Biomedical subjects
Publications and source records attributed to L S Mann.
25 adult HIV patients were evaluated in a study of appointments, medication, and compliance with restrictions on sexual activity. The Executive Interview (EXIT) was useful in assessing these patients for cognitive difficulties; compliance with medication and countertransference issues were negatively correlated with EXIT scores.
OBJECTIVE: To determine the effects of endotracheal intubation on respiratory mechanics during xylazine sedation and xylazine-diazepam-ketamine anesthesia in adult horses. ANIMALS: 5 healthy adult horses. PROCEDURE: Measurements were derived from recordings of respiratory gas flow, and transpulmonary and transtracheal pressures. Total pulmonary resistance (RT) was partitioned into upper airway resistance (extrathoracic portion of trachea, larynx, pharynx, nasal cavity, nares; RUA) and lower airway resistance (intrathoracic portion of trachea, bronchi, bronchioles). Baseline measurements were obtained in unsedated horses, after xylazine administration, and following nasotracheal intubation (ID, 18 mm). Measurements were obtained following induction of xylazine-diazepam-ketamine anesthesia and subsequent to endotracheal intubations (ID, 22, 20, and 16 mm). During recovery, horses were nasotracheally intubated (ID, 18 mm). Measurements were obtained upon standing, and repeated after extubation. Data were examined by use of ANOVA with repeated measures. RESULTS: Significant increases in mean work of breathing (W), RT, and RUA observed with xylazine sedation were variably attenuated by nasotracheal intubation. During xylazine-diazepam-ketamine anesthesia, the highest mean values for W, RT, RUA, transpulmonary and transtracheal pressures developed during non-intubation periods. The magnitudes of resistance and pressure values were inversely proportional to the internal diameter of the endotracheal tube. At recovery, values of the W and all measurements of resistances and pressures were significantly increased, compared with presedation values. Extubation resulted in further increases in these measurements. CONCLUSIONS: Work of breathing in horses is substantially increased when RUA is increased during xylazine sedation and xylazine-diazepam-ketamine anesthesia. Endotracheal intubation reduces W by reducing RUA.
To investigate the nature and treatment of pain complaints in psychiatric patients, 75 patients in a general hospital psychiatric unit who utilized any form of analgesic medication were studied. Patients with a primary or secondary diagnosis of substance abuse were excluded. The results indicate that most of the pain complaints were musculoskeletal or headaches and mild to moderate in degree. Nonopiod analgesics were commonly prescribed, and the degree of disability from the pain complaint was minimal. Patients who did utilize pain medications stayed in the hospital significantly longer than those who did not, and this was not an effect of age or diagnosis.
The stability of alexithymia as measured by the Toronto Alexithymia Scale (TAS) and its relationship to depression were investigated in 50 depressed inpatients. The test-retest coefficient for TAS over a 5-day period was 0.57 (p < 0.001). A reliable change index for depressed mood indicated that mood covaried with the TAS, but changes in TAS were not clinically significant. The data support alexithymia as a stable personality construct.
A total of 80 adults (40 normal volunteers, 40 substance abusers) participated in a study about alexithymia and five factors of personality, measured on the Toronto Alexithymia Scale and the NEO Five Factor Inventory, respectively, and their relationship to recognition of affect. The substance abusers scored the same as the age- and sex-matched normal volunteers on recognizing posed facial expressions, but higher on the alexithymia scale, while on Neuroticism and Extraversion they had lower scores on Agreeableness.
Both amplification of normal visceral phenomena and the personality trait of alexithymia are factors in the process of somatization, whereby somatic symptoms become metaphors for emotional distress. The relationship between these two variables was investigated in 101 psychiatric out-patients. Each subject was administered the Somatosensory Amplification Scale (SSA); the Toronto Alexithymia Scale (TAS); the NEO-FFI, which measures five personality factors; and the health locus of control (HLC). In addition, anxiety and depression were quantitatively measured. SSA and TAS significantly correlated only in the female subjects. A regression model found neuroticism to contribute the most variance in predicting SSA while TAS did not fit into the model. Amplification is a perceptual element in potentiating somatization, whereas alexithymia contributes to the cognitive aspects of the process. The role of neuroticism is discussed as a mediating factor.
Research regarding psychological factors in head pain have generally focused upon personality traits and psychopathology. The role of illness beliefs offers another method of elucidating perceptions, attitudes and convictions towards a somatic complaint. One hundred patients, evaluated for head pain at a neurology clinic, were administered the illness Behavior Questionnaire (IBQ) to delineate illness beliefs; the illness Effects Questionnaire (IEQ) to quantify the disruptive aspects of head pain; and the Toronto Alexithymia Scale (TAS) to assess the subjects propensity to somatize as well as the ability to identify and report emotions. The data found no difference between subjects diagnosed with migraine syndrome and those with tension head pain in the IBQ dimensions, the TAS or in reported levels of anxiety or depression. However, chronicity of symptoms was associated with increased irritability. The clinical implications of the findings suggest that patients with head pain are psychologically distressed but often possess alexithymic characteristics that make insightful associations difficult.
