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PubMed2002

[Psychic and somatic findings in jaw or facial pain of unclear origin. Comparison of patients with severe and mild symptoms].

BACKGROUND: Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease. OBJECTIVE: To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters. METHOD: We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS</=5; n=50) and high pain (VAS>5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index). RESULTS: The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group. CONCLUSIONS: These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.

Acute Disease↗

PubMed1997

A longitudinal study of students' depression at one medical school.

PURPOSE: Using a standardized measure of depression at three assessment points, to examine depression in medical students during their training. METHOD: Students entering the University of Massachusetts Medical School in the fall in 1987, 1988, and 1989 were mailed a recruitment letter and baseline questionnaire four weeks prior to the start of classes. Subsequent assessments took place in the middles of year 2 and year 4 and included only the students who had participated in the baseline assessment. The baseline assessment included the Center for Epidemiological Studies Depression (CES-D) scale, the Bortner Type A Behavior scale, the Spielberger Trait Anger scale, and the Spielberger Anger Expression scale. In addition, the baseline package included a rating of perceived stress, a demographics questionnaire, and a social-life survey. The follow-up assessments included the CES-D scale, the rating of perceived stress level, and the social-life survey. Analytic methods used were univariate descriptive statistics, correlation, and multiple-linear-regression analyses, two-sample t-tests, analysis of variance, and chi-square tests. RESULTS: Of the initial pool of 300 students, 264 responded at the baseline assessment (88% response rate; 53% men); 171 of these participated in the year-2 assessment (65% response rate; 51% men), and 126 participated in the year-4 assessment (48% response rate; 48% men); a total of 99 students participated in all three assessments. CES-D scores > or =80th percentile were obtained for 18% of the entering students. This rose to 39% at year 2 and 31% at year 4 (p = .0001). No gender difference was found at baseline; however, the women experienced higher depression levels than did the men at year 2 (p = .004) and at year 4 (p = .04). Overall, gender and increases in perceived stress (from baseline to year 2) were significant predictors of increased CES-D scores (from baseline to year 2; p = .01 and p = .0001, respectively). For the women, increased perceived stress, angerin, and frequency of social contacts outside work/school were significant predictors of the magnitude of increases in CES-D scores (baseline to year 2; p = .0001, p = .02, and p = .03, respectively). CONCLUSION: These preliminary data support the view that, upon entering medical school, students' emotional status resembles that of the general population. However, the rise in depression scores and their persistence over time suggest that emotional distress during medical school is chronic and persistent rather than episodic. Also, the women had more significant increases in depression scores than did the men.

Analysis of Variance↗

PubMed2003

Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison.

OBJECTIVE: To examine the effectiveness of an eighteen-month treatment based on dialectical behaviour therapy (DBT) targeting anger and violence, on a group of male forensic patients. METHOD: Eight male forensic patients in a high security hospital who met the criteria for borderline personality disorder measured by the Personality Assessment Inventory underwent 18 months of treatment. They completed three psychometric tests at pre-, mid- and post-treatment and at a six-month follow up. A comparison group (TAU) of nine patients, assessed as having similar personality disorders, received the usual treatment available in the hospital but excluding DBT. They completed the same tests at the same time intervals corresponding to the pre-, mid- and post-testing of the DBT group. In both groups, all instances behaviours related to anger and violence were monitored for three six-month periods, prior to, during and post-treatment. RESULTS: Overall, patients in the DBT group made greater gains than patients in the TAU group in reducing the seriousness of violence-related incidents, and in self report measures of hostility, cognitive anger, disposition to anger, outward expression of anger and anger experience. CONCLUSION: The results suggest a potential for DBT to impact positively and lastingly on violent behaviour and components of anger in male forensic patients when compared with standard treatment. The power of the current study to detect group differences was reduced by small ns, large confidence intervals, and a non-contemporaneous comparison group. Cost-effective strategies are proposed to take forward research on DBT with this population.

Adult↗

PubMed1995

Occupational and nonoccupational correlates of alcohol consumption in urban transit operators.

