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Essay Instructions: Select one of the areas of investigation described below, and set out the ethical landscape for it, i.e. indicate what features of the subject should be relevant to morally sensitive decision. If you discover that there are legal complications to such a decision, note them as well. How would an ethical care-giver manage the difficulties you may notice in the area? Since this is a preliminary investigation, the emphasis will be on understanding the issues at hand rather than resolving them. However, since there has been some discussion about these matters in print, your discussion should reflect consideration of at least some of it. Your comments about resolution should take the form of suggestions for which you can give reasons. One important academic journal for the field is Philosophy, Psychiatry and Psychology. There is also an on-line Journal of Ethics in Mental Health, edited at McMaster University. Since you could become a greater expert in the area you choose than either the instructor or the marker, you should engage in careful exposition of your subject. Do not however, assume that the reader of your paper is completely uninformed about the area of discussion

A) Some psychoactive drugs are to be used as treatment for people judged to have mental disorders, and some of these disorders are said to affect decision-making capacity. How may one ethically test for effectiveness drugs thought to help those who have such disabilities, since many of these disorders are thought to affect the ability to make informed decisions, and the possibility of improved condition counts as a strong inducement to say yes?

B) Do people undergoing treatment for mental disorders have a right to “effective treatment”? If so, what would that right entail? Some have claimed that this supposed right should allow actions on behalf of mental health clients against caregivers who avoid pharmaceutical and other therapies that have shown some effect in controlled studies when those therapists have chosen modes of treatment not readily subjectible to such investigation. What do you think of this? Suppose, for example that a pharmaceutical treatment offers a near certainty of a limited remission of symptoms, but at the cost of serious side effects, while a less invasive (and less-resisted) treatment delivers some insight, and a limited chance of a fully adaptive way to manage symptoms.

C) One common therapeutic response to Dissociative Identity Disorder is to encourage the patient to resolve the multiple “alters” into a single dominant personality. Since the caregiver must attempt to steer this process, she or he must select one. On what basis should a good caregiver focus attention on one rather than others in cases where there are several possible candidates? One possible example to consider: a strong candidate with one gender-identification in a body that ordinarily takes on a different one.

D) Many anorexic patients will not eat, and will not do so even though they know that their action could kill them. Since there is insight on some level, and usually full competence to assess information, little indication of acute suicidal tendencies but a strong resistance to treatment, how can a caregiver respond responsibly?

E) A person indicates to her/his holders of the power of attorney for care, that if she/he becomes incompetent due to a geriatric dementia, no treatment beyond the palliative should be allowed for any potentially fatal disease. The reason given at the time cites loss of ability to carry on at anything like the level of self-awareness and planning that she/he considers essential to a worthwhile life. However, at some point after a dementia sets in, the person in question experiences a condition that will be fatal if not treated. She/he expresses no discontent with life as it has developed ( and perhaps takes great pleasure in much of her experience), She/he can understand that she/he is sick and requests treatment. How should the ethical caregiver respond? How should the good psychiatrist advise such a caregiver?

F) Psychopaths and those with anti-social personality disorder are often characterized as rational, but morally incompetent in some way or another. They can understand that nature of their disorder, and that they have it. A history of criminal convictions can play a role in the diagnosis of both of these conditions. Consider whether treatment (and even diagnosis) would amount to some form of sophisticated social control technique applied without regard to patient consent (considering that assessment, at least, could be the result of the decision of a medical or law-enforcement official). It would also not involve an adversarial “fact-finding” process, such as a trial. Would this be objectionable? Alternatively, consider whether there is a way that a good caregiver can intervene to produce a change in behaviour without manipulation.

G) Because of his condition, J. has trouble managing his own life: his rented room is a wreck, he has trouble communicating, and walks the street shouting instead. He sometimes forgets to eat, and cannot recall doctor’s appointments, but resists all attempts to offer treatment, help or even provide a good meal. J. suspects, and rejects, any offer of help by screaming in fear at the offer or threatening the one who offers with violence. Past treatments have led to bad responses. The current possibilities for treatment are risky. How should a caregiver respond to J.?

Essay Instructions: Meta-Analysis of Fibromyalgia Treatment

The following is a list of requirements for a concept paper and forthcoming dissertation quality research paper.

A list of required topics for the dissertation quality research paper that must be investigated include: (Highlighted portions are for the concept paper, which are to be incorporated into the dissertation at a later date ? See attached Fibromyalgia research for assistance). Concept paper information is to be fairly brief and basic in scope and depth. Graphs and/or charts may or may not apply for concept paper, but will be specified in later research investigation on this topic.

