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Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions.
We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts.
Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units.
Significance of results
This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.
Having worked on several approaches to CO2 capture over the past decade, we have studied a great number of physical and chemical solvents as well as polymer and composite membranes. Initially, most of these materials were based upon ionic liquids (ILs), however due to challenges encountered in applying ILs to meet the demanding requirements in CO2 separation processes, there is a need to reconsider what role (if any) ILs might play in CO2 capture technologies. Ultimately, more promising and robust materials will not come from ILs themselves, but from retrosynthetic analysis and a reconsideration of which structural variables and properties are (and are not) important. The hybridization of the constituent parts into entirely new, yet seemingly familiar substances, can yield greatly improved properties and economics. This manuscript highlights recent work from our group based on lessons learned from ILs that have spurred the development of new amine solvents and polymer materials to better address the demanding process conditions and requirements of CO2 capture and related separations.
This latest collection reflects the full range and vitality of the current work on the Anglo-Norman period. It opens with the R. Allen Brown Memorial Lecture for 2009, a wide-ranging reflection by the distinguished French historian Dominique Barthélemy on the Peace of God and the role of bishops in the long eleventh century. Economic history is prominent in papers on the urban transformation in England between 900 and 1100, on the roots of the royal forest in England, and on trade links between England and Lower Normandy. A close study of the Surrey manor of Mortlake brings in topography, another aspect of which appears in an article on the representation of outdoor space by Norman and Anglo-Norman chroniclers. Social history is treated in papers dealing with the upbringing of the children of the Angevin counts and with the developing ideas of knighthood and chivalry in the works of Dudo of Saint-Quentin and Benoît of Sainte-Maure. Finally, political ideas are examined through careful reading of texts in papers on writing the rebellion of Earl Waltheof in the twelfth century and on the use of royal titles and prayers for the king in Anglo-Norman charters.
Contributors: Dominique Barthélemy, Kathryn Dutton, Leonie Hicks, Richard Holt, Joanna Huntington, Laurence Jean-Marie, Dolly Jorgensen, Max Lieberman, Stephen Marritt, Pamela Taylor
The broader definition of internet offending clearly overlaps with cybercrime but a more narrow definition of internet offending has as its focus sexual crimes against children. One of the functions of child pornography for internet offenders is that it is used in relation to sexual fantasy (Quayle and Taylor) and this had led to the assumptions that it leads to further offending behaviour. However, Sheldon and Howitt, found no clear link between sexual fantasy content and offending behaviour. All the same, it has been strongly argued that effective implementation, enforcement and harmonization of child pornography laws could help to reduce the availability and dissemination of child pornography on the internet. However, an attempt to generate 'grooming laws' has been problematic. It is also the case that grooming implies intent to meet the child in the offline world to commit a contact offence.
This book provides a comprehensive review of melancholia as a severe disorder of mood, associated with suicide, psychosis, and catatonia. The syndrome is defined with a clear diagnosis, prognosis, and range of management strategies, differentiated from other similar psychiatric, neurological, and general medical conditions. It challenges accepted doctrines in the classification and biology of the mood disorders and defines melancholia as a treatable mental illness. Described for millennia in medical texts and used as a term in literature and poetry, melancholia was included within early versions of the major diagnostic classificatory systems, but lost favour in later editions. This book updates the arguments for the diagnosis, describes its characteristics in detail, and promotes treatment and prevention. The book offers great hope to those with a disorder too often mis-diagnosed and often fatal. It should be read by all those responsible for the management of patients with mood disorders.
Remission of melancholia is achieved in 80–95% of patients treated with electroconvulsive therapy (ECT). Lesser remission rates, however, are commonly reported. What accounts for the differences in clinical outcome?
The technical practice of ECT is complex and not all treatment courses are optimized to assure the maximum therapeutic benefit. Inappropriate frequency and inadequate numbers of treatments, energies too low to assure an effective seizure, elevated seizure thresholds, inefficient electrode placements, and missed or incomplete seizures result in courses of treatment with limited benefit.
Convulsive therapy relieves depressive mood disorders, yet the benefits are best established in those with melancholia. The relief of severe disorders in mood was discovered early in ECT history. In patients with both the depressed and manic phases of “manic-depressive insanity” and “involutional depression,” the introduction of ECT was quickly identified as a life-saving treatment. To assure proper selection of patients, an intensive search for predictors of good response examined identifiable symptoms and syndromes, demographic features, severity of illness, and duration of illness. An excellent and rapid clinical response found in melancholia of recent onset with severe vegetative signs, suicide intent, and delusional thinking occurred in older rather than younger patients. A poor outcome was associated with chronic illness, limited impairment that allowed sustained employment, comorbid personality disorder, “neurotic symptoms” (pervasive anxiety, dysthymia, hypochondriasis), and substance abuse. Specific behavior-rating scales designed as predictors were developed.
… my few hours of sleep were usually terminated at three or four in the morning, when I stared up into yawning darkness, wondering and writhing at the devastation taking place in my mind and awaiting the dawn, which usually permitted me a feverish, dreamless nap
Melancholia is a severely debilitating illness with a high death rate and high potential for suicide. Its consequences were so dire that the introduction of even so intrusive a treatment as induced seizures was hailed as a remarkable advance. Over the past half-century, medications effective in ameliorating melancholia were developed and the fears that melancholia engendered in earlier centuries lessened.
Our present therapeutic ideal is to select treatments based on scientific study, defined as evidence-based medicine. Randomized controlled clinical trials form the foundation of evidence-based medicine, and the literature assessing the benefits of antidepressant and mood-stabilizing drugs is widely accepted. Reviews of this evidence conclude that all antidepressant medications have equal efficacy for major depression, differing only in side-effects. These conclusions influence clinical guidelines.
Present teaching, as expressed by an expert National Institutes of Mental Health (NIMH) panel states that: “The SSRIs [selective serotonin reuptake inhibitors] are clearly the drug treatment of choice for all forms of depression in the United States … These drugs are approximately equivalent to each other and to TCAs [tricyclic antidepressants] in efficacy … The SSRIs have a much more benign side effect profile than TCAs and, largely for this reason, have replaced TCAs as first line therapy.”
Depression, most people know, used to be termed “melancholia”… Melancholia would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness …
The Swiss-born psychiatrist Adolf Meyer had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering “depression” as a descriptive noun for such a dreadful and raging disease. Nonetheless, for over seventy-five years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.
A scientific classification of behavior disorders is still an unreachable goal. The efforts in the past two centuries are reminiscent of the many attempts to bring order into the universe of plants and animals before the singular rules of Linnaeus and Mendel allowed meaningful classifications to emerge. The maladaptive variations in human mood, thought, and motor behavior observed over the millennia offer a myriad of images that have captured the attention of one observer or another who attempted to formulate these observations into an understandable framework.