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Krakow, Poland

Stary Rynek

Summer

On our first full day in the city, we decided to get up early and beat the crowds into the center since it looked to be such a lovely day. Admittedly, I am not the biggest fan of large crowds especially during the summer months as I tend to get lost in the chaos of the crowd and my focus becomes a bit out of whack with feelings of frustration and lack of focus. And here in Krakow during the summer months, the crowds tend to get thick. Except for the early part of the morning when most of the tourists are sleeping off the night before. I am an early riser regardless, but by the time the crowds surge I like to have a feeling of accomplishment with exploring and then spend the remainder of the day eating. :)

 

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I've finally gotten around to developing the rest of my color rolls from July. No excuses, I just didn't want to. I really don't think I enjoy developing color film. But then when I'm doing it, I remember that it's not so bad. And then when I see the photos, I'm usually pretty happy with the results.

 

It's a case of needing to get over myself. Honestly, what isn't?

 

This photo was taken just south of Hells Canyon. There was a burn along the Snake River a year or so ago. I wanted a photo of it, but wanted to contrast it with the terrain. So I did this.

 

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'All Remainders'

 

Camera: Mamiya RB67

Film: Kodak Vericolor III; x-11/1997

Process: DIY ECN-2

 

Oregon

July 2025

A store window of a closed-up resale shop. Waynesville, NC

The Embankment, London

 

Continuing with my long exposure experiment... the conditions weren’t getting any better with each passing hour and I really wanted to capture movement in the Eye. This was the third LE attempt from this location and timed at about 40secs.

 

As well as resident and principle tripod carrier, Mrs R did a sterling job as a mobile wind break as conditions were getting darker and stormier by the minute. No sooner had the shutter closed, the heavens opened and didn’t let up for the remainder of the day. This image turned out to be the last shot of the weekend before catching the train back to Manchester.

SMC Pentax-M 50mm f/1.7

Arriving into London from Sarnia, CN 509 is in the process of yarding the remainder of the train before heading to the shops.

apologies for the poor shot but a peak time working which then goes on to operate the 4/4A for the remainder of the day

The Giant's Causeway (Irish: Clochán an Aifir) is an area of about 40,000 interlocking basalt columns, the result of an ancient volcanic fissure eruption. It is located in County Antrim on the north coast of Northern Ireland, about three miles (4.8 km) northeast of the town of Bushmills.

 

It was declared a World Heritage Site by UNESCO in 1986 and a national nature reserve by the Department of the Environment for Northern Ireland in 1987. In a 2005 poll of Radio Times readers, the Giant's Causeway was named the fourth-greatest natural wonder in the United Kingdom.

 

The tops of the columns form stepping stones that lead from the cliff foot and disappear under the sea. Most of the columns are hexagonal, although some have four, five, seven, or eight sides. The tallest are about 12 metres (39 ft) high, and the solidified lava in the cliffs is 28 metres (92 ft) thick in places.

 

Much of the Giant's Causeway and Causeway Coast World Heritage Site is owned and managed by the National Trust. It is one of the most popular tourist attractions in Northern Ireland, receiving over 998,000 visitors in 2019. Access to the Giant's Causeway is free of charge: it is not necessary to go via the visitor centre, which charges a fee. The remainder of the site is owned by the Crown Estate and several private landowners. Wikipedia

www.altviewphoto.com

 

Just a few random shots while the remainder of the fall season is evident.

CP 8560 leads CP 143 through Fort Erie, Ontario on the CN Stamford Sub as they head towards Buffalo to be handed off to the CSX for the remainder of the journey.

remainder of the roman period, Mazarra di Valli, Sicily

The black-crowned night heron (Nycticorax nycticorax), or black-capped night heron, commonly shortened to just night heron in Eurasia, is a medium-sized heron found throughout a large part of the world, except in the coldest regions and Australasia (where it is replaced by the closely related rufous night heron, with which it has hybridized in the area of contact).

