Biomedical subjects

C Tennant

Publications and source records attributed to C Tennant.

At least 55 records · Page 3Linked to original sources

PubMed1994

Resuscitation in cancer. Comparison of patient and health staff preferences.

One hundred oncology patients from a major teaching hospital and their treating health staff were studied in the second phase of research examining attitudes towards cardiopulmonary resuscitation (CPR). A descriptive approach was used incorporating semistructured interviews of patients and established questionnaire measures, examining knowledge of and attitude towards disease and treatment, psychological functioning, and current and projected attitude toward resuscitation. Health staff also participated in a semistructured interview. This phase of the project focused particularly on a direct comparison of patient and staff assessments. In current circumstances, 10% of patients refused resuscitation. This was associated with disease of good prognosis. In a future hypothetical deteriorated scenario presented to patients, 39% declined resuscitation. This was associated with a past history of suicidal behavior. In current circumstances, health staff designated 14% of patients "Do-Not-Resuscitate" (DNR)--this was associated with a number of variables considered to predict poor outcome in resuscitation. In the future scenario, staff designated 54% of patients DNR--this was associated again with poor resuscitation outcome variables, but also independently, with a past psychiatric history. Comparison of patient and health staff preferences for resuscitation showed moderate yet significant concordance in current circumstances but not in the future scenario. The findings indicate firstly the feasibility of discussing resuscitation preferences with seriously ill patients and secondly an urgent need to improve patient and staff discussions regarding resuscitation, as staff and patients' attitudes to resuscitation differ.

Adult↗

PubMed1993

Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology (IVF/ET).

The association between mood state and treatment outcome after In Vitro Fertilization/Embryo Transfer (IVF/ET) was assessed in a prospective sample of 330 women, of whom 113 were first time participants (inductees) and 217 were repeat cycle women (veterans). Initial evaluation of mood state indicated a significantly higher level of depression amongst veterans than inductees and a significantly greater proportion of veterans (25%) with clinically elevated depression scores compared with inductees (15%) and community norms (approx. 12%). Up to 12 months after initial assessment and after controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women. The results and their implications are discussed.

Adult↗

PubMed1993

Stress and personality in patients with chronic peptic ulcer.

The concept that stress and personality are associated with ulcer is widely held by lay persons and to some extent by the medical community. By means of epidemiological techniques and more precise terminology, the role of psychosomatic factors in ulcer disease has been more clearly defined. Regarding acute stress, the number of events experienced and the change and distress they are purported to produce has been found to be similar in ulcer patients and their controls matched on age, sex, and social class. However, chronic difficulties, i.e., events or circumstances that have persisted for > or = 6 months, are twice as common in duodenal ulcer patients as in controls. Events, either acute or chronic, are more strongly associated with duodenal ulcer if they contain a component involving personal threat or goal frustration. Associations that have been found between acute or chronic stress and duodenal ulcer have been relatively weak, with odds ratios of 2 to 3. For some patients, it is possible that depression and social incongruity may have played some role in initiating ulcer disease. Personality studies have shown that ulcer patients are more neurotic than controls, but the difference is small and there is no evidence to indicate an ulcer personality. As regards both stress and personality, gastric ulcer patients do not differ from duodenal ulcer patients.

Acute Disease↗

PubMed1993

The influence of spinal cord injury on coping styles and self-perceptions: a controlled study.

Well-controlled research investigating psychological responses following Spinal Cord Injury (SCI) is lacking. In addition, much of the literature is based on depression following SCI and is dominated by data from the USA. The effects of SCI on perceptions of control, self-esteem and coping styles over the first year of SCI were investigated. Forty-one acute spinal injured patients and 41 able-bodied controls matched for age, sex and education completed a variety of standardised questionnaires on three occasions over one year. The instruments included the Locus of Control of Behaviour Scale, Rosenberg's Self-Esteem Scale, and an adapted Mental Adjustment to Cancer (MAC) Scale which measures coping styles, including fighting spirit, helplessness/hopelessness and fatalism. The SCI group were found to be more external in their perceptions of control, lower in self-esteem, and more helpless/hopeless and fatalistic in attitude than the controls. The majority of the SCI group had scores reflecting adaptive coping styles and intact levels of self-esteem but there were still a substantial proportion who displayed maladaptive coping styles (e.g. external locus of control, fatalism, helplessness). No differences in scores across time were found for either group. Implications for psychological rehabilitation are discussed.

