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Biomedical subjects

T M Laidlaw

Publications and source records attributed to T M Laidlaw.

At least 19 recordsLinked to original sources
PubMed2002

Personality testing and profiling for anaesthetic job recruitment: attitudes of anaesthetic specialists/consultants in New Zealand and Scotland.

Specialist/consultant anaesthetists based in New Zealand and Scotland were sent a reply paid postal questionnaire asking about their attitudes to personality testing and personality types in the recruitment process for registrars and specialists. The questionnaire consisted of nine Likert-style questions and 14 visual analogue questions. The overall response rate was 65% (523/808). The responses to all the questions were broadly similar in the two countries. Personality testing was deemed of use in recruiting trainees and specialists, with a slightly greater proportion considering personality traits more important than academic achievement. An overwhelming majority believed the presence of an adverse personality trait would influence an appointment process, but few believed that the personality makeup of anaesthetists influenced the way in which they react to stressful situations. A slight majority considered the interview process a poor predictor of personality. New Zealand anaesthetists rated independence, orderliness, compassion, empathy, reflectiveness and patience higher than did anaesthetists in Scotland. In contrast, anaesthetists in Scotland rated pragmatism, as opposed to perfection, as a more important characteristic than did the New Zealand specialists. Personality assessment, although not effective as the sole tool for candidate selection, may have a role in the process of anaesthetic job recruitment and warrants further investigation.

Anesthesiology↗
PubMed2001

Prevalence of psychiatric disorders in New Zealand prisons: a national study.

OBJECTIVE: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. METHOD: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview - Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. RESULTS: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive- compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. CONCLUSIONS: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.

Adult↗
PubMed1999

Aggressive acts and assaults in intimate relationships: towards an understanding of the literature.

Far more people in relationships are subjected to violent acts than those who receive injuries. The degree of damage sustained may not reflect the perpetrator's intent to deliberately harm a partner. Data documenting aggressive acts determines the population at risk and their prevention and early treatment requirements; whereas data focusing on harm and injury helps determine emergency medical and refuge services. Data from national crime surveys, police records, or clinical populations should not be generalized to the population at large. Even if men perpetrate the majority of serious partner attacks, addressing the issue of female violence will significantly reduce the overall level of domestic violence. Judicial, medical, and social services should take note that while male violence may be more problematic, violence is a relationship issue, not a male issue.

Adolescent↗
PubMed1999

The stress of caring for people with obsessive compulsive disorders.

This paper presents a survey of stress of key carers of 46 consecutive cases of chronic obsessive-compulsive disorders who were receiving combined drug and cognitive-behavioral therapy in an out-patient clinic. A reliable semi-structured interview was used to estimate the overall stresses in various aspects of life. The effects of the disorder were most commonly expressed by carers in their marital relationship and in home management. Twenty-eight percent were severely burdened by their carer role, and 35% were extremely distressed at the prospect of ongoing care provision. Caregivers require support, and may be considered to be consumers of mental health services themselves.

Adolescent↗
PubMed1999

Personality traits of anaesthetists and physicians: an evaluation using the Cloninger Temperament and Character Inventory (TCI-125).

The personality profiles of Specialist Anaesthetists, Trainee Anaesthetists and Specialist Physicians were examined using Cloninger's Temperament and Character Inventory. These were compared with validated Community Sample 'average values' and a historical Norwegian Physician sample. Completed forms were returned from 364 doctors (Specialist Anaesthetists 222, Trainee Anaesthetists 75, Physicians 67), an overall response rate of 71%. Specialist Anaesthetists were more Cooperative, Harm Avoidant and Self-Directed than the Community Sample but less Reward Dependent, Novelty Seeking and Persistent than the Community Sample. Physicians were more Cooperative than their Specialist Anaesthetist colleagues, but both more so than were the general population. Trainee anaesthetists appear to be more Novelty Seeking and Reward Dependent than the Specialist Anaesthetists, this factor being predominately age related. Extreme/Mild personality traits were identified in 33% of Specialists, 41% of Trainees and 33% of Physicians, whilst personality disorders were found at the expected rates (Specialist Anaesthetists 9%, Trainee Anaesthetists 10%, Physicians 2%). Personality assessment has implications for recruitment, crisis management and professional development within anaesthesia.

Adult↗
PubMed1999

The interrupt distraction procedure: a brief hypnotic intervention for belief change and diminishing distress.