 

Adults are approximately 64 cm (25 in) long and weigh 800 g (28 oz). They have a black crown and back with the remainder of the body white or grey, red eyes, and short yellow legs. They have pale grey wings and white under parts. Two or three long white plumes, erected in greeting and courtship displays, extend from the back of the head. The sexes are similar in appearance although the males are slightly larger. Black-crowned night herons do not fit the typical body form of the heron family. They are relatively stocky with shorter bills, legs, and necks than their more familiar cousins, the egrets and "day" herons. Their resting posture is normally somewhat hunched but when hunting they extend their necks and look more like other wading birds.

 

Immature birds have dull grey-brown plumage on their heads, wings, and backs, with numerous pale spots. Their underparts are paler and streaked with brown. The young birds have orange eyes and duller yellowish-green legs. They are very noisy birds in their nesting colonies, with calls that are commonly transcribed as quok or woc.

 

The breeding habitat is fresh and salt-water wetlands throughout much of the world. The subspecies N. n. hoactli breeds in North and South America from Canada as far south as northern Argentina and Chile, N. n. obscurus in southernmost South America, N. n. falklandicus in the Falkland Islands, and the nominate race N. n. nycticorax in Europe, Asia and Africa. Black-crowned night herons nest in colonies on platforms of sticks in a group of trees, or on the ground in protected locations such as islands or reedbeds. Three to eight eggs are laid.

 

This heron is migratory in the northernmost part of its range, but otherwise resident (even in the cold Patagonia). The North American population winters in Mexico, the southern United States, Central America, and the West Indies, and the Old World birds winter in tropical Africa and southern Asia.

 

These birds stand still at the water's edge and wait to ambush prey, mainly at night or early morning. They primarily eat small fish, crustaceans, frogs, aquatic insects, small mammals, and small birds. They are among the seven heron species observed to engage in bait fishing; luring or distracting fish by tossing edible or inedible buoyant objects into water within their striking range – a rare example of tool use among birds. During the day they rest in trees or bushes. N. n. hoactli is more gregarious outside the breeding season than the nominate race.

 

For more information, please visit en.wikipedia.org/wiki/Black-crowned_night_heron

 

It is a large 17th-century chapel in Quito, Ecuador. It is adjacent to, and attached to, the 16th-century Quito Cathedral, but is generally accessed separately. It is located in the historic center of the city, on Calle Garcia Moreno (formerly De las Siete Cruces), a few meters from the corner of Calle Eugenio Espejo. It is a part of the whole of the Cathedral complex, although it seems more an independent church than an attached chapel, both due to its size and to its importance in the Quiteño imagination.

 

Work on the foundation began in 1617 and the structure was built on a series of arches which overtopped and closed off the old Gorge of Zanguna (Quebrada de Sanguña or Zanguña). The façade was completed in 1706 and the remainder of the building in 1715. Between 1731 and 1747 the altarpieces of the interior were emplaced.

 

In El Sagrario is the mausoleum dedicated to Marshal Antonio José de Sucre, hero of Ecuadorian and Latin American independence, who had requested to be interred in his beloved Quito. (The urn containing his remains is carved from dark Pichincha andesite and all around are arranged the flags of all the countries whose freedom he secured. Here too Luis Mideros has highlighted the historical facts of the "Hero of Pichincha" in murals.)

 

The most important work of art in El Sagrario is the sculpture ensemble known as La Sábana Santa ("The Holy Shroud") by Manuel Chili (Caspicara), which is in the retrochoir.

forming a very small remnant of something that was once much larger or more noticeable...

 

* Cigüita Garganta Amarilla, Yellow-throated Warbler (Setophaga dominica)

* Status:

* (Mc) Migratoria invernante común

 

* La reinita gorjiamarilla (Setophaga dominica

), también denominada chipe dominico o cuelliamarillo, bijirita de garganta amarilla y cigüita de garganta amarilla,3 4 es una especie de avepaseriforme de la familia de los parúlidos que anida en el oriente de América del Norte. Es un ave migratoria que en invierno se distribuye en las Antillas, México y América Central.