Adaptation, Psychological↗

PubMed1993

Functional gastrointestinal disorders in unselected patients with non-cardiac chest pain.

Patients with non-cardiac chest pain (NCCP) (n = 387) and cardiac chest pain (CCP) (n = 93) were compared with community controls (n = 81), using a symptom questionnaire that assessed the presence of irritable bowel syndrome (IBS), functional dyspepsia, and oesophageal dysfunction and chest pain characteristics. A significantly (p < 0.05) increased prevalence of symptoms compatible with IBS occurred in NCCP patients when compared with those with CCP and with controls. Dysphagia was more frequent in both those with non-cardiac and cardiac chest pain than in controls; this was not apparent, however, when patients with concomitant IBS were excluded. The presence of oesophageal or gastrointestinal symptoms did not enable discrimination with regard to the chest pain characteristics. We conclude that unselected referred patients with documented NCCP are more likely to have IBS and that the presence of oesophageal symptoms such as dysphagia may merely reflect the spectrum of the 'irritable gut'.

Angina Pectoris↗

PubMed1992

The acute appendicitis syndrome: psychological aspects of the inflamed and non-inflamed appendix.

The aetiological importance of stressful life events and psychological characteristics was assessed amongst 280 appendicectomy patients of whom 80% were classified with 'acutely inflamed' (organic) appendicitis and 20% with 'non-inflamed' (non-organic) appendicitis. Patients were compared with a community comparison group. Specific characteristics of life stressors, namely severe goal frustration for organic patients and severe threat for non-organic patients, were the best predictors of patient outcome. Whilst psychological characteristics were not useful in discriminating between patients, depression in particular, was clearly associated with both conditions, with 38% of non-organic and 28% of organic patients with depression scores in the clinical range. As the patient's clinical depression status failed to modify the effect of the life stress predictors, it was concluded that life stress played an important role in the development of the patients GI symptoms, irrespective of their clinical depression status.

Adolescent↗

PubMed1992

Resuscitation. Patient and staff attitudes in the context of cancer.

One hundred oncology and hematology cancer patients from a major teaching hospital and their treating doctors were studied regarding their attitudes toward cardiopulmonary resuscitation (CPR). A descriptive approach was used, incorporating semistructured interviews of patients and medical staff and established questionnaire measures, examining knowledge of and attitudes toward disease and treatment, and projected attitude toward CPR and current psychological functioning. One-third of the patient sample anticipated a time when they would not consent to cardiopulmonary resuscitation. This was significantly associated with good disease prognosis. Patients with a psychiatric past history were also overrespresented. It appears that patient attitude to treatment withdrawal and refusal of CPR is related to disease progression and likely to change over time. This supports a dynamic and evolving model of advance directives rather than any fixed decree. Medical staff reported that they planned to provide half the sample with intensive medical treatment (including Intensive Care support in the event of their cardiac arrest), and 32% were designated for ward-based resuscitation only. Eighteen percent would not be resuscitated. These patients were older, had more treatment side effects, and a poorer quality of life. Those patients with either a psychiatric past history or higher ratings of depressive affect were also overincluded in the doctors' "Do-Not-Resuscitate" (DNR) group. These results suggest that there are other qualitative factors (e.g., current psychological functioning and past psychiatric history) that contribute to DNR decisions beyond the usual disease-based criteria seen in formal DNR protocols.

Adult↗

PubMed1991

The Camberwell Community Survey: a summary of results.

