Interpersonal relationships

Interpersonal, family, or group therapy with a licensed psychiatric nurse practitioner/clinical nurse specialist, psychologist, social worker, or counselor assists individuals with bipolar disorder to establish and maintain a daily routine and sleep schedule and to improve interpersonal relationships.3,20 These therapies may help treat and protect against manic episodes. 

Although it has received the most attention, CBT is not the only form of psychotherapy that is effective for depression. Other psychological treatments include interpersonal psychotherapy, short-term psychodynamic therapy and non-directive supportive therapy. Interpersonal psychotherapy focuses on problems that arise in interpersonal relationships, such as marital conflict, the loss of a loved one and social isolation.20 Short-term psychodynamic therapy focuses on acquiring insight and understanding of unresolved conflicts arising from the person s childhood. It is based on Freud s psychoanalytic theory, but requires only months, rather than the years it takes for a full psychoanalysis.21 Non-directive supportive therapy provides a warm, supportive atmosphere in which the depressed person can explore life issues... 

On the other hand, you rightly emphasised the problems that arise when dealing with patients whose value systems or cultural backgrounds are different. In Africa, one is frequently confronted by patients whose faith in sangomas, or witch doctors, is profound and whose language presents a barrier that requires the intervention of an interpreter and hence the loss of the interpersonal relationship that the holistic approach requires. Under these circumstances, reductionism is often the easiest answer to providing a good deal by Western standards. 

Kennedy, S., Kiecolt-Glaser, J.K., and Glaser, R., Immunological consequences of acute and chronic stressors Mediating role of interpersonal relationships, Brit. J. Med. Psychol., 61 (Pt 1), 77, 1988. 

The expression of emotions in inappropriate ways can cause a vicious cycle for a person. For example, expressing emotions inappropriately can cause problems with interpersonal relationships. If a person is perceived as emotionally awkward or volatile, others may go out of their way to limit contact with that person. The result maybe increased social isolation, which in turn may reinforce the belief by many clients with drug problems that they are social misfits (recall the earlier discussion about environmental risk factors). In addition, the disinhibiting effects of drugs may exacerbate emotional dysregulation, potentially making the dys-regulation that much worse. 

Changes in behavior, routine, values, or interpersonal relationships... 

Besides the intake interview, which can help gather information, there are a number of assessment measures for determining the quality of an important interpersonal relationship. The questions on these measures generally ask about things like communication styles, satisfaction in the relationship, joint decision making, and in some cases, abusive behavior. Two of the most well-known measures are the Dyadic Adjustment Scale (Spanier, 1976) and the Marital Satisfaction Inventory (Snyder, 1979). Therapists and counselors also may choose to interview couples together (with the consent of client and partner), and some therapists may recommend couples therapy (see Chapter 5) as part of the overall approach to treatment if deemed appropriate to help the client. Relationship assessments can yield important information that may be useful when working with couples. 

Another area in which you may need to teach clients new skills is the domain of social skills. Many of our clients have large deficits in their social skills that often contribute to their seeking socialization among drug-using peers or having problems in interpersonal relationships. For example, people with drug problems... 

Major depression is one of the most common mental disorders. It has a lifetime prevalence of 17% in the general population, and a current prevalence of 4.9%, constituting a significant public health problem (Blazer et al. 1994). It is characterized by intense sadness and cognitive impairments most notable in concentration, worry, pessimism, and lowered self-esteem (American Psychiatric Association 1994). Interpersonal relationships may suffer and social withdrawal occurs. Physio-... 

Financial considerations were not the only factor influencing job decisions. Some interviewees indicated that their job decisions were based on interpersonal relationships and the culture or climate of the employing organization. Sometimes academic advisors played key roles in these decisions. One Cohort III interviewee remarked My Ph.D. advisor was a good friend of the Research Director... 

Shin Hwa Li would like to thank his previous graduate school advisor. Prof. G. B. Stringfellow, University of Utah. He provided invaluable teaching, not only in science but in interpersonal relationships as well. More recently, he gave guidance in presenting a book proposal to our publisher (Academic Press). Both editors would like to also thank Dr. Z. Ruder,... 

