Monthly Archives: March 2017

Treating Mental Health and Forensic Populations

No longer is it possible to assess and/or treat a mental health population without also interfacing with forensic issues such as legal infractions, Courts, violence, sexual behavior problems, delinquency, crime, Not Guilty by Reason of Insanity, substance abuse, and others. The training and approaches to the mental health population is different than that for a forensic population. So what is to be done, if a person has both issues? We must be cross trained for dually affected clients.

How Are the Populations Different

A Mental Health population is comprised primarily Axis I disorders, such as Bipolar Disorder, Schizophrenia, Major Depression, PTSD, and Anxiety Disorders. Daily functioning is on a continuum. Recovery is quick for some and slow for others and is also on a continuum. Well controlled intermittent, mild to moderate episodes of a mood or anxiety disorder will not necessarily interfere with daily functioning. Someone with severe, chronic Schizophrenia or Mood Disorder requiring periodic hospitalizations and extensive community support, will have impairment in daily functioning. Goals for these folks are often pro-social and involve being an active member of society. A therapist can be fairly sure that the mental health client without forensic issues will be relatively honest in his or her interactions and the therapist can take most of what he/she says at face value. An emphasis on a strengths model works well when no personality disorder is involved.

A forensic population can be defined as having personality disorders, interpersonal difficulties, behavioral problems, multiple problems and life long courses of various levels of dysfunction or difficulty. Again, this population fills the full spectrum of effective daily functioning. However, social functioning is often the most severe impairment. There are issues of trust, appropriate relationships, ego centrism, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of themselves and others, especially authority figures. Moral development is often delayed leaving them at the egocentric stage of development. This means that what serves the self is what matters and empathy for others and the ability to have an honest relationship with another person may not yet have developed. Their goals are often self-serving.

The capacity to understand the importance of the best interest of the group through laws and rules that we voluntarily follow, may not be well understood. Many, if not most, have histories of childhood abuse, neglect, or exposure to domestic violence. The assessment and interventions with this population is necessarily different that those for a people with no Axis II disorder or trait. The people with forensic issues do not always tell the truth because of their lack of trust in relationships. The therapist cannot take what he/she says at face value. The therapist must separate the sincere from the manipulative moves for self-gain. The internal boundaries are such that they need the therapist to put external boundaries into place for them. Information must be checked with other sources of information.

How Assessment Tools Differ

In a mental health population, assessment can quite effectively be done through instruments such as the MMPI-A, BASC, and MACI. These self-report tools are quite sufficient for this population and will elucidate psychological dynamics and mental illness, if present. Self-report is not as much of an issue as it is in the forensic population, where third party verification is more important. However when a youth has multiple problems, both mental health and forensic, a combination of tools is preferred.

Forensic evaluation tools rely less on self-report because of the trust issues and because it is not always in the client’s best interest to be completely truthful. Self-report assessment instruments can be used, but third party and official reports should also be used in the evaluation phase of a forensic assessment. Courts are concerned with public safety, therefore, the need for tools that assess future risk of dangerousness to others. Risk of future aggression and sexual behavior problems that have been derived from statistical models (actuarial tools) should be part of the evaluation since clinical assessment of risk of future dangerousness is only a little better than chance. While risk assessments are not perfect, they are better than clinical judgment in this area.

How are Interventions Different?

Major Mental Illnesses, while often chronic, can often be very effectively treated with medication and therapy. At the higher functioning end of the continuum, therapy can be supportive, psychotherapeutic, family, or cognitive behavioral. Therapists are trained to accept what the client presents and start where the client is functioning and how the client sees the world. The clients are usually self-motivated and seek therapy voluntarily. They accept responsibility for their behaviors and for making changes in their lives. Use of a strengths model is often very effective. Many people recover fully and lead quite “normal,” non-disrupted lives. When someone is on the lower end of the continuum, with major disruption in every day functioning (work and family),despite medication and therapy, major supports for housing, jobs, and activities of daily living and medication are needed for a very long time, perhaps a life time. However, their life goals are often still pro-social. Serlf-directed care works well with the mental health population without Axis II diagnoses.

In the area of intervention, different approaches are needed for the forensic population. Some level of social and family dysfunction is generally intergenerational and lifelong. These clients are often Court ordered to an assessment or therapy or they are having significant problems at work or within the family causing others to seek assessment or therapy for them. They do not always accept responsibility for their actions or for changing. There are skill deficits that need to be addressed, such as social skills, anger management, and problem solving. You cannot take what these clients say at face value. Third party information is always needed. This is because you need to trust someone in order to be honest with them and most of these folks have been abused, neglected, or exposed to domestic violence and a suspicious arm’s length treatment of others is a coping strategy that is difficult to give up.

This population often has multiple problems so that Multi-systemic Therapy that approaches many areas that need to be addressed is often effective (treating the whole person). Group work and trauma therapies are also good tools. Self-directed therapy may not be effective because of the need to protect oneself from what may appear to be an unsafe world. Nurturing, setting good boundaries, and structure are essential in this work. Motivational interviewing and stages of change can be very helpful. When clients have issues in the mental health and forensic arenas, both approaches must be used to the extent possible.

Conclusions

Clients in a mental health setting range from the single diagnosis of a major mental Illness to the dual diagnosis of a major mental illness and a personality disorder and/or forensic/legal issue. The approaches to these dissimilar populations is unique when clients are dually diagnosed, both approaches are needed. Assessments and treatment for a mental health population can be self-directed and strengths based.

