By X. Deckard. University of Georgia.

Studies have produced a variety of statistics related to age of the homeless: 39% are younger than 18 years; indi- viduals between the ages of 25 and 34 comprise 25%; and 6% are ages 55 to 64 roxithromycin 150 mg on-line. Families with children are among the fastest grow- ing segments of the homeless population roxithromycin 150mg discount. Families comprise 33% of the urban homeless population roxithromycin 150 mg cheap, but research indicates that this number is higher in rural areas purchase 150mg roxithromycin with visa, where families, single mothers, and children make up the largest group of homeless people. The homeless population is estimated to be 42% African American, 39% white, 13% Hispanic, 4% Native American, and 2% Asian (U. The ethnic makeup of homeless populations varies according to geographic location. Other prevalent disorders include bipolar affective disorder, substance abuse and dependence, depression, person- ality disorders, and organic mental disorders. Deinstitutionalization is frequently implicated as a contributing factor to homelessness among persons with mental illness. Deinstitutionalization began out of expressed concern by mental health professionals and oth- ers who described the “deplorable conditions” under which mentally ill individuals were housed. Some individuals be- lieved that institutionalization deprived the mentally ill of their civil rights. Not the least of the motivating factors for deinstitutionalization was the financial burden that these cli- ents placed on state governments. Cuts in various government entitlement programs have depleted the allotments available for individuals with severe and persistent mental illness living in the community. The job market is prohibitive for individuals whose behavior is incomprehensible or even frightening to many. The stigma and discrimination associated with mental illness may be di- minishing slowly, but it is highly visible to those who suffer from its effects. The gap between the number of affordable housing units and the number of people needing them has created a housing crisis for poor people. Between 1970 and 1995, the gap between the number of low-income renters and the amount of affordable housing units sky- rocketed from a nonexistent gap to a shortage of 4. So many individuals currently frequent the shelters of our cities that there is concern that the shelters are becoming mini-institutions for people with serious men- tal illness. For families barely able to scrape together enough money to pay for day-to-day living, a catastrophic illness can create the level of poverty that starts the downward spiral to homelessness. Battered women are Homelessness ● 343 often forced to choose between an abusive relationship and homelessness. For individuals with alcohol or drug ad- dictions, in the absence of appropriate treatment, the chances increase for being forced into life on the street. The following have been cited as obstacles to addiction treatment for home- less persons: lack of health insurance, lack of documentation, waiting lists, scheduling difficulties, daily contact require- ments, lack of transportation, ineffective treatment methods, lack of supportive services, and cultural insensitivity. Mobility and migration (the penchant for frequent move- ment to various geographic locations) 2. Among homeless children (compared with control samples), increased incidence of: a. Psychological problems Common Nursing Diagnoses and Interventions (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community health clinic, “street clinic,” and homeless shelters. Client will assume responsibility for own health-care needs within level of ability. The triage nurse in the emergency department, street clinic, or shelter will begin the biopsychosocial assessment of the homeless client. An adequate assessment is required to en- sure appropriate nursing care is provided. This information is essential to ensure that client achieves an ac- curate understanding of information presented and that the nurse correctly interprets what the client is attempting to convey. Client may need as- sistance in determining the type of care that is required, how to determine the most appropriate time to seek that care, and where to go to receive it. Answers to these questions at admission will initiate dis- charge planning for the client. The client must have this type of knowledge if he or she is to become more self-sufficient.