The principles of autonomy, beneficence, nonmaleficence, and justice form a foundation for analysis of ethical quandaries. In addition, a comprehensive ethical analysis will include considerations of cultural and reh-gious diversity of patient-subjects, health care providers and interpersonal relationships an assessment of the profession-based duties and obligations of the health care professionals, including an examination of relevant professional oaths and codes and an analysis of relevantly similar previous bioethical dilemmas. 

How you are with your patients in your office is a model for how you would like them to be conducting their interpersonal relationships outside the office. 

Puig-Antich, J., Lukens, E., Davies, M., Goetz, D., Brennan-Quattrock, J., and Todak, G. (1985) Psychosocial functioning in prepubertal depressive disorders. II. Interpersonal relationships after sustained recovery from the affective episode. Arch Gen Psychiatry 42 511-517. 

Most bulimic patients (60%-80%) have a lifetime history of depression (Braun et ah, 1994). They have problems with interpersonal relationships, self-concept, and impulsive behavior and show high levels of anxiety and compulsivity. Chemical dependency is not unusual in this disorder, alcohol abuse being the most common. Bulimics will abuse amphetamines to reduce their appetite and lose weight (Braun et ah, 1994). 

Pattern of instability in interpersonal relationships, self-image, affect... 

In contrast to minimal risks for long-term antidepressant administration, the risks of treatment discontinuation are profound, attributable to the greatly increased risk of recurrence. With each new episode, the patient is likely to have increased risk of occupational dysfunction, job loss, social impairment, problems with interpersonal relationships, marital discord, separa-... 

The techniques of interpersonal therapy (IPT) developed by Klerman, Weissman and other authors are based on the concept that depressions have their origin in the area of interpersonal relationships and that they also run their course in that area (see Klerman et al., 1984). The purpose of IPT is to restore the patients within a short time to a position in which they can better understand their interpersonal problems and are able to change their unsatisfactory behavior towards others that leads to conflicts and frustrations. An early IPT study is presented in Box 8.5. 

Some patients initially diagnosed as having borderline disorder and followed longitudinally will develop periodic exacerbations in their interpersonal relationships. At times, they may even be reclassified as having either a classic bipolar disorder, a subsyndromal variant, or an atypical presentation. Peselow et al. ( 38) studied 66... 

BPD is characterized by a pervasive pattern of unstable affect, stormy interpersonal relationships, and behavioral dyscontrol. An estimated 1% to 2% of the general population manifest this syndrome. It is also a co-morbid condition with major mood disorders (i.e., different studies estimate from 25% to 75% of these patients have a major depression and 5% to 20% a bipolar disorder). Furthermore, as many as 25% of bulimics may also suffer from BPD, and approximately 70% of BPD patients abuse alcohol or drugs. Self-mutilation, suicide attempts, and completed suicides are all too frequent. Indeed, it is estimated that 3% to 10% of these patients will take their own lives. 

Social anxiety disorder is an uncommonly diagnosed but a fairly common condition in which the patient experiences severe anxiety in social interactions. This anxiety may limit their ability to function adequately in their jobs or interpersonal relationships. Several SSRIs and venlafaxine are approved for the treatment of social anxiety. The efficacy of the SSRIs in the treatment of social anxiety is greater in some studies than their efficacy in the treatment of MDD. 

Because it is difficult to learn about interpersonal relationships in an individual session, some therapists begin to take the drugs with their patients to maximize the empathic process. This kind of activity limits the number of people... 

As with any highly addictive drug, methaqualone abusers become preoccupied with when and where they will be able to get their next dose. Interpersonal relationships with family and friends frequently deteriorate as drug use dominates the addict s life. Personal finances may also suffer as the drug user funnels more money towards his or her habit or becomes unemployed due to poor job performance resulting from drug impairment. 

Sleep disorders such as sleep apnea, narcolepsy, delayed sleep-phase syndrome (DSPS), and insomnia can cause problem sleepiness and difficulty functioning during the day for adolescents (103). Over the course of several studies, Roberts and colleagues have shown that insomnia and related sleep problems have adverse consequences for the future functioning of adolescents (107,108). In particular, insomnia symptoms such as nonrestorative sleep, difficulty initiating sleep, and daytime sleepiness predicted self-esteem difficulties, interpersonal relationship problems, and symptoms of depression, along with somatic complaints (108). 

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