Severe Emotional Distress Research Articles

Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

'God Hates Fags' Is Not the Same as 'Fuck the Draft': Introducing the Non-Sexual Obscenity Doctrine

In Miller v. California, the United States Supreme Court erred by limiting the definition of obscenity to speech appealing to the prurient (sexual) interest. Speech having no relationship to sex can be so vile that it lacks social, literary, or artistic value, contributes nothing to public debate, and causes severe emotional distress. It is called non-sexual obscenity, and it may, but does not always, intimidate others, incite imminent violence, defame, or have a sexual component. In each case, it traumatizes, humiliates, and shocks its audience. Neither the original purpose nor the plain text of the First Amendment shields this speech from restrictions of reasonable time, place, and manner. Non-sexual obscenity is a narrow class of speech that: (1) consists of low-value speech (and expressive conduct); (2) intentionally targets private and vulnerable individuals; (3) renders these individuals a quasi-captive audience; (4) occurs in places where the speaker’s message can be disseminated in an alternative public forum that provides equivalent, if not greater, benefits than those available in the speaker’s intended forum; and (5) results in severe emotional distress. This definition does not discriminate on the basis of viewpoint because speech cannot be deemed non-sexually obscene simply because it lacks social, literary, or artistic value. Examples of non-sexual obscenity include signs stating “God Hates Fags” and “Thank God for 9/11” on display outside of a private funeral, photographs of dismembered fetuses confronting women entering an abortion clinic, and a Nazi Swastika flag outside of a synagogue. Limiting obscenity to speech that appeals to the prurient interest (which is obscene) ensures that a significant portion of truly “obscene” material will never be restricted. In short, we not only know obscenity when we see it. We know where we see it as well.

Insurance company denial of payment and enforced changes in the type and dose of opioid analgesics for patients with cancer pain.

Opioids are the mainstay of treatment for moderate to severe cancer pain. The variations in average monthly cost can make it difficult for most patients to procure them without adequate insurance coverage. There are increasing numbers of denials of payment and statements made by insurance agents and other sources regarding inappropriate opioid use, resulting in severe pain and emotional distress for cancer patients and their families. This case series describes five events where the insurer was a major barrier to opioid access.

Indero: Intergenerational Trauma and Resilience between Burundian Former Child Soldiers and Their Children

Since many former child soldiers are aging and having children of their own, this study aimed to understand how the effects of trauma are passed to the next generation. In this qualitative study, semistructured interviews, focus groups, and observations were conducted with 25 former child soldiers and 15 matched civilian parents. Analysis used a grounded-theory approach. Trauma may be transmitted from former child soldiers to their offspring via (a) the effect on indero (how to raise a child); (b) severe parental emotional distress; and (c) community effects. Incorporating themes of indero values on how to raise children, the effects of parental posttraumatic stress and depressive symptoms on offspring, and the stigma associated with the families of former child soldiers may provide key areas of intervention in mental healing.

Perceived injustice contributes to poor rehabilitation outcomes in individuals who have sustained workplace injuries

The experience of unnecessary suffering as a result of another's actions or the experience of irreparable losses are likely to give rise to perceptions of injustice. Until recently, little systematic research had been conducted on the effects of perceptions of injustice on recovery outcomes following injury. It is now becoming clear that justice-related appraisals can have a dramatic impact on the physical and emotional consequences of injury. High levels of perceived injustice have been associated with more severe pain, more severe emotional distress, and more pronounced disability. Research has also pointed to multiple sources of a client's perceptions of injustice including, the person responsible for the accident, the insurance representative, as well as the health care provider. This presentation will summarize what is currently known about the relation between perceived injustice and recovery outcomes. The presentation will also address the processes by which perceptions of injustice might contribute to adverse health and mental health outcomes consequent to injury. Implications for prevention and intervention will be discussed.

