- Email: [email protected]
Management of challenging behaviors in dementia
Journal of Psychosomatic Research 54 (2003) 607 – 608
Book reviews Review of ‘‘Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention’’ Edited by Kees van Heeringen. Published by John Wiley, 25th May 2001, £55.00, 322 pages Deliberate self-harm and suicide are worldwide public health problems. This multi-author book aims to describe the processes underlying such behaviours. Its central hypothesis — that individuals have an innate vulnerability that may result in suicidal acts at times of stress — is not new. However, the way that the stress-diathesis model is developed is both thought provoking and novel. Early on in the book, the central role traditionally given to psychiatric disorder is discarded. The authors argue that trait factors, such as a tendency towards impulsivity and aggression, are much more important. Moreover, underlying vulnerabilities are not fixed but may vary over time. The book is split into two parts. Part 1 reviews research evidence and presents a rationale for using a suicidal process approach. It includes a discussion of the epidemiology, neurobiology and ethology (‘‘the biological study of behaviour in natural settings’’) of suicidal behaviour, as well as an exploration of the role of personality factors. I found the chapter on psychological aspects of the process particularly interesting. The authors suggest that actual or imagined defeat, a perception that there is no escape, and feelings that no rescue is possible are potent trigger factors. Experimental evidence for the role of attentional biases and overgeneral memory is also presented. Once the case for a psychobiological model of suicidal behaviour has been made, Part 2 goes on to discuss the practical implications of the model for practice and research. This section is particularly relevant to those working with suicidal individuals. Risk assessment in psychiatry is likened to earthquake prediction. It is argued that our ability to predict suicide will improve if we can identify independent biological markers and investigate how risk factors interact over time. There are useful summaries of psychological and pharmacological approaches to treatment. Other chapters encourage us to see suicidal behaviour in a wider social context and to listen to patients’ narratives. Finally, there is a discussion of the process approach with respect to future directions in research treatment and prevention. This book is impressive in its scope, stimulating and generally easy to get to grips with. However, those who are looking for a practical guide to management should look 0022-3999/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved.
elsewhere. Anyone who wishes to understand the processes underlying suicidal behaviour will find it helpful. Navneet Kapur Department of Psychiatry and Behavioural Sciences Rawnsley Building, Manchester Royal Infirmary Oxford Road Manchester M13 9WL, UK doi:10.1016/S0022-3999(02)00513-5
Management of challenging behaviors in dementia Ellen K. Mahoney, DNS, RN, CS, Ladislav Volicer, MD, PhD, Ann C. Hurley, DNS, FAAN, CNA; Health Professions Press, 2000; US$34.00, 236 pages Over the years, the well-known team of Mahoney, Volicer and Hurley has contributed much to our understanding of dementia care, palliative care and instrument development. With this book, their contributions continue. Management of Challenging Behaviors in Dementia is a highly readable/understandable and useful text for professional caregivers in a variety of care settings (i.e., nursing homes, special dementia care units, assisted living facilities, adult day care, etc.), as well as those who provide education and support to informal (family) caregivers. I recommend the book to psychologists, social workers, nurses, psychiatrists, neurologists and geriatricians, and occupational, activities/recreational and physical therapists. The book is organized into 13 chapters with case studies, tables and figures that reflect components of the underlying conceptual model (i.e., agitation, food refusal, ADL dependence and so on). A useful glossary of terms is provided at the conclusion of the text. Among the many strengths is that it is conceptually and contextually grounded, and provides a balanced perspective between pharmacotherapies and nonpharmacological interventions. The authors rely extensively on their own research and clinical experiences, but are clearly knowledgeable about the extant literature in this area, and other references are cited liberally. I particularly appreciated the book’s focus on individualized care and the underlying philosophy of care that emphasized safety, comfort, quality of life and dignity for those with dementia. I also valued the fact that this book devotes an entire chapter to topics, like spatial disorientation, that are typically given only passing attention in other dementiarelated texts.
608
Book reviews / Journal of Psychosomatic Research 54 (2003) 607–608
Several of the chapters (e.g., Mood Disorders, Insomnia) provide initial background information on the topic alone. Then, partway through the chapter, the relationship to dementia is discussed. The text presents a broad range of behavioral and environmental intervention strategies. Some, like music therapy, have a growing empirical base. Others, like Snoezelen, do not and are largely anecdotal in their support. Discussion of the same intervention may appear in more than one chapter, if it is applicable to more than one behavior. For example, music is discussed as a management strategy under Inability to Initiate Meaningful Activities, Anxiety, as well as Resistiveness to Care. Although there is some overlap in content, the intervention is targeted for the particular behavior under discussion. Further, readers may read only the chapter covering a particular behavior they are trying to deal with, so this repetition is acceptable. In sum, Management of Challenging Behaviors in Dementia is a thoughtful, useful, easy-to-read and understand text that will enhance the knowledge base and intervention repertoire of a clinicians and caregivers of persons with dementia in a variety of settings. I highly recommend it. Kathleen Coen Buckwalter The University of Iowa, 316 CMAB Iowa City, IA 52242, USA E-mail address: [email protected] doi:10.1016/S0022-3999(02)00528-7
ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment Edited by Weiss, Hechtman and Weiss. John Hopkins U Press, 1999. 357 pages, US$22.50. This book is noteworthy. It is written by leading authorities in the field of Attention Deficit Hyperactivity Disorder (ADHD) and fills a gap in the literature by providing an excellent teaching source for clinicians and researchers. What this book offers is an excellent integration of the scientific literature with case examples that allow the reader to not only understand ADHD intellectually, but to truly experience the lives of these individuals. With increasing numbers of adults seeking ADHD diagnoses and treatment, this user-friendly text will be important for clinicians such as psychiatrists, psychologists, family physicians, neurologists, occupational therapists, social workers, and trainees, as well as individuals with ADHD and their families.
