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Influence of relatives on fatigue experienced by patients with facioscapulohumeral dystrophy, myotonic dystrophy and HMSN-I.

OBJECTIVES: Fatigue is a common symptom experienced by patients with various neuromuscular disorders. The purpose of this study was to assess the influence of relatives on fatigue experienced by patients with various neuromuscular disorders. METHODS: In total, 106 close relatives of patients with facioscapulohumeral dystrophy (FSHD), adult-onset myotonic dystrophy (MD), and hereditary motor and sensory neuropathy type I (HMSN), completed the Checklist Individual Strength for themselves, and how they thought their relatives filled in this questionnaire. We compared the agreement between the two. The reaction of the relative to the fatigue and to the neuromuscular disorder of the patient was assessed by the Family Response Questionnaire. Marital dissatisfaction was also measured. The influence of the relative's response to the patients' fatigue and the relatives' fatigue on the fatigue of the patient was tested in linear regression models. RESULTS: In all 3 patient groups, the responses of the relatives to fatigue and disease were characterized by sympathetic-empathic responses. Low agreement existed between relatives and MD patients (r = 0.26) over the patients' level of fatigue, but higher agreement was found between relatives and FSHD (r = 0.67) and HMSN (r = 0.73) patients. The spouses of MD patients reported less marital satisfaction. The sympathetic-empathic responses of the relatives of FSHD and HMSN patients, and in FSHD also the fatigue experienced by the relative, contributed significantly to higher levels of fatigue experienced by the patients. CONCLUSION: The sympathetic-empathic responses of close relatives to the fatigue of the patient were related to the higher levels of fatigue experienced by FSHD and HMSN patients, but not MD patients.

Adult↗

The actor-director and patient-therapist relationships: a process comparison.

The relationship between the actor and director, like that between the patient and psychotherapist, relies on intense emotional involvement. Both demand sensitivity, reciprocity, and a deep understanding of human behavior. Because dramatic action is created through continuous conflict between characters, actors must explore not only their actions, but also the reactions of those with whom they are in relationship. The process of therapy is equally interdependent. Through the relationship, therapists provide a context in which their patients can work through their conflicts. As in the rehearsal process, actions are explored in a supportive environment. This paper has presented a process comparison of the actor-director and patient-therapist relationships by proposing that both are art forms that rely on the skill of a trusted facilitator. Some of the techniques explored include: empathic attunement, emotional recall, transference, overcoming performance obstacles, improvisation, risk-taking, the pleasure principle, and creating a sense of family through new object relations. Like therapists, directors never forget that their work cannot be performed alone; it depends on interaction with the most delicate of phenomena: the human soul.

Communication↗

What can we learn from consumer studies and qualitative research in the treatment of eating disorders?

The aim of this paper is to review all qualitative research and questionnaire surveys with people who have experienced an eating disorder or received treatment for it. Studies were identified on PubMed and PsychInfo. Twenty-three studies were identified and key findings are reviewed. Support and understanding are critical aspects of treatment perceived as helpful. Empathic relationships, whether professional or non-professional, were reported as essential to recovery. Psychological interventions (counselling and therapy) are the most popular and perceived as the most helpful. Many patients report that "medical interventions" were unhelpful. Interventions which focus exclusively on weight are reported negatively and many studies identify the importance of addressing wider issues than food and weight in treatment.

Anorexia Nervosa↗

The initial encounter: what to do first?

The first interview presents dilemmas to the psychiatric practitioner. Is he or she to concentrate in objective-descriptive fashion, observing symptoms and signs, seeking the likely syndrome or disease concept? Is he or she to work associatively, toward unconscious themes as developed by the psychoanalytic schools? Would an existential approach be best, an attempt to understand the patient's life purposes and difficulties empathically? Alternatively, should the therapist grasp the patient's situation in interpersonal terms? The authors suggest that these decisions are less central than the need to establish a working relationship in order to continue the investigation or treatment and to uncover as much as possible of the relevant data, and that the newer schools of existential and interpersonal psychiatry offer the critical keys to achieving this.

