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A randomised controlled trial of breast cancer genetics services in South East Scotland: psychological impact.

This study compared the psychological impact of two models of breast cancer genetics services in South East Scotland. One hundred and seventy general practices were randomised to refer patients to the existing standard regional service or the novel community-based service. Participants completed postal questionnaires at baseline (n=373), 4 weeks (n=276) and 6 months (n=263) to assess perceived risk of breast cancer, subjective and objective understanding of genetics and screening issues, general psychological distress, cancer worry and health behaviours. For participants in both arms of the trial, there were improvements in subjective and objective understanding up to 4 weeks which were generally sustained up to 6 months. However, improvements in subjective understanding for the women at low risk of breast cancer (i.e. not at significantly increased risk) in the standard service arm did not reach statistical significance. Cancer worry was significantly reduced at 6 months for participants in both arms of the trial. The two models of cancer genetics services tested were generally comparable in terms of the participants' psychological outcomes. Therefore, decisions regarding the implementation of the novel community-based service should be based on the resources required and client satisfaction with the service.

Adolescent↗

Health related quality of life and psychological outcome in patients treated for craniopharyngioma in childhood.

UNLABELLED: Patients with craniopharyngioma are at risk for many adverse effects related to the tumour's invasive behaviour and its proximity to many vital structures. Profound psychosocial problems, memory impairment, pituitary and hypothalamic dysfunction in addition to the physical handicap of visual loss are frequently recognized sequelae of craniopharyngioma treatment. OBJECTIVES: To examine health related quality of life (QoL) and psychological outcomes of patients treated for craniopharyngioma at the Royal Children's Hospital, Melbourne, between January 1980 and September 2003. PATIENTS: Seven (17.4%) of 46 (26 male) had died. Thirty-nine remained, of whom 30 were contactable. Eighteen of 30 (8 male), mean age 21.2 +/- 6.7 years, agreed to evaluation, of whom 16/18 (88.9%) had three or more pituitary hormone deficiencies, 11/18 had visual impairment and 9/18 obesity. MEASUREMENTS: The Adult GH-Deficient Assessment (AGHDA) and Psychological General Well-Being (PGWB) questionnaires were employed to assess quality of life in patients and age- and sex-matched healthy controls. Additional psychological assessment, including intellectual and academic skills, emotional function, and adaptive behaviour, had been undertaken in 12 patients at a previous time. RESULTS: High levels of physical morbidity and psychological disability were described. The General Health score of patients was significantly worse than for controls on PGWB (p = 0.025), anxiety was higher in those who had surgery alone (p = 0.008) and subjective QoL associated with GHD using AGHDA was lower (p = 0.006). Few craniopharyngioma survivors (18/30) were available for evaluation, demonstrating difficulties in attempts to assess this complex group. The discrepancy between results of objective and subjective measures of QoL is discussed in terms of adaptation to illness, disabilities and changed perception of life fulfilment. CONCLUSIONS: Craniopharyngioma and its treatment result in significant, complex medical, social, psychological and emotional difficulties. The degree of global disability is not reflected in subjective QoL reports for this group, highlighting the need for careful selection of assessment instruments.

Activities of Daily Living↗

Cognitive psychology and mental handicap.

The psychology of mental handicap has been influenced by two traditions in general psychology, pychometric measurement following Binet and experimental psychology first initiated by Wundt. The weakness of the former is its lack of explanatory power and, of the latter, its lack of sound alignment with the neuropathology of mental handicap. A closer association of experimental psychology and neuropathology might help us to reframe our concepts of intelligence, cognitive functions and their handicaps.

Education of Persons with Intellectual Disabilitie↗

STIMULUS GENERALIZATION ALONG A LIGHT FLICKER RATE CONTINUUM AFTER DISCRIMINATION TRAINING WITH SEVERAL S-'S.

Four pigeons were trained with VI reinforcement to peck a key which was briefly illuminated by a flickering light. Generalization gradients were then obtained with nine different rates of flicker, four faster than S+ and four slower. Two birds were then trained to discriminate between S+ and the fastest stimulus (S-). These birds were then trained to discriminate between S+ and the two fastest stimuli, alternated as S-'s. This procedure was continued, adding one new S- at a time, until all four stimuli faster than S+ were S-'s. The remaining two birds were trained on this latter discrimination without intervening training. In a final stage, using the first two birds, the slowest stimulus was added as a fifth S-. Generalization gradients in extinction were obtained from each bird after each stage of training. As more stimuli from one end of the continuum served as S-'s, responding increased in the presence of stimuli from the other end of the continuum, and the gradient tended to become flattened at this end.

Animals↗

The role of body image in sexually avoidant behavior.