BACKGROUND: The influence of occupation and the worksite has emerged as an important area of study in research on alcohol consumption. Occupational and nonoccupational factors were studied in relation to alcohol consumption using data from a 1983-1985 cross-sectional study of transit operators. METHODS: A total of 1.853 operators underwent a medical examination for driver's license renewal (including information on age, ethnicity, gender, education). Of these operators, 1,448 completed a questionnaire about occupational (e.g., time of shift, job stressors) and nonoccupational (e.g., personality, life stressors) factors. From either the medical examination or the questionnaire, weekly alcohol consumption was available for 1,820 operators. Variables related to alcohol consumption in previous studies, or theoretically linked to consumption, were analyzed in relation to heavy ( > or = 15 drinks/week) and average weekly consumption. RESULTS: Heavy and average consumption were both related to several nonoccupational variables, including demographic (age, ethnicity, gender, marital status), personality (depression, anger expression), and life stress variables (i.e., life events). Heavy and average consumption were also related to several occupational variables, including job history (number of years driving, specific worksite) and job stressors. Neither measure was related to subjective job content (job demand, decision latitude). CONCLUSIONS: Variability in consumption by demographic factors among this population reflects that seen in society as a whole. However, occupational factors may influence consumption, since consumption was strongly related to (a) specific worksite and time of shift and (b) reported job stressors. Clarifying the exact influence of occupational and worksite factors on alcohol consumption will depend on the convergence of findings from different research designs (e.g., cross-sectional, longitudinal, ethnographic).

Adult↗

PubMedDate not supplied

The white-coat hypertension response: prevalence and predictors.

This study was designed to determine the clinical characteristics of hypertensive patients whose blood pressures are substantially higher in the medical office than in their natural environments. Thirty-nine percent of patients enrolled in a nonpharmacologic hypertension treatment program had systolic or diastolic office blood pressures (OBPs) that were at least 10 mm Hg higher than their ambulatory blood pressures (ABPs). Although these white-coat responders (WCRs) had higher systolic OBPs than did non-white-coat responders (NRs), both their systolic (p less than 0.02) and their diastolic (p less than 0.0001) ABPs were significantly lower than those of NRs. Furthermore, patients with white-coat hypertension did not have greater blood pressure reactivity in their natural environments, suggesting that their blood pressure elevations may be specific to the medical setting. White-coat hypertensives were older (p less than 0.005), had less angry dispositions (p less than 0.01), and reported less overt anger expression (p less than 0.005). They were also taking more antihypertensive medications than were the other patients in the study (p less than 0.001).

Antihypertensive Agents↗

PubMedDate not supplied

The perception of available social support is related to reduced cardiovascular reactivity in Phase II cardiac rehabilitation patients.

OBJECTIVE: Numerous studies have observed a relationship between social support (SS) and post coronary event survival. Laboratory research suggests one mechanism regulating this relationship may be exaggerated cardiovascular reactivity (CVR). What has not been as well explored is (1) whether the SS-CVR relationship holds up for a heart diseased sample, and (2) whether this relationship is evidenced only in supportive environments or can be found as a function of generalized perception of being socially supported. Thus, the purpose of this study was to examine the relationship of perceived SS and a locally supportive presence to CVR to a speech-induced stressor in post coronary event patients. METHOD: Forty-one Phase II cardiac rehabilitation patients participated in a research protocol that consisted of BP and HR measurement during two identical affective stress interviews where local support was systematically varied by presence or absence of a friendly small pet dog. Perception of SS was assessed by completion of psychosocial questionnaire packet that included measures of SS, anger expression and pet attachment. RESULTS: Repeated measures ANCOVAs revealed that patients who believed they had greater SS available to them during difficult times exhibited significantly less CVR for MAP (p<.007) and DBP (p<.024). No significant main effects for local support (pet presence) and no interactions between local and perceived support were found. CONCLUSIONS: These findings are of interest as they: (a) demonstrate an association between reduced CVR and higher (amounts of) SS in a clinical sample; (b) demonstrate this effect in a sample medicated to dampen CV levels and surges; (c) suggest that perceived amount of SS provides an ameliorative influence on CVR independent of situational support; (d) suggest that for certain conditions pet-models of support may be ineffective at establishing an local support presence.

Aged↗

PubMed2005

Reactions of Indian adolescents to the 9/11 terrorist attacks.