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The yellow-throated warbler (Setophaga dominica

) is a small migratory songbird species breeding in temperateNorth America. It belongs to the New World warbler family (Parulidae).In summer, male yellow-throated warblers display grey upperparts and wings, with double white wing bars. Their throats are yellow, and the remainder of their underparts are white, and are streaked with black on the flanks. Their heads are strongly patterned in black and white, with a long supercilium; the different subspecies may display yellow and white superciliums. Remiges and rectrices are black

 

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Lugar de Observacion: Jardin Botanico De Santo Domingo

* Republica Dominicana.

 

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* Scientific classification

* Kingdom:•Animalia

* Phylum:•Chordata

* Class:•Aves

* Order:•Passeriformes

* Family:•Parulidae

* Genus:•Setophaga

* Species:•S. dominica

* Binomial name

* Setophaga dominica

*

 

IMG_yellowThroted-2899

Mink at the edge of the river. It was snacking on the remainder of a big Salmon. Here he had had his fill and was leaviing.

PLEASE press L to view larger on black

 

Once a year, Pigeon Point Lighthouse turns on the Fresnel lens for two hours to celebrate the anniversary of the original lighting. The light is stationary for five minutes then rotates for the remainder of the time. You can see the color version here. I like the BW better, what do you guys think? Due to this rare event and the Lighthouses' historical importance, I spend quite a bit of time processing this one. Most of the processing came in the form of manually cloning elements that compromised the integrity of the composition. Click on the video to see what I mean, video courtesy of Joshua Cripps.

 

However, I'm not sure when we will see this again? Pigeon Point Lighthouse just started a 2-5 year restoration project in which the Fresnel lens will be restored. It is the first time since the lighthouse was built in 1871 that its lens (a complex network of 1,008 glass prisms hand-built in 1860s Paris, shaped like a beehive and rotated on a brass assembly like a grandfather clock) has been removed. As part of the project, three "lampists," craftsmen who work on the nearly dead art of restoring lighthouse lenses, have been methodically inspecting, cleaning and resetting each one of the prisms so the 10-foot-tall lens can be reassembled and shown to the public early next year at Pigeon Point.

 

I'm so glad i was able to witness this scene for myself. There was an estimated 500+ photographers here on this night, the biggest frame-bang I have ever witnessed. Jave

Cold and bright morning at Hadrian's Wall with the remainder of a great cloudinversion in view.

  

Division St - Portland, OR

Summer 2015

 

Camera: Nikon F

Film: CineStill 50

Lens: Nikkor-S 55mm

 

Do not use image without permission, Thanks.

This is a very special place for landscape and forest bathing in beautiful light

So happy with the glow-in-the-dark thread! I will send the remainder of the spool your way, too. :)

The remainder of some mammatus clouds near Burlington, IL, on 5-16-15.

April 4, 2030

 

After being gifted tickets to the Wasps vs Arrows game in Appleby, Bree spent some time with a close friend to celebrate the remainder of her birthday.

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It was fairly late when the pair arrived in Hogsmeade, but Eric, despite some fatigue, was still riding the high of a victory over his team's hated rivals. Not to mention it was the birthday of his companion, and that called for celebrating. "Not /exactly/ the safest place for a drink these days, but certainly the most familiar. Hope you're okay with the Three Broomsticks tonight?" Eric queried. "I don't usually show up places still in uniform, but who knows, maybe we'll get the royal treatment tonight." He joked with a playful smirk.