Adenosine’s Autacoid Function in the Central Nervous System and the Behavioral State of Conservation-Withdrawal

The purine nucleoside adenosine has the critical autacoid function of directly linking cellular excitability to energy availability. The mechanism is activated whenever the rate of adenosine triphosphate (ATP) utilization exceeds the rate of synthesis. In CNS neurons, adenosine is produced by the rapid intracellular hydrolysis of purine nucleotides during neural excitation and then is extruded into extracellular space. The nucleoside is also produced by the extracellular hydrolysis of ATP by ectonucleotidases. Extracellular adenosine interacts with G-protein linked stereospecific receptors to reestablish metabolic homeostasis by exerting extraordinarily potent inhibition of neural excitation via a number of mechanisms. This autacoid mechanism is directly linked to the production of a depression like behavioral state termed conservation-withdrawal during times of physical stress or severe emotional distress. We review evidence here that adenosine produces a transition to conservation-withdrawal by activation of A2A receptors in the ventral-medial striatum.

Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients.

Advanced cancer patients often experience moderate to severe physical and emotional distress. One of the main components of emotional distress is depression. The objective of this study was to examine the association between supportive care interventions and patient self-reported depression (PSRD) among advanced cancer outpatients. We included consecutive patients seen in the outpatient Supportive Care Center between February 2008 and February 2010 with at least one follow-up visit. We used the Edmonton Symptom Assessment Scale (ESAS) to assess their symptom intensity. Clinical improvement of PSRD was defined as an improvement of at least 30% between the initial visit and the first follow-up. We used logistic regression models to assess possible predictors of improvement in PSRD. We included 444 patients with a median age of 59 years (Q1-Q3; 51-65). The most common type of cancer was gastrointestinal (98, 22%). Out of the 444 patients, 160 (36%) reported moderate/severe depression at baseline (ESAS item score ≥ 4/10). Higher baseline depression intensity was significantly associated to anxiety (r = 0.568, p = 0.046), total symptom distress score (TSDS; r = 0.550, p < 0.001) and personal history of depression (r = 0.242, p = 0.001). Of the 160 patients, 90 (56%) with moderate/severe PSRD at baseline showed a significant improvement at the follow-up visit (p = 0.038). Improvement in anxiety, sedation, and feeling of well-being were associated with higher depression improvement (OR 7.93, CI 3.74-16.80 and OR 2.44, CI 1.09-5.46, respectively). More than 50% patients with moderate/severe PSRD significantly improved after one single supportive/palliative care consultation. Improvements of anxiety and sedation were independently associated with PSRD improvement.

Identifying the Mechanisms for Workplace Burden of Psychiatric Illness

Although previous research indicates that mental disorders detract from labor market outcomes, little is known about which psychiatric symptoms are most important. The objective of this study was to identify the mechanisms, or most important symptoms, through which psychiatric disorders affect labor market outcomes. We focus on major depressive episode, panic attack, social phobia, and generalized anxiety disorder. Our approach builds on prior work in that we consider the effects of symptoms both among individuals meeting and among individuals not meeting the diagnostic criteria for mental disorders. Data were obtained from the National Comorbidity Survey Replication and the National Latino and Asian American Study. We used a structural equation model with latent indices for mental disorders, where the indices are generated from the model using multiple indicators (symptoms) and multiple causes of the disorders. The outcomes were current employment/labor force participation, weeks worked in last year, and number of work absences in the last month among employed individuals. We found that for major depressive episode, symptoms of insomnia/hypersomnia, indecisiveness, severe emotional distress, and fatigue are crucial for labor market outcomes. In the case of generalized anxiety disorder, the length of the episode, symptoms relating to difficulty controlling worry, and symptoms of worry/anxiety/nervousness causing significant emotional distress were most detrimental for work outcomes. Social phobia and panic attack were not associated with labor market outcomes. Our findings suggest that interventions targeting these particular symptoms may be most helpful in improving work functioning.