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I will also email/reply to an email from "Jayson" with this list in Word, which has highlighted portions. I will also email additional documentation, as it will be too long to fax.
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Historical Evolution of Fibromyalgia (FM): (General and/or Basic understanding for the purposes of the concept paper)

1. When was the first diagnosis of FM made and what was it then known as?
2. How far do symptoms and formerly diagnoses of FM go back into history?
3. Who were the major contributors to FM becoming discovered, when and where?
4. What was the etiology / genesis of FM?s history from myth to medical ?fact??
5. How was it / is it diagnosed then?
6. When was the first time FM was introduced into Medical Schools (1992) and where, by who?
7. Who was the typical patient diagnosed with FM and has it changed?
8. What psychological, sociological, anthropological, physiological, neurological, and familial etiologies / genesis of FM components existed and what were the possible relationships and/or links to each of these co-existing/co-morbid systems?
9. Any other historical information that can be helpful to the understanding of FM.

Present Understanding of FM: (Again General Concept for the Concept Paper)
1. What are the current standards of diagnosis?
2. Explain thoroughly (briefly for concept paper) the 18 tender points associated with FM and what there physiological and neurological pathways are (presently known/thought of pathways), as they relate to the pain signals that are relayed to the brain. How does the brain (to the best of our knowledge) receive a pain signal from these tender points?
3. What is the role of collagen in FM? (Collagen is the sticky stuff between joints and muscles, which helps the joint fight against friction, causing pain when collagen is not present as a buffer between joints and muscles).
4. FM is a collagen disorder, but what is collagen and why do we need it? (briefly for Concept Paper)
5. What is the role of sleep on FM and how does it affect collagen?
6. Explain the 4 stages of sleep, including REM sleep and what chemicals are released into the body in what stages of sleep? Also, where in the brain these chemicals come from and what path they take, if possible. (This is a crucial piece to the understanding of the role of sleep on FM).
7. Explain as specifically as possible the chemicals that are thought to play an important role in FM (Somatomadin-C and Substance-P for example).
8. How is this important in FM?
9. What theoretical/factual role do these chemicals released in stage-4 sleep (Somatomadin-C, among other restorative sleep chemicals) play in FM?
10. What is Substance-P and how is it important in FM? How do we test for it and what does it tell us and why? (test for it in blood, based on levels it exists?)
11. Why is sleep so important in FM?
12. Why are sleep aids (sleeping pills / medications) generally not effective for FM (they only increase quantity, not quality of sleep)? Site articles that come close to even supporting this.
13. What symptoms are specific to FM and what is the typical manifestation of FM symptoms?
14. Who typically gets diagnosed with FM, why do we think this is?
15. What is the trend of FM and what theories have been developed on what FM is and how to ?cure? it?
16. What medications are typically effective with FM?
17. Why and how do they work?
18. What systems do they work on and what is there to be known about the medications, i.e. general side effects, action potentials, routes of metabolism, etc.?
19. What is unknown about the medications used in general, which is specific to all medication limitations (action potential unknown for many medications, therefore side effect profile can be problematic)?
20. Explain the limitation often overlooked in medication research as compared to psychological research, i.e. double blind studies are often inappropriate for psychologically based studies.
21. What biases are often present with medication research? (See November / Winter Issue of Journal of Neurotherapy by snr-jnt.org ? The Society of Neuronal Regulation and the Journal of Neurotherapy. This is an editorial by the outgoing President of iSNR).
22. What other remedies have been and are currently reported in the literature as possible effective treatment modalities, i.e. biofeedback, yoga, exercise, and other nutritional remedies, etc.?
23. How and why do we think they are effective?
24. What role do we think they play in reducing the symptoms associated with FM?
25. What about Quantitative Electroencephalogram (qEEG) and Neurofeedback?
26. What emerging role do they play as reported in the literature? (see Donaldson?s research out of Canada for at least one reference from the journal of pain management).
27. Why is it proposed that they (emerging treatment modalities) may have some effectiveness in the diagnosis and treatment of FM?
28. What studies have been published at all with regard to standard EEG?s, qEEG (quantitative), and/or Neurofeedback?
29. Are they promising?
30. Why, what do they offer?
31. What theoretical underpinnings might exist with regard to the link between brainwaves and FM?

