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Biomedical subjects

A F Fontana

Publications and source records attributed to A F Fontana.

At least 19 recordsLinked to original sources
PubMed1989

Defensive coping and blood pressure reactivity in medical patients.

Two defensive coping styles, denial of illness and repressive coping, were studied in two groups of medical patients whose blood pressure (BP) was measured during a stress interview. Denial of illness was measured using the Levine Denial of Illness Scale (LDIS), and repressive coping was measured using a combination of the Marlowe-Crowne (MC) Social Desirability Scale and the SCL-90R anxiety subscale (ANX). Consistent with our prior research indicating that LDIS was associated with adaptive outcomes in the short run, high deniers manifested reduced systolic BP reactivity compared to low deniers. Although not related to repressive coping, systolic BP reactivity was correlated positively with MC and ANX separately. The results demonstrate that LDIS and MC measure different types of defensive coping. Current theories of the MC scale suggest two possible interpretations of the MC findings, one that focuses on avoidant coping and the second on attentional coping in high MC scorers.

Adaptation, Psychological↗
PubMed1989

Cynical Mistrust and the search for self-worth.

Cynical Mistrust was examined among 64 medical and surgical patients, 23 of whom were selected for a history of CHD and 41 for an absence of such a history. Cynical Mistrust was found to differentiate subjects with a positive history from those without such a history. As hypothesized, persons scoring high in Cynical Mistrust also scored high in Self-Worth by Social Comparison, Playing Hardball with Others and Self-Criticism. Surprisingly, high scorers in Cynical Mistrust among subjects with a coronary history also scored high in Dependency on others for validation that they were deserving of being loved. We suggest that the pathogenicity of Cynical Mistrust for CHD may be potentiated by the presence of certain other dispositions. Further investigation of dependency on others in particular appears to be worthwhile in order to determine whether consideration of this disposition can improve the identification of risk for CHD.

Adult↗
PubMed1989

Support, stress, and recovery from coronary heart disease: a longitudinal causal model.

Measures of support, stress, distress, and cardiac symptoms were obtained from a cohort of 73 male cardiac patients at hospitalization and at 3, 6, and 12 months thereafter. Sets of general and alternative hypotheses regarding the direction of causality among these variables were drawn from the literature on cardiac rehabilitation, stress, and support. Structural equation modeling was used to evaluate the stability and duration of these hypotheses over three time-lags. The results showed strong support for the general hypotheses and minimal support for the alternative hypotheses. Support ameliorated the subsequent experience of stress and distress and had opposing effects to these variables on cardiac symptoms. Support was more influential in the first half of the year than it was in the second half, however, whereas stress was predominant causally in the second half. Implications of this pattern for clinical intervention are drawn and directions for further research are proposed.

Adult↗
PubMed1987

Type A behavior pattern, inhibited power motivation, and activity inhibition.

The constructs of the Type A behavior pattern and the Inhibited Power Motive Syndrome (IPMS) have many features in common. The empirical relation between the two constructs was investigated in this study with 45 employed, male medical and surgical patients. Four different measures of the Type A pattern were examined. Results showed that, of the four measures, the Structured Interview and the Hostility Scale were related significantly to the IPMS. Systolic blood pressure reactivity was also related significantly to the IPMS. These relations could be ascribed largely to activity inhibition alone. The contribution of activity inhibition to an understanding of the biological and psychological substrates of the Type A behavior pattern is discussed.

Adult↗
PubMed1986

Social insecurity, the type A behavior pattern, and sympathetic arousal.

Social insecurity is a psychological orientation that has been found to be associated significantly with both coronary atherosclerosis and psychological distress. Although sympathetic arousal has been assumed to be a cause of coronary atherosclerosis and an effect of psychological distress, neither of the prior studies included a measure of sympathetic arousal in its design. The present study fills this gap by examining social insecurity in relation to blood pressure, as an index of sympathetic arousal. The results, derived from 50 male, medical/surgical patients, are consistent with the pattern of findings in previous studies in that social insecurity was independent of the Type A pattern and additive to it in its association with blood pressure. Differences between social insecurity and the Type A pattern are discussed in terms of their differential associations with systolic versus diastolic pressure and their differential trait-like and state-like patterns of association with blood pressure.

