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Biomedical subjects

N B Kaltreider

Publications and source records attributed to N B Kaltreider.

14 recordsLinked to original sources
PubMed1990

The impact of a medical student's suicide.

The suicide of a medical classmate can have a profound effect upon the survivors. After the violent death of a third-year medical student at the University of California-San Francisco, the level of concern expressed in discussion groups suggested a need to study the impact in more detail. Interviews and scale data from 20 volunteer medical students identified a pattern of posttraumatic symptoms persisting over several months. The interviewees' tendency to identify with the victim was related to the prevalent experience of medical student depression. Specific suggestions are made both for immediate crisis management and for preventive intervention strategies within a medical school.

Adaptation, Psychological↗
PubMed1988

A controlled trial of brief psychotherapy and mutual-help group treatment of conjugal bereavement.

Sixty-one women who sought treatment for unresolved grief reactions 4 months to 3 years after the death of their husbands were randomly assigned to either brief dynamic psychotherapy with experienced clinicians or mutual-help group treatment led by nonclinicians. Women in both groups experienced a reduction in stress-specific and general symptoms as well as improvement in social and work functioning. Women in the brief psychotherapy group showed a greater decline in one measure of general symptoms, and there was greater attrition in the group treatment condition. When two subgroups who had completed the majority of sessions were compared, treatments were found to be equally effective.

Adaptation, Psychological↗
PubMed1986

Comprehensive analysis of change after brief dynamic psychotherapy.

This report provides data on symptom levels by using group means as well as categories of clinical relevance as they change over the course of treatment and also examines change "beyond symptoms" as levels of adaptive functioning. This approach allows a more comprehensive analysis of change in a series of patients with pathological grief reactions treated with brief dynamic psychotherapy. The different perspectives on outcome of the patient, the evaluating clinician, the treating clinician, and independent judges are compared. The findings from all perspectives indicate that major symptom relief occurred in the majority of patients, with less change in adaptive abilities.

Adaptation, Psychological↗
PubMed1985

A proposed method for measuring change beyond symptoms.

The initial report of the Patterns of Individual Change Scales battery presented the rationale, development, and conceptualization of this measurement package. Empirical data supported the reliability and validity of the scales as measures of patient characteristics that extended beyond the symptomatic domain. This article presents more extensive reliability and validity data. Ratings on two new samples were collected, and the interrater reliability coefficients for the scales were again of appreciable magnitude. Discriminant validity was examined, as was the factor structure of the battery. The results suggested that the scales tap three distinct sources of variance. Comparisons with symptom measures and case illustrations indicated that the measurement of changes in patients' functioning beyond symptoms is necessary and viable.

Adult↗
PubMed1984

Relationship testing after the loss of a parent.

In this study of adults presenting with symptoms of pathological grief after the death of a parent, there was a frequent pattern of strain on a current love relationship. The attempt to master negative views of the self, precipitated by loss of the parent, through reenactment with the significant other was prominent. Psychotherapy offered an opportunity to rework the feared representation of the self.

Adult↗
PubMed1983

Judging change in psychotherapy. Reliability of clinical formulations.

Careful clinical formulation describing the dimensions of core neurotic conflicts is integral to the practice of psychodynamic psychotherapy. Therefore, a method for reliable and valid formulation is a necessary precursor for the empirical investigation of the impact of such therapy. Our study evaluated a method of outcome assessment based on clinical formulations. Results from 18 patients indicate that independently derived formulations of a central conflict do not agree and that these disagreements in formulation are reflected in disagreements in the change ratings that are based on them. Additional analyses suggested that symptomatic change represents the major component in outcome rating.

Adjustment Disorders↗
PubMed1981

Patterns of individual change scales.

Measurement of complex modifications in personal functioning is a necessary step to the relevant translation of psychotherapy research into clinical practice. Using an assessment strategy aimed toward decreasing subjective bias, we pursued an inductive clinical approach in constructing the Patterns of Individual Change Scales (PICS) battery. Designed for use with a bereaved population, each of the 13 scales has a unitary focus and hierarchy of functional levels across the domains of symptoms, social relations, and self-concept. Nine experienced clinical judges rated the scales after viewing videotaped evaluation interviews of 18 patients and 18 field subject. In general, the PICS had a suitable range for our borderline through normal population, reached acceptable levels of reliability, and could discriminate among subjects in clinically meaningful ways. Future analyses will consider issues of bias, validity, and generalization.

Adult↗
PubMed1979

A field study of the stress response syndrome. Young women after hysterectomy.

The symptom pattern previously delineated as the stress response syndrome in a mental health setting was hypothesized to be useful in conceptualizing reactions to a traumatic event in a nonpsychiatric patient population. The experience of loss resulting from nonelective hysterectomy for benign disease in women of childbearing age was selected as a relevant field study model. Twenty-eight women were studied one year after hysterectomy, using extensive psychological interviewing by women clinicians and experiential rating scales. Twelve subjects had a mild stress response syndrome, and five subjects had a serious level of intrusive and avoidant symptoms. Increasing severity of response was associated with persisting child-wish, deterioration in sexual functioning, and change in self-concept. Women who did well postoperatively generally had no future wish for children and were actively committed to achievement outside of the home.

Adaptation, Psychological↗
PubMed1979

The impact of midtrimester abortion techniques on patients and staff.

We studied 250 midtrimester abortions by dilatation and extraction (D and E) under general anesthesia and compared them with abortions by the intra-amniotic injection of prostaglandin (amnio) in order to assess the physical and emotional changes experienced by patients and staff under the different circumstances represented by each procedure. We found patients undergoing D and E abortions had fewer physical complications and described the procedure as minor surgery which went smoothly. The patients who had amnio abortions had more pain and reacted with more anger and depression afterward. Nurses were more disturbed by amnio abortions in which they played major roles in supporting the patient as well as in her abortion. Physicians reported the D and E procedures to be emotionally difficult which may limit the adoption of this procedure despite its value to patients.

Abortion, Induced↗
PubMed1977

Childless by choice: a clinical study.

The authors report on a longitudinal study that involved the interviewing and testing of 33 young women volunteers who chose either contraception (N=18) or tubal ligation (N=15) to achieve infertility. They found that for these women the choice to be childless was multidetermined, persistent over time, and ego-syntonic. Comparison with other samples of women indicate that this is a distinct and nontraditional population.

Adult↗
PubMed1977

The response to stress.

The normal response to stress can be understood in terms of periods of outcry, denial, and intrusive thoughts leading to working-through to completion. The general physician who understands this pattern can assist the patient through the denial phase by encouraging ventilation and through the intrusive phase by providing structure, advice, and medication to temper the painful feelings. With such assistance, most patients can integrate the stress event into their lives, with the duration of response related to the severity of the stress. A year of stress response after the death of a loved one is common. Psychiatric referral is indicated if the stress response seems unduly prolonged, has lead to maladjustive reactions, is disproportionate to the actual loss, or threatens to overwhelm the person.

Adaptation, Psychological↗