Meaning in life, emotional distress, suicidal ideation, and life functioning in an active duty military sample

The present study examined the relationship of meaning in life with emotional distress, suicidal ideation, and life functioning in a sample of 273 active duty Security Forces personnel assigned to two US Air Force bases. Results of regression analyses indicated that stronger meaning in life was significantly associated with less severe emotional distress (p < 0.001, ΔR 2 = 0.047) and suicidal ideation (p = 0.043, ΔR 2 = 0.017), and better functioning at work and in intimate relationships, nonfamily relationships, and recreational activities (p < 0.001, ΔR 2 = 0.073). Meaning in life showed stronger associations with outcomes relative to other predictors and covariates and explained the relationship between belonging and life functioning. Findings suggest that meaning in life is associated with less emotional distress and suicide risk, and greater success and performance across multiple domains in life among military personnel.

Sudden cardiac death: An increasingly recognized presentation of apical ballooning syndrome (Takotsubo cardiomyopathy)

We present an unfortunate case of a previously healthy woman who suffered an out-of-hospital cardiac arrest in the setting of severe emotional distress, likely due to apical ballooning syndrome. This case highlights the fact that although patients with apical ballooning syndrome typically do well following recovery from transient left ventricular dysfunction, they should be monitored closely in the acute setting due to the potential for life-threatening arrhythmias.

Basal Cell Carcinoma Masked in Rhinophyma

Rhinophyma, the advanced stage of rosacea, is a lesion characterized by progressive hypertrophy and hyperplasia of sebaceous glandular tissue, connective tissue, and blood vessels. Rhinophyma can lead to a significant facial disfigurement and severe emotional distress, but it is not only an aesthetic problem, since rare cases of simultaneous presence of malignant tissue are described in the literature. The case of an 84-year-old farmer affected by basal cell carcinoma (BCC) and diagnosed in the context of rhinophyma is presented. The anatomical distortion produced by the chronic inflammation and fibrous scarring makes the BCC diagnosis difficult and uncertain. The histological examination of the entire mass and its margins is fundamental. A partial biopsy can lead to a false negative result, and the histological examination must be repeated intra- or postoperatively.

3007 – Treating clinical realities through virtual reality: ICTS as a new therapeutical weapon

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Moreover, research indicates that far from all who suffer from depression and suicidal ideation seek treatment and the determination of suicide risk and prevention of suicide attempts is traditionally difficult. In an era of empowered public and patients awareness, internet may be a more powerful determinant of health-seeking behavior than medical opinion. Suicide information is easily accessible over the web, as are special chat rooms for discussions with likeminded people. Internet can be considered as well as efficiently exploited to help people in severe emotional distress, including those contemplating suicide. Some websites advise acutely suicidal persons to seek help. Promotion and announcement of suicide are forbidden. Some websites offer a variety of professional help, including psychological and health-related information on various troubling issues, questions and answers and professional guidance intended to promote self-help in coping with numerous psychological problems. One promising treatment is activation, two kinds of which are behavioural activation, and one solely focused on physical exercise. These two kinds of activation therapy have the potential to be administered via the Internet, which would both lower the threshold for those seeking treatment, while also providing effective treatment to a low cost.

PROTOCOL: Psychosocial Interventions for School Refusal Behavior With Elementary and Secondary School Students

PROTOCOL: Psychosocial Interventions for School Refusal Behavior With Elementary and Secondary School Students

The benefits of discussing suicide with Alaska native college students: Qualitative analysis of in-depth interviews.

Suicide represents a significant health disparity for communities in rural Alaska, and has implications for mental health among people who have lost loved ones from suicide. A qualitative interview study was conducted to examine the ways in which suicide has affected the lives of college students who have migrated from rural villages to an urban university (N = 25). The present research represents a secondary aim of the study-specifically, we examined the affective responses of Alaska Native college students from rural villages after completing in-depth semistructured interviews about their experiences related to suicide. Debriefing questions posed at the conclusion of the interviews revealed that the majority of participants (n 16) stated they felt "better" after completing the interview, and no participants reported feeling "worse." No participant required the use of the safety plan developed in case of severe emotional distress. All participants indicated they would be interested in participating in future research. Analysis of questions pertaining to the interview experience revealed the salience of foundation (the participant's prior experience discussing issues like suicide), process (the interview questions and questioning style), and outcomes (the challenges and benefits of participation described by the respondent). Findings provided important insights concerning the experience of discussing past trauma, perceived importance of research addressing coping with suicide, and the influence of past experiences in the process of talking about suicide.