However, the approach for the forensic population cannot be self-directed because the client’s goals are often antisocial and by definition counter to the best interests of society. The therapist or evaluator cannot accept everything the client says at face value because not being honest is part of the disorder that the therapist is treating. Motivational interviewing seems to blend the views of traditional mental health and forensics in a way that is beneficial for the client and society.

Modern Methods For Biochemistry Analysis

A biochemisty analyser is a device designed to perform a variety of biochemical tests. Invented by Hans Baruch, they were introduced to the medical community, commercially, in 1959, and allowed medical laboratories and hospitals to process more samples more quickly and effectively than before. With this automated testing process, the testing time went from days – sometimes weeks – to mere minutes.

Before then, the most common form of biochemical analysis involved open test tubes placed in racks which were then either moved along a track or spun in a carousel. To protect the samples from contamination, and the laboratory staff from illness or injury, closed tube sampling soon followed. The automated biochemistry analysers did not remove the need for clinical lab technicians, however, but it did make working in the labs safer, and helped reduce errors.

There are a variety of tests a biochemistry analyser performs. They can range from testing enzymes for liver function tests, to testing ions for sodium and potassium levels. Blood glucose, creatine, and serum albumin – a plasma protein – among others, can also be analysed.

There are three categories of biochemistry analysers: The wet type, the dry type and the bio sensor. The wet type method involves mixing a test sample with a reagent to encourage a chemical reaction. A reading device, such as a spectrophotometer or a calorimeter can then be used to read the color change before and after the reaction, allowing for analysis. However, this form of testing requires expensive instruments and the ability to keep the reagents valid for long periods of time.

The dry type biochemistry analyser requires the application of a chemical reagent to a test strip, such an antibody or enzyme, which will react directly with the test sample. With the dry type of testing there is a greater risk of oxidation of the test strip which can allow for faulty readings.

When using a biosensor type biochemistry analyser, the test sample may be oxidized and placed on a thin film which is placed onto the surface of an electrode, such as pillar hydrogen peroxide, which is among the most common, and then a polarized potential is applied to the anode and cathode, which releases elctrodes, which may be measured. However, the pillar electrodes require constant maintenance which can lead to cross pollution which can lead to mistaken readings.

Some tests require more specialized tests and require a separate biochemistry analyser. This analyser may be used for several tets, or a single test. Some of these are performed frequently, but others are not, and the majority are expensive to perform, as well as time consuming. Due to the shortage of skilled clinical laboratory professionals, manufacturers are working to develop automated systems for these rare tests.

With the recent contributions in biology, chemistry and genetics, the biochemistry analyser has been evolving and improving. Biochemical research is being pushed, and is now moving from the study of a few molecules to the functional study of all biomolecules. Today, biochemical analysers are being used to help tag proteins and nucleic acids with special dies thhat allow scientists to make great headway in their quest to sequence the human genome.

Italian Food – An Overview

Italian food is more than a form of nourishment; it’s a way of life in a country where family, friendship and feasts are all indelibly linked. Italian food is simple, vibrant and good for you. From roasts to risotto, pasta to preserves, soups to sauces, Italian food is popular all year round. Italian food is highly famed: greatly loved and tirelessly imitated the world over, it has been a source of endless pleasure and joie-de-vivre in countries far and wide. Italian food is not just for Italians, but for everyone.

Cooking

For hundreds of years Italian cooking has followed a very simple principle: food is best when it’s cooked fresh and in season. I am a great fan of Italian cuisine, and a firm believer that cooking is an art, not a task. Most traditional Italian dishes as we know today, are on the whole derived from simple peasant cookery, for example the Pizza, which could be found a couple of centuries ago on the streets of Naples being sold by street vendors to those that had no cooking facilities of their own at home. The regional cooking depends on a number of factors, not only as to what ingredients are most abundant each region, but also historical factors. The recipes of Northern and Southern Italian dishes are quite different and use different methods of cooking. With the exception of a few areas near lakes that exert a moderating influence, Northern Italy is too cold for olive trees to grow, and as a result much of the population used butter for cooking.

Pasta

Pasta, no doubt, plays a large part in most traditional Italian food, and few cultures know how to employ a tomato the way that Italians can. Pasta and olive oil are considered the characteristics of southern Italian food, while northern food focuses on rice and butter (although today there are many exceptions). Italian food is all about combinations of delicious local flavours, a simple sauce, a sprinkling of Parmesan and of course real Italian pasta.

Ingredients

Ingredients used in Italian cooking, such as pasta, olive oil, garlic, tomatoes and red wine have proved to be contributory factors to a healthier lifestyle. Finding the right balance of ingredients is vital in creating vibrant good food. Although there are essential ingredients that every Italian kitchen should have, basil, garlic and olive oil, the most important ingredient is creativity. Italian cookery is exceptionally varied, nutritious and healthy; traditions have been handed down from one family to the next over the centuries, and are associated mainly with country life in that dishes are directly linked to what the Earth produces over the changing seasons: in other words, wholesome cooking whose goodness depends on all-natural ingredients.

Somebody once said “The trouble with eating Italian food is that 5 or 6 days later you’re hungry again”. Italian food is not just for Italians, but for everyone. Did you know that Italian food is the most popular cuisine for eating out throughout the world? I think the success of Italian food is that it’s the food that is easiest to live with.