The Camberwell Community Survey was carried out during 1978 and 1979 on a random sample of the population of Camberwell in south London. This is an inner city area with high deprivation indices. 800 members of the community and a random sample of 74 out-patients with affective symptoms were interviewed using the Present State Examination (PSE) and Life Events and Difficulties Schedule (LEDS) of Brown and Harris. The survey has resulted in many publications. The present paper summarises its aims, methods and results.

Adult↗

PubMed1991

Life stress and non-ulcer dyspepsia: a case-control study.

Sixty-two patients with persistent NUD symptoms were compared with healthy persons of comparable age, sex and social status on a variety of life stress, personality, mood state and coping measures. Highly threatening chronic difficulties were significantly more evident in the NUD group than controls (98 and 2% respectively), as were acute life events which remained highly threatening one week after their onset. Other psychological variables significantly related to NUD were high levels of anxiety and depressive symptoms, personality traits indicating neurotic or anxious tendencies, a tendency to use less mature stress-coping mechanisms and to have less high-quality emotional support. Multivariate analysis revealed the presence of highly threatening stressors to be by far the most important predictor of NUD status. The implications of these findings in relation to the significance of stress and other psychological variables in the aetiology and treatment of NUD are discussed.

Adaptation, Psychological↗

PubMed1991

Perceived interpersonal risk factors of non-endogenous depression.

In a case-control study, two potential interpersonal risk factors of non-endogenous depression, namely a patient's perception of their current intimate partner as dysfunctional and a patient's recall of exposure to previous deprivational parenting, were quantified. The interpersonal characteristics of the partner were assessed principally by a brief self-report questionnaire, the Intimate Bond Measure (IBM). By cross-sectional and longitudinal comparison of this instrument with other interview-derived and self-report measures, the convergent, discriminant and predictive validity of the IBM in depressed patients was established. Further, little evidence of any distorting effect of depressed mood or neuroticism was detected. The perception of the current intimate partner as dysfunctional imparted a risk to non-endogenous depression of at least five times, while reported exposure to parental 'affectionless control' was quantified as a four times' risk. Importantly, IBM care scores predicted the course of the depressive disorder over a six-month period.

Adaptation, Psychological↗

PubMed1991

Adversity in groups with an increased risk of minor affective disorder.

The hypothesis that the sociodemographic distribution of minor affective disorder can be explained by high-risk groups experiencing more psychosocial stress, defined in terms of life events and chronic difficulties, was tested. Linear logistic analysis of data from 275 subjects identified in a community psychiatric survey provided little support for this. Although high-risk groups uniformly experienced more psychosocial adversity, and adversity was strongly associated with disorder, this did not provide an adequate explanation for the increased risk of disorder. This must therefore be explained in other ways.

Adaptation, Psychological↗

PubMed1991

Gender, parity and the prevalence of minor affective disorder.

Data from a two-stage survey of the general population were used to test the proposition that the over-representation of minor affective disorders among women was restricted to those who had had children, independently of current involvement in childcare. Initial analyses supported this proposition strongly. Subsequent linear logistic analyses were largely in favour of an effect of marriage rather than of parity, but it remains possible that part of the gender differences in rates of depression arises because of the effect of parity in raising female prevalence. If substantiated, the parity effect could operate through social or biological mechanisms; although its nature is unclear, it merits further investigation.

Adult↗

PubMed1990

Serologic evidence of Yersinia infection in patients with anterior uveitis.

Anterior uveitis is a common inflammatory eye disease associated with the HLA-B27 phenotype. Bacteriologic cofactors have been implicated in the pathogenesis of several diseases associated with HLA-B27. Using a sensitive enzyme-linked immunosorbent assay, we examined the incidence of previous Yersinia infection in a group of 28 consecutive patients with anterior uveitis. Twelve patients had a significantly increased antibody response to Yersinia, 8 of whom were HLA-B27 positive. Eight patients had IgM antibodies, possibly indicative of recent infection. There were no positive Yersinia serologic findings in our control group of 28 subjects, 13 of whom were HLA-B27 positive. A strong association was found between previous Yersinia infection and the development of anterior uveitis in HLA-B27-positive and HLA-B27-negative patients.