OBJECTIVE: There is information about the impact of disasters and trauma on children, but little is known about the effects of terrorism particularly in India. (i) To assess the knowledge of the 9/11 terrorist attacks to the school going adolescents of India who were miles away from the actual incident. (ii) To compare the reactions to this event among the boys and girls. METHODS: The study used a survey design with a self-report questionnaire administered to 406 students in 6 schools of standards 9-12. The questionnaire was administered within 3 weeks of occurrence of this event. The mean age of the subjects was 16.34 years (SD= 1.22; range= 13-20) and 44.1% were boys. RESULTS: All the students were aware about this event. Awareness that the twin towers were hit was in 81.06 but only 51.94% knew that Pentagon was also hit. All the children knew who the prime suspect was although only 12.62% were aware about the country to which he belonged. The source of knowledge of the events was the television in 74.7% of the adolescents and 17.95% of them viewed foreign news channels additionally to the Indian channels to gather details about the event. Newspaper, radio and internet were the sources of information in 44.17%, 3.4% and 3.5% children respectively. Of the adolescents who gathered information from the television, 84.7% agreed that there had been an increase in their TV viewing time since the event and it was more than one hour per day in 47.5% of them. None of the students supported the terrorist attacks. The number of students with negative stressors was significantly more than the ones who were unaffected (p 0.0001). The girls were significantly more affected than the boys and while the former expressed anger the latter were more fearful and sad. (p 0.05) The idea of USA going for war against Afghanistan was supported by 69.4% and one third of them believed that such an event might adversely affect India. The adolescents who had witnessed the events on television were more fearful and shocked than the ones who read about the event in the print media (p 0.05). CONCLUSION: This study emphasizes the adverse reactions in the minds of adolescents in India to terrorist events even though they did not directly witness the events of September 11,2001. The role of media exposure in causing stress is also revealed. Pediatricians should be aware of the adverse effects of terrorism in the minds of the children and should be able to identify and help those who are in need.

Adolescent↗

PubMed1998

The relation of hostility to lipids and lipoproteins in women: evidence for the role of antagonistic hostility.

We examined the relation of antagonistic, neurotic, and cynical hostility to lipids and lipoproteins in 77 healthy women (aged 18-26) selected for having high (> 17) or low (< 12) scores on the Cook-Medley Hostility (Ho) scale. Fasting lipids were determined during the luteal phase of the menstrual cycle for oral contraceptive (OC) non-users (N = 41), and during pills 15-21 for OC users (N = 36). Factor scores for antagonistic and neurotic hostility were derived from a principal component of the Buss-Durkee Hostility Inventory, Spielberger's Anger Expression, and the NEO-Personality Inventory. High Ho scores were significantly associated with higher cholesterol. Antagonistic hostility significantly predicted cholesterol, low density lipoprotein cholesterol, triglycerides, and the ratio of cholesterol to high density lipoprotein cholesterol, with higher antagonistic hostility scores associated with higher levels. Neurotic hostility did not predict lipids. Results suggest a potential pathophysiological mechanism that may contribute to the association between hostility and coronary heart disease. Moreover, a measure of antagonistic hostility, relative to cynical and neurotic hostility, was the best predictor of lipid levels.

Adolescent↗

PubMed2005

Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: preliminary data.

OBJECTIVE: The Karolinska Psychodynamic Profile (KAPP) was used for the assessment of the six-month outcome of Brief Adlerian Psychodynamic Psychotherapy (B-APP). METHOD: Fifty-seven eating disordered women (28 with anorexia nervosa, 29 with bulimia nervosa), were included in the study. The sample was evaluated at baseline (time 0) and after six months (T6) with a clinical assessment and with Temperament and Character Inventory (TCI), Eating Disorder Inventory (EDI-2), State-Trait Anger Expression Inventory (STAXI), and KAPP. RESULTS: Based on symptomatologic improvement, two sub-groups were obtained: responders (66.6%) and non-responders (33.3%). Significantly higher baseline scores emerged in the responders group on Ineffectiveness and Impulsivity (EDI-2) and on Harm Avoidance (TCI). Several KAPP items and areas improved in both groups at T6. CONCLUSION: Multimodal treatment centered on B-APP lead to both a global clinical improvement and an improvement in several psychological and psychopathological features as assessed by EDI-2, STAXI and KAPP. The results suggest interesting clinical implications, though outcome predictors are quite weak.