Adult↗

Functional modularity of the medial prefrontal cortex: involvement in human empathy.

To investigate medial frontal lobe mediation of human empathy, the authors analyzed the activation areas in statistical parametric maps of 80 studies reporting neural correlates of empathic processing. The meta-analysis revealed 6 spatially distinct activation clusters in the medial part of the frontal lobe dorsal to the intercommissural plane. The most dorsal cluster coincided with the left supplementary motor area (SMA). Rostrally adjacent was a cluster that overlapped with the right pre-SMA. In addition, there were 3 left-hemispheric and 1 right-hemispheric clusters located at the border between the superior frontal and anterior cingulate gyrus. A broad spectrum of cognitive functions were associated with these clusters, including attention to one's own action, which was related to activations in the SMA, and valuation of other people's behavior and ethical categories, which was related to activations in the most rostroventral cluster. These data complement the consistent observation that lesions of the medial prefrontal cortex interfere with a patient's perception of own bodily state, emotional judgments, and spontaneous behavior. The results of the current meta-analysis suggest the medial prefrontal cortex mediates human empathy by virtue of a number of distinctive processing nodes. In this way, the authors' findings suggest differentiated aspects of self-control of behavior.

Brain Injuries↗

The relationship between nurses' limit-setting styles and anger in psychiatric inpatients.

OBJECTIVE: Violence by patients in psychiatric settings is frequently associated with the quality of staff-patient interactions. Impulsivity has been identified as a high risk factor for anger and aggression. This study was designed to test the influence of nurses' limit-setting styles on anger among psychiatric inpatients grouped by high or low levels of impulsivity. METHODS: Ninety-seven patients with various diagnoses and either high or low levels of impulsivity participated in role-play scenarios in which nurse actors played out six limit-setting styles, ranging from belittlement to explanations of rules to empathy linked with a presentation of an alternative course of action. Patients' level of anger in response to the acted scenario was assessed using the Spielberger State-Trait Anger Scale. RESULTS: Patients' level of anger was highest in response to unempathic limit-setting styles, moderate for explanations, and lowest for empathic styles. Impulsive subjects were more likely to respond with anger than nonimpulsive patients, regardless of the limit-setting style. CONCLUSIONS: Although many current intervention programs focus on reducing patients' anger after it occurs, the study results suggest that it may be possible to prevent some of patients' anger by improving nurses' limit-setting styles.

Acting Out↗

Purposive aspects of the erotic transference.

This paper illustrates the erotic transference of a male patient towards his female analyst and the pressures and resistances within the transference and counter-transference to act out sexually. The patient's desire to act out sexually is seen both as a form of repetition compulsion within the transference and, in its purposive aspect, as an expression of the patient's need to find a loving breast and an empathic father. The patient's confused sexual identity is seen as a narcissistic defence against the experience of unbeatable frustration in the pre-Oedipal stage. Through internalizing a new primal scene, the patient is able to separate from his past and to work through the Oedipus complex within the transference.

Acting Out↗

The relationship between moral reasoning, provictim attitudes, and interpersonal aggression among imprisoned young offenders.

This study examined the relationship between moral reasoning, provictim attitudes, and interpersonal aggression among imprisoned young offenders. The participants were 60 imprisoned male young offenders from a young offender institution or remand centre. Using the Direct and Indirect Prisoner Behaviour Checklist, the offenders were categorised as one of four groups: perpetrator, victim, perpetrator-victim, or not involved. Participants in the four groups were compared on measures of provictim attitudes and sociomoral reasoning. The results showed that the majority of the participants were involved in victimising behaviours, with 43.3% falling into the perpetrator-victim category. Victims had significantly more empathic attitudes toward victims than did those in the perpetrator-victim group. No significant differences were found among the four groups on the sociomoral reasoning measure, nor was there a significant correlation between sociomoral reasoning and provictim attitudes. The results are discussed in terms of previous research and their implications for practice.