  

Brianna Malcolm waited in the stand after the game, the rush of watching her friends fly pro in person, not to mention the epic win over the Arrows. "Must suck for your team to lose in their hometown." she muttered to a passerby Arrows fan. Did she get some sort of joy out of rubbing the win in their face? Probably. She could blame the moon for that and her increasingly savage attitude, or she would to cover up what was troubling her on the inside anyway. A few more spectators passed before Bree bounded down the steps of the bleachers and made her way to where she'd been asked to meet after the match. There were a couple of Wasps players that passed, none she recognized until Ayo gave her a friendly wave. "Good match Onyilgowu. Have you seen..." Bree paused when she thought she saw who she was waiting for, but the longer hair threw her for a loop. "Eric? Eric!" she called out, waving excitedly despite the nearness of the full moon sapping her energy. "You did wonderful! Odin that was amazing to see up close!" the lioness rambled, only quieting for the quick trip to Hogsmeade. "Hey, your here and I'm not too shabby with my wand. I think we'll be alright. Three Broomsticks is...okay. Just as long as Jade shuts her gob about Goblins." she rolled her eyes. "I suppose we'll see, but first." Bree took a step closer and opened her arms wide. "A hug for the birthday girl?"

Going back through seascapes from La Jolla a few months ago. The remainder of this evening with Jimmy Gekas, Max Vuong and Glenn Tunaley. Man I miss it out there. Still trying to find some time to shoot out here in the northeast. Clear skies all weekend coming up, boo.

 

Explored. :)

 

Website | Google+

Cold hunks of metal, once thriving and full of life, silently live out the remainder of their now-useless existence at the wrath of Gobi's harsh elements.

homemade chicken soup

 

chicken soup made from the christmas chicken, onion, carrot, water and oil sprinkled with coarse black pepper and fresh thyme from the garden

the remainder boxed for the freezer to reheat as and when

 

just one thing with michael mosley

food special with professor tim spector

7 days 30 different plant based foods

www.bbc.co.uk/sounds/play/m001ngjx

 

ps i'm not recommending any of these cookery adventures. they suit my personal taste. photographing to encourage myself to eat more healthily ...

 

i've created a group www.flickr.com/groups/cooking_is_my_hobby/ to gather ideas and encourage myself to continue with healthy eating by learning from others if you're interested in cooking, sometimes or a lot, or enjoy the cooking of others, you're always welcome ...

  

This lighthouse has a cylindrical tower set to the side on a round flat dwelling pad. The tower is painted with red and white stripes and makes in coordination with the remainder of the structure, it looks similar to a child’s toy top. This waisted caisson designed tower is one of the most dangerous lighthouses found on the St. Lawrence River. ​

Originally, there was a light station that was built there in 1902, but in 1964 the light replaced the former structure.

The lighthouse tower is 83 feet high, with a focal plane of 81 feet, The white light will flash every 2.5 seconds and offers a viewing range of 18 nautical miles. In 2002, the Canadian government granted C$1,4000,000 to rebuild and repair the upper portion of the lighthouse. In 1962, they purposely sunk the hourglass-shaped base in 38 feet of water which took 3 hours to sink. They opened up the valves allowing it to slowly sink to a new location at the river bottom. It was filled up with 8,000 tons of concrete and rock in order to more firmly anchor it into position.

 

The concrete slab that was then constructed was used as a landing platform for helicopters for lighthouse staff. Other parts of the outside walls were also rebuilt as well. The new base of the lighthouse was intentionally tapered so as to help resist the 20 foot tides that are found in the waters nearby. Oddly enough, in 1966, it was pounded by high waves, snow, and fierce winds for 48 hours but it was able to withstand the storm conditions which were actually much worse than the structure had been built to withstand.

 

It is currently an active lighthouse but it is not open to the public. You can view the lighthouse from some of the neighboring whale watching tour boats that operate in the area.

 

The lighthouse is recognized as a Federal Heritage Building due to its historical associations and architectural values. Learn more about Great Lakes Tours and Attractions and cruising the St. Lawrence Seaway with Great Lakes Cruises.

--- www.greatlakescruises.com/prince-shoal-lighthouse-tadouss...

This is a very special place for landscape and forest bathing in beautiful light

the remainders of the day. I add the small things you can glean in hedgerows, rose hip, crab apple.