Perception of stress level, trunk appearance, body function and mental health in females with adolescent idiopathic scoliosis treated conservatively: a longitudinal analysis

PurposeIn the presented study, we aimed to assess changes over time in the perception of trunk deformity, body function, stress level and mental health in females with adolescent idiopathic scoliosis (AIS) who were treated conservatively with a Cheneau brace, taking the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22 (SRS-22) and Bad Sobberheim Stress Questionnaires (BSSQ) criteria of evaluation into consideration.MethodsThe study design was comprised of three questionnaire assessments, with the second and the third evaluation taking place 6 and 12 months after the beginning of the study, respectively. Thirty-six females treated conservatively were asked to fill in the TAPS, SRS-22 and BSSQ forms.ResultsIn regards to TAPS, the results differed between the 1st and the 2nd assessment in Figure 2 only (p = 0.013). The difference between the 1st and the 3rd evaluation concerned Figure 3 and the total score (p = 0.011 and p = 0.005, respectively). The SRS-22 and BSSQ results of study participants did not differ significantly between the 1st and the 2nd, between the 2nd and the 3rd and between the 1st and the 3rd evaluations.ConclusionsThe study indicated that the assessment of girls with AIS concerning body function and mental health did not deteriorate in the course of orthosis treatment. Furthermore, they showed improvement in perceptions particularly in regards to trunk shape. We pointed out that the negative perceptions of mental health, self-image and low level of activity held by females with AIS coexisted with severe emotional distress. Moreover, factors that improved functioning or subjective physical appearance ratings in particular, such as level of activity, were indicated.

Psychiatric clinical course strengthens the student–patient relationships of baccalaureate nursing students

Psychiatric nursing teaches students how to engage and communicate with patients who have severe emotional distress. Nurses need this knowledge as the majority of patients encountered in hospitals are distressed. This study explores the impact of a psychiatric clinical course in helping students learn to relate to distressed patients. The study used a mixed research methodology to survey 67 baccalaureate students about their experiences in the placement portion of the psychiatric nursing course. The pre-clinical questions focused on students' anticipation regarding individuals with mental illness and how the clinical experience would affect them as nurses and as individuals. The post-clinical questions asked how the clinical experience affected them. The students stated that their time with patients had changed them. Ninety-nine per cent were no longer frightened of the patients. Students realized the patients were distressed and were glad to help them. This work sensitized them to the individual rather than the generic patient. It initiated a process in self-awareness, in sensitivity to the feelings of another person and in communication skills. These are steps in the development of an empathetic presence. The students recognized the need for these skills in all nursing. The authors recommend strategies to assist students in developing an empathetic presence.

The Influence of Depression on the Progression of HIV

The authors suggest a theoretical model of pathways of HIV progression, with a focus on the contributions of depression-as well as secondary, behavioral and emotional variables. Literature was reviewed regarding (a) comorbid depression and the direct physiological effects on HIV progression and (b) intermediary factors between HIV and disease progression. Intermediary factors included (a) substance use, (b) social support, (c) hopelessness, (d) medication nonadherence, and (e) risky sexual behavior and the contraction of secondary infections. The authors suggest direct physiological pathways from depression to HIV progression and indirect pathways (e.g., behavioral, social, and psychological). In addition to depression, substance use, poor social support, hopelessness, medication nonadherence, and risky sexual behavior seem to be integral in HIV progression. Based on the individual relationships of these variables to depression and HIV progression, a comprehensive multipath model, incorporating all factors, serves to explain how severe emotional distress may lead to accelerated progression to AIDS.

Evaluación de las propiedades psicométricas del cuestionario de Detección de Malestar Emocional (DME) en pacientes oncológicos

ObjectiveTo evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit. MethodsThe DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain). ResultsA total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%. ConclusionsThe DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care.