Adult↗
PubMed1980

Social class and suitability for psychodynamic psychotherapy A causal Model.

A causal model is postulated to mediate the connection between patients' social class and therapists' evaluations of patients' suitability for psychodynamic psychotherapy. The model postulates that patients' social class gives rise to the learning of intellectual skills cognitive styles, which lead to ways of interacting verbally with others, which in turn result in therapists' evaluations of patients suitability. Thirty psychiatric outpatients were assessed therapists during the first therapy session. One mediational pathway was discovered as postulated by the model. This pathway was found to mediate the connection between patients' social class and their subsequent attendance in psychotherapy as well. Two unexpected pathways were found to mediate therapists' judgments of suitability, one of which also mediated patients' attendance in psychotherapy. These unexpected pathways are of particular interest for the clues they offer to the ways in which psychodynamic psychotherapy may be possible and rewarding with lower-class patients.

Adult↗
PubMed1980

Psychological impairment and psychological health in the psychological well-being of the physically ill.

There has been a growing acceptance of the view that psychological health is not merely the absence of psychological impairment, but rather is a separate state making its own contribution to a person's overall psychological well-being. Research on the separation of positive and negative affect represents a major empirical development of this view. The present study supports the model as it has been developed from people's self-reports. However, the postulation of complete separation of positive and negative affect is too extreme for others' reports about people. For others' reports, the model should be modified to state that positive and negative affect are partially separate and have differentially strong associations with harmonious and disruptive/distressing behaviors. These findings have implications for the measurement of psychological well-being in investigations of the physically ill. Both psychological impairment and psychological health should be represented, particularly when they are assessed from people's self-reports. Finally, there are promising indications that this view of psychological well-being is applicable to mentally ill persons as well.

Affect↗
PubMed1980

Ward polity and therapeutic outcome: II. Ratings of patient behavior.

In a study to determine the therapeutic value of ward policies of restriction and coercion, as in a step system of privileges, investigators compared the adjustments of patients in three ward settings: one with a formal step system, one in which the formal system had been abolished but a significant degree of restriction-coercion maintained, and one in which almost all activities and medications were optional. Patients' behaviors in seven areas were rated at admission, at discharge, and at one and six months after discharge. The patients on the ward with the formal step system showed better adjustment on 23 out of 35 ratings, although only one of the ratings was statistically significant. The slight therapeutic value of restriction-coercion suggested by these data contrasts with the results of an earlier, retrospective study. Cost-benefits involving economic, political, and therapeutic issues are raised.

Behavior↗
PubMed1977

Cognitive mediators between patients' social class and therapists' evaluations.

Previous research has shown that therapists are more likely to accept middle-class than lower-class persons for psychotherapy and to rate middle-class patients more favorably than lower-class patients. One explanation that has been offered is that lower-class patients may not conceptualize their experiences in a manner compatible with traditional kinds of therapy. This study investigated several cognitive variables that could theoretically serve as mediators between patients' social class and therapists' differential evaluations--specifically, verbal intelligence, psychological differentiation, and locus of control. Therapists evaluated patients after the initial therapy session. Results indicated that psychological differentiation was a mediator for therapists' judgments of both patients' desire for structure and their suitability for psychotherapy. Similarly, a locus of control orientation emphasizing the role of chance functioned as a mediator of therapists' judgments of suitability.

Attitude of Health Personnel↗
PubMed1977

The world hypotheses scale: rationale, reliability and validity.

Theoretical descriptions are presented for four different sets cognitive assumptions concerning the fundamental meaning of events. These cognitive assumptions or world hypotheses are called formism, mechanism, organicism, and contextualism. The development of a 12-item scale to measure individual preferences for these world hypotheses is described. Finally, several empirical studies are reported in which diverse behavioral correlates have been found for individuals preferences among world hypotheses. Specifically, significant results have been obtained for choice of careers, stability of friendships, and success in both group and individual therapies.

Journal Article↗
PubMed1976

Psychological differentiation and psychotherapy.

