Biomedical subjects
Publications and source records attributed to A Bellissimo.
The roles of family, peers, and selected social factors in the origins of depression were assessed in a school-based study of adolescents. Social self-efficacy and social support from family and peers were found to be interrelated in their links with depression. Risk factors are delineated and suggestions for preventive intervention are offered.
This study assessed the association between parental style, family functioning and adolescent well being, contrasting intact families with those of changed configuration. Eight hundred and one grade 10 general level teenagers in 11 high schools of a single educational system were the subjects. Results indicated that the configuration of the family was not the key determinant of effectiveness of family functioning. Instead the style of parenting turned out to be the main determinant of both family functioning and well being of the adolescents. While both "parents" were judged to have contributed to these outcomes cross gender effects were found.
One objective of psychiatric education can be to help trainees describe and understand major concerns patients experience in their key relationships, inner conflict and sense of self. A precis of major concepts and principles in this area (usually known as psychodynamics) is presented without the metapsychological framework which makes some of the literature difficult to grasp. This is intended to make learning more efficient and to facilitate the formulation of hypotheses about the presence or absence of specific conflicts, and problems in key relationships. We do not propose that these hypotheses necessarily explain psychopathology but that they (a) supplement formal diagnosis; (b) enrich the clinical data base by providing hypotheses which are testable in part by clinical observation and which can be tested scientifically; (c) provide understanding crucial to psychotherapy.
Insomnia is a public health problem because of its high prevalence, the risk of hypnotic drug abuse, and self medication combined with alcohol and other nonprescription chemicals. Clinical experience has given rise to a descriptive classification of the insomnias many of which are secondary to medical disease. The information now available allows us to suggest a systematic approach to the assessment of insomnia emphasizing its history, events associated with sleep onset, observable behaviour and experience associated with interruptions in sleep. This paper attempts to organize the present state of knowledge in a format that can be taught to general physicians who deal with the most insomnia patients.
Evidence for non-pharmacological effects of hypnotics on sleep is presented. This suggests that behavioural variables may be involved in the regulation of sleep onset in insomnia. Chronic 'true' insomnia is described in terms of precipitating events: fixed behavioural patterns which perpetuate it and the disordered timing of electrophysiological and hormonal events. Specific behavioural factors relevant to an individual patient's insomnia must be identified. The factors are: (i) the patient's expectations of the experience of going to sleep and his/her belief that he can or cannot control the onset of sleep, (ii) the patients' personal theory of the cause of the problem, (iii) what the patient says to himself privately about the problem, (iv) the presence of stimuli in the sleep setting which arouse the patients including objects, persons and behavioural rituals. Treatment requires that patients be taught special skills, individually tailored to the specific behavioural variables found to perpetuate their insomnia. Non specific 'placebo' effects are also involved as is the case with drug administration. Patients who fail to respond to treatment may have a masked disturbance of circadian rhythms. This recent observation requires the addition of new approaches to assessment and treatment.
Communication is the essence of the process of psychotherapy. Understanding the parameters of communication can form the foundations for the development of psychotherapeutic skills in the student therapist. Using learning objectives within the context of teaching psychotherapy, the process of communication in individual psychotherapy is explored in this paper. With the aim of offering a practical framework to assist in the analysis of the communication process involved in individual psychotherapy, the following concepts are first examined. 1) channels of communication; 2) modes of functioning; 3) interaction between channels of communication and modes of functioning. Following this exploration, the learning objectives in communication are discussed. Using clinical examples, the relationship between the communication process and other concepts of individual psychotherapy are illustrated. Finally, some pedagogic reasons for teaching students the analysis of the communication process early in their psychotherapy training are presented.
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This paper constitutes an initial attempt to establish specific end-point objectives for the teaching (and learning) of individual psychotherapy skills. A working framework for teaching psychotherapy, which includes intrapsychic as well as interactional phenomena, is articulated. The framework also tries to achieve an integration of basic concepts of psychotherapy and specific skills for clinical practice. It draws on concepts derived from communication theory, psychoanalytic theory, adaptational theory (ego theory), learning theory, and transactional theory. In presenting these objectives three classes of skills are articulated: perceptual, conceptual, and executive. The end-point objectives are discribed for the following categories: 1) therapeutic stance, 2) history and mental status, 3) models and concepts, 4) communication channels, 5) patient's affect, 6) therapist's affect, 7) acceptance of affect, 8) interpretation, 9) transactions and 10) reinforcement and adaptation. This framework is truly eclectic in nature and effects a healthy compromise between the technique oriented "ABC's of psychotherapy" school and proponents of the view that psychotherapy is an art that cannot be taught. By drawing from more than one model it encourages the student to recognize early the distinction between theoretical formulation and ideological commitment in psychotherapy. It presents these objectives in the form of an instrument that can, with continuous refinement and testing, be used to evaluate student's progress in a psychotherapy training program.
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OBJECTIVE: To determine the proportion and characteristics of mild hypertensives who remain normotensive after withdrawal from drug treatment. DESIGN: Longitudinal descriptive study. SETTING: A university family practice unit (FPU) and a large steel company (DOFASCO) in Hamilton, Ontario. PATIENTS: Participants were 107 of 125 (86%) eligible hypertensives at the two sites; 103 (96%) subjects completed the study. INTERVENTION: Subjects discontinued antihypertensive medication and were followed until blood pressure (BP) became elevated or for 12 months, whichever was shorter. MEASUREMENTS AND MAIN RESULTS: BPs were monitored according to a predefined schedule and before, during, and after mental and physical stress tests. Thirty-eight (37%, 95% confidence interval [CI] 27-46%) subjects remained normotensive at 12 months. Predictors of remaining normotensive included lower medicated standing diastolic blood pressure (DBP) (87.6 versus 91.8 mm Hg, 95% CI for the difference 2.2-6.2, p less than 0.001) and longer duration of normotension on drugs (12.6 months versus 8.7, 95% CI for the difference 0.9-6.9, p = 0.012). There was no significant relationship between maintenance of normotension and age, medication potency, duration of hypertension, weight, lying BP, change in heart rate, or BP during mental or physical stress tests; the power to detect a clinically important difference in lying DBP was 99% but for other variables was lower (21-75%). CONCLUSIONS: The probability of hypertensives' remaining normotensive for one year after drug withdrawal increases as the medicated standing DBP decreases and as the number of months of BP control while on medication increases. Studies with larger sample sizes are warranted to determine whether other variables may be significant predictors.
In this industrial-based study we compared the blood pressure (BP)-lowering effectiveness of relaxation, a beta blocker, and the combined use of these two treatments in 47 untreated, mildly hypertensive blue collar steel workers. Using a randomized two by two factorial design, patients received either nadolol or placebo drug daily, and either a relaxation training or an education program, each lasting 8 weeks. A pre-intervention and post-intervention stress test measured response of heart rate and BP to mental and physical tasks. BP assessments were done at baseline, post-intervention, 1 month, and 3 month follow-up. Change in several self-report measures was determined. Results showed that beta blocker was more effective in lowering BP than placebo, but relaxation was not more effective in lowering BP than health education. The combined effect of beta blocker and relaxation was not superior to beta blocker alone. Compliance with relaxation practice was not superior to compliance with medication. We conclude that pharmacologic treatment is superior to the relaxation therapy tested.