Adolescent↗

PubMed1984

Coping with chronic illness: strategy preferences, changes in preferences and associated emotional reactions.

Coping strategy preferences, changes in those preferences and their associations with different patterns of psychological reaction were investigated in three studies of chronically ill patients. A simple self-appraisal device, consisting of the ranking of six clusters of strategies, was used to assess patients' coping preferences. In Study 1 patients were found to prefer optimism, and probably fatalism , more than non-patients, while non-patients preferred action strategies and, to some extent, interpersonal coping. In Study 2 coronary patients were bound to prefer more optimism strategies but fewer escape strategies than other chronically ill patients. All patients also changed some of their coping preferences over time, preferring optimism in hospital and fatalism at home. Study 3 showed preferences for action strategies to be associated with desirable psychological reaction patterns such as relatively little uncertainty and helplessness. Preferences for escape strategies were linked with patterns which may be less desirable, such as much anxiety and indirectly expressed anger. Optimism and fatalism , although preferred by many patients, were associated with patterns of psychological reaction in which desirable and undesirable elements were mixed. Preferences for control strategies proved to be linked with reactions of patients when in hospital only, while those for interpersonal coping proved to be reaction-linked only when patients were at home.

Adaptation, Psychological↗

PubMed1986

Expression of positive emotion by people who are physically ill: is it evidence of defending or coping?

Content analysis scales were used to explore whether the expression of positive emotion by patients is better interpreted as defending or coping. This intensive study of the psychological states of a large sample of hospitalised patients showed that positive emotion was associated for them with expressions of competence and reports of satisfying interpersonal relationships. Positive emotion was also associated with relatively little depression or indirectly expressed anger. This support for the assumption that positive emotion occurs as a result of effective coping was reinforced by other findings. Positive emotion was also found to be associated with little interference with their interpersonal relationships by the patients' illness and with support perceived to be available from family and community. These findings are discussed in terms of the value of positive emotion for patients and their implications for the management of patients while they are hospitalized.

Adaptation, Psychological↗

PubMed1992

Negative affect and the experience of chronic pain.

Although it is clear from previous research that pain is associated with negative affect, the relative contribution of specific affective dimensions, e.g. depression, anxiety and anger, to the subjective experience of chronic pain is unclear. The literature is also mixed concerning the relative importance of state versus trait influences in the experience of chronic pain. The present study analyzed the ability of anxiety, anger, and depression (as measured by the State-Trait Personality Inventory, State-Trait Anger Expression Inventory, and the Beck Depression Inventory, respectively) to predict self-report of clinical pain as indicated by the McGill Pain Questionnaire (MPQ) in a sample of 60 chronic pain patients. The results of stepwise regression analyses consistently demonstrated that the state measures were more strongly related to MPQ pain ratings than trait measures. These data suggest support for the hypothesis that chronic pain adversely impacts mood rather than the opposing hypothesis that negative mood is a predisposing factor in the development of chronic pain. Furthermore, different aspects of the state emotional experience were found to be related to different components of pain report. The results of this study also suggest that attributional processes could be an important component of the relationship between negative mood and the experience of pain.

Adaptation, Psychological↗

PubMed1985

Developmental milestones in abused children, and their improvement with a family-oriented approach to the treatment of child abuse.

Few objective measures of the efficacy of intervention programs in the treatment of child abuse exist. One such measure may be improvement in the developmental delays often seen in abused children. Using the Learning Assessment Profile, we tested 53 abused children, ages 2.5-5 years, just before and after involvement in our Family Development Center Program (FDC). The FDC emphasizes therapy-group-interaction for parents, where alternative ways of expressing anger are explored. Children attend daily preschool classes, and take occasional outside field trips. Of the 53 children tested 42 (79%) showed greater than expected developmental skills gains. Six children demonstrated no improvement in developmental skills, four of whom had severe developmental delays in one or two areas. Fine motor and language skills were significantly delayed for the group as a whole; these areas showed the greatest improvement after FDC. There did not appear to be an overall association between increased improvement in developmental skills and length of time in the FDC program, although certain subgroups of children appeared to improve with time while others appeared to lose ground. A five-year follow-up study of these children is presently underway. We conclude that a program which involves both parent and child, and focuses on their interaction, appears to be effective in dealing with abusive families; monitoring developmental levels in the abused children is one means of assessing their progress in such a program. Further controlled prospective trials are needed in this area.

