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Biomedical subjects

A C McFarlane

Publications and source records attributed to A C McFarlane.

At least 19 recordsLinked to original sources
PubMed1992

Epidemiology by computer.

Collecting epidemiological data from a large community sample has, in the past, been a costly and time-consuming exercise. This paper outlines a methodology for undertaking such research by using a set of standard psychiatric questionnaires, including a computerised version of the Diagnostic Interview Schedule Screening Interview on a portable laptop computer. The study of 1009 country South Australian subjects found that this technique provided prevalence estimates similar to those obtained from the more established Diagnostic Interview Schedule, with the added benefit that all interviews were successfully carried out by lay interviewers under minimal supervision, in the subject's home.

Computers↗
PubMed1992

Avoidance and intrusion in posttraumatic stress disorder.

Longitudinal data from 290 firefighters who had completed questionnaires 4, 11, and 29 months after exposure to a natural disaster were used to examine the role of intrusive and distressing memories in the etiology of posttraumatic stress disorder. At 42 months, all those who were at risk of having developed a psychiatric disorder (N = 113) and a randomly selected comparison group (N = 34) who had never developed symptoms were interviewed using the Diagnostic Interview Schedule. The intrusion subscale score of the Impact of Events Scale accounted solely for the etiological link between the disaster and posttraumatic disorders. Avoidance had no direct relationship with the onset of symptoms and appeared to be a defensive strategy to contain the distress generated by the re-experiencing of the disaster, indicating the importance of separating these phenomena from disorder mood and arousal in posttraumatic stress disorder. An information processing model was validated using three different data sets, which suggests its robustness. Using cross-lagged panel correlations, a bidirectional relationship was demonstrated between disorder and intrusive recollections, suggesting that the intensity of recurring memories of a traumatic experience is as indicative of a disturbance of mood and arousal as the exposure to the trauma.

Affect↗
PubMed1992

Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster.

A population of the fire fighters who had been exposed to a natural disaster were screened using the General Health Questionnaire 4, 11, and 29 months after a natural disaster. On the basis of these data, a high-risk group of subjects who had scored as cases and probable cases and a symptom-free comparison group were interviewed using the Diagnostic Interview Schedule 42 months after the disaster. The prevalence of posttraumatic stress disorder (PTSD), affective disorders, and anxiety disorders was examined. Only 23% of the 70 subjects who had developed a PTSD did not attract a further diagnosis, with major depression being the most common concurrent disorder. Comorbidity appeared to be an important predictor of chronic PTSD, especially with panic disorder and phobic disorders. The subjects who had only a PTSD appeared to have had the highest exposure to the disaster. Adversity experienced both before and after the disaster influenced the onset of both anxiety and affective disorders.

Adult↗
PubMed1990

Psychoimmunology and rheumatoid arthritis: concepts and methodologies.

The recent growth of knowledge about the immune-neuroendocrine network has important implications for future research into psychosomatic hypotheses about the aetiology of rheumatoid arthritis. The available evidence suggests that three phases of the aetiological process in rheumatoid arthritis need to be considered separately because of the different role that psychological and social variables may play at different points of the disease. These are the loss of immunological tolerance, the onset of joint inflammation and the long-term disease course. It is suggested that future studies will need to be prospective, include multiple sampling techniques and comparisons within patient groups if they are to elucidate the precise role of psychoneuroimmunological factors in rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1989

A factor analytic study of clinical competence in undergraduate psychiatry.

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.

Clinical Clerkship↗
PubMed1989

The treatment of post-traumatic stress disorder.

This report reviews treatment studies of post-traumatic stress disorder (PTSD). Much of the literature is descriptive and concentrates on particular treatment modalities without attempting to integrate these different approaches into the wider body of knowledge about PTSD. No study has randomly assigned patients to experimental and control groups. The treatment of 56 patients with PTSD is described, highlighting issues which influence the choice of approach and focus of therapy. These issues are seldom mentioned in the PTSD literature and include the unusual difficulties involved in developing a therapeutic alliance, the role of non-specific elements and the treatment of coexistent psychiatric disorders which are frequently present. The need to consider separately the degree of disturbed attention and arousal, the nature of the traumatic preoccupation and the patient's social and occupational functioning are stressed. The lack of knowledge about the natural history of PTSD and the different effectiveness of treatments in the acute and chronic stages are other uncertainties about the treatment of PTSD. Consideration of these points has led to a series of recommendations for future studies of the treatment of PTSD.

Adaptation, Psychological↗
PubMed1989

Blindness and anorexia nervosa.

Two cases of anorexia nervosa in blind patients are reported. They demonstrate that blind children experience many developmental problems which are thought to be important in the etiology of anorexia nervosa. Similarly, blind children are unusually susceptible to misperceive their body size and weight. The apparent absence of a strong association between congenital blindness and anorexia nervosa challenges the presumed aetiological link between disturbed body image and identity diffusion, and anorexia nervosa.

Adolescent↗
PubMed1989

The aetiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors.

A group of 469 firefighters were studied 4, 11 and 29 months after having an extreme exposure to a bushfire disaster. The relative importance of the impact of the disaster, personality and ways of coping were investigated as determinants of post-traumatic morbidity. Neuroticism and a past history of treatment for a psychological disorder were better predictors of post-traumatic morbidity than the degree of exposure to the disaster or the losses sustained. These results raise doubts about the postulated central aetiological role a traumatic event plays in the onset of morbidity.