The book is comprised of four parts. The first part, Chapter 1, provides a thorough introductory review of the literature, in the form of commonly asked questions and answers. This innovative style is an effective teaching tool. The second part of the book, Chapters 2 –4, addresses the complicated issue of assessment. The chapters cover the assessment process, issues of differential diagnosis and comorbidity, and difficult diagnoses. The assessment process is described in a how-to manner, providing step-by-step procedures with a review of most of the interviews and rating scales that are currently utilized in the field. To aid in the assessment process, several useful assessment instruments are found in the appendices. The American Academy of Child and Adolescent Psychiatry’s (AACAP) Practice Parameters for the Assessment and Treatment of Child, Adolescent, and Adult ADHD are not included in the book and should be reviewed since minor discrepancies between the book and guidelines exist (see www.aacap.org/clinical/ adhdsum.htm). The third part of the book, Chapters 5 – 10, focuses on treatment. The chapters cover psychoeducational approaches, medications, psychological therapies, environmental restructuring at home and work, family/parenting/ marital interventions, and community and support organizations. With regard to medications, the book offers a nice guide to managing stimulant medications, along with useful medication management checklists. The book concludes with a wonderful chapter about a family talking about ADHD in its family members and what life is like from different family members’ perspectives as well as a chapter covering future directions and challenges, such as the need for adult diagnostic norms and outcome data and the ethical considerations of stimulant medication. Overall, this is an excellent resource for any clinician assessing and/or treating adults with ADHD, as well as for adults with ADHD and their families. I have no significant negative comments to make about this book. The book’s strength is the use of case examples imbedded in sound, scientific literature, resulting in a text that captures the experience of ADHD in a user-friendly format. Diane E. Johnson Institute for Healing in Society and Medicine P.O. Box 2286, Chapel Hill NC 27515, USA E-mail address: [email protected] doi:10.1016/S0022-3999(02)00518-4
Book reviews Review of ‘‘Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention’’ Edited by Kees van Heeringen. Published by John Wiley, 25th May 2001, £55.00, 322 pages Deliberate self-harm and suicide are worldwide public health problems. This multi-author book aims to describe the processes underlying such behaviours. Its central hypothesis — that individuals have an innate vulnerability that may result in suicidal acts at times of stress — is not new. However, the way that the stress-diathesis model is developed is both thought provoking and novel. Early on in the book, the central role traditionally given to psychiatric disorder is discarded. The authors argue that trait factors, such as a tendency towards impulsivity and aggression, are much more important. Moreover, underlying vulnerabilities are not fixed but may vary over time. The book is split into two parts. Part 1 reviews research evidence and presents a rationale for using a suicidal process approach. It includes a discussion of the epidemiology, neurobiology and ethology (‘‘the biological study of behaviour in natural settings’’) of suicidal behaviour, as well as an exploration of the role of personality factors. I found the chapter on psychological aspects of the process particularly interesting. The authors suggest that actual or imagined defeat, a perception that there is no escape, and feelings that no rescue is possible are potent trigger factors. Experimental evidence for the role of attentional biases and overgeneral memory is also presented. Once the case for a psychobiological model of suicidal behaviour has been made, Part 2 goes on to discuss the practical implications of the model for practice and research. This section is particularly relevant to those working with suicidal individuals. Risk assessment in psychiatry is likened to earthquake prediction. It is argued that our ability to predict suicide will improve if we can identify independent biological markers and investigate how risk factors interact over time. There are useful summaries of psychological and pharmacological approaches to treatment. Other chapters encourage us to see suicidal behaviour in a wider social context and to listen to patients’ narratives. Finally, there is a discussion of the process approach with respect to future directions in research treatment and prevention. This book is impressive in its scope, stimulating and generally easy to get to grips with. However, those who are looking for a practical guide to management should look 0022-3999/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved.