"Spectatoring" refers to a cognitive self-absorption, wherein individuals fixate on and carefully monitor personal body parts and/or the adequacy of personal sexual functioning. To examine this process within a university population, undergraduate and graduate students (108 male and 140 female) filled out questionnaires that assessed body image, sexual knowledge, global sexual attitudes (i.e., liberal-conservative), general psychological adjustment, and frequency of sexual behaviors. Multiple regression analyses were used to determine if spectatoring, operationalized by measures of body image, would significantly predict sexually avoidant behavior. Results indicated that body image scores significantly predicted frequency of sexual behaviors for both genders, while general sexual knowledge and psychological adjustment did not predict sexual behavior. Overall, sexual attitude scores were the best predictors of sexual approach/avoidance behaviors for both genders. Implications are drawn for future research using the assessment of more global sex attitudes in the study of spectatoring.

Adaptation, Psychological↗

Social class and psychological ill-health during unemployment.

This study explores psychological health and the experience of being unemployed for between 6 and 11 months in two social class groups: unskilled and semi-skilled workers v. white-collar, managerial and professional workers. The respondents were British married men aged between 25 and 39. Information was obtained through interviews about financial and other problems, perceived threats associated with unemployment, anxiety, depression, general psychological distress and ratings of general health. It was expected that the working-class sample would exhibit poorer psychological health than the middle-class, but this was not confirmed. Medium-term unemployment appeared to have a homogenizing effect, with similarly poor health in both social class samples, although working-class respondents reported significantly greater financial problems and difficulties in filling the time.

Adult↗

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery.

No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent idiopathic scoliosis. A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment group (ST), n=156; 145 females and 11 males] or with a brace [brace treatment group (BT), n=127; 122 females and 5 males] were followed at least 20 years after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination including radiography and clinical examination. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly, reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine percent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back [P<0.001 ST vs controls, P=0.0010 BT vs controls, and n.s. (P=0.024) ST vs BT], mostly due to difficulties with physical participation in activities or self-consciousness about appearance. Pain was a minor reason for limitation. No correlation was found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.

Adolescent↗

The psychological profiles of patients with whiplash-associated headache.

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.

Case-Control Studies↗

A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy.

BACKGROUND: To evaluate changes in psychological well-being and sexuality 1 year after laparoscopic and abdominal hysterectomy. MATERIAL AND METHODS: Seventy-four women scheduled for abdominal hysterectomy due to benign disorders and assessed as not suitable for vaginal hysterectomy were randomized to abdominal hysterectomy (n = 38) or laparoscopic hysterectomy (n = 36). The Psychological General Well-Being (PGWB) Index was used to evaluate changes in psychological well-being and the McCoy scale was used to evaluate changes in sexuality. The differences in outcome before and 1 year after the hysterectomy were calculated for each individual and the changes were compared within and between the two patient groups. RESULTS: There were no significant differences between the two patient groups with respect to changes in psychological well-being and sexuality 1 year after surgery. CONCLUSIONS: This study implies that psychological well-being and sexuality after hysterectomy are not influenced by surgical technique.

Adaptation, Psychological↗

Providing psychological treatments in general practice: how will it work?

Provision of "Focussed Psychological Strategies" by general practitioners is one component of the recent Better Outcomes in Mental Health Care (BOiMHC) initiative. The BOiMHC initiative requires GPs to undertake minimum training requirements before they may provide services under the new Medicare Benefits Schedule item number. We argue that GPs need further training and ongoing clinical interaction with mental health specialists (beyond the minimum training requirements) for refinement of psychological skills. Research focusing on GP training and how GPs interact with specialist services in the provision of psychological treatments is urgently required.

Australia↗

Psychological interventions in general hospitals: background, current status and clinical guidelines.

PURPOSE: To promote the systematic development, interests, practice, research and clinical applications of health psychology in general hospitals in Hong Kong and the mainland of China. DATA SOURCES: The targets and aims of therapeutic work with patients in pain, cancer patients, child and adolescent patients, patients with chronic illnesses, the elderly, and patients requiring organ transplantation are highlighted. STUDY SELECTION: The psychological interventions described are experiences derived from routine clinical services carried out in the Clinical Health Psychology Unit where the authors are affiliated, and can be seen as an example of a more comprehensive psychological intervention program for physically ill patients in Hong Kong. RESULTS: Psychological interventions have intrinsic values in reducing patients' distress and sufferings. The services are also an integral part of modem day comprehensive patient care with positive effects on treatment effectiveness and eventual illness outcome. CONCLUSIONS: Physical illnesses affect a person physically as well as psychologically. Psychological care in general hospitals is cost effective and beneficial in reducing undue psychological complications precipitated by physical afflictions as well as in promoting better overall outcomes.

Chronic Disease↗

[Acupuncture against climacteric disorders? Lower number of symptoms after menopause].