Historical Perspective of Electromyogram (EMG or muscles) and Electroencephalogram (EEG or Brainwaves) to Present Understanding:
1. What is EMG and what is the difference between surface EMG (sEMG)? (basic understanding will suffice)
2. How are EMG recorded and what role does the recording of standard EMG play? (they are typically invasive procedures and painful - again general understanding).
3. How is it related to general EMG-Biofeedback or what is often called sEMG (surface EMG)?
4. How has Biofeedback been used for FM?
5. Has it been proven effective and/or useful as demonstrated in the literature?
6. Who are the major contributors to EMG-Biofeedback and its application to FM?
7. What is the general conceptual understanding of how Biofeedback works?
8. How does Biofeedback basically differ from Neurofeedback? (Muscle feedback as compared to brainwave feedback)
9. What are brainwaves?
10. What is the general understanding of the role brainwaves play in humans? (why are they important to understand?) Theoretical framework.
11. How are they recorded?
12. What measurements are used and why? (Power, Amplitude, Percent Power, etc.)
a. See qEEG interpretations for a more comprehensive look at how brainwaves are viewed in their different mathematical underpinnings. Robert Thatcher?s work which can be seen at www.appliedneuroscience.com
13. What is the history of brainwaves?
14. When was the first brainwave recorded? (about 150 years ago)
15. what are the general criticisms of brainwave recordings and/EEG-Biofeedback / Neurofeedback in general? (how do we know what to make of them and how do we know that they are consistent throughout the life span, etc.
16. What is the proposed usefulness generally accepted by the medical community for recording brainwaves? (seizure activity and evoked potentials in standard EEGs?, etc.)
17. Who are some of the pioneers in brainwave research and more specifically Neurofeedback or EEG-Biofeedback research? (Joe Kamia Univ. of Chicago, Joel Lubar Univ. of Tenn., Barry Sterman UCLA, etc.)
18. Who are some of the pioneers with regard to EEG-Biofeedback, EMG-Biofeedback and FM? (Stu Donaldson out of Canada, etc.)
19. What research has been published with regard to the efficacy of Neurofeedback, Neurotherapy, and/or EEG-Biofeedback (all synonymous)?
20. What is qEEG?
21. What is the history of qEEG?
22. What is the importance of qEEG and how does it differ from standard EEGs? (standard EEGs only record individual sites, whereas qEEG records individual sites and compares them to each other, which helps to determine how well or not so well the brain communicates with itself, among other reasons).
23. What research has been done on the efficacy of qEEG and how has it evolved?
24. Who are some of the pioneers in the field of qEEG?
25. What research is available on qEEG and FM? (Stuart Donaldson out of Canada is a major contributor to qEEG, Neurofeedback and General Biofeedback?
26. What are all of the ways in which qEEG is measured and what do the difference mathematical calculations of the qEEG data generally mean? (co-modulation, coherence, synchrony, phase, power, percent power, amplitude, etc., again www.appliedneuroscience.com and R. Thatcher?s work).
27. What research is available to support the validity of qEEG data and who are some of the major contributors of qEEG research? (Dr. Duffy out of Harvard, Dr. Daniel Amen, Dr. Joel Lubar Univ. of Tenn., Dr. Barry Sterman UCLA, etc.)
28. What are some of the general emerging applications that qEEG is being used for?
29. Why might it be important for FM research, at least according to Stuart Donaldson out of Canada?

Meta-analysis comparing most popular treatments for FM, as well as compared to Biofeedback and most importantly qEEG and Neurofeedback / EEG-Biofeedback:
1. Explain the general principals and dynamics of a meta-analysis and why it should be used for this type of comparative analysis with regard to how the most popular approaches to treatment stack up against each other, as well as compared to Neurofeedback / EEG-Biofeedback?
2. What are limitations, pros and cons for this type of analysis?
3. Explain what the research indicates about how close or far apart some treatment approaches really are from others?
4. What might contribute to limitations of any study included into the studies investigated here?
5. What are the conclusions of what might be/was found with regard to research available in this meta-analysis?

General Conclusions & Summary:
1. What is/was the overall purpose of this investigation? (to understand more thoroughly what research was available with regard to FM and how effective was any one treatment approach over another).
2. General conclusions about restatement of the problem, what was investigated, how, and what was the overall conclusion?
3. What are/were the limitations of this investigation?
4. What might be a better approach to investigating FM research and efficacious treatment modalities used to treat the symptoms of FM?
5. What direction might be next and of course there is a need for further research in this area?

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General Sections of the Concept Paper include the following:
A. Introduction
B. Statement of the Problem
C. Brief Overview of the Literature
D. Methods
E. Limitations of the Study
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Concept paper should be 15 pages with approximately 20-30 references.

Essay Instructions: STATISTICS RESEARCH PAPER TOPIC: Effective treatment for individuals suffering from anxiety, who range in age from late teens to late twenties.

Paper is to be 14 pages, NOT counting the cover/title page and reference list pages. (A bibliography and title page must be included).

There needs to be 15 quality articles. You MUST include copies of ALL articles, but the articles will NOT count towards the overall total length of the paper.


