Biomedical subjects
Publications and source records attributed to R A Pierloot.
A group of 30 black African patients and a group of 30 occidental patients, all presenting a hysterical structure, were compared with regard to clinical manifestations, provoking psychosocial stressors and histrionic personality traits. Cultural characteristics in several areas are discussed as possible explanations of the differences found.
In the last years the doctor-patient relationship has been the subject of many studies. However, the framework in which this relationship is approached is not always specified. The doctor-patient relationship is a specific form of interpersonal relationship. But this does not exclude that different models, formulated in the approach to interpersonal relationships in general, can also be applied to the doctor-patient relationship: the communication model, the socio-cultural model, the model of medical transference and the model of human encounter. According to a given model, specific expectations of patient and doctor emerge and their interaction processes are formulated in specific concepts. The choice of a given model should be determined by the characteristics of a given medical situation and/or the objectives pursued.
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Despite some resistances from the nursing personnel, the patients and their relatives, we have realized in the period from 1968 to 1977 the transferral of 78 patients into the family care at Geel. A brief survey of the selection criteria and the composition of this group is presented. The outcome is analysed with regard to a number of parameters: stability of the family placing, symptoms or behaviour abnormalities, subjective attitude of the patient, interactions wih foster family and other persons, occupational activities, distraction, contacts with the own family. Of the total group, 56 patients are considered as relatively well integrated in the foster family setting. For a large majority of those patients, their social functioning seems enriched and more differentiated.
Psychogenesis, considered as a linear sequential process by which psychological influences lead to somatic disturbances, is only a link in a larger bio-psycho-social interactional field. Therefore, in practice, a multilateral approach of the whole person, in his psychological, social and somatic aspects, in health and disease, in his habitual and his therapeutical contacts, should be stressed. it seems unlikely that the somatic symptoms we are confronted with can be considered as pure psychogenetically determined phenomena. This does not exclude that in the complex psychosomatic interaction, there exists at one or more stages a transition from the sphere of psychological functioning to the somatic area, ending up in somatic symptoms. This process, which we call psychogenesis, is not a single event but should be considered as an abstraction, grouping a number of component processes possibly occurring at different moments in the total system. We have distinguished four components: a psychopathological component, a psychophysiological component, a phychophysiological component, a physiopathological component and a 'somatic illness experience' component. For each of these components, a number of conceptions are proposed according to the different theoretical models of psychosomatic connections. Most of these formulations are largely hypothetical or based only on fragmentary observations. Still, they offer guidelines for further research.
The estimation of body dimensions in a group of 31 patients with anorexia nervosa and a control group of 20 psychoneurotic females has been studied with different techniques, including a visual size estimation apparatus and the marking of indicated body points on a paper attached to the wall. The results confirm the previously described tendency by patients with anorexia nervosa to overestimate body size in the stage before their treatment in hospital. Various differences between the two groups were found and the anorexic patients were more inconsistent in the estimation of the different body measures. On the basis of correlations with the results of an internal-external control questionnaire, it is suggested that overestimation and variability in visual size estimation could be promoted by an orientation towards external control.
According to several follow-up studies in the literature, anorexia nervosa has to be considered as an affection with a grave prognosis. We have studied the outcome in a group of 32 female patients who could be considered as homogeneous in a number of aspects. The following five criteria, on which the delineation of the syndrome is based, were realized in all the patients: considerable weight loss; limited food intake; amenorrhea; juvenile age of onset; absence of primary organic or specific psychotic disorder. All of them presented a serious symptomatology and had undergone some previous treatment under the form of ambulatory psychotherapy and/or forced feeding. They all received, during their admission in the same hospital, the same form of combined intensive medical and psychotherapeutic treatment. All of them maintained regular psychotherapeutic contacts with the same psychiatrist. According to the outcome, the patients could be categorized into three groups: the cured, the improved, the unimproved. In order to circumscribe some prognostic elements, we have compared a number of clinical, family and personality variables in these groups. As favorable clinical factors can be mentioned: younger age at admission and shorter duration of the illness. Manifestations of impulsive behavior (automutilation, kleptomania, fugues, etc. ...) and sucide attempts are unfavorable. No definite family factors can be defined, although the absence of psychological interaction with the father seems to be unfavorable. A better prognostic outcome is offered by the following personality characteristics, determined by psychological testing: lower neuroticism and higher self-defensiveness on the ABV; a lower general profile and especially a lower score on the schizophrenia scale of the MMPI; less pronounced tendencies to infantile regression, passivity and sexual repression as these are expressed in the TAT.
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Three issues relating to the treatment of psychosomatic disorders by the general practitioner are discussed: 1) the characteristics of the therapeutic relationship in general practice, with more spontaneous intimacy and greater continuity, which often enable the physician to treat psychosomatic disorders more effectively than specialists, 2) the challenging task for the general practitioner of distinguishing a psychosomatic disorder, and 3) the special treatment forms available to the general practitioner in approaching the patient with a psychosomatic disorder.
Clinical descriptions of affective expression and fantasy life in anorexia nervosa patients suggest that they could be considered as alexithymic; weight restoration could improve these feature. Using some Rorschach indices and the MMPI subscale of Kleiger and Kinsman as standards of alexithymia, we studied a group of 35 anorexia nervosa patients at low and restored weight and a control group of 35 neurotic patients. The results on the Rorschach indices indicate that the anorexia nervosa group is not more alexithymic than the control group and that weight restoration does not influence the phenomenon. The findings with regard to the MMPI alexithymia subscale do not permit clear conclusions; they confirm the doubts, expressed by some authors, about the value of this scale in the measurement of alexithymia.
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