Biomedical subjects
Publications and source records attributed to L Valach.
General practitioners were trained in the recognition and treatment of suicide risk either by written text alone or combined with a seminar meeting. They filled in questionnaires before and after training. In the seminar group, knowledge and attitudes changed significantly, while those doctors receiving written material only had similar results to those without training.
Psychiatrists who recently finished their postgraduate training filled in a questionnaire about their training experiences. Two thirds considered the training as generally insufficient although many gave high ratings when asked about the quality of their clinical experiences and the acquisition of skills. It appears that the main areas for possible improvement of the training should concern knowledge and practical experiences with disorders which are typical for psychiatric out-patients.
A questionnaire filled in by psychiatrists shortly after the end of their postgraduate training showed that the majority invested a considerable amount of time and money for a psychotherapy training on private initiative. Three quarters had a training analysis. About 70% felt that their private training efforts had been more important than the official psychotherapy training in the institutions. Psychiatrists working in institutions tended towards a more positive rating of the official postgraduate training.
A questionnaire was sent to general practitioners in order to evaluate their knowledge and attitudes about suicide and suicide prevention. Our hypothesis was that many physicians do not sufficiently recognize the medical dimension of this problem and that their knowledge is insufficient. The results show that the physicians are generally well aware of the medical dimension and thus of their potential role in the prevention of suicide. However, they do not feel competent in managing suicidal patients, and we found serious gaps in their knowledge. Most physicians showed interest in further training. In view of these results as well as the frequency of suicidal behaviour it appears clearly necessary to give more weight to the teaching of knowledge and skills of suicide prevention in medical schools.
58 patients with whiplash injury of the cervical spine underwent formal testing with respect to self-rated cognitive impairment and processing of visual and auditory information. The results indicated disturbances in divided attention for auditory information, particularly in patients with so-called cervicoencephalic syndrome. Impaired attentional control was assumed to be relevant to processes of the working memory.
The main goal of part B of the National Research Program No 26 is to investigate the process leading to chronic low back pain. Starting from epidemiological facts the main risk factors are described from a systemic viewpoint. The rapid increase of disabling low back pain in the past decades makes it clear that factors outside the spine have to be made responsible for this process. There are changes in life-style and interpersonal relations, as well as in society and the health-care system. From these factors means of prevention are derived. Besides psychological factors general fitness and the training condition of the back muscles play an important role in effective prevention.
To evaluate the frequently attributed psychogenic origin of symptoms following "whiplash" injury, 66 patients who had suffered such an injury underwent clinical and psychometric examination. Data were collected on subjective symptoms and their possible psychogenic origin and psychopathology. Personality profile, subjective well-being and cognitive impairment were evaluated. The amount of long-lasting psychopathological alterations was comparatively small. The results do not support the notion of a psychogenic origin for symptoms after "whiplash" injury; personality traits and psychopathology do not explain the nature of the complaints.
Records of 575 patients operated on for the first time for lumbar disc herniation have been reviewed. Four to 17 years after the operation 371 (65%) patients answered a questionnaire on number of reoperations, working capacity, lumbar or sciatic pain as well as necessity of treatment. Of these, 255 (70%) still complained of back pain, and 83 (23%) of this group complained of constant heavy pain; 172 patients (45%) have a residual sciatica; 131 (35%) are still under some kind of treatment; 47 (14%) patients are receiving a disability pension. Repeat operations were performed in 17%. Based on the criteria given by Spine Update 1984 as related to justified or unjustified indication there was no statistical difference in long-term results concerning the above-mentioned criteria of success. The so-called justified indication for disc herniation neurosurgery does not necessarily imply a good long-term result. In the preoperative investigation, not only symptoms and neurological signs, but also the socially and personally defined career of the illness are of importance. The patients with complaints, mainly those receiving a pension, are psychologically conspicuous and show more psychopathological features as monitored by MMPI than the patients without complaints after surgery. Psychological assessment should increasingly be used in the preoperative evaluation, especially in patients who do not present an absolute indication for neurosurgical intervention.
We propose that the operated patients without complaints, patients with complaints and pensioned patients with complaints differ in their psychosocial situation. Thus, the first group show the best and the third the worst psychosocial condition. A sample of 135 patients after disc surgery was chosen at random from the patient population (n = 435) responding to a questionnaire. The patients were divided into three groups: no pain (n = 51), pain, no pension (n = 40), pain and a disability pension (n = 44). All have attended a psychosocial screening. They filled in the MMPI and were interviewed on some aspects of their social life, and reported on the coping modes they used in order to subdue their low-back complaints before or after the operation. Independent from the preoperative low-back pain condition and the immediate postoperative results, the operated patients showed, several years after the operation, traceable differences in several psychosocial factors according to the socially and personally defined illness career and its stages. The difference is particularly strong between the patients without complaints and the pensioned patients. The patients with complaints, mainly those receiving a pension, showed more psychopathological features as monitored on MMPI than the patients without complaints. They also reported substantially less satisfactory occupational, family and social life than the patients considered to be complaint-free. Finally, they also differed in their modes of coping with their back problems.