Child Abuse↗

PubMed1990

Interrelationships between psychological factors, overweight, and blood pressure in adolescents.

Relationships between psychological factors and physical factors such as body mass, overweight, and blood pressure were examined in a sample of black and white adolescents enrolled in health science courses. Black female adolescents were significantly more overweight and obese than either other group. Psychological factors were not significantly associated with body mass (weight/height) for females. A small percentage of the variance in body mass for black (6%) and white (4%) males was explained by Trait Anger, the frequent experience of anger and the intensity of anger (S-Anger-Reaction/TP) in pressure situations. Trait Anger also significantly (p less than 0.01) discriminated between black male adolescents who were normal weight and those 20% overweight for age and height. The relationships between traditional risk factors and blood pressure among adolescents who were 20% underweight, normal weight, and 20% overweight for age and height suggest that few traditional risk factors contribute significantly to the prediction of blood pressure in overweight adolescents. In contrast, psychological measures of suppressed anger (Anger-In, Anger Expression) were significantly (p less than 0.001) associated with blood pressure among overweight adolescents. The findings regarding the associations between overweight and psychological factors are complex. Prospective studies using better measures of overweight are needed to clarify the processes involved.

Adolescent↗

PubMed1982

Psychological reactions to the onset of chronic illness.

Patients (N = 126) interviewed during hospitalization at the onset of chronic illness were found to be experiencing considerable emotional arousal. Their psychological reactions were assessed by applying content analysis scales to accounts of their current experienced and comparing these with the accounts of non-patients. Multivariate analysis of variance indicated that patients experienced significantly more anxiety, depression, and directly and indirectly expressed anger, as well as positive feelings and that they perceived themselves to be more helpless. Canonical analyses were applied to investigate the relationships between patients' reactions and their biographic and illness-related characteristics. Patients' reactions were related to demographic factors and their perceptions of their handicaps. No relationships were found between patterns of reaction and patients' life styles, medical records of their illnesses or the types of their disabilities.

Adult↗

PubMed1995

The association between childhood irritability and liability to substance use in early adolescence: a 2-year follow-up study of boys at risk for substance abuse.

The aim of this investigation was to determine whether irritability, defined as the propensity to experience and express anger following actual or perceived provocation, is a component of the liability to alcohol and drug abuse. Sons of substance abusing fathers (n = 40) and normal fathers (n = 56) were studied when they were 10-12 years of age and followed-up 2 years later. Hierarchical regression analysis revealed that resting salivary cortisol concentration, impulsivity and family discord measured when the subjects were 10-12 years of age explained 35% of the variance on a scale measuring irritability 2 years later. At follow-up, when the boys were 12-14 years of age, it was observed that irritability scale scores and family discord were the only variables that accounted for significance variance on a scale measuring coping via alcohol and drug use. Latency and amplitude of the N1 and P3 event-related potentials of an auditory oddball task, measured at age 10-12, were not associated with drug use at age 12-14. These results indicate that family dysfunction, stress state of the child, and low behavioral self-control additively account for a significant proportion of variance on irritability scale scores 2 years later, and that this trait, in conjunction with family discord, is associated with substance use as a coping response by early adolescence.

Adolescent↗

PubMed2006

What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggression.

There are few examples in the literature of the application of functional analysis to psychiatric inpatient aggression. Structural assessment approaches have dominated. This paper introduces a system for classifying the functions of aggression in psychiatric inpatients that was applied to 502 aggressive behaviours exhibited by patients in a secure forensic psychiatric hospital. At least one function was identified for the majority of aggressive incidents; the most common functions pertaining to patients' responses to the restrictions and demands of the inpatient setting, to express anger or to punish others perceived as provocative, and to maintain status. There was little evidence suggesting that aggression was used to obtain tangible rewards, to reduce social isolation, or to simply observe the suffering of others. Differences in the function of aggressive behaviour were found across victim types. Results of this study have implications for the prediction and prevention of inpatient aggression and for the treatment of aggressive inpatients.

Aggression↗

PubMed2006

Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context.

In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre- or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings.

Adult↗