many users and even society at large. Three large cohort trials were the first to demonstrate, on a grand scale, certain emotional and behavioral associations with contraceptive use. Current contraceptive use was associated with an increase rate in depression, divorce, tranquilizer use, sexual dysfunction, and suicide and other violent and accidental deaths. Despite the advent of more “user friendly” contraceptives, the discontinuation rate secondary to side effects has changed little through the years. While in rare cases hormonal preparations can be deadly to the user, there is substantial evidence that their negative effect issues more from their emotional and behavioral properties. This paper reviews the results of over seven studies which further characterize these prominent associations, particularly with hormonal contraception, in an attempt to demonstrate their association with the intrinsic pharmacologic properties of hormonal preparations. Hormonal contraceptive users, in contrast with non users, were found to have higher rates of depression, anxiety, fatigue, neurotic symptoms, sexual disturbances, compulsion, anger, and negative menstrual effects. The question of whether the association of these maladies is directly due to the effect of taking exogenous hormones versus the psychological impact of the contraceptive behavior itself had yet to be studied. Seven small randomized-controlled trials were found in a review of the literature which studied this hypothesis in a direct way. They do not support the origination of these side effects being from the pharmacological properties of hormones. No association was found between hormone levels and emotional functioning in females. Psychiatric evaluations among IUD and oral contraceptive pill (OCP) users reveal no significant differences. Women who were given an OCP placebo experienced a similar side effect profile of OCP users. Different hormonal concentrations and combinations made no significant difference in the side effect profile. A study of women who were given either “weak female hormones” or a placebo failed to duplicate the side effect profile found in all of the other studies where the hormones were labeled as contraceptives. The evidence suggests that most of the side effects of hormonal contraception are a result of a psychological response to the practice of contraception. More study is warranted to further understand this psychological phenomenon, especially now that an effective non-contraceptive method of fertility regulation and more reliable psychological instruments are available. Furthermore, it is reasonable to hypothesize, given the present data, that contraceptive activity itself is inherently damaging to women.

Satisfaction with quality of life varies with temperament types of patients with schizophrenia.

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

Negotiating medications: patient perceptions of long-term medication use.

To investigate how adults with one of several chronic illnesses (bipolar disorder, multiple sclerosis, rheumatoid arthritis, schizophrenia/schizoaffective disorder, or systemic lupus erythematosus) perceive their need to take medications during the course of their illness. Eighty-three adults, aged 18-64 years, all members of a health maintenance organization, were interviewed. Each participant completed an ethnographic interview that was transcribed verbatim and analysed using grounded theory techniques. Participants described two forms of ongoing efforts to negotiate their need for medications, internal and external. The former category includes struggles over self-identify (e.g. worries about becoming dependent on drugs, feeling like a 'guinea pig'). The latter includes negotiations with health care providers over the type, route, and frequency of medication use. Dimensions of both negotiation types include acceptance and resistance. Specifically, patients with chronic illness must manage not only drug regimens, but also renegotiate their self-identities as formerly well persons. During this dynamic process, patients may accept and/or resist taking prescribed medications. Practitioners should recognize that patients experience not only physical, but emotional side effects of medications, and that resistance might be part of a negotiation process rather than a final stance.

Short Term Modafinil Use During Sleep Disorder Evaluations: Focus on High Risk Professions and Behaviors