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In a prospective longitudinal study over several years, 58 patients with breast cancer are compared to 52 patients with fibrocystic disease and 24 patients with mastodynia. Results of coping (as assessed with the Bernese Coping Modes) are presented for the illness course of the first 6 months: (1) There is considerable variation of coping depending on illness situation and illness state. A core group of coping modes is predominant in most situations: 'attention & care', 'problem analysis', and 'Tackling'. In average 10 different coping modes were used by patients per given illness situation. (2) The different aspects of illness (in the same organ) ask for different coping. In the initial evaluation phase, however, the possibly fatal diagnosis overrides these differences. (3) Change over time (first 6 months) is net. Besides the core group of coping modes mentioned above, there is more variability in coping; in cancer a trend from a more fighting to a more accepting attitude is obvious; in fibrocystic disease more restricted coping is observed. Interdependence of coping with emotional stability and social adaptation will be studied as well.
The post traumatic evaluation of patients after soft tissue injuries of cervical spine is not clear. As objective criteria of the injury are often absent, the judgement in the medical expertise is difficult. 1100 medical records as a representative sample of 11,000 patients with cervical spine injury recorded at the Swiss National Insurance Company during the years 1978-81 were analysed. 320 records were evaluated in detail. Those injured received a questionnaire about their present psychosocial situation, complaints, necessity of treatment and financial compensation. 207 or 65% returned the filled out questionnaire. X-rays verified that 12.6% of all injured had fractures or luxation of the cervical spine, 4.2% of all patients showed fracture combined with spinal cord lesion. In 87.4% only soft tissue injury was described. About the half of the accidents were road accidents, the other half occurred during sport, work etc. 30% of the patients with fracture are receiving financial compensation as a result of working disability, 70% of them are still, i.e. 4-7 years after injury, under medical care. Only 1% of the injured patients without fracture are receiving a financial compensation, while 25% of them do need treatment for their symptoms caused by the accident. The therapeutical procedures range from application of Myotonolytics, pain killers, Infiltrations to Physiotherapy and Manipulation. Almost all of those 25% injured are not in agreement with the decision of the insurance company based upon the medical expertise. 12% of all injured developed, after the accident, psychological symptoms, such as decreased concentration, vitality or productivity, melancholy etc. The discrepancy between the judgement of the insurance company based upon the medical records and the patients complaints also 4-7 years after injury as well as the diversification of therapeutical procedures used in the long term patients career are indicating a necessity of prospective study on cervical spine injury.
This explorative study compared the patients', doctors', and nurses' views regarding their attribution of reasons for attempting suicide and the patients' emotional state immediately preceding their suicide attempts. A sample of 30 out of 94 consecutive patients seen in the emergency room of University Hospital were examined shortly after they had attempted suicide. Immediately after the routine clinical interview, conducted by a psychiatric resident and a nurse, patients filled in a questionnaire giving 14 possible reasons for attempting suicide as well as 8 feelings characterizing the emotional state preceding the suicide attempt. In the meantime, and without prior discussion of the case, the resident and the nurse independently completed the same questionnaire. In addition, sociodemographic and clinical data were obtained. Intrapersonal reasons such as to get relief from a terrible state of mind or from an unbearable situation were most frequently chosen by patients, nurses, and doctors alike. The most striking difference was found for "loss of control": this item was chosen significantly more often by patients than by nurses and doctors. Accordingly, patients reported significantly more often feelings of anxiety/panic and emptiness (mental vacuum), whereas feelings of despair and powerlessness/hopelessness were mentioned most frequently by nurses and doctors. Mental health professionals should bear in mind that many suicide attempters experience feelings of anxiety/panic prior to their suicidal act, and that a majority report having lost control over themselves, thus indicating a state of emotional crisis.
OBJECTIVES: This study examined the relationship between coping and psychosocial adaptation in cancer patients over time and across distinct clinical events. METHODS: In a prospective longitudinal study 74 patients with breast cancer were observed for 3 to 5 years at 3- to 6-month intervals. A total of 684 interviews were conducted at different observation points. Three rating scales were used to assess coping and adjustment: first, the Bernese Coping Modes, an observer rating scale devised to elicit 26 coping modes aggregated in this paper as the five Basic Coping Strategies of support, self-control, denial, diverting, and negative-emotional; second, an observer rating scale to ascertain psychosocial adaptation; and third, a self-rating scale as a measure of either emotional distress or well-being. RESULTS: a) When aggregated in illness stages, coping and distress data on the observed clinical time points showed greater variability than time measures alone (analysis of variance (ANOVA) for repeated measures p < .001). b) A significant relationship between the Basic Coping Strategies and psychosocial adaptation was demonstrated using discriminant and correlational analysis. Furthermore, in stage-dependent Pearson r correlations (p < .05 to .001), a clear-cut relationship was found for hospitalization, chemotherapy, and rehabilitation, but not for convalescence and metastasis. c) A positive relationship was demonstrated between psychosocial adaptation and strategies that can be generally categorized as good forms of coping such as support and self-control, and, to a lesser degree, diverting and denial. Conversely, poor coping exerted a negative effect on almost all illness stages and on most criteria of adjustment. CONCLUSIONS: In long-term studies on psychosocial adaptation and coping, stage-related measures should be preferred to time measures alone. The implications of different strategies for the psychological treatment of cancer patients are discussed.