Australia↗
PubMed1988

Relationship between psychiatric impairment and a natural disaster: the role of distress.

The relationship between adversity, distress and psychiatric impairment was examined in a group of 469 firefighters who had an intense exposure to an Australian bushfire disaster. The data suggested that psychiatric impairment measured by the General Health Questionnaire and distress measured by the Impact of Event Scale were relatively separate phenomena. Psychiatric impairment in these people appeared to be related more to their level of distress after the fires than to the severity of their exposure and losses.

Adult↗
PubMed1988

The International Classification of Impairments, Disabilities and Handicaps: its usefulness in classifying and understanding biopsychosocial phenomena.

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was developed because of the growing awareness that ICD-9 failed to reflect many of the problems that people bring to health care systems. The ICIDH was designed to classify the consequences of disease such as the disruption of daily activity and the social disadvantage that accompany illness. However, since its introduction, the ICIDH has largely been ignored by psychiatry, despite its conceptual strength. In particular, it provides a framework for applying the biopsychosocial model and studying the phenomena of mental illness. The latter is an important issue because of clinical psychiatry's inherent weakness in distinguishing between symptoms of disease and the psychosocial consequences, a particular inadequacy of the DSM-III diagnostic criteria. The utility of the ICIDH is shown in the study of the phenomena of panic disorder and agoraphobia, where I conclude that agoraphobia should be classified as a disability/handicap and not a disorder.

Activities of Daily Living↗
PubMed1988

Determinants of disability in rheumatoid arthritis.

The longitudinal determinants of disability were studied in a group of 30 patients with rheumatoid arthritis over a 3-year period. The patients were investigated on two occasions using quantitative measures of disease activity and disability as well as a series of reliable psychometric instruments. Both longitudinal and cross-sectional data analyses were performed. Psychological factors consistently predicted more of the variance of disability than disease activity. These factors were associated with the tendency to deny the emotional dilemmas caused by having a chronic illness, difficulty in accepting doctors' reassurances and clinical depression. Such psychological variables required specific attention in rehabilitation programmes.

Adult↗
PubMed1988

The phenomenology of posttraumatic stress disorders following a natural disaster.

This study examined the utility of the DSM-III diagnostic criteria for posttraumatic stress disorder (PTSD) in a high-risk group of 50 firefighters who had had an intense exposure to a natural disaster 8 months before being interviewed. Follow-up over the next 3 years allowed examination of the ability of these diagnostic criteria to predict a pattern of chronic posttraumatic morbidity. They predicted a pattern of chronic disorder, demonstrated by the finding that eight of the 15 subjects who had definite or borderline PTSD at 8 months remained symptomatic 3 years later. A disturbance of attention and concentration appeared to be the best predictor of chronic PTSD. The longitudinal course of posttraumatic morbidity in these 50 firefighters was compared with a matched group of 96 uninterviewed subjects 11 and 29 months after the disaster. Although the interview provoked an emotional catharsis in a number of firefighters, the long-term morbidity in the two groups was comparable. Fourteen subjects who did not have PTSD continued to experience intense imagery 8 months after the disaster. This observation raises questions about whether such thoughts and feelings have adequate specificity as diagnostic criteria for PTSD in a group that has recently been exposed to a traumatic event.

Anxiety Disorders↗
PubMed1988

The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors.

This study examined the longitudinal course, over a 25-month period, of posttraumatic morbidity in a group of 469 firefighters exposed to a bushfire disaster. The patterns of posttraumatic morbidity were defined by the General Health Questionnaire. Contrary to expectation, an acute pattern of morbidity was less common than the delayed-onset or chronic forms. Predisaster variables were found to be as important in the onset and course of the disorder as were the firefighters' losses or extent of exposure to the disaster. These data suggest that exposure to an extreme trauma is necessary but not sufficient to explain the onset and pattern of posttraumatic morbidity.

Adult↗
PubMed1988

Recent life events and psychiatric disorder in children: the interaction with preceding extreme adversity.

This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.

Adaptation, Psychological↗
PubMed1988

The aetiology of post-traumatic stress disorders following a natural disaster.

The onset of post-traumatic stress disorders in a group of firefighters who had an intense exposure to a bushfire disaster was investigated using a longitudinal research design. Contrary to expectation, the intensity of exposure, the perceived threat, and the losses sustained in the disaster, when considered independently, were not predictors of post-traumatic stress disorder. By contrast, introversion, neuroticism, and a past history and family history of psychiatric disorder were premorbid factors significantly associated with the development of chronic post-traumatic stress disorders.

Australia↗
PubMed1988

An analysis of the relationship between psychological morbidity and disease activity in rheumatoid arthritis.

The hypothesis that the duration and activity of rheumatoid arthritis (RA) determine a patient's psychological state and adjustment was tested with a longitudinal research design using quantitative measures. A group of 30 patients with RA was examined on 2 occasions, 3 years apart. There were few significant relationships between duration of illness, disease severity and the psychological measures. A strong correlation occurred between disability and attitude to illness. Our data suggest that a patient's psychological state needs to be assessed as a variable, independent of physical impairment.

Adult↗