A total of 62 staff members from a general hospital participated in a study about alexithymia and the five-factor model of personality, measured by the Toronto Alexithymia Scale and the NEO Five Factor Inventory, respectively, and their relationship to recognition affect. Subjects with alexithymic characteristics were less able to recognize affective states in posed facial expressions and so may have modified their empathic capacity.
The Illness Effects Questionnaire, Illness Behavior Questionnaire, and visual analog scales of mood were given to 100 adults with nonmalignant headaches. Using regression analysis, scores on IBQ Disease Conviction, IBQ Irritability, and depression accounted for 50.6% of the variance in predicting IEQ scores. Scores on the Illness Effects Questionnaire correlated with the Illness Behavior Questionnaire subscales of General Hypochondriasis (.33), Disease Conviction (.60), Affective Disturbance (.49), and Irritability (.40), and also with rated depression (.38) and anxiety (.26).
The seclusion room is an integral component of hospital psychiatry. This study prospectively surveyed 50 patients shortly after each was released from an isolation room in a voluntary general hospital psychiatric unit. Fifty-eight percent of the sample were diagnosed with mood disorders. Previous studies found generally negative attitudes toward seclusion. These data revealed that patients often found seclusion to be restful and therapeutically helpful. The clinical implications of these data are discussed.
OBJECTIVE: Both locus of control and alexithymia have been considered personality factors fostering health concerns and behaviors. This study investigates the relationship between the health locus of control and alexithymia. METHOD: Seventy-eight psychiatric outpatients were administered the Wallston Health Locus of Control Scale (HLC), the Toronto Alexithymia Scale (HLC), and the Five Factor Inventory, which measures neuroticism, extraversion, openness, agreeableness, and conscientiousness. Depressive and anxious affect was also measured. Regression models were developed to assess the influence of the above variables upon alexithymia. RESULTS: Although there was a significant bivariant correlation between an external locus of control and increased alexithymia, regression models found that HLC did not significantly predict TAS. Neuroticism, however, provided the most significant contribution to predict increased alexithymia. CONCLUSION: Neuroticism may link HLC and TAS due to the face validity of each construct. A sense of vulnerability is stated in each measure. This may foster somatic preoccupation. The data suggest HLC and TAS to be separate phenomena and further support the validity of alexithymia as a unique personality trait.
The Toronto Alexithymia Scale (TAS) offers a reliable method to measure alexithymia, a personality construct describing individuals endorsing the inability to identify and report emotions, processing a minimal fantasy life, utilizing an analytic cognitive style, and tending to somatize. Utilizing four cohorts of both patients and controls, a three-factor solution emerged from a principal-components analysis utilizing a varimax rotation. The factors of inability to identify and report feelings, an analytic cognitive style, and paucity of fantasy life were independent and internally reliable. These data are reviewed in the context of previous research and offer three subscales for future investigations utilizing the Toronto Alexithymia Scale.
Fifty-six mildly depressed psychiatric outpatients were evaluated for alexithymia measured by the Toronto Alexithymia Scale. Each subject also completed a Defensive Style Questionnaire that assessed the maturity of their ego defenses. Alexithymia was strongly associated with immature ego defenses, but not with depression. The data suggests that alexithymia and such primitive defensive operations are separate phenomena. These findings empirically support earlier observations regarding the nature of alexithymia.
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Utilizing a systematic methodology (The Consultation-Liaison Outcome Evaluation System), the compliance of nonpsychiatric consultations within a general hospital psychiatric unit staffed by private practitioners was assessed. Thirty-one percent of the patients received such consultations and these patients had a longer length of stay than those without a consultation. Psychiatrists were generally compliant with both medication and diagnostic recommendations; but in only half the discharge summaries was the consultant's primary medical diagnosis fully reflected. The implications of these data are discussed.
Nonpsychiatric consultations to a general hospital psychiatric unit were investigated for concordance with diagnostic testing advice, drug recommendations, and representation of the medical diagnoses in the discharge summary. Those patients who received consultations were older and had less social support but did not have more severe medical illnesses. The level of concordance with medical consultants' recommendations was far greater than previous reports of psychiatric consultants' advice to nonpsychiatric colleagues.
Nonpsychiatrist physicians were surveyed regarding problems that they had experienced when seeking a psychiatric consultation or treatment referral. They gave three main reasons for not referring more patients to psychiatrists: a belief that other mental health professionals could do as well at less cost, that psychiatrists were less available to discuss patients, and that greater stigma was attached to seeing a psychiatrist than seeing other mental health professionals. Psychiatrists might improve their consultation and referral networks by addressing the misperceptions of their nonpsychiatrist physician colleagues.
In order to determine the needs and goals of substance abuse teaching, vis-à-vis child psychiatry training, a questionnaire was sent to the training directors at every child psychiatry program accredited by the Accreditation Council of Graduate Medical Examination. The results demonstrated that most child psychiatry programs schedule at least some didactic time specifically for substance abuse topics. However, only 59% of the training directors felt that their fellows were adequately educated to identify and at least initially manage a drug abusing adolescent.