This process is termed thought proven 150mg roxithromycin, called Logic Theorist order roxithromycin 150mg line, at Carnegie-Mellon Uni- cognitive restructuring cheap 150mg roxithromycin with amex. Other major contributions in this Cognitive therapy is a treatment option for a number area include D generic roxithromycin 150mg otc. It is also tures of behavioral modification into the traditional cog- frequently prescribed as an adjunct, or complementary, nitive restructuring approach. In cognitive-behavioral therapy for patients suffering from back pain, cancer, therapy, the therapist works with the patient to identify rheumatoid arthritis, and other chronic pain conditions. Patients may have certain fundamental core beliefs, known as schemas, which are flawed, and are having a Cognitive therapy is usually administered in an out- negative impact on the patient’s behavior and function- patient setting (clinic or doctor’s office) by a therapist ing. For example, a patient suffering from depression trained or certified in cognitive therapy techniques. Ther- may develop a social phobia because he/she is convinced apy may be in either individual or group sessions, and he/she is uninteresting and impossible to love. A cogni- the course of treatment is short compared to traditional tive-behavioral therapist would test this assumption by psychotherapy (often 12 sessions or less). Therapists asking the patient to name family and friends that care are psychologists (Ph. The therapist asks the patient to defend behavioral techniques such as conditioning (the use of his or her thoughts and beliefs. If the patient cannot positive and/or negative reinforcements to encourage de- produce objective evidence supporting his or her as- sired behavior) and systematic desensitization (gradual sumptions, the invalidity, or faulty nature, is exposed. The patient is asked to imagine a ly reintroduce the patient to social situations. When the patient Preparation is confronted with a similar situation again, the re- Cognitive therapy may not be appropriate for all pa- hearsed behavior will be drawn on to deal with it. The therapist and patient then review lationship is critical to successful treatment. Individuals the journal together to discover maladaptive thought interested in cognitive therapy should schedule a consul- patterns and how these thoughts impact behavior. The consultation session is similar to an in- reinforce insights made in therapy, the therapist may terview session, and it allows both patient and therapist to ask the patient to do homework assignments. During the consultation, the may include note-taking during the session, journaling therapist gathers information to make an initial assess- (see above), review of an audiotape of the patient ses- ment of the patient and to recommend both direction and sion, or reading books or articles appropriate to the goals for treatment. They may also be more behaviorally focused, learn about the therapist’s professional credentials, applying a newly learned strategy or coping mecha- his/her approach to treatment, and other relevant issues. The intake interview is typically performed by a psychiatric nurse, counselor, or social worker, either face-to-face or over the phone. It is used to gather a brief background on treatment history and make a preliminary evaluation of the patient before assigning them to a therapist. Typical results Because cognitive therapy is employed for such a broad spectrum of illnesses, and is often used in con- junction with medications and other treatment interven- tions, it is difficult to measure overall success rates for the therapy. Cognitive and cognitive behavior treatments have been among those therapies not likely to be evaluat- ed, however, and efficacy is well-documented for some symptoms and problems. Some studies have shown that cognitive therapy can reduce relapse rates in depression and in schizophrenia, particularly in those patients who respond only margin- ally to antidepressant medication. It has been suggested that this is because cognitive therapy focuses on chang- ing the thoughts and associated behavior underlying these disorders rather than just relieving the distressing symptoms associated with them. The integrative power of cognitive throughout the world and how they cope with war, therapy. Mind over mood: chiatry and medical humanities at Harvard University a cognitive therapy treatment manual for clients. Further Information Coles was born in 1929 in Boston to parents who Beck Institute For Cognitive Therapy And Research. During advanced training in psychoanalysis in New Orleans, Coles reached a turning point.

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Zimbardo (1969) evaluated the effects of post hoc justification on hunger and thirst effective 150 mg roxithromycin. Subjects were asked not to eat or drink for a length of time purchase 150 mg roxithromycin overnight delivery, and were divided into two groups roxithromycin 150 mg line. Group one were offered money if they managed to abstain from eating and drinking cheap roxithromycin 150 mg otc, providing these subjects with good justification for their behaviour. Group two were simply asked not to eat or drink for a length of time, but were given no reason or no incentive, and therefore had no justification. Having good justification for their behaviour, group one were not in a state of dissonance; they were able to justify not eating and still maintain a sense of being rational and in control. Group two had no justification for their behaviour and were therefore in a state of high dissonance, as they were performing a behaviour for very little reason. Therefore in order to resolve this dissonance it was argued that group two needed to find a justification for their behaviour. At the end of the period of abstinence all subjects were allowed to eat and drink as much as they wished. The results showed that group two (those in high dissonance) ate and drank less when free food was available to them than group one (those in low dissonance). The subjects in group two, being in a state of high dissonance, needed to find a justification for their behaviour and justified their behaviour by believing ‘I didn’t eat because I was not hungry’. The subjects in group one, being in a state of low dissonance, had no need to find a justification for their behaviour as they had a good justification ‘I didn’t eat because I was paid not to’. The results of this study have been used to suggest that high dissonance influenced the subject’s physiological state, and the physiological state changed in order to resolve the problem of dissonance. Research has also examined the effects of justification on placebo-induced pain reduction. Half of the subjects were offered money to take part in the study, and half were offered no money. Totman argued that because one group were offered an incentive to carry out the study and to experience the pain they had a high justification for their behaviour, they therefore had high justification and were in a state of low dissonance. The other group, however, were offered no money and therefore had low justification for subjecting themselves to a painful situation; they therefore had low justification and were in a state of high dissonance. Totman argued that this group needed to find some kind of justification to resolve this state of dissonance. If the drug worked, Totman argued that this would provide them with justification for subjecting themselves to the experiment and for choosing to take the drug. The results showed that the group in a state of high dissonance experienced less pain following the placebo than the group in low dissonance. Totman argued that this suggests that being in a state of low justification activated the individual’s unconscious regulating mechanisms, which caused physiological changes to reduce the pain, providing the group with justification for their behaviour, which therefore eradicated their state of dissonance. An example of Totman’s theory The following example illustrates the relationship between justification, the need to see oneself as rational and in control, and the problem of dissonance between these two factors. Visiting Lourdes in order to improve one’s health status involves a degree of invest- ment in that behaviour in terms of time, money, etc. If the visit to Lourdes has no effect, then the behaviour begins to appear irrational and unjustified. If the individual can provide justification for their behaviour, for example ‘I was paid to go to Lourdes’, then they will experience low dissonance. If, however, the individual can find no justification for their visit to Lourdes and therefore believes ‘I chose to do it and it didn’t work’, they remain in a state of high dissonance. Dissonance is an uncomfortable state to be in and the individual is motivated to remove this state. Therefore, according to cognitive dissonance theory, dissonance can be resolved by the placebo having an effect on the individual’s health status by activating unconscious regulating mechanisms. Support for cognitive dissonance theory The following factors provide support and evidence for cognitive dissonance theory: s The theory can explain all placebo effects, not just pain. This helps to explain those reported instances where the individual does not appear to expect to get better. This can explain some of the proposed effects of treatment characteristics, individual characteristics and therapist characteristics.

