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Non-morbid forms of fantasy were studied in 120 individuals with psychopathy (n = 80) and psychopath-like manifestations of traumatic genesis (n = 40) in psychogenic conditions. The authors identified such variants of fantasy at a non-psychotic level as "expansive-sthenic" and "paraphrenia-like" which are considered as manifestations of adaptive psychological mechanisms.
Using an adapted psychologic technique, the authors considered the predominant types of therapeutic behaviour of 70 psychotherapists from the USSR and CSSR who employ methods of group psychotherapy in treating neuroses. The frequency of optimal variants of the therapeutic behaviour resorted to by psychotherapists in difficult situations arising in the course of group psychotherapy was established. Characteristic features of the therapeutic tactics used by psychotherapists from both countries are shown.
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Three hundred patients underwent gastroplasty surgery for morbid obesity. The operation consisted of formation of a 45 to 60 millilitre (ml) proximal gastric pouch with a 10 to 12 millimeter (mm) channel located on the greater curvature of the stomach. The channel was supported by a continued seromuscular inverting layer of 2-0 polypropylene and a second interrupted inverting layer of 4-0 Dacron sutures. The early postoperative complication rate was 18.7 percent, including one cardiac death, for a 0.33 percent mortality rate. Late postoperative complication rate was 27.0 percent, with vomiting heading the list. Staple-line disruption continued to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreased the incidence of vomiting which contributed to early staple-line dehiscence. Two applications of the TA 90 and preservation of adequate blood supply to the pouch were important factors in the prevention of this complication. The department of clinical nutrition was directly involved in the preoperative classes in nutrition designed to assist patients in making the proper psychological adaptation to the newly imposed dietary restrictions. Over 90 percent of total weight loss occurred at 12 months. At 24 months there was a 32.5 percent decrease from preoperative weight and a 63.4 percent excess weight loss.
Heart failure has been associated with poor quality of life, which can improve after heart transplantation. Long-term quality-of-life comparisons between patients with heart failure stabilized with medical therapy and heart transplant recipients have not been performed. We assessed quality of life at the time of heart transplantation evaluation and again after 41 months in 12 patients with advanced heart failure stabilized with medical therapy and in 19 patients who had gone on to undergo heart transplantation. Quality of life was measured by three questionnaires. Both groups had similar quality-of-life and clinical features during the transplantation evaluation. Over time, feelings of anxiety and depression, psychologic adaptation, and perceived functional capability improved in the transplant recipients. However, transplant recipients reported more weakness after surgery; this was the major symptom that limited activities. At follow-up 41 months later, we found no significant differences in quality-of-life changes over time between patients stabilized with medical therapy and heart transplant recipients. Overall quality of life for patients who remain stable while receiving medical therapy may not be significantly different from patients who have undergone transplantation.
This paper presents an analysis of studies in which vocational rehabilitation was followed up during the 1980s and early 1990s. Its purpose is to clarify the outcome of vocational rehabilitation as well as the factors predicting that outcome. In these follow-up studies the variables by which the outcome is measured are closely linked with the subjects' employment opportunities, and are basically the same as those applied in earlier follow-up studies. Because of the study designs it is difficult to make any generalizations concerning the results. Little attention has been paid to the evaluation of psychological adaptation in most of these studies. Also, follow-up studies generally have not taken into account the employment situation. Whether those who have had rehabilitation are able to find employment depends essentially on employers' policies towards the handicapped and the disabled.
Using the materials of foreign researches the article provides data concerning the modern methods of rehabilitation of cardiological patients taking into account its efficiency for various age groups. Operation on heart itself is a psychological shock to the patient. It needs adequate psychological adaptation and corresponding medical care. 300 patients with ischemic heart disease were under the authors' observation after aortocoronary shunting (age 31-69). Clinical and functional results were studied after operation. The results of early and late loading tests were analysed. Indication for hypolipidemic therapy were determined. The article reports on the errors in determining the proof loads and limitations in the correction of myocardial insufficiency. The authors substantiate the possibilities towards prognostication of the course of ischemic heart disease after operation.
Heat cramps, heat exhaustion, and heat stroke are major disorders resulting from the body's reaction to overexposure to hot environments. Physiological and psychological adaptation to hot environments--acclimatization--can improve heat tolerance. A number of measures determine the environmental contributions to heat stress. The occupational health nurse can establish priorities for addressing the work related health needs of workers in hot environments.
The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV- comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV- men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress and diminished quality of life than HIV+ men with no SUD, but HIV-illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.
Diethylstilbestrol (DES) exposure in utero in females is a cause of clear-cell adenocarcinoma of the cervix and of several anatomical and functional disorders of the genital tract. DES exposure must be evoked whenever counselling women for reproductive disorders. In France around 80,000 women have had in utero DES exposure. The cases of 4 young women who consulted our Reproduction Center for reproductive disorders illustrate the usual difficulties faced by these patients. In spite of their difficult past reproductive history (uterine malformations, repeated miscarriages, ectopic pregnancies) and low fertility rate, all four women conceived successfully, either after spontaneous or induced ovulation. We stress the need for adapted psychological and medical care which can lead to successful childbearing in the vast majority of these high-risk patients.
