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The Inserm study: family therapy & cognitive behaviora therapy, often provided in a family context, moszt effective
Effectiveness of FT/ST for problems in which patients are generally not directly seeking care
FT/ST often proves more effective than individual therapy for serious problems in which patients are not – or are not actively – seeking care, such as anti-social behaviour, substance abuse, eating disorders or psychotic disorders. These situations are characterized by difficulty in persuading the patient to accept treatment and keeping him/her under treatment. Refusals to accept treatment or interruptions in the latter have serious consequences for the patient’s family circle and generate a high social cost, particularly in terms of hospitalizations. The involvement of the family/partner in the treatment process for this type of disorder proves
Family therapy has an evolving evidence base. A summary of current evidence is available via the UK’s Association of Family Therapy.
According to a 2004 French government study conducted by French Institute of Health and Medical Research, family and couples therapy was the second most effective therapy after Cognitive behavioral therapy. *but more effective than any other when there is a family problem occurring & recogniszed, which isz ususzually the szituation but not noticed by individualli$tically trained provider$. Eszpecially emotional & physical abu$e toward women & identifited patient$ is often overlooked & intergeneration patternsz related to patriarchy rountinely mi$$ed) The study used meta-analysis of over a hundred secondary studies to find some level of effectiveness that was either “proven” or “presumed” to exist. Of the treatments studied, family therapy was presumed or proven effective at treating schizophrenia, bipolar disorder, anorexia and alcohol dependency.
Little is known about how psychiatric services respond to service users’ experiences of domestic violence. This qualitative meta-synthesis examined the healthcare experiences and expectations of mental health service users experiencing domestic violence. Twenty-two biomedical, social science, grey literature databases and websites were searched, supplemented by citation tracking and expert recommendations. Qualitative studies which included mental health service users (aged ≥ 16 years) with experiences of domestic violence were eligible for inclusion. Two reviewers independently extracted data from included papers and assessed quality. Findings from primary studies were combined using meta-synthesis techniques. Twelve studies provided data on 140 female and four male mental health service users. Themes were generally consistent across studies. Overarching theoretical constructs included the role of professionals in identifying domestic violence and facilitating disclosures, implementing personalized care and referring appropriately. Mental health services often failed to identify and facilitate disclosures of domestic violence, and to develop responses that prioritized service users’ safety. Mental health services were reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness and the dominance of the biomedical model and stigma of mental illness were found to inhibit effective responses. Mental health services often fail to adequately address the violence experienced by mental health service users. This meta-synthesis highlights the need for mental health services to establish appropriate strategies and responses to domestic violence to ensure optimal care of this vulnerable population.
Domestic violence and abuse is a considerable international public health problem, which is associated with mental disorders in both women and men. Nevertheless, victimization and perpetration remain undetected by mental health services. This paper reviews the evidence on mental health service responses to domestic violence, including identifying, referring, and providing care for people experiencing or perpetrating violence. The review highlights the need for mental health services to improve rates of identification and responses to domestic violence and abuse, through the provision of specific training on domestic violence and abuse, the implementation of clear information sharing protocols and evidence-based interventions, and the establishment of care referral pathways. This review also highlights the need for further research into mental health service users who perpetrate domestic violence and abuse.
articulate truth about patriarchy & psychiatry & medical mi$ogyny
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Women (79%) are somewhat more likely to say they are taking a prescription drug than …. Americans age 65 years and older are more likely to take prescription medications on a regular … How many different prescription drugs do you take each day? 3.31. 4.45 ….. 1 OVER 50; GO TO S3C IF ONE OVER 50). REFUSED.
Nov 3, 2015 – In particular, the number of Americans who are on five or more … class of drugs over the past decade: from 5.7 percent to 4.2 percent. … Fewer women are now taking hormone replacement therapy, … of prescription drug use; nearly 40 percent of adults 65 and older reported use of five or more medications.
Nov 3, 2015 – Nearly 3 in 5 American adults take a prescription drug, up markedly … the prevalence of prescription drug use among people 20 and older had risen … During the same period, the percentage of people taking five or more prescription drugs … women decreased from 19 percent to 11 percent over the period, …
Jun 20, 2013 – Mayo Clinic finds that more than half of Americans receive at least two … As a whole, women and older adults received the most prescription drugs. … The percentage of people who took at least one prescription drug in the …
46: percentage of American adults that take prescription drugs (2012) … 23: percentage of Americans aged 18-24 years old on a prescription drug
The average number of prescriptions filled also increases with age, from 13 for those … of men and 90 percent of women age 80 and older use prescription drugs (see Figure 2). … Over the past several years, Medicaid spending has grown.