The Interrupt Distraction Procedure (IDP) is a brief therapeutic technique for cognitive and emotional change. It is comprised of a hypnotic induction, several 20-sec iterations during which the person concentrates on distressing thoughts or imagery or a thought they would like to believe, as well as on a neutral distracting image. It is simple to administer for clinicians familiar with other hypnotic techniques. IDP is useful when a change in beliefs is desired by a client, but some internal process is preventing such a change, and it lessens concomitant distress. It appears to be a simple therapeutic intervention that decreases emotional reactions that accompany certain thoughts or imagery providing some alleviation of symptoms in somatoform, mood and anxiety disorders.

Adult↗
PubMed1998

Parents and other relatives accused of sexual abuse on the basis of recovered memories: a New Zealand family survey.

AIM: To survey New Zealand families where an alleged perpetrator and/or other family member denies an accusation involving the childhood molestation of one family member by another, based on a memory recovered in adulthood. As the validity of such memories is crucial, our aim was to develop a profile of such families and to compare it with New Zealand epidemiological data. METHOD: Information was collected by questionnaire regarding family demographics, characteristics of the accuser, family life, events surrounding and leading up to the accusations, consequences of the accusations and details of the accuser's current life situation. The 73 subjects included fathers, mothers, siblings and other relatives of the accusing adults. RESULTS: Most accusers were highly educated white women, frequently first born or older children from relatively large families, statistically different proportions from those expected. Many accusations involved events of low base-rate probability including satanic ritual abuse. Proportions differed from those of another New Zealand prevalence survey of 1019 18-year-olds in almost every way. CONCLUSION: The data suggest that it is unlikely that many, if not most, of the memories of child sexual abuse recovered in adulthood are a true reflection of history. Memories recovered during therapy should be treated with respect as part of the patient's narrative truth, but not assumed to be factually accurate without corroborative evidence.

Adult↗
PubMed1998

Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature.

Since tampon availability has become ubiquitous, several authors have opined about their effect on the virginal hymen, but only one paper has scientifically addressed the subject of tampon use and clefts in the hymens of never-sexually-active adolescent girls. It naturally has become an authority used by the courts. The Emans et al. (1994) study asserts that 'for physicians testifying in court about sexual assault cases, complete clefts in adolescents cannot be attributed to prior tampon use'. On closer inspection, however, it appears that the authors have interpreted their statistical finding using a strict scientific convention (chi 2, P = 0.06 as not having statistical significance) that may mislead in a clinical or legal situation. Indeed, there is a definite possibility that tampon use compared to not having used tampons in their never-sexually-active sample was associated with an increased percentage of complete hymenal clefts (14% vs. 6%; P = 0.06). Nevertheless, clefts were found in both the sexually active and the never-active groups: 20 of their 200 never-sexually-active subjects possessed complete hymenal clefts, as did only 84 of their 100 sexually active subjects. Caution should be used by all physicians asked to testify in courts regarding possible causes of a hymenal cleft.

Adolescent↗
PubMed1998

What is an 'intact' hymen? A critique of the literature.

The purpose of this study was to establish medico-legal guidelines based upon medical findings which support or refute allegations of sexual penetration, taking into account non-sexual explanations for positive physical findings. A review of the literature was undertaken to examine what has been determined about the range of usual findings which can be expected if the hymen has been penetrated. While a large body of literature is available on the topic, some findings are ambiguous, and further research is required to advance and clarify our knowledge base in these areas. In only a minority of non-acute cases can definitive statements be made as to whether an alleged molestation has occurred. A non-scarred hymen that will not admit a finger is 'intact'; a hymenal opening accommodating two fingers or a vaginal speculum, with evidence of a deficit or scarring at the lower pole, indicates past sexual or, possibly, non-sexual penetration. Other findings are not definitive and, at best, can estimate only relative probability of occurrence of penetration. Findings within the normal range should be presented as 'neither confirm nor deny abuse', not 'consistent with abuse'. Often, it is impossible to establish whether a hymen is 'intact' in regard to past sexual intercourse.

Adolescent↗
PubMed1998

Optimal treatment strategies to enhance recovery from schizophrenia.

OBJECTIVE: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. METHOD: A review of the literature on schizophrenia with particular emphasis in management considerations. RESULTS: Effective treatment components include psychoeducation, medication strategies, career-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms. CONCLUSIONS: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

Activities of Daily Living↗
PubMed1998

Early intervention for schizophrenic disorders. Implementing optimal treatment strategies in routine clinical services. OTP Collaborative Group.