Patients can present with undiagnosed sleep disorders. Modest fatigue can impair their neurological, functional and psychological capacities. Four patients demonstrated improved functioning on modafinil, during the months required for a complete sleep evaluation, specialist consults and successful treatment. Sleep disorders increase morbidity or mortality until definitive diagnosis and full treatment. In four patients, modafinil was immediately useful as a bridging medication over 3-7 months until final successful diagnosis and treatment. Even one month of significant fatigue is unacceptable. For example, driving a motor vehicle is dangerous with some sleep disorders. Falling asleep driving or involuntary “minisleep” at the wheel is a common cause of motor vehicle accidents.1 In the United States, sleep causes at least 56, 000 motor vehicle crashes each year, resulting in 1, 550 deaths.2 Over a year, 10% of men and 4% of women admitted to falling asleep while driving.3 Insight into drowsiness can be flawed, lagging behind electroencephalographic and other evidence that the process of falling asleep has actually started.4 In clinical care, the patient may be sleepy or fatigued, but not a clear risk to drive or work. Further, many occupations do not allow for fatigue, sleepiness and errors, e.g., truck drivers, heavy construction operators, nurses dispensing medications, pilots, boat captains, military and police personnel using dangerous equipment, and childcare workers with children. Modafinil was used because it may be more selective than traditional stimulants, has a low abuse potential, is already used in many specific sleep disorders, and has a reasonable safety record. Modafinil's mechanism as a waking agent appears to be a more selective than amphetamine or methylphenidate in cats, 5 possibly causing less emotional side effects in humans, e.g., agitation and rebound depression. Perhaps due to this proposed selectivity, modafinil receives low ratings for abuse desirability, 6 and with a low solubility in water and instability at high temperatures, I.V. injections and smoking were less likely. 7 These are some reasons that modafinil might be considered in light of the non-specificity and addiction potential of traditional stimulants. Modafinil has cognitive benefits in aviation alertness and functioning. 8, 9 It decreases fatigue in narcolepsy, obstructive sleep apnea, Parkinson's disease, multiple sclerosis, stroke and fibromyalgia.10,11,12,13,14,15 Also, medically fragile patients seemed to tolerate modafinil. Our patients were much healthier than those treated with Parkinson's disease, stroke and multiple sclerosis. These private patients were all waiting for a sleep specialist appointment. They read handouts on the common use of modafinil, e.g., narcolepsy. However, they understood they were trying it for the off-label purpose of daytime sleepiness. Rare questions were answered to their satisfaction.

Breast Cancer and Sexuality

Breast cancer is the most common form of cancer among women today. With early detection and advanced treatment options, survival rates are continuing to improve, but not without some long-term physical and emotional side effects. This article reviews the effects of breast cancer in general and breast cancer treatment specifically on sexuality in cancer survivors. How the cancer and its treatment may affect women at different ages is discussed. The psychological impact of cancer therapy on both the patient and her spouse are noted; and options for treatment interventions are reviewed.

A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation

The purpose of the study was to explore predictors of discontinuation of oral contraceptives (OC) including pre-OC use characteristics and adverse physical, emotional, and sexual effects of OCs. Women aged 18+ years in committed, sexually active relationships were assessed before starting OC and reassessed at 3, 6, and 12 months or shortly after discontinuation. Assessment included pre-OC use attitudes and expectations about the pill; self-reported side effects and perimenstrual symptoms including premenstrual syndrome (PMS); physical and emotional well-being; and sexual interest, enjoyment, and frequency of sexual activity. Seventy-nine women completed the study, 38% continued OCs, 47% discontinued, and 14% switched to another OC. Emotional side effects, worsening of PMS, decreased frequency of sexual thoughts, and decreased psychosexual arousability correctly categorized 87% of cases by using logistic regression. Emotional and sexual side effects were the best predictors of discontinuation/switching, yet such OC effects have been largely ignored in the research literature.

Successful management of EPSDT funded community-based behavioral health rehabilitation services for children (Wrap Around): What OBM has to offer.

As part of the Behavior Analyst Todays (BAT) on going discussion of ways to improve and reform Behavioral Health Rehabilitation Programs (BHRP) for children, this paper addresses the role of behavioral management in increasing treatment integrity. With the questionability of traditional organizational development procedures (Terpstra, 1981), organizational behavior management rose in the field of management and human resources. Thus while changing corporate culture has remained an elusive task, changing corporate behaviors has prove to be quite successful and enduring (Wilhelm, 1992). ********** Critical to the long term goals of an OBM approach is increasing service quality and integrity of socially valid services, while improving specific outcomes for children within the programs. Also OBM attempts to produce more productivity and greater satisfaction in workers, thereby improving effectiveness and efficiency in organizations (Mawhinney, 1984). In addition, reducing costs is a major theme that needs to be addressed. It is hoped that this paper will spark interest from those involved in organizational behavior management to address issues of performance in social service agencies, particularly in the areas where the programs are involved directly in the field and not in the office, where practices are readily and clearly observed. An OBM approach involves (a) specification of standards for workers guided by strong behavioral objectives linked to long term agency objectives and treatment objectives tailored to the needs of the particular child in which they serve (b) measurement, particularly measures of compliance and treatment integrity (c) monitoring and feedback systems that reward appropriate behavior and offer corrective feedback and training to lessen performance discrepancies. To achieve these goals, a BHRP company needs to move past three types of common management errors: (1) inadequate structural support including supervision and representative management (2) blaming employees and (3) solely relying on grievances as a measure of treatment integrity performance. This paper will define these issues, starting with the management errors. Inadequate structural support The key player in the structuring of BHRP is the first line Supervisor (Cautilli, Rosenwasser, & Clarke, 2000). Cautilli and colleagues (2000) laid out a clear job description of the roles, responsibilities, and function of the clinical supervisor. Unfortunately, few agencies have supervisors who understand and can apply the technology of both administrative and clinical roles enhancement. Even more problematic is that most agencies have not recognized the importance of management and supervision in the overall effectiveness of BHRP. Blaming the Employee One of the strongest achievements of statistical process control and total quality management, for which behavior analysts should be deeply indebted, is the enduring lessen that these approaches have left on managers to recognize that many performance problems are indeed systemic and not the fault of a particular employee. Over the years management has developed a style in which the most natural thing for a manager to do, when a grievance or problem arises is to blame it on the particular staff member involved. For example, when faced with a grievance from the school about an employee sitting in the back of the class and not being helpful when the child is engaged in disruptive behavior, the first reaction might be to decide to remove the employee and start the process of helping this employee to find another career. This is a simplistic but counterproductive reaction. Whenever employees are punished it leads to a suppression of not just the current behavior but all behavior emitted by that employee. In addition, punishment has the distinction of bringing negative emotional side effects to the employee. Thus the employee may become less effective from the action and actually begin to blame the supervisor. …