Formed 75 years ago, occupational pathology has defined structure of occupational morbidity, determined principles of occupational diseases' pathogenesis and pathomorphosis, demonstrated dependence of occupational entities on acting occupational hazards, described clinical manifestations of occupational diseases, emphasized informative diagnostic complexes. Diagnosis in occupational pathology now is established on basis of etiology. Manifold activities helped to form a system preventing health disorders caused by occupational hazards. Topical problem is to elaborate and put into practice some criteria for compensation of occupational damage with differential expert assessment of functional disorders caused either by occupational disease or by general one. Prospective trend could be to create a system organizing and managing workers' health on workplace and to put "protection by time" principle into practice with forecasting risk of occupational diseases and dose-effect dependence. Another prospect is to elaborate and put into practice a training in social and psychologic adaptation for occupational managers and industrial workers.
BACKGROUND: The acquisition and nurturing of humanistic skills and attitudes constitute an important aim of medical education. In order to assess how conducive the physician-learning environment is to the acquisition of these skills, the authors determined the extent to which clinical teachers are perceived by their trainees as humanistic with patients and students, and they explored whether undergraduate and graduate students share the same perceptions. METHODS: A mail survey was conducted in 1994/95 of all senior clerks and second-year residents at Laval University, University of Montreal and University of Sherbrooke medical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-point Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). RESULTS: On average, only 46% of the senior clerks agreed that their teachers displayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of clerks) and that their teachers did not try to understand students' difficulties (78%) or to support students who have difficulties (77%). Compared with the clerks, the second-year residents were significantly less critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. INTERPRETATION: This study suggests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the course of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent research is needed to understand better the factors influencing students' perceptions.
We analyzed the effects of evaluative observation and baseline duration on cardiovascular reactivity and adaptation to recurrent psychological stress. Cardiovascular reactivity to mental arithmetic stress was assessed in college men and women (N=224) during two pretest tasks, a test task, and a posttest task. Participants were assigned randomly in a 2 x 2 design to manipulations of baseline duration before the test task (4 min vs. 12 min) and evaluative observation during the test task (observed vs. control). Repeated exposure to stress attenuated cardiac but not vascular reactivity. Evaluative observation disrupted cardiac adaptation, resulting in a resurgence of beta-adrenergic cardiac reactivity during the test task. Cardiac adaptation resumed fully during the posttest task. Baseline duration had no effect on reactivity. The results replicate and extend previous work, and support the dual process theory of habituation and sensitization.
The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up. Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.
This study compared subjects who had received standard tapered withdrawal of benzodiazepine (BZD) (group 1) with a group with comparable diagnosis still receiving BZD (group 2) and a control group of comparable diagnosis not yet receiving treatment (group 3). Sixty subjects aged 21-65 years with a diagnosis of nonpsychotic anxiety or insomnia were included. The assessment of psychological distress and quality of life was timed to coincide with the maximum immediate effect of BZD discontinuation, as calculated according to drug half-life. Subjects diagnosed with insomnia reported lower distress in all three groups. The pattern of distress experienced by group 1 was closer to group 3 than to group 2, indicating the potential importance of re-emergence of anxiety. High neuroticism, lower education level, and lower quality of life were associated with higher levels of distress during withdrawal.
Contemporary view on the issue of adjustment potential in an aging human being is presented. In a prognostic model the following features, ranked according to their importance, were identified: for younger individuals--friendship, warmth, responsibility, thoroughness, persistence, control of conditioned and unconditioned reflexes, sensitivity, tenderness, wide range of interests, tolerance towards other people and high level of intellectual efficiency; for older individuals--self control, social maturity and balanced approach to the others, lack of conflicts in interpersonal relationships, self sufficiency and independence, tolerance with a tendency to self subordination and psychological immunity. Attention is drawn to the results of the obtained prognostic models which will constitute a reference base for psychologists working in geriatric wards.
The effects of prior task exposure on cardiovascular reactivity to stress were examined in two experiments by randomly assigning participants to repeated exposure groups that performed mental arithmetic pretest and test tasks versus delayed exposure groups that performed only the test task after prolonged rest. Impedance cardiographic and blood pressure measures were recorded continuously from 60 undergraduate men in Experiment 1 and 112 undergraduate men and women in Experiment 2. Task repetition attenuated cardiovascular reactivity and improved task performance in repeated exposure groups (p < .001), suggesting an integrated process of behavioral adaptation. During the test task, delayed exposure groups showed greater cardiac reactivity (p < .01), but not vascular reactivity, than repeated exposure groups. Thus, cardiac reactivity varied as a specific function of prior task exposure, whereas vascular reactivity varied as a general function of time.
The paper takes issue with the traditional view of Darwin's influence on psychology; namely, that it is he who passed on to psychology the concept of individual adaptation. Three arguments are presented: a) that Darwin, qua scientist, was only interested in species adaptation, an entirely different concept from that of individual adaptation, b) that Darwin's writings on individual adaptation are so unexceptional that it is inconceivable that psychologists should have been influenced by them and c) that the two concepts are logically incompatible since species adaptation presupposes a strict hereditary determinism, while individual adaptation conceives of the organism either as free and undetermined or else as determined by the environment.