BACKGROUND: Early detection and intervention in schizophrenic disorders is an important challenge for psychiatry. METHOD: Review of literature on effective biomedical and psychosocial intervention strategies. RESULTS: Comprehensive programmes of drug and psychosocial interventions with adults who show early signs and symptoms of schizophrenic disorders may contribute to a lower incidence and prevalence of major episodes of schizophrenia. These programmes combine early detection of psychotic features by primary care services, with close liaison with mental health professionals. Long-term monitoring of signs of recurrence, with further intervention, appears essential to maintain these benefits. CONCLUSIONS: Field trials demonstrate that effective early treatment strategies can be routinely applied in clinical practice.

Adult↗
PubMed1997

Memory recovery and repression: what is the evidence?

Both the theory that traumatic childhood memories can be repressed, and the reliability of the techniques used to retrieve these memories are challenged in this paper. Questions are raised about the robustness of the theory and the literature that purports to provide scientific evidence for it. Evidence to this end is provided by the authors which surveyed New Zealand families in which one member had accused another (or others) of sexual abuse on the basis of recovered memories. It is shown that a number of these allegations involve very low probability events. Since memory repression theory is not currently scientifically substantiated it is argued that care needs to be taken in the mental health, legal and insurance compensation arenas. Memories recalled during therapy may be treated as metaphorical but, in the absence of corroborative evidence, should not be considered factually true. Clinicians who wish to use memory recovery techniques should inform patients of their experimental and controversial nature, point out adverse effects, and obtain consent before proceeding.

Child↗
PubMed1996

Early detection and intervention for initial episodes of schizophrenia.

Comprehensive programs of drug and psychosocial interventions with adults who show early signs and symptoms of schizophrenic disorders may contribute to a lower incidence and prevalence of florid episodes of schizophrenia. These programs combine (1) early detection of psychotic features by family practitioners and other primary care providers and (2) close liaison with mental health professionals well trained in psychiatric assessment and treatment strategies effective in reducing the prevalence of established cases of schizophrenia. Long-term monitoring for signs of recurrence of these subthreshold psychotic episodes, with further intervention as needed, appears essential to maintain these benefits.

Antipsychotic Agents↗
PubMed1994

The variability of type I hypersensitivity reactions: the importance of mood.

Immediate (Type I) hypersensitivity skin reactions to allergens or antigens have been used as immune measures that may be subject to intentional modulation. In preliminary experiments using hypnosis we encountered unacceptably large, uncontrollable variability. A method was subsequently devised in which serial, five-fold dilutions of allergen or histamine were administered to the subject's forearm and reactions were recorded photographically on slide film. Areas were determined by computer-assisted image analysis. Seven healthy volunteers were tested for eight sessions (testing included mood scales, blood pressure, pulse and skin temperature). Mean wheal size and titration gradient data from allergen reactions correlated strongly with the psychological factor of liveliness but not stress, although no manipulation of mood was involved. A stepwise regression analysis accounted for 61% of the variance of the allergen mean wheal data, and 31% was from the liveliness factor alone. Thus, the more lively the subject felt, the smaller was the allergic response.

Adult↗
PubMed1994

Immediate-type hypersensitivity reactions and hypnosis: problems in methodology.

Hypnosis has been used to ameliorate skin test reactivity in studies dating back to the 1930s. This study using modern methodology and statistical analyses sets out to test the hypothesis that it was possible to decrease reactions to histamine by hypnotic suggestion. Five subjects, all asthmatic and untrained in hypnosis, were given three hypnotic sessions where they were asked to control their reactions to histamine administered by the Pepys technique to forearm skin. These sessions were to be compared with three non-hypnotic sessions. The flare sizes but not wheal sizes were found to be significantly reduced after the hypnosis sessions, compared to sessions without hypnosis. Skin temperature was correlated with the size of reactions. The day upon which the sessions took place contributed significant amounts of the remaining unexplained variance, giving rise to questions about what could cause these day to day changes.

Adolescent↗
PubMed1993

Hypnosis and attention deficits after closed head injury.

In a controlled study of patients attending a concussion clinic because of ongoing postconcussion symptoms, attention deficits were recorded in the head-injured group for the aspects of alertness, assessed by the Continuous Performance Test (CPT), and processing capacity, assessed by a version of the Paced Auditory Serial Addition Test (PASAT). Selective attention was intact. Hypnotizability was assessed by the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), with normal means and standard deviations found in both the concussed and control groups. There was a significant correlation, however, between HGSHS:A scores and PASAT scores in the concussed group only. The results of this preliminary study suggest that slower processing capacity after a closed head injury may predict higher hypnotizability and that hypnosis could be an appropriate rehabilitation technique for these patients who present with postconcussion symptoms.

Adolescent↗