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Obsessional Indecision: Its Psychological Conceptualisation, Assessment, and Treatment

This paper examines the clinical entity of obsessional indecision. It argues for its conceptualisation as a form of “pure” obsessional disorder and discusses assessment issues and proposed intervention techniques. Data gathered from four patients treated by the authors is used to substarniate the arguments and points made. The paper illustrates the nature of the problem, as well as highlighting its varying topography and elucidating a novel treatment package that appears to show promise.

The impact of foot complications on health-related quality of life in patients with diabetes

BACKGROUND

The concept of health-related quality of life (HRQoL) has been the focus of much debate in recent years. However, within diabetes the focus has centred on the behavioural adaptation to a chronic disease state. The impact of foot complications is witnessed regularly in the clinical setting; amputation in this group is usually preceded by ulceration and a worsening cycle of foot problems.

OBJECTIVE

This review sets out to investigate the literature on foot complications in those with diabetes, to assess the cost to the individual in terms of impact on everyday living.

CONCLUSION

The literature on the specific impact of foot complications is limited, but indicates a situation in which those with diabetic foot ulceration may have an even poorer HRQoL than those who have experienced an amputation related to diabetes. In order to assess the full impact of new treatments or therapeutic interventions, it is vital that further research is conducted in this area.

Self-efficacy in chronic illness: the juxtaposition of general and regimen-specific efficacy

Changes in lifestyle are difficult for most people but necessary for those with a chronic illness, for whom changes may involve, among other adjustments, learning new behaviours and/or modifying one's lifestyle. The ease with which such changes occur depends on the person's efficacy beliefs and outcome expectations. This paper will discuss the conceptual issues related to self-efficacy: general, domain, and specific. Examples will be drawn from the health-related behaviour changes required to manage diabetes and rheumatoid arthritis. For this paper, regimen-specific or task-specific behaviour refers to the multiple tasks that the person carries out for management of their chronic illness. Confounding the issue of perceived efficacy (general, domain or specific), is the fact that compliance with all aspects of a recommended self-care regimen will not necessarily result in metabolic control for the person with type 1 diabetes mellitus, weight loss for the person with type 2 diabetes mellitus, or pain control for the arthritic person.