Another one from the mid-west!

 

Dakota and Iowa train MDRSC-18 is seen rounding the curve in Westfield, with D&I #3030 picking up the rear. The train is heading back to BNSF property at the wye in Elk Point, South Dakota, for the remainder of their trip back to Sioux City.

 

May 2021

Westfield, Iowa.

Snow is melting as some leaves are still hanging on. Will there be one more blast of winter? Or are the green buds just about to reappear and replace these wilted remainders of the season past?

CP and BNSF GE's bring CP train 567 past the Ex-MILW searchlight signals and code line poles on Main Track 2 of the CP Kansas City Sub at Birmingham. Here in Kansas City, this train will be handed off to the KCS for the remainder of the trip south. 2/5/22.

With the exception of Jo Davies County, the remainder of the topography of Illinois is relatively flat due to the glacial drifts. Jo Davies County is located in what is called a driftless area and as such was not as effected by the sliding plats of ice. As part of the Driftless Area, Jo Daviess County is known for its scenic stretches of road and valley views. Within Jo Daviess County lies Charles Mound, the highest natural point in Illinois. The scenery in Jo Davies county is refreshing and breathtaking to those accustomed to the flat plains of Illinois.

One from last weeks sunrise visit to Susan Gilmore (Newcastle, NSW; Australia) with fellow flickr tog Paul Hollins.

Conditions were somewhat tricky thanks to some decent sized seas and swell - plenty of sea spray on filters and lenses didn't help!! :-)

I managed to get a few keepers before time required us to leave.

Hope you like this one - much appreciate any comments, views or favorites!!

Hopefully you're having a good day and week, best wishes for the remainder and the weekend ahead!

With a fresh crew for the remainder of the trip to Schiller Park, a rare daylight I165-10 heads west out of Blue Island, IL with CP 8781 (ES44AC) the “Saint John Express” unit painted up in Canadian Pacific’s main intermodal carrier, Hapag Lloyd for their service to the Port of St John. Seen here at CP 154 about to suck under Kedzie Avenue on the IHB West Line. Taken: 12-11-21

 

Both trains I165/I166 are usually nocturnal on their runs in and out of Chicago.

Ouff, 4 photos at once, sorry about the diarrhea of upload, I was enjoying the peace and quiet of this minor hilltop with no other people around, perfect place to enjoy the sunset in the Saint Donat area with the remainder of duty free Icelandic brennevin, it takes 30-40 minutes to walk up, and 20 minutes to walk down even if you're drunk and it's dark.

The first historical records on Aalst date from the 9th century, when it was described as the villa Alost, a dependency of the Abbey of Lobbes. During the Middle Ages, a town and port grew at this strategic point, where the road from Bruges to Cologne crossed the Dender. While it was within the Holy Roman Empire it was considered the capital of the province of Flanders. In 1046, Aalst was transferred to the Countship of Imperial Flanders, and absorbed a portion of Brabant, and in 1173 it was united with the remainder of the Flanders province. Its frontier position on the border of the Holy Roman Empire allowed the town to keep a certain degree of independence. Its relation with Brabant has been preserved in the city's white and red coat of arms, the colours of Lotharingia.

 

Construction of the town hall began in the middle of the 12th century, making it the oldest surviving town hall in Belgium. Several manuscripts from this period still survive in the town archives. During the Hundred Years War the town of Aalst allied themselves with Louis de Male against Philip van Artevelde and sent troops in the victorious Battle of Roosebeke. The town hall, and the city itself, were almost entirely destroyed by fire in 1360. The town was soon rebuilt and a new belfry in gothic style was built in the 15th century. This was a time of great prosperity for the city, dominated by the powerful weavers' guild. It is also at that time that Dirk Martens, a local citizen, became the Southern Netherlands’ first printer, founding a printing shop in 1473 that published books by various authors including Christopher Columbus; Martens would later become a professor at the Old University of Leuven, and he was laid to rest in the Saint Martin's Church (Aalst) [nl].