Psychosocial Challenges of Elderly Patients Coping With Cancer

The objective of discussion is to stimulate healthcare professionals to deepen knowledge and understanding of the difficulties, challenges, and developmental tasks of elderly patients coping with cancer. Current research suggests that the psychological impact of cancer is less negative among the elderly, compared with younger patients (such as easier adjustment process). However, the specific psychosocial themes and needs of the elderly patients are not well enough adapted. Evidence-based data may offer clinicians and researchers a better understanding of the coping mechanisms defining elderly people, which may play a role in protecting them from severe emotional distress. Clinical implications would be improved screening, evaluation and intervention skills, which are suitable and adequate to the needs of the elderly population.

Long-term results of the surgical treatment of Peyronie's disease with plaque incision and grafting.

Peyronie's disease is frequently associated with erectile dysfunction, and a variety of other comorbid disorders, including diabetes, hypertension, dyslipidemia and low testosterone. Two-thirds of patients with Peyronie's disease are likely to have risk factors for arterial disease and therefore worsening long-term erectile function.1 The severe emotional distress that occurs is, in part, due to the deformity, but mainly due to the penile shortening that occurs in almost all patients with up to 50% of them being clinically depressed. It is imperative therefore that the stretched penile length is measured preoperatively so that the patients realize that the length loss postoperatively is mainly due to the disease itself and not to the surgery.2, 3 Patients that have significant deformities often desire a grafting procedure that minimizes any additional length loss. Currently, it appears that the nature of the graft is less likely the determining factor with respect to postoperative erectile dysfunction (ED). On the other hand, it is most likely due to patient selection with respect to preoperative erectile status and operative technique.4 Larger grafts, men older than 60 years old, and those with ventral grafting also appear to have a higher risk of postoperative ED.5, 6 Following surgery, postoperative rehabilitation is recommended to enhance recovery of erectile function. Massage and stretch therapy, is performed by grasping the glans penis and pulling it gently and repeatedly away from the body while also gently massaging the graft area. Daily phosphodiesterase inhibitors have been recommended to begin 7–10 days after surgery and to be maintained for 6 weeks, in order to enhance nocturnal erections, stretch the tissue, encourage nourishment of the graft4 and possibly reduce the risk of postoperative ED. Finally, the use of external penile traction therapy has been noted to reduce postoperative penile shortening for patients who have undergone either plication or grafting procedures.7 The results from published reports on grafting show that on average 74%–100% of patients were adequately straight, with a postoperative ED ranging from 5% to 53%.8 Recently, a report by Sansalone et al.9 was published in Asian Journal of Andrology. This is an interesting article of the management of Peyronie's disease using the Egydio technique of plaque incision and grafting. The technique has been tried and tested before and is proven to straighten the penis without the use of plication sutures which cause penile shortening.10 The results of this series are outstanding and the reason for this is case selection. With the knowledge that erectile function may deteriorate over time, the results at 5-year follow-up should be considered. Kalsi et al.11 studied 40 patients who underwent vein grafting and followed for at least 5 years and reported a postoperative ED rate of 22.5% and a loss of length was noted in 35%. Montorsi et al.12 reported on 50 patients with a 5-year follow-up after venous grafting where there was either persistent or recurrent curvature in 12%, length loss in 100%, postoperative ED in 22%, diminished orgasm in 41% and overall patient satisfaction of only 60%. The poor results in all other series are related to post operative ED, reaching 67% in one series.13 In the Sansalone series, only patients with good preoperative erectile function were included (International Index of Erectile Function >15, peak systolic velocity >35 cm s−1), the others offered a penile prosthesis. Despite this, 32% did develop postoperative ED and were treated with phosphodiesterase type 5 inhibitors, but as least the authors tried to streamline patients to get better satisfaction results.9 The take home message is that this technique has a high success rate in advanced Peyronie's disease and that patient selection is crucial. It may be that in the future, patients should have even higher preoperative erectile function parameters to improve on these results further.