Adolescent↗

The difficult patient: identification and response.

A group of "difficult" psychiatric outpatients in a university hospital system was identified and its distinguishing characteristics compared to a sample of other psychiatric outpatients not so labeled. "Difficult" patients were perceived to be significantly more demanding (p less than or equal to 0.005), dangerous, difficult to empathize with, manipulative and likely to polarize the staff. These patient were perceived differently by physician and nonphysican staff. An analysis revealed that a major source of "difficulty" appeared to be the structure of the treatment system rather than the patient. A corrective strategy was devised to test this hypothesis.

Adult↗

Empathy and narcissism in a sample of child abuse perpetrators and a comparison sample of foster parents.

OBJECTIVE: The purpose of this research was to study the personality variables of empathy and narcissism in a sample of child abuse perpetrators and a comparison sample of foster parents, conceptualized as nonabusive parents, in order to gain further understanding of perpetrators and to provide clues for intervention. METHOD: The sample consisted of two groups: physically and emotionally abusive parents (n=52) and foster parents (n=101). Participants responded to three instruments: the Interpersonal Reactivity Index (IRI), an instrument measuring individual differences in empathy, and two instruments measuring narcissism: the Narcissistic Personality Inventory (NPI) and the Hypersensitivity Narcissism Scale (HSNS). RESULTS: Statistically significant differences were found between the two groups on three of the four subscales of the IRI: perspective-taking, empathic concern, and personal distress. Based on the definition of these subscales, the abusive parents as compared to the foster parents were not able to take the perspective of another or see things from another's viewpoint, showed less warmth, compassion and concern for others, and experienced difficulty in tense interpersonal situations. Statistically significant differences were found for the two groups on three of the six subscales of the NPI: authority, exhibitionism, and superiority, and on the HSNS. The abusive parents demonstrated less self-confidence, a greater lack of impulse control and were more narcissistic than their foster parent counterparts. CONCLUSIONS: The results suggest that it is how the perpetrators experience aversive behavior in their children that may provoke them to physically and emotionally abuse their children. Their self-centeredness in addition to their deficiencies in empathy may cause them to experience their children's misbehavior as an affront to their authority. Implications for treatment are made from this conceptualization of parental abuse.

Adult↗

Construing action abstractly and blurring social distinctions: implications for perceiving homogeneity among, but also empathizing with and helping, others.

Most people's actions serve goals that, defined abstractly enough, are quite similar to one another. The authors thus proposed, and found, that construing action in abstract (vs. concrete) terms relates to perceiving greater similarity among persons both within and across different social groups (Studies 1-3). By fostering perspective taking, viewing action abstractly also related to empathizing with and expressing willingness to help nonstigmatized and stigmatized others (e.g., AIDS patients; Studies 3-5) and to donating money to help those in need (Study 6). These findings held when controlling for ideological, motivational, and broad personality variables. Abstract action construals, then, appear to blur social distinctions, fostering perspective taking and empathy on the one hand but also perceptions of group homogeneity on the other.

Adolescent↗

Psychosocial adjustment in preschool children with atopic eczema.

Atopic eczema is a chronic skin disorder that is most common in early childhood, an important stage in the child's social and emotional development. The psychiatric adjustment and mother-child attachment in 30 preschool children with severe atopic eczema was compared with 20 matched controls. Patients with eczema had a significant increase in behaviour symptoms, 7/30 (23%) v 1/20 (5%); with significant excess of dependency/clinginess, 15/30 (50%) v 2/20 (10%); fearfulness, 12/30 (40%) v 2/20 (10%); and sleep difficulty, 19/30 (63%) v 9/20 (45%), but there was no significant difference between the two groups in the security of attachments, 25/29 (86%) v 14/20 (70%). Significantly fewer mothers of children with atopic eczema were in outside employment, 8/29 (27%) v 13/20 (65%), or felt supported socially, 10/29 (34%) v 13/20 (65%). Significantly more of them, 9/30 (30%) v 1/20 (5%), felt particularly stressed in relation to their parenting and less efficient in their disciplining of the affected child. In spite of this and at variance with earlier reports in the literature, they did not display negative attitudes towards their child. On the contrary mothers had a positive empathic attitude towards the child, 7/14 (50%) v 2/16 (12%). Child behaviour problems, 7/14 (50%) v 2/16 (12%), and maternal distress, 12/14 (85%) v 5/16 (31%), were significantly more common in the more severely affected children. Minor behaviour problems and parenting distress are important features of severe atopic eczema in early childhood but atopic eczema does not lead to insecurity of the mother-child attachment.