 

Aalst suffered considerably under the Eighty Years' War (1568–1648). It was later taken by the French Marshal Turenne in the War of Devolution of 1667, then occupied by France until 1706, when it became independent once more following the Battle of Ramillies, along with Southern Flanders in general. The textile-based economy flourished under the French. In the 18th century, the Austrians controlled the region. 1830 saw Belgium gain independence and Aalst became part of the country, this ended a long period, starting in 1056, of foreign control, by such as the Spanish, German, French, and the Dutch. The 19th century was marked by social crises engendered by the Industrial Revolution, with Father Adolf Daens and his Christene Volkspartij emerging as the local defender of workers' rights. This was in response to Rerum novarum, which established worker rights. However Daens felt this did not do enough. Eventually, he was made to pay for his "splinter movement".[how?] In the Pre-World War II years, the fascist movement in the Low Countries gained momentum, with the collaborationist Vlaamsch Nationaal Verbond (Flemish National Union) putting down roots in the region. Aalst, along with Brussels and Antwerp were the strongest subscribers to this line of thought.The 20th century was marked by bombardment and occupation by the Germans during both world wars.

A humpback whale takes a good long look at the people watching him.

119 in 2019

#13 - Bedraggled

 

Thank you in advance for your views, comments, and faves. They are much appreciated!

Life aboard Leon's Claw had taken a major turn when Vincent's abduction left him with grievous injuries. It meant ship operations would be suspended for the remainder of the Summer while he recovered from his ordeal. Between the stress of that, Damien and Aiden's growing animosity, and hovering loved ones? Well, it was quickly making Vincent feel he'd go mad! Though fate would have it that he wouldn't have to go through it all alone...

Aiden had discovered more about himself since leaving home than he could have ever imagined. When his beloved captain's life was at stake, Aiden risked everything to get him back...and he succeeded!

Now with nothing but time on their hands, Vincent and Aiden are finding themselves in each other's company more and more, as if unable to help themselves. And with pressure of the Midsummer Masquerade approaching and new friendships testing the boundaries of their relationship, will Aiden finally get the courage to tell Vincent how he feels before it's too late?

Join the crew and read on as Vincent and Aiden take on a whole new set of more personal adventures as The Captain and The Engineer continues with Volume 3!!

  

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The Captain and the Engineer continues in....

 

Next Part:

www.flickr.com/photos/153660805@N05/53234396773/in/datepo...

 

To read the rest of the story, here's the album link:

www.flickr.com/photos/153660805@N05/albums/72157717075565127

 

***Please note this is a BOY LOVE (BL/yaoi/gay) series. It is a slow burn and rated PG13!***

 

Special thank you to my husband Vin (Be My Mannequin? Pose Store) for collaborating with me on this series and co-starring as The Captain!

Vin also custom-made this pose for me and did the titling on the picture for me too!

  

DISCORD SERVER: That's right! The Captain and The Engineer has a Discord Server! If you wanna join and chat with other crewmates and see what's new and happening before it gets posted to Flickr, click the link!

discord.gg/qBa769TAC4

 

***NEW!!!!***

 

The Captain and the Engineer now has a FACEBOOK PAGE! Please come Like, Follow, and join the crew! Thank you so much for all your support!

FACEBOOK PAGE:

www.facebook.com/profile.php?id=61558531406088

 

Having got our supplies for a home cooked evening meal, with Viodka of course, it is suggested by Sven that our best chance of freight action as the year ends will be from Huta Katowice. Of course he is right and it is mutually agreed that we will go there for the remainder of the afternoons daylight. Poland is shutting down for the new year, by 2pm most shops, bars, restaurants and businesses have shut down for the New Year celebrations.

 

EU07 Electrics in the service of Kolprem await their next duties at the stabling point of the eastern end of the Huge yards of Dąbrowa Górnicza Towarowa which serve Huta Katowice. December the 31st 2024.

