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Biomedical subjects

H Leigh

Publications and source records attributed to H Leigh.

At least 19 recordsLinked to original sources
PubMed1999

Repressive/defensive coping, endogenous opioids and health: how a life so perfect can make you sick.

Hyperactivity of endogenous opioid systems has been postulated to mediate the associations between defensive/repressive coping styles, enhanced stress responsivity, and reduced immunocompetence. Study 1 examined whether repressive/defensive coping would be associated with greater sensitivity to opioid antagonism. Judgments of the painfulness of ascending series of electrocutaneous stimulation applied to the forearm were determined before and after the administration of naloxone and placebo in 38 men and 42 women. All subjects were healthy with a mean age of 32.9 years. Naloxone (10 mg i.v.) and placebo were administered in double-blind fashion and counterbalanced. Subjects were classified as High- and Low-defensive and repressive copers on the basis of scores on the Marlowe-Crowne Social Desirability Scale and the Balanced Inventory of Desirable Responding, respectively. High Self-Deception was associated with naloxone-induced hyperalgesia, whereas no effects of naloxone on pain ratings were observed in low-Self-Deceptive subjects. In Study 2, resting plasma beta-endorphin levels were found to be positively correlated with defensiveness in men (n = 26), but not women (n = 44). Study 3 examined 82 healthy subjects (mean age = 28.7 years). Beta-endorphin/defensiveness correlations were found to be greater following, compared to prior to, electrical nociceptive stimulation in men (n = 49), but unrelated in women (n = 33). These findings are consistent with the hypothesized endorphinergic dysregulation associated with repressive/defensive coping styles and are discussed in terms of the immuno-regulatory implications of such a dysregulation.

Adaptation, Psychological↗
PubMed1993

Physical factors affecting psychiatric condition. A proposal for DSM-IV.

A new diagnostic category, "Physical Factors Affecting Psychiatric Condition," is proposed for inclusion in the DSM-IV. In addition, there should be a new category called "Chronic Adjustment Disorder." Psychiatric syndromes meeting Axis I or Axis II criteria that arise as an emotional reaction to a chronic or episodic physical illness or disability should be subsumed under the diagnosis of "Physical Factors Affecting Psychiatric Condition--Specific Axis I or II syndrome." Psychiatric symptoms that do not meet other Axis I or Axis II criteria should be diagnosed as "Chronic Adjustment Disorder." These categories will be especially useful in consultation-liaison settings.

Adams-Stokes Syndrome↗
PubMed1987

Psychological predictors of survival in cancer patients undergoing radiation therapy.

In a prospective study to identify psychological factors affecting survival in cancer patients receiving radiation therapy, 101 consecutive patients were evaluated for anxiety, depression, and perception of the seriousness of the condition. In 3 years, the survivors were compared to the nonsurvivors. The survivors had significantly higher mean trait anxiety (p less than 0.05) than the nonsurvivors. State anxiety and depression scores also tended to be higher in the survivors (p less than 0.01). Self-assessment of the seriousness of their disease did not differentiate the two groups. The nonsurvivors had significantly more pain (p less than 0.05). Within the nonsurvivor group, survival time was negatively correlated with state anxiety (p less than 0.01), trait anxiety (p less than 0.02), and depression (p less than 0.01). In the nonsurvivors, women rated their condition to be significantly more serious than men (p less than 0.01). Female nonsurvivors tended to rate their condition to be more serious than female survivors (p less than 0.1), while male nonsurvivors rated their condition to be significantly less serious than male survivors (p less than 0.01). Only among female nonsurvivors did the seriousness rating correlate significantly with anxiety (p less than 0.01). The sex differences confirm our previous finding that men may tend to cope with cancer with more massive denial than women. We hypothesize that patients with higher anxiety and depression in the nonsurvivor group had a massive defensive failure, while those who had high anxiety levels in the survivor group had been more realistic about their disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1987

Multidisciplinary teams in consultation-liaison psychiatry: the Yale model.

The consultation-liaison service at Yale features integrated teams of psychiatrists, social workers, and clinical nurse specialists working together in both consultation and outpatient settings. The model is based on the tenets that (1) comprehensive evaluation of patients is essential for effective treatment; (2) role definition is necessary for specific disciplines, including the definition of overlapping and separate areas of expertise and practice. The multidisciplinary teams are coordinated by a psychiatric resident, who is supervised by an attending psychiatrist. The role of the resident is that of a diagnostician and coordinating physician. The social worker functions as an expert in family evaluation and treatment, and the nurse specialist functions as supportive therapist and liaison with the nursing staff. The structure of the division of consultation-liaison and ambulatory services at Yale is described and the advantages and disadvantages of the multidisciplinary team concept are discussed in comparison with other models of consultation-liaison psychiatry.

Combined Modality Therapy↗
PubMed1986

Comparison of theoretically oriented and patient-oriented behavioral science courses.