Approximately 2/3 of the paper should be the Abstract, Introduction and Literature Review. (specifics requirements for each of these sections are listed below)

1/3 of the paper should be the Conclusion and Application sections. (specifics also listed below)

The focus of this paper is a clinical treatment application based on 15 articles dealing with psychotherapy outcomes or the effectiveness of counseling and what general or specific “ingredients” produce the effectiveness found in the studies. The type of counseling research can be individual psychotherapy (adult, child or adolescent), marital or family therapy. The paper must summarize the articles and make application of the summary for clinical practice. Therefore you must have a treatment issue with a client you are trying to solve for this paper.

If you cannot find 15 psychotherapy outcome articles around your specific topic, you can add articles based on the important aspects of your topic and tie these articles together. For example, 10 articles on the effectiveness of cognitive-behavioral therapy for individuals suffering from anxiety, plus 5 articles on the specific causes (genetics, caffeine, etc), and side effects (sleeping and eating habits, miscarriage, etc) of individuals who suffer from anxiety. You then would need to provide an integration of the findings of all 15 articles.

You MUST follow APA style guidelines.

Please attach a note as to whether you are following the 5th or 6th edition of the APA Manual.



SPECIFIC DETAILS FOR EACH SECTION OF PAPER:
Abstract:
An abstract should begin with a definitive statement of the problem, study or project. The purpose, scope, and limit of the review and application should be clearly delineated. Then, as concisely as possible, a summary of the research, major findings, the significance of the work (if appropriate), conclusions and clinical application should be described. (adapted from Journal of Thesis Abstract Guidelines)

Introduction:
First passage in a journal article, dissertation, or scholarly research study that -
• Creates reader interest.
• States or establishes the problem that leads to the study.
• Indicate why the problem is important by citing references and clinical/treatment issue.
• Places the study within the larger context of the field, research, etc.
• The use of literature in the introduction differs from the full literature review: Summarize large groups of studies (broad categories) in the introduction.
Reaches out to a specific audience: Clinical practitioners.
May provide theoretical perspective.
May provide research question(s).

Introduction Grading: Clear overview of paper, demonstrates importance of topic, “hooks” the reader into the paper.


Review of the Literature:
Focus on recent research studies (past 10-15 years) and any seminal articles (first or key article to throw light or new direction on the subject).
Do NOT simply list and explain each article. It needs to be cohesive, tying the topics together utilizing a common theme or theory. A literature review is a critical analysis and synthesis of the various studies. The organization of the literature review is based on the literature itself. Identify specific deficiencies in past literature.



Review of the Literature Grading:
• Variety of studies and attention to detail about the topic.
• Information is gathered from multiple, research-based sources.
• Objective, balanced view of the literature presented
• Each cited study is related to the topic and to other studies.
• Well organized, demonstrates logical sequencing and structure.
• The writing goes from general ideas to specific conclusions.
• Transitions tie sections together, as well as adjacent paragraphs.
• The appropriate content in consideration is covered in depth without being redundant.
• Significance of article, finding, etc. is unquestionable.

Conclusion:
Information synthesized and brought to a logical conclusion.
For any conclusion you draw from the studies you must use the "P.E.E." criteria listed below.

Point – State the Point or big idea of your conclusion.
Explain – Explain the point of the conclusion as needed.
Evidence – Provide Evidence for your conclusion.

Conclusion Grading:
• Succinct and precise conclusions based on the review.
• Insights into the problem are appropriate.
• Conclusions are strongly supported in the report.


Application:
Conclusions of the literature review are appropriately applied to the clinical problem.
Application is clearly explained so another clinician could make the same application for his or her client.

References Grading:
• References correctly typed, appropriate number and quality.
• All needed citations were included in the report.
• References matched the citations, and all were encoded in APA format.

Mechanics and Writing Style Grading:
• Correct spelling, punctuation, sentence structure, word usage.
• Writing is crisp, clear, and succinct.
• Uses the active voice when appropriate.
• The use of pronouns, modifiers, parallel construction, and non-sexist language are appropriate.
• Information logically organized with good flow.
• Issues threaded throughout paper.


One final note: The bottom line on how you organize and write your literature review and application is based on the clinical problem and the themes and data of the research literature. Do NOT organize your paper per article! This will result in a failing grade. The objective is to write a cohesive paper tying the topics together, utilizing a common theme or theory.

Essay Instructions: "Systems of classification for psychiatric diagnosis have several
purposes: to distinguish one psychiatric diagnosis from another, so that
clinicians can offer the most effective treatment; to provide a common
language among health care professionals; and to explore the causes of the
many mental disorders that are still unknown (Kaplan @ Sadock 1998:287).

Discuss this statement with reference to one of the major classification
systems currently in use accross the world (DSM-IV [Diagnostic &
Statistical Manual of Mental Health Disorders -IV]), and how this uniform
classification system assists in the delivery of health care.