Adaptation, Psychological↗

Human morality and temperament.

This chapter has tried to make two points. First, the concept of morality refers to a developmental cascade of phenomena whose essential features are (a) inhibition of punished acts; (b) a representation of prohibited actions; (c) the emotions of uncertainty, empathy, shame, and guilt; (d) the semantic concepts of good and bad; (e) accepting the moral obligations of social categories; and (f) the concepts of fairness and the ideal. The inhibition of prohibited actions and the cognitive representation of prohibited behaviors, as well as the affect states that follow violations, appear by the end of the second year of life. The concepts of good and bad appear early in the third year, the experience of guilt and awareness of social categories by 4-6 years, and the notions of fairness, the ideal, and relational social categories during the school years. Second, some of the variation in the intensity and frequency of the moral emotions is attributable to the child's temperament. Eleven-year-old children who had been high-reactive infants and admitted to feelings of guilt when they violated a family standard were cortically and autonomically more aroused than the low reactives who reported equally frequent experiences of guilt. Further, high reactives who were perceived by their mothers as highly sensitive to punishment were biologically more aroused than high reactives perceived as less sensitive. Both universal developmental phenomena tied to brain maturation and temperamental variation associated with neurochemistry contribute to the complex phenomena that constitute the moral domain. The role of affect in promoting the adherence to standards remains controversial. Kant believed that people acted morally because acceptance of the categorical imperative required proper behavior-reason was the guardian of social harmony. Peirce and Dewey, by contrast, argued that anticipation of the emotions of anxiety, shame, and guilt motivated loyalty to the community's ethical standards. The fact that adults pay to watch a film that they know will generate a deep feeling of sadness--an emotion most do not seek or welcome in their daily lives--and will remark that they enjoyed the movie warrants an explanation. One possibility is that the experienced emotion affirms their moral values. The Australian film The Rabbit Proof Fence describes three aboriginal sisters who have been taken from their mother to a camp a thousand miles away to be socialized in Australian values. The three girls run away, and most of the film illustrates the hardships that they endure and their close escapes from the authorities who are pursuing them as they walk the thousand miles to reach their home. The audience's empathic sadness for the children affirms their moral belief that children should love their parents and miss their home. I suspect that those in the audience who felt the most intense sadness would praise the film with greater enthusiasm than those who had muted feelings. Because sadness is an emotion that few enjoy or try to attain, there must be another reason for deciding that the film was gratifying. The affirmation of one's moral beliefs could be that source of gratification. The tension between the importance of a rational and the importance of an affective basis for morality is seen in modern industrialized societies where the balance between the feeling of virtue that follows enhancing another and the pleasure that follows the enhancing of self has shifted toward favoring the latter state. Increasing numbers of Americans do not regard their gender, ethnicity, vocation, place of residence, or friendships or the religion of their parents as distinctive sources of virtue. As a result, they are freed from the moral obligations that were attached to these categories in the past and rely primarily on the anticipation of sensory delight and self-enhancement as guides for action and sources of reassurance that they are managing their lives correctly. Although it is likely that future scientists will synthesize a drug that blocks feelings of guilt without affecting the knowledge that an act is wrong, it is less certain that broad use of this drug would eliminate loyalty to the mutual obligations that make a society habitable. Nonetheless, a posture of vigilance is appropriate, for humans, unlike gorillas, can hold representations of envy, hostility, and anger, even toward those whom they have never met, for a very long time. Therefore, empathy and the anticipation of guilt or shame may restrain rudeness, dishonesty, and aggression when reason fails.