Vasomotor symptoms are very common among perimenopausal women, but also among orchidectomized men. The cause of the symptoms is not the low steroid concentrations per se, but probably changes in central neuropeptide activity. Twenty-four healthy women with natural menopause, suffering from hot flushes, were included in the study and randomly assigned to either of two groups, one group received treatment with electrostimulated acupuncture (EA), the other with superficial needle position (SNP) acupuncture. Treatment was given for totally of eight weeks, twice a week during the first two weeks, and then once a week for the remaining six weeks. As recorded in logbooks kept by the participants, the frequency of flushes decreased significantly by more than 50 per cent in both groups, and remained decreased in the EA group, whereas in the SNP group it increased slightly again over the three months after treatment. Values for the Kupperman Index decreased in both groups during treatment, changes still evident at three-month follow-up, whereas the self-rated general climacteric symptoms (VAS) decreased significantly in the EA group only. The PGWB (Psychological General Well-Being) index did not change significantly in either group during treatment.

Acupuncture Therapy↗

Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors.

OBJECTIVES: Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy. METHODS: Forty-three patients with ulcerative colitis (UC) and 40 with Crohn's disease (CD), who had been in remission for at least 1 yr according to laboratory parameters and clinical and endoscopical appearance, were included. These patients completed four different self-administered questionnaires, evaluating GI symptoms, anxiety, depression, and psychological general well-being. The two patient groups were compared with the general population, and within-group comparisons in psychometric scores were made between patients with and without IBS-like symptoms. RESULTS: The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients. CONCLUSION: The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.

Adaptation, Psychological↗

Evaluation of a Web-based introductory psychology course: II. Contingency management to increase use of on-line study aids.

In a Web-based general psychology course, students were observed to postpone use of on-line study aids until 2 days prior to examinations, thus negating any influence of advance organizers (Taraban, Maki, & Rynearson, 1999). We attempted to modify this behavior by providing course credit in the form of short quizzes as rewards for using on-line study aids to preview each chapter. Some students received quizzes after previewing frequently asked questions (FAQ); other students received quizzes after previewing chapter outlines. Students who received quizzes for previewing FAQ pages accessed those pages more frequently than did students who received quizzes for previewing outline pages. Increased access to FAQs was associated with higher scores on FAQ-related midterm examination questions. However, the advantage on examination items was not apparent on a cumulative final examination. Navigational structures and reward values need to be considered when one is managing contingencies in Web courses.

Analysis of Variance↗

Mental wellbeing and quality of sexual life in women with primary Sjögren's syndrome are related to circulating dehydroepiandrosterone sulphate.

OBJECTIVES: To evaluate the possible effect of androgen status on sexuality and mental wellbeing in patients with primary Sjögren's syndrome (pSS). METHODS: Serum levels of dehydroepiandrosterone sulphate (DHEA-S), testosterone (T), androstenedione, sex hormone binding globulin (SHBG), and the SHBG/T ratio were measured in 21 women with pSS. Sexual life was assessed by a Swedish version of the McCoy scale, which covers sexual experience and responsiveness during the past 30 days. A standardised questionnaire, the Psychological General Well-Being Index (PGWB), was used to examine quality of life and psychological symptoms in patients with pSS. RESULTS: Positive correlations were found between DHEA-S serum levels and the total McCoy score (r(s)=0.62; p<0.01), as well as the subscales of this score reflecting arousal (0.59; p<0.05), desire (r(s)=0.52; p<0.05), and satisfaction (r(s)=0.66; p<0.01). Serum DHEA-S concentrations were also related to the total PGWB score (r(s)=0.60; p<0.01) and subscales of this score: depression (r(s)=0.62; p<0.01), wellbeing (r(s)=0.64; p<0.01), general health (r(s)=0.67; p<0.01), and self control (r(s)=0.67; p<0.01). Total McCoy and PGWB scores and their subscales were not related to the serum levels of testosterone and androstenedione or the T/SHBG ratio. CONCLUSIONS: Circulating levels of the weak androgen DHEA-S are positively related to the quality of sexual life and mental wellbeing in women with pSS.

Adult↗

Psychological assessment in general orthopaedic practice.

The importance of psychologic distress and illness behavior is well recognized in low-back pain but has rarely been studied in other orthopedic conditions. Psychologic and clinical assessment of 100 patients undergoing elective surgery for minor leg conditions or joint replacement for osteoarthritis or rheumatoid arthritis showed surprisingly little psychologic distress or illness behavior, particularly when compared with 235 patients with low-back pain. The most striking finding was that in low-back pain there was a close relation between psychologic disturbance and failed surgery, but the nonspinal patients showed a complete absence of such a relation. This type of psychologic assessment is neither necessary nor helpful in the routine management of most clearly defined, nonspinal, correctly managed orthopedic conditions.

Adult↗