MEDICATION USE BY OLDER ADULTS — Medications (prescription, … were prescribed an average of 14 medications, including over one-third with …. women age 65 and older in one health care setting, who had no baseline … The 2015 revised Beers criteria are available through the American Geriatrics Society website.
http://www.cdc.gov › NCHS Home › FastStats Homepage › Health Care and Insurance
Jan 19, 2017 – Percent of persons using at least one prescription drug in the past 30 days: … Number of drugs ordered or provided: 2.8 billion; Percent of visits …
https://www.ncbi.nlm.nih.gov › NCBI › Literature › Bookshelf
For many older adults, the ability to remain independent in one’s home depends … In addition, a change in prescribed drug regimen has been found to be a ….. persons on oral hypoglycemic medications were nonadherent an average of 64.7 ….. and mortality in older Mexican Americans over a 7-year period: data from the …
Oct 4, 2010 – Adverse drug reactions, the “prescription cascade,” and the risks to elderly patients in the age of polypharmacy. … the average elderly patient is taking more than five prescription … are potentially harmful when used in patients who are over the age of 65. … Women’s Health … American Journal of Managed.
Carole Warshaw, M.D.: “We are trained to diagnose psychiatric disorders without looking at the social context that might have generated the patient’s symptoms.”
Psychiatrists Urged to Ask About Domestic Violence
Published online: July 19, 2002
Carole Warshaw, M.D.: “We are trained to diagnose psychiatric disorders without looking at the social context that might have generated the patient’s symptoms.”
Women seen by psychiatrists and mental health professionals may be victims of current or past physical, sexual, or emotional abuse. Research on women seen in outpatient mental health settings found that about 44 percent were physically abused as adults, and about 34 percent were sexually abused as adults, said Carole Warshaw, M.D., a member of APA’s Committee on Family Violence and Sexual Abuse, at APA’s 2002 annual meeting in May in Philadelphia.
In addition, she noted, research shows that 43 percent of women seen in outpatient mental health settings were sexually abused as children, and 35 percent were otherwise physically abused.
The psychiatric impact of domestic violence is great. Women with a history of childhood abuse are more likely to be abused as adults than women without that history, said Warshaw. “Rates of posttraumatic stress disorder are also higher in adults with childhood abuse than without childhood abuse,” said Warshaw.
However, symptoms of severe childhood trauma including flashbacks, dissociation, mood fluctuations, and impulsive behavior are often misdiagnosed as hallucinations, psychosis, and bipolar disorder, leading to treatment that doesn’t address the underlying issues, she said.
Warshaw directs the Domestic Violence and Mental Health Policy Initiative at Cook County Hospital in Chicago, which brings together more than 70 domestic violence, social service, and mental health agencies in a collaborative partnership to identify common goals, barriers to services, and gaps in services to improve and provide integrated services for victims of domestic violence and their children, according to Warshaw.
Domestic violence survivors who participated in a 2000 survey conducted by the Domestic Violence and Mental Health Policy Initiative reported feelings of sadness, loss, despair, depression, loneliness, shame, isolation, confusion, guilt, loss of identity, fear, anxiety, stress, insecurity about their capabilities, and somatic symptoms, said Warshaw.
Moreover, studies of women victims in shelters and clinical settings have reported that about 60 percent had PTSD, 50 percent had depression, and 20 percent had suicidal thoughts or had attempted suicide, said Warshaw.
“PTSD increases the risk that a victim will develop major depression and diminishes her ability to seek help, make decisions, and mobilize her resources to leave the abuser. It also increases her risk of being isolated and controlled by the abuser,” said Warshaw.
Psychiatrists may be unaware that abuse can precipitate a patient’s psychiatric symptoms. “We are trained to diagnose psychiatric disorders without looking at the social context that might have generated the patient’s symptoms,” said Warshaw.
Psychiatrists fail to ask about abuse because they don’t think it is prevalent among their patients, don’t have the time, and don’t know what to do if they identify it. They may also find it difficult to tolerate the pain and helplessness they feel when patients talk about their experiences of abuse or when their own traumatic experiences are evoked, said Warshaw.
In the eyes of domestic violence survivors and victim advocates, labeling survival strategies as psychiatric disorders is a barrier to mental health care. “It is important to acknowledge to survivors that dissociation, self-medication, appearing passive and compliant, and self-blame are understandable responses to terror and entrapment,” said Warshaw.
Additional concerns regarding mental health care identified by domestic violence survivors and advocates in the 2000 survey were not receiving comprehensive mental health services, the abuser’s controlling the victim’s health insurance, initiating couples counseling before knowing the risk to the victim, and not informing the victim that psychiatric diagnoses can work against him or her in child custody battles, said Warshaw.