Wed-P44 - Cognitive and emotional side effects and the efficacy of classical and atypical neuroleptics in acute schizophrenia

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Leuprolide acetate treatment of catamenial pneumothorax

A 35-year-old nulligravid female with a 20 pack year history of smoking and continuous OC use since age 16 presented with recurrent pneumothoraces coinciding with the onset of menses at age 28. At that time she underwent a right partial pleurectomy and lobectomy, which demonstrated bullous disease but no glandular or stromal elements. Although catamenial respiratory discomfort persisted while on OCs, no pneumothoraces were documented until age 33 at which time she was given the diagnosis of catamenial pneumothorax. A diagnostic laparoscopy failed to demonstrate endometriosis or the presence of diaphragmatic defects. In an effort to preserve her fertility, she began a course of LA-GnRH-a therapy with depot LA. Because of disabling vasomotor and emotional side effects, continuous conjugated estrogens and MPA acetate were given as add-back therapy. She has remained symptom and side effect free for over 2 years on this regimen.

Screening for scoliosis.

Introduction Screening programs for scoliosis have been in effect in the United States and Canada for 30 years. The belief is that with early detection, treatment of scoliosis may be instituted sooner, thereby reducing the number of patients who will require surgery or have crippling deformities. In addition, some of the cost of treatment may be reduced. Currently, school screening for scoliosis has been challenged as a viable means of achieving these goals, and such screening programs have been discontinued in Great Britain and parts of Canada. In the United States, as well as Great Britain and Canada, research has been devoted to issues of cost-effectiveness of these programs as well as the emotional side effects of being misdiagnosed as having scoliosis. School Screening The advocates of school screening espouse the philosophy that if a single case of scoliosis can be treated adequately and surgery avoided, cost is irrelevant. Those who criticize school screening note many flaws in the system. To screen in such a manner that no one with scoliosis is missed, many individuals are identified falsely as having scoliosis and are referred for confirmation by the pediatrician or orthopedist. Because so many patients are identified falsely, the true cost of screening is unacceptably high.

Emotional Side Effects of Diabetes Educational Program

Emotional Side Effects of Diabetes Educational Program

Psychometric Properties of the Theophylline Side Effects Scales

A psychometric evaluation was performed on the two versions ofthe Theophylline Side Effects Scale (TSES). These instruments are designed to assess the cognitive, physiologic, and emotional side effects believed to be associated with this medication. Both parent and child forms of the TSES demonstrated excellent retest and interrater reliabilities, as well as high internal consistency estimates. The construction and research conducted with the TSES suggest that it has applications in both research and clinical settings.

Issues in toilet training normal children

The toilet training method described by Azrin and Foxx in Toilet Training in Less Than a Day was employed with five children whose mothers were supervised and five children whose mothers were not supervised. All children were between 20 and 26 months of age. Supervised mothers received pretreatment training as well as assistance during training, while nonsupervised mothers trained their children on the basis of their reading of the book. Training was more effective and the number of emotional side effects was less for both mothers and children in the supervised condition.

Self-control procedures in modification of smoking behavior: replication.

Nolan's (1968) method of modifying smoking behavior was replicated with an S who became depressed whenever he tried to stop smoking. The results suggest that the technique has applicability when undesirable emotional side effects are associated with efforts to stop smoking.