Adult↗

PubMed1990

Acute and chronic stress in duodenal ulcer disease.

Acute and chronic life event stressors were objectively assessed in a sample of duodenal ulcer patients and community controls. Stress was assessed on two dimensions, "personal threat" and "goal frustration." Chronic stressors (those of 6 months' duration or more) involving high goal frustration were significantly and independently associated with the onset and relapse of duodenal ulcers, as were acute events of high immediate but transient personal threat.

Acute Disease↗

PubMed1990

Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease.

Patients with dyspepsia of unknown origin (DUO) and those with similar upper abdominal symptoms but with an organic cause (peptic ulcer) were assessed on personality and psychological symptom measures. The DUO patients had significantly more symptoms of anxiety and tension and higher scores for trait tension and hostility than the organic group. The two groups did not differ significantly in terms of depressive symptoms, neuroticism, psychoticism, or suppression of negative affects. The implications of these findings for the aetiology and diagnosis of DUO are discussed.

Adult↗

PubMed1990

Memories of Vietnam: post-traumatic stress disorders in Australian veterans.

We compared a random sample of Australian Vietnam veteran inpatients suffering from Post Traumatic Stress Disorder (PTSD) (N = 13) with veteran inpatients with other neurotic diagnoses. Those with PTSD had experienced substantially higher levels of combat stress, were more likely to have manifested conduct disorder in childhood, and had poorer work adjustment. Only three had been diagnosed as having traumatic or war neuroses by their original treating psychiatrist in the Veterans Affairs Department. Post traumatic stress disorder (or war neurosis) has possibly been under-diagnosed by treating psychiatrists in the Veterans Affairs Department, especially in the pre-DSM-III era.

Adaptation, Psychological↗

PubMed1989

Coronary artery bypass surgery--impact upon the patient's spouse.

The spouses of 65 coronary artery bypass graft surgery (CAGS) patients were assessed to determine levels of psychological symptoms and social impairment both before and 12 months after surgery. There was substantial psychological morbidity in spouses pre-operatively, with from one-third to one-half having clinically significant levels of depression and/or anxiety symptoms. Pre-operatively there was also significant global psychosocial impairment in the spouse. Of the specific domains of psychosocial adjustment, recreational and psychological adjustment was most severely affected, vocational/domestic adjustment and sexual adjustment being less impaired, and extended family relationships showing minimal impairment. There was significant improvement in spouses' psychological and global psychosocial adjustment at 12 months, with recreational adjustment showing the greatest improvement. Significant improvements also occurred in vocational adjustment but not in domestic or sexual adjustment. Neither physical, psychological nor social adjustment variables preoperatively in either the patient or spouse were predictive of psychological morbidity in the spouse (anxiety or depression) at 12 months. Similarly there were no significant patient or spouse preoperative predictors of social adjustment in the spouse at 12 months. However, the patients post-operative psychological morbidity and the spouses social and psychological morbidity were related.

Adult↗

PubMed1989

A prospective evaluation of the psychosocial effects of coronary artery bypass surgery.

Eighty-nine patients were prospectively studied to determine psychological and psychosocial impairment prior to and after coronary artery graft surgery (CAGS). Psychological morbidity prior to surgery was high, with one-third having clinically significant levels of depression and/or anxiety symptoms. Scores on the Psychosocial Adjustment to Illness Scale indicated a generally high level of psychosocial impairment pre-operatively, with vocational and domestic functioning being most severely affected, social and sexual functioning being less impaired, and extended family relationships being largely unaffected. In general, there was a significant reduction in psychological morbidity and an improvement in psychosocial functioning at 6 months, which remained at 12 months. Vocational and domestic functioning showed the greatest improvement. Sexual and social functioning showed modest improvements overall, with significant numbers reporting residual impairment due to their heart disease. These findings add to a growing body of evidence demonstrating generally favourable psychological and social outcome following CAGS.

Adaptation, Psychological↗