EU07-139, EU07-499 and EU07-062.

read each of the statements and select the one which discribes how you feel / discribe

 

psychosocial therapies are part of the standard management of schizophrenic illnesses, but have not been subjected to systematic evaluation and are therefore not included in this guideline. This does not imply that they are not essential components of good practice.

 

The remainder of this section describes the evidence for the effectiveness of Education Programmes, Family Interventions, and Cognitive Behaviour Therapy in the management of schizophrenia. Section 3 provides recommendations for the application of these interventions in clinical practice, according to the phase of the illness.

 

Education programmes

Education Programmes are directed at either patients or carers/family members and have several aims. Improvement in knowledge of schizophrenia and its course and in compliance with treatment has been shown. There is also evidence of greater satisfaction with services provided. Some programmes go beyond the provision of information and take an educational approach to skills training or problem solving.

 

Education Programmes for patients may be undertaken in individual or in group settings. Simple information-giving is less effective than interactive sessions. The focus includes giving information about the course and management of the illness, including the importance of compliance with medication and the management of stress.

 

Providing carers and family members with information on the likely course of the illness, the treatments available, the importance of compliance and the services available is an essential element of good practice It may be undertaken as part of a Family Intervention programme

 

Specific techniques, e.g. use of homework or video, have not been shown to improve the assimilation of information, but a group setting has advantages

 

Family interventions

The aims of 'Family Intervention' include reduction of frequency of relapse into illness and reduction of hospital admissions, reduction in the burden of care on families and carers, and improvement in compliance with medication.

 

Some Family Intervention Programmes have targeted families where there are high levels of criticism, hostility and over-involvement. 'High expressed emotion' is a measure of these features and programmes which reduce this or reduce the amount of 'face to face' contact between the patient and family members have been shown to reduce the frequency of relapse. However, the measurement of expressed emotion is a research technique which is not practical for everyday use. Family Intervention Programmes which are not derived from this theoretical background have been shown to be effective.

 

Most intervention strategies contain more than one technique. Separating and defining the effects of the components of an intervention strategy is not possible at present as few studies examine the effect of a single technique and only a general description of interventions used in research studies is usually given. However, a number of practice guides have been published which give detailed descriptions of the techniques employed in some studies. Family Intervention has been shown to be effective with some variation in the components of the programme, but family sessions to address the problems identified in the analysis may not be effective if the patient is not included. Social skills training and vocational rehabilitation were included in some studies. These are not covered as separate interventions in the guideline.

 

Cognitive behaviour therapy

Cognitive Behaviour Therapy for psychosis is a modification of standard cognitive behavioural therapy. The aim is to modify symptoms (e.g. delusions, hallucinations) or the consequences of the symptoms which may be cognitive, emotional, physiological or behavioural. The treatment programme is intensive (involving about 20 hours of individual treatment) and based on an individually tailored formulation which provides an explanation of the development, maintenance and exacerbation of symptoms and of pre-morbid mood, interpersonal and behavioural difficulties.

 

There is now good evidence that treatment resistant symptoms (delusions, hallucinations) can be substantially reduced in a significant proportion of those who complete therapy. It is not yet clear who is most likely to benefit from treatment and many patients may be unwilling to participate. The treatment is well tolerated. However, reduction of symptoms has not been shown to lead to significant social or lifestyle improvements.

 

A combination of the following techniques has been shown to be most effective in lessening symptoms of psychosis resistant to other forms of treatment:

 

◦enhancement of cognitive behavioural coping strategies5

◦developing a rationale to explain symptoms28◦realistic goal setting

◦modification of delusional beliefs29◦modification of dysfunctional assumptions.

A number of these techniques are a refinement of normal good practice using a systematic approach.

 

'Early Intervention Studies' have aimed to identify prodromal symptoms or the 'signature' preceding relapse. The approach is not a form of cognitive therapy, but early intervention with medication or Cognitive Behaviour Therapy may be facilitated

 

... gave it a 'kick' with Intensify CK ...

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