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According to this scale discount roxithromycin 150 mg on-line, subjects were defined as precontemplators (n = 166) discount roxithromycin 150 mg without prescription, contemplators (n = 794) and those in the preparation stage (n = 506) generic roxithromycin 150 mg online. Results The results were first analysed to examine baseline difference between the three subject groups 150 mg roxithromycin with visa. The results showed that those in the preparation stage smoked less, were less addicted, had higher self-efficacy, rated the pros of smoking as less and the costs of smoking as more, had made more prior quitting attempts than the other two groups. The results were then analysed to examine the relationship between stage of change and smoking cessation. At both one and six months, the subjects in the preparation stage had made more quit attempts and were more likely to not be smoking. Conclusion The results provide support for the stages of change model of smoking cessation and suggest that it is a useful tool for predicting successful outcome of any smoking cessation intervention. Clinical interventions: promoting individual change Clinical interventions often take the form of group or individual treatment programmes based in hospitals or universities requiring regular attendance over a 6- or 12-week period. These interventions use a combination of approaches that reflect the different disease and social learning theory models of addiction and are provided for those individuals who seek help. Disease perspectives on cessation Within the most recent disease models of addiction, nicotine and alcohol are seen as addictive and the individual who is addicted is seen as having acquired tolerance and dependency to the substance. For example, nicotine fading procedures encourage smokers to gradually switch to brands of low nicotine cigarettes and gradually to smoke fewer cigarettes. It is believed that when the smoker is ready to completely quit, their addiction to nicotine will be small enough to minimize any withdrawal symptoms. Although there is no evidence to support the effectiveness of nicotine fading on its own, it has been shown to be useful alongside other methods such as relapse prevention (for example, Brown et al. Nicotine replacement procedures also emphasize an individual’s addiction and depend- ency on nicotine. For example, nicotine chewing gum is available over the counter and is used as a way of reducing the withdrawal symptoms experienced following sudden cessation. The chewing gum has been shown to be a useful addition to other behavioural methods, particularly in preventing short-term relapse (Killen et al. More recently, nicotine patches have become available, which only need to be applied once a day in order to provide a steady supply of nicotine into the bloodstream. They do not need to be tasted, although it could be argued that chewing gum satisfies the oral component of smoking. However, whether nicotine replacement procedures are actually compensating for a physiological addiction or whether they are offering a placebo effect via expecting not to need cigarettes is unclear. Treating excessive drinking from a disease perspective involves aiming for total abstinence as there is no suitable substitute for alcohol. Social learning perspectives on cessation Social learning theory emphasizes learning an addictive behaviour through processes such as operant conditioning (rewards and punishments), classical conditioning (associations with internal/external cues), observational learning and cognitions. Therefore, cessation procedures emphasize these processes in attempts to help smokers and excessive drinkers stop their behaviour. These cessation procedures include: aversion therapies, contingency contracting, cue exposure, self-management techniques and multi-perspective cessation clinics: 1 Aversion therapies aim to punish smoking and drinking rather than rewarding it. Early methodologies used crude techniques such as electric shocks whereby each time the individual smoked a puff of a cigarette or drank some alcohol they would receive a mild electric shock. However, this approach was found to be ineffective for both smoking and drinking (e. Wilson 1978), the main reason being that it is difficult to transfer behaviours that have been learnt in the laboratory to the real world. In an attempt to transfer this approach to the real world alcoholics are sometimes given a drug called Antabuse, which induces vomiting whenever alcohol is consumed. This has been shown to be more effective than electric shocks (Lang and Marlatt 1982), but requires the individual to take the drug and also ignores the multitude of reasons behind their drink problem. Imaginal aversion techniques have been used for smokers and encourage the smoker to imagine the negative consequence of smoking, such as being sick (rather than actually experiencing them). However, imaginal techniques seem to add nothing to other behavioural treatments (Lichtenstein and Brown 1983). Smokers are required to sit in a closed room and take a puff every 6 seconds until it becomes so unpleasant they cannot smoke any more.

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