Patient's level of psychological differentiation was studied in relation to patients' and therapists' evaluations of the initial psychotherapy session. The evaluations assessed two broad dimensions of the interaction which generally have been considered important for psychotherapeutic success and which have been found to be related to patients' psychological differentiation: namely, patients' and therapists' satisfaction with the amount of structure, and therapists' impressions of patients' appropriateness for therapy. Significant correlations were obtained between patients' psychological differentiation and both of these dimensions. However, two control variables, socioeconomic status and alcohol use, were also found to be related to these dimensions. When the effects of these variables were partialed out, the relationships with therapists' impressions of appropriateness disappeared, but the relationships with patients' and therapists' satisfaction with the amount of structure remained significant. The relationship of these findings to other studies of psychological differentiation and psychotherapy is discussed. Finally, the contribution of the present results to the choice of the most appropriate measure of psychological differentiation is noted.

Adult↗
PubMed1976

Coping with interpersonal conflicts through life events and hospitalization.

Previous studies have helped to explicate the coping process prior to hospitalization by investigating the frequency and pattern of life events during this period. The present study extends the empirical applicability of the model to the period following hospitalization. Predictive validity for the model is provided by an investigation of posthospital community adjustment and rehospitalization. It was found that the resolutions of interpersonal conflicts during the period of hospitalization enhanced the ability to predict these outcome measures substantially when the conflict resolutions were added as predictors to patients' demographic and background characteristics, their hospital behavior, and their therapists' evaluations. Two case histories are presented to illustrate the applicability of the model for furthering the understanding of individual patient's lives.

Conflict, Psychological↗
PubMed1975

Assessing treatment outcome. I. Adjustment in the community.

In recent years, the re-examination of treatment outcome has substantially advanced the sophistication with which the issues involved have been conceptualized. This study is directed toward the empirical elaboration of four of these issues as they relate to adjustment in the community. They may be stated briefly as the extent to which a) a common outcome pattern exists across different dimensions of adjustment; b) the vantage point of the observer influences adjustment ratings; c) judgments of overall improvement encompass the major dimensions of adjustment; and d) judgments of overall improvement represent changes in adjustment levels. With regard to the first issue, the data indicate that each major dimension of adjustment has a somewhat different pattern over time. Secondly, a substantial consensus exists between patients and their significant others concerning patients' adjustment relative to the adjustment of other patients as described by them and their significant others, although not in terms of the actual magnitude of their adjustment. Third, global improvement ratings are related to two dimensions of adjustment primarily (symptomatology and social involvement), and they are virtually unrelated to other major dimensions. Finally, global improvement ratings are highly reflective of the current level of adjustment. The relevance of these findings to outcome assessment is discussed and some suggestions are offered.

Adult↗
PubMed1975

Assessing treatment outcome. II. The prediction of rehospitalization.

Many of the previous studies of rehospitalization are surveyed and those findings are abstracted that are relevant to three basic methodological issues: the selection of predictor content, the source of predictor information, and the length of the follow-up interval. An empirical examination is made of several questions surrounding each issue, including the relative predictive power of a) patients' background characteristics vs. their behavior; b) symptomatic behavior vs. instrumental role behavior; c) patients' own reports vs. others' reports; d) hospital behavior vs. community behavior; and e) each domain of predictor content at a 6-month vs. a 1-year follow-up interval. Finally, individual predictors are selected from each domain to produce a composite picture of the person who is at high risk for rehospitalization.

Adult↗
PubMed1975

The immediate effects of chlorpromazine in newly admitted schizophrenic patients.

To evaluate the clinical effectiveness of chlorpromazine in comparison with placebo over a brief period of hospitalization, the authors conducted a double-blind study of the drug in 44 acutely ill schizophrenic patients. These patients had been newly admitted to a brief treatment unit where the average length of stay was 7 to 10 days. The results of this study indicate that chlorpromazine had no more calming or antipsychotic effect than placebo during the first 5 days of treatment. The authors suggest that 5 days is too short a time for a clinical trial to gauge patient response to chlorpromazine.

Acute Disease↗