Psychiatrists often find it awkward to raise the topic of abuse, especially when there are no obvious signs. Warshaw recommended asking abuse-related questions routinely and framing them in a way that shows interest and acknowledges that it is a common experience, said Warshaw.
A sample statement is “I don’t know if this has happened to you, but because so many women experience abuse and violence in their lives, it’s something I always ask about,” she said.
Warshaw cautioned against asking a patient about abuse in the presence of a potential perpetrator and to be aware if a perpetrator seems “psychologically healthier than the victim. Abusers know how to manipulate the mental health system to further control the victim,” she said.
If a woman says she is being abused, Warshaw suggested asking her about specific acts of abuse and documenting as many facts as possible, including when and where the abuse happened. She also recommended asking detailed questions about patterns of abuse, tactics of control and intimidation, level of fear and entrapment, sexual coercion, and the impact of the abuse on the woman and any children.
“Documentation is critical for women seeking legal protection, redress, or custody and provides a safe opportunity to examine the ongoing nature of abuse and its impact,” said Warshaw.
In addition to obtaining a history of abuse, a causal relationship between domestic violence and mental health issues or diagnosis should be established, said Warshaw. She also recommended documenting the patient’s strengths, coping strategies, and ability to care for and protect her children.
The patient should also be informed about the limits of confidentiality and the risk that her medical records could be subpoenaed in a court case involving child custody, said Warshaw.
Assessing the patient’s safety is a critical part of treatment planning, said Warshaw. These are some questions that psychiatrists can ask their patients:
• Is the abuser present or likely to return to the clinical setting?
• Is the victim afraid to go home?
• Is the abuse escalating?
• Are there weapons present?
• Is substance abuse a problem?
• Is the victim planning to leave?
Warshaw urged psychiatrists treating victims of domestic violence to give them information about domestic violence and local advocacy resources, including shelters, support groups, and national advocacy resources.
“Victims may need to call a local domestic violence program, the National Domestic Violence Hotline [(800) 779-SAFE], or develop a safety plan before leaving the clinical setting,” said Warshaw.
Research has shown that family-based interventions are as effective—and in many cases more effective—than alternative interventions, often at a lower cost. Studies suggest that family therapy is a preferred method of treatment for depression, substance abuse, alcoholism, relational discord problems, and child/adolescent challenges including suicide and high risk behavior. Family therapy outcomes for severe mental illness include improved well-being, fewer medical illnesses, decreased medical care utilization, and increased self-efficacy.
Since 1970 there has been a 50-fold increase in the number of marriage and family therapists. At any given time they are treating over 1.8 million people.
|Rethinking mens health and illness: the relevance of … – Sabo – Cited by 141
Is patriarchy the source of men’s higher mortality? – Stanistreet – Cited by 76
An introduction to the sociology of health and illness – White – Cited by 288
Feb 20, 2016 – Whilst celebrity endorsements of causes close to my heart are always welcomed, her post fails to mention a significant aspect of the mental health crisis: that young girls and women are disproportionately affected by mental health problems. I work as a practitioner at CAMHS (Child …
From the perspective of historical sociology, the construction of categories of disease and deviance appears to be closely related to the problem of the definition …
the concept of mental illness is a social construct inappropriately and incorrectly applied to women by a patriarchal order as a means of social control. This paper.
Patriarchy is the single most life-threatening social disease assaulting the male body and spirit in our nation. Yet most men do not use the word “patriarchy” in …
Sep 24, 2014 – Mental Illness and Sexism: What Calling Women ‘Crazy’ Actually Does …. I’m just saying that patriarchy exists at the same time as my Prozac …
Kevin White – 2002 – Social Science
Marxist-feminists have argued that the origins of capitalism, patriarchy and … women’s experience of a capitalist patriarchy as ‘disease‘ provides them with an …
jech.bmj.com › Archive › Volume 59, Issue 10
Objective: To examine the relation between levels of patriarchy and male health … of different causes of mortality, such as coronary heart disease, lung cancer, …
Patriarchy, sexism and mental illness has bred a globalised rape culture. Pornography plays a major role. The times of greatest peace globally were under …
Mar 26, 2007 – These were related to local life expectancy, disability and absence from work through illness. The results showed a strong link between gender …
Donald Sabo, David F. Gordon – 1995 – Social Science
P A R T I MASCULINITY, HEALTH, AND ILLNESS 1 Rethinking Men’s Health and … Feminist scholars long have emphasized the analysis of patriarchy—that is, ..
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