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Psychosocial indexes and cardiovascular risk factors in a community sample.

BACKGROUND: Psychosocial characteristics might contribute to a more comprehensive understanding of cardiovascular disease as it is increasingly recognised that biomedical risk factors do not fully explain its dynamics. This study aimed to describe psychometric indexes in a Portuguese community sample relating them to known cardiovascular disease risk factors. METHODS: Anthropometric, blood pressure, serum measurements and information on demographic, social, medical and behavioural characteristics were obtained for 215 women and 156 men. Self-administered questionnaires were used for the psychometric evaluation (Bortner scale, Beck Depression Inventory, Hopkins Symptom Distress Checklist 90-Revised, Psychological General Well-Being and the Nottingham Health Profile, NHP). RESULTS: There were significant differences according to gender regarding almost every psychometric dimension assessed. After adjusting for the presence of different biomedical risk factors, significant decreasing mean behaviour pattern scores were found with increasing age. Mean depression scores were significantly higher in women and in individuals with lower educational level. As to general psychological well-being, the highest scores were obtained for men and individuals with higher educational level. For the assessed dimensions of quality of life, as well as indexes of psychopathology, men scored better than women. No significant differences in mean scores of behaviour pattern, depression, psychological general well-