The purpose of this study was to explore potential differences among three groups of caregivers with a relative who had experienced a mental ill This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.Psychosocial Rehabilitation Journal ness or a head injury. Guiding questions included the following: 1) what dif ferences exist between the groups differing primarily on type of disability, and 2) what differences exist between the groups differing primarily on membership in a family support group? SIMILARITIES BETWEEN MENTALLY ILL AND BRAIN INJURED PATIENTSOverall, patients with mental illnesses, like schizophrenia, and brain injured patients share many similar characteristics. Decreased ability to obtain and sustain employment, threatening behavior, apathy, mood swings, lack of spontaneity, cognitive impairment, increased dependency, and bizarre behaviors are a few of the sequel common to both mental illness and brain injury. Both patient groups appear to experience a loss in emotional control (Brooks, 1984; Lefley, 1987; Lezak, 1988) and to be hypersensitive to stress in their environment (Falloon et al., 1985; Lewis &c Rosenburg, 1990; Thomsen, 1974). Both types of patients think, feel, and behave differ ently from the past following the onset of their illness or injury.The average age of onset of schizophrenia and closed head injury is roughly equivalent (late adolescence through early adulthood) (Stavros, 1987; Torrey, 1988). Due to the similar age of onset, the families of patients in both groups are likely to be at roughly the same family developmental stage. At the time of illness or injury onset, parents are likely to be in the middle or later stages of a career and siblings are more likely to be indepen dent adults or adolescents than young children.

Managing response burden is key to ensuring an ongoing and efficient supply of fit-forpurpose data. While statistical organizations use multi-faceted approaches to achieve this, response burden management has become an essential element of the strategy used by the U.S. Census Bureau, Statistics New Zealand, Statistics Canada, and Statistics Netherlands. Working in collaboration with respondents, with internal resources dedicated to provide customized approaches for large respondents and with other stakeholders (constituency representatives, associations, etc.) response burden management endeavors to minimize burden and educate stakeholders on the benefit of official statistics. The role continues to evolve with important initiatives regarding the compilation of burden metrics, improvements to existing tracking tools, and an expanded communication role.

Patients with obsessive-compulsive disorder (OCD) often have comorbid psychiatric disorders, such as depression, bipolar disorder, psychotic disorders, and eating disorders, which present challenges to the treating physician. Symptoms of OCD may have an earlier onset and be more severe in patients with comorbid illnesses than in those with OCD alone. Both cognitive-behavioral therapy (using exposure and response/ritual prevention) and medication may be needed to treat patients with OCD and comorbid mood, psychotic, or eating disorders.

Some of the most common complicating factors for clinicians treating a person with obsessive-compulsive disorder include suicidal obsessions, dangerous compulsions, overvalued ideation, and low motivation. When a patient reports suicidal thoughts, clinicians must assess whether these thoughts are ego-syntonic or ego-dystonic because patients with ego-dystonic suicidal obsessions have less risk of imminent harm. For individuals whose compulsions are dangerous, clinicians must determine the best type of treatment facility to reduce the risk of harm. Patients with overvalued ideation may require unique interviewing approaches and the support of family members. Finally, clinicians should assess for health problems that can cause low energy and fatigue and consider motivational interviewing and additional therapies for patients who have low motivation to continue treatment.

No abstract