elsewhere. Anyone who wishes to understand the processes underlying suicidal behaviour will find it helpful. Navneet Kapur Department of Psychiatry and Behavioural Sciences Rawnsley Building, Manchester Royal Infirmary Oxford Road Manchester M13 9WL, UK doi:10.1016/S0022-3999(02)00513-5
Management of challenging behaviors in dementia Ellen K. Mahoney, DNS, RN, CS, Ladislav Volicer, MD, PhD, Ann C. Hurley, DNS, FAAN, CNA; Health Professions Press, 2000; US$34.00, 236 pages Over the years, the well-known team of Mahoney, Volicer and Hurley has contributed much to our understanding of dementia care, palliative care and instrument development. With this book, their contributions continue. Management of Challenging Behaviors in Dementia is a highly readable/understandable and useful text for professional caregivers in a variety of care settings (i.e., nursing homes, special dementia care units, assisted living facilities, adult day care, etc.), as well as those who provide education and support to informal (family) caregivers. I recommend the book to psychologists, social workers, nurses, psychiatrists, neurologists and geriatricians, and occupational, activities/recreational and physical therapists. The book is organized into 13 chapters with case studies, tables and figures that reflect components of the underlying conceptual model (i.e., agitation, food refusal, ADL dependence and so on). A useful glossary of terms is provided at the conclusion of the text. Among the many strengths is that it is conceptually and contextually grounded, and provides a balanced perspective between pharmacotherapies and nonpharmacological interventions. The authors rely extensively on their own research and clinical experiences, but are clearly knowledgeable about the extant literature in this area, and other references are cited liberally. I particularly appreciated the book’s focus on individualized care and the underlying philosophy of care that emphasized safety, comfort, quality of life and dignity for those with dementia. I also valued the fact that this book devotes an entire chapter to topics, like spatial disorientation, that are typically given only passing attention in other dementiarelated texts.
608
Book reviews / Journal of Psychosomatic Research 54 (2003) 607–608
Several of the chapters (e.g., Mood Disorders, Insomnia) provide initial background information on the topic alone. Then, partway through the chapter, the relationship to dementia is discussed. The text presents a broad range of behavioral and environmental intervention strategies. Some, like music therapy, have a growing empirical base. Others, like Snoezelen, do not and are largely anecdotal in their support. Discussion of the same intervention may appear in more than one chapter, if it is applicable to more than one behavior. For example, music is discussed as a management strategy under Inability to Initiate Meaningful Activities, Anxiety, as well as Resistiveness to Care. Although there is some overlap in content, the intervention is targeted for the particular behavior under discussion. Further, readers may read only the chapter covering a particular behavior they are trying to deal with, so this repetition is acceptable. In sum, Management of Challenging Behaviors in Dementia is a thoughtful, useful, easy-to-read and understand text that will enhance the knowledge base and intervention repertoire of a clinicians and caregivers of persons with dementia in a variety of settings. I highly recommend it. Kathleen Coen Buckwalter The University of Iowa, 316 CMAB Iowa City, IA 52242, USA E-mail address: [email protected] doi:10.1016/S0022-3999(02)00528-7
ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment Edited by Weiss, Hechtman and Weiss. John Hopkins U Press, 1999. 357 pages, US$22.50. This book is noteworthy. It is written by leading authorities in the field of Attention Deficit Hyperactivity Disorder (ADHD) and fills a gap in the literature by providing an excellent teaching source for clinicians and researchers. What this book offers is an excellent integration of the scientific literature with case examples that allow the reader to not only understand ADHD intellectually, but to truly experience the lives of these individuals. With increasing numbers of adults seeking ADHD diagnoses and treatment, this user-friendly text will be important for clinicians such as psychiatrists, psychologists, family physicians, neurologists, occupational therapists, social workers, and trainees, as well as individuals with ADHD and their families.
The book is comprised of four parts. The first part, Chapter 1, provides a thorough introductory review of the literature, in the form of commonly asked questions and answers. This innovative style is an effective teaching tool. The second part of the book, Chapters 2 –4, addresses the complicated issue of assessment. The chapters cover the assessment process, issues of differential diagnosis and comorbidity, and difficult diagnoses. The assessment process is described in a how-to manner, providing step-by-step procedures with a review of most of the interviews and rating scales that are currently utilized in the field. To aid in the assessment process, several useful assessment instruments are found in the appendices. The American Academy of Child and Adolescent Psychiatry’s (AACAP) Practice Parameters for the Assessment and Treatment of Child, Adolescent, and Adult ADHD are not included in the book and should be reviewed since minor discrepancies between the book and guidelines exist (see www.aacap.org/clinical/ adhdsum.htm). The third part of the book, Chapters 5 – 10, focuses on treatment. The chapters cover psychoeducational approaches, medications, psychological therapies, environmental restructuring at home and work, family/parenting/ marital interventions, and community and support organizations. With regard to medications, the book offers a nice guide to managing stimulant medications, along with useful medication management checklists. The book concludes with a wonderful chapter about a family talking about ADHD in its family members and what life is like from different family members’ perspectives as well as a chapter covering future directions and challenges, such as the need for adult diagnostic norms and outcome data and the ethical considerations of stimulant medication. Overall, this is an excellent resource for any clinician assessing and/or treating adults with ADHD, as well as for adults with ADHD and their families. I have no significant negative comments to make about this book. The book’s strength is the use of case examples imbedded in sound, scientific literature, resulting in a text that captures the experience of ADHD in a user-friendly format. Diane E. Johnson Institute for Healing in Society and Medicine P.O. Box 2286, Chapel Hill NC 27515, USA E-mail address: [email protected] doi:10.1016/S0022-3999(02)00518-4