Effective teaching of medical behavioral science is an important challenge for psychiatrists. Two behavioral science courses taught at different times at the Yale University School of Medicine are described: a theoretically oriented course emphasizing symbolic function, primary source reading, and conceptual thinking and a patient-oriented course emphasizing the relevance of behavioral science to the practice of medicine, taught primarily by consultation-liaison psychiatrists. Students' evaluations of the two courses during the fifth year each course was taught were compared. The students' acceptance of the patient-oriented course was dramatically greater than that of the theoretically oriented course. The class mean scores on the behavioral science subtest of the Part I examination of the National Board of Medical Examiners during the last four years that the courses were taught were compared. The mean scores of the classes that had taken the patient-oriented course were significantly higher than those of the classes that had taken the theoretically oriented course. The mean score for the class that took the fifth year of the patient-oriented course was 52 points higher than the mean score for the class that took the fifth year of the theoretically oriented course. The authors concluded that the skills that consultation-liaison psychiatrists use every day in their work may be exactly those that are useful in teaching a successful behavioral science course for medical students.

Behavioral Sciences↗
PubMed1985

Skin conductance changes and psychotherapeutic content in the treatment of a phobic patient.

This study examined the relationship between skin conductance response (SCR) and psychotherapeutic content in a single case study. Four SCR conditions of one minute's duration each, reflecting maximal increase (amplitude) and least amount of change as well as one-minute periods preceding these criterion conditions, were measured for each psychotherapy session across 12 consecutive sessions. Psychotherapeutic content corresponding to these SCR conditions was evaluated according to 14 categories by five judges. There were significant relationships between SCR conditions and four psychotherapeutic content categories. Increases in SCR corresponded to a decreasing sense of mastery, increased symptom experience, increased symptom occurrence, and increased negative affects. This study suggests that there was a relationship between a responsive physiological measure and relevant psychotherapeutic content categories in an individual patient.

Adult↗
PubMed1983

Panic-induced elevation of plasma MHPG levels in phobic-anxious patients. Effects of clonidine and imipramine.

Six subjects with the phobic-anxiety syndrome were treated in a controlled, crossover trial of clonidine hydrochloride v imipramine hydrochloride for periods of four weeks each. During each drug trial and during baseline placebo treatment, each patient exposed himself or herself to a situation that previously elicited panic attacks. Self-rated anxiety and plasma levels of 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) were measured to study the effect of the drug treatments on noradrenergic activity and anxiety. Plasma MHPG level correlated highly with rated anxiety under all conditions, and was consistent with significant symptom reduction by clonidine or imipramine. Diminished suppression of plasma MHPG concentrations in two subjects was associated with the continued emergence of panic symptoms in response to phobic stimuli.

Adult↗
PubMed1982

A general systems taxonomy for psychological defence mechanisms.

A taxonomy of psychological defence mechanisms based on general systems concepts is proposed. The personality system consists of the subsystems concerned with input, internal processing, and output of information. Psychological defence mechanisms can be classified according to the subsystem whose function is mainly altered. Defence mechanisms primarily altering the input apparatus function through changes in the perceptual process. These include diminution of perception (denial), distortion of the origin of the percepts (projection and introjection), and distortion of subjectively perceived direction of the feelings and thoughts (displacement). Defence mechanisms that primarily alter the functions of the internal processing apparatus include repression, rationalization, intellectualization, isolation, and fantasy/day-dreaming. These mechanisms alter associative and cognitive processes either directly (repression) or indirectly. In reaction formation, there may by a selective distortion to produce an opposite affect. Defence mechanisms that primarily affect the output apparatus include acting out, counterphobic activity, undoing, sublimation, and non-specific activity. Regression and identification are defence mechanisms that affect all the subsystems, input, internal processing and output, more or less uniformly producing effects throughout the personality system. The advantage of this classification scheme is that it relates primarily to directly observable phenomena that can be readily classified. Another advantage is that it may generate researchable neuropsychological hypotheses concerning possible neural substrates of defence mechanisms.

Defense Mechanisms↗
PubMed1982

DSM III and consultation-liaison psychiatry: toward a comprehensive medical model of the patient.

The descriptive and multiaxial approaches in DSM III encourage comprehensive conceptualization of the patient. The use of explicit criteria for diagnosing syndromes facilitates communication between psychiatry and general medicine. The DSM III category Psychological Factors Affecting Physical Condition should be further elaborated into (a) Psychiatric Factors Affecting Physical Condition, and (b) Physical Condition Affecting Psychiatric Disorder. In addition, the phase of the illness these factors affect should be specified, i.e., the precipitation, course, and recovery. Somatoform Disorder should not be a diagnosis of exclusion, and the diagnostic criteria should clearly specify that conversion symptoms may be superimposed on a pre-existing physical disorder. The DSM III axes are not coherent: they include diagnostic categories, statements concerning possible relationships, and factors that might affect outcome. We propose an alternative to the DSM III Axes based on the Patient Evaluation Grid (PEG), a system comprised of four axes, including Biological Dimension, Personal Dimension, Environmental Dimension, and Assessment of Interaction Among Dimensions. Developing a comprehensive diagnostic model for both medical and psychiatric patients that can be shared by all physicians may be an important function of the liaison psychiatrist.