Child↗

Part 2, Conflict management. How to shape positive relationships in medical practices and hospitals.

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.

Communication↗

Nurses' attitudes towards clients who self-harm.

BACKGROUND: Deliberate self-harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self-harm. AIM: The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self-injury. METHODS: Items on Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia (n = 1008) was then undertaken. RESULTS: A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self-harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self-harm. CONCLUSION: There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.

Attitude of Health Personnel↗

Social cognition, brain networks and schizophrenia.

BACKGROUND: A better understanding of the neural basis of social cognition including mindreading (or theory of mind) and empathy might help to explain some deficits in social functioning in people with schizophrenia. Our aim was to review neuroimaging and neuropsychological studies on social cognition, as they may shed light on the neural mechanisms of social cognition and its dysfunction in patients with schizophrenia. METHOD: A selective literature review was undertaken. RESULTS: Neuroimaging and neuropsychological studies suggest convergence upon specific networks for mindreading and empathy (the temporal cortex, amygdala and the prefrontal cortex). The frontal lobe is likely to play a central role in enabling social cognition, but mindreading and empathic abilities may require relatively different weighting of subcomponents within the same frontal-temporal social cognition network. CONCLUSIONS: Disturbances in social cognition may represent an abnormal interaction between frontal lobe and its functionally connected cortical and subcortical areas. Future studies should seek to explore the heterogeneity of social dysfunction within schizophrenia.

Brain Mapping↗

Perceptions of cognitive behavioural guided self-help treatment for bulimia nervosa in primary care.

This study examined perceptions of 36 women who participated in Guided Self-Help (GSH) treatment for bulimia nervosa delivered by general practitioners (GPs) in primary care. Qualitative responses revealed factors perceived to contribute toward treatment effectiveness including: improved eating behaviours, body image and emotional and general well-being; the empathic and practical style of the manual; specific behavioural strategies; GP facilitated positive therapeutic alliance and interventions with program implementation; and accessible treatment. Factors perceived as contributing to treatment ineffectiveness concerned: lack of changes to eating and body image; inadequacies of treatment program and approach; inadequate treatment dose; poor service delivery; and perceptions of low GP competence/professionalism and poor therapeutic alliance.

Adaptation, Psychological↗

Health-related concerns of people who receive psychological support for inflammatory bowel disease.

BACKGROUND: People with inflammatory bowel disease (IBD) cope with a number of disease-specific concerns, which may result in referrals for supportive counselling. OBJECTIVE: To determine differences between the health-related concerns of people with IBD who seek counselling or are referred for psychiatric assessment and those who have no recent contact with counselling or psychiatry. METHODS: Forty-five consecutive patients with IBD referred for psychiatric consultation and 31 IBD out-patients who had recent counselling were compared with 190 IBD out-patients at the same hospital with no recent history of counselling. Disease-related concerns, demographic data and perceived symptom severity were assessed with self-report instruments. RESULTS: Counselling patients had greater overall intensity of concern. Counselling patients differed from noncounselling patients on several measures related to illness severity and were more likely to be female. Correcting statistically for illness severity and sex, the counselled patients had significantly higher levels of concern about being a burden, pain and suffering, feeling out of control, financial difficulties, feeling alone, sexual performance, feeling dirty or smelly and being treated as different. CONCLUSIONS: Beyond the intensity of their physical suffering, patients who seek counselling report a pattern of concern in which interpersonal and emotional concerns are prominent compared with those of out-patients who do not seek counselling. Clinicians should be aware of interpersonal concerns, which may increase the need for empathic support. Psychosocial interventions in IBD may be indicated without respect to psychiatric comorbidity.

Adaptation, Psychological↗