Depressive Disorder↗
PubMed1982

Comment: the role of psychiatry in medicine.

Psychiatry shares with the rest of medicine all basic goals, assumptions, and approaches as well as many techniques. Any apparent "differences in approach" between psychiatry and general medicine arise from a confusion between the essentials and the specialized techniques and procedures developed in psychiatry. The educational task of psychiatry--to integrate relevant knowledge and skills from the behavioral sciences with the biological sciences and to operationalize a comprehensive approach to patient care--can be accomplished by the general psychiatrist through consultation and collaborative care of patients.

Attitude of Health Personnel↗
PubMed1981

Psychosocial care in a medical genetics clinic.

In the process of genetic counseling, many patients and their families need psychosocial evaluation and care to help them cope with the genetic information and its implications. Such psychosocial work may be routine or extended. For two years we assessed the actual psychosocial evaluation and care provided by us in a medical genetics clinic, using six categories to classify the nature of a patient's need for extended psychosocial work. Of 138 new patients, 82 (59%) required extended psychosocial evaluation and care. In particular, young patients, seen with many family members, and requiring multiple medical consultations, were found to need the most extensive psychosocial care. Ongoing clinic patients (N = 35) referred for psychosocial care were used as a comparison group. We concluded that a significant number of patients and their families receiving genetic counseling also require extended psychosocial evaluation and care, and that these patients may be identifiable early in the counseling procedure.

Adaptation, Psychological↗
PubMed1981

Behavioral medicine: toward a comprehensive psychosomatic approach.

Behavioral medicine is the practice of a comprehensive approach to the patient. It integrates the biological, personal, and environmental-social dimensions in evaluation and treatment. An operational method of implementing this practice is the Patient Evaluation Grid (PEG), in which three dimensions of the patient (biological, personal, environmental) are intersected by three time contexts (current, recent, background) to form a nine-square grid. An examination of information contained in the PEG and their interaction results in a three-dimensional diagnosis and a three-dimensional management plan. The psychiatrist is the only professional with formal training in all the areas of the PEG to interpret, integrate, and prioritize the information that leads to diagnoses and treatment plans. In this role of the psychiatrist as integrator/co-ordinator of evaluation and treatment, he/she must collaborate with other professionals to provide the best available care for the patient.

Behavior Therapy↗
PubMed1981

Biofeedback and hypertension.

A review of the history and recent directions in the treatment of essential hypertension by direct biofeedback is presented. Current instrumentation and techniques as well as the status of biofeedback in the treatment of hypertension and the follow-up of previous studies is presented. Given the current uncertain status of biofeedback and behavioral treatment of hypertension, the authors present speculation of putative subgroups of essential hypertensives with respective biochemical markers and possible selective behavioral treatments for these respective subgroups of central nervous system hypertensives.

Arousal↗
PubMed1980

Denial and helplessness in cancer patients undergoing radiation therapy: sex differences and implications for prognosis.

One hundred consecutive outpatients undergoing radiation therapy were prospectively studied using the Locus of Control Inventory designed by Rotter and a questionnaire covering various aspects of diagnosis, implications of disease, and details of therapy. The Locus of Control Inventory, which measures a person's belief that life's important events are controlled by personal effort (internality) as opposed to factors outside of one's control (externality), revealed a significant difference between men and women in this study. Although women were similar to the general healthy population, men expressed a greater sense of control as their radiation therapy progressed. Men were also more likely to characterize their illness as not very serious and to deny knowledge of their correct diagnoses or details of their treatment. With survival determined at two years following the study, it was found that living and deceased women had initially rated the seriousness of their illnesses appropriately, while deceased men had rated their illnesses as significantly less serious than women or surviving men. It is concluded that sexual differences in coping mechanisms may be accentuated by malignancy and men may actively deny their diagnosis and its implications. This amount of denial and sense of personal control in the face of a potentially fatal illness may indicate a need for more supportive clinical intervention for the radiation therapy patient.

Age Factors↗
PubMed1980

The patient evaluation grid: a systematic approach to comprehensive care.

A comprehensive approach to patients requires a systemic method that complements the clinical approach to disease. The method described here utilizes a patient evaluation grid that takes into account the biological, personal, and environmental dimensions of the patient and the current, recent, and background contexts of illness. It allows the clinician to anticipate problems relating to patient care and to assign priorities to management plans formulated in the three dimensions. It may also facilitate further research into the interrelationships among the multiple determinants of illness. This approach may help to bridge the gap between psychiatry and medicine by providing an integrated conceptual framework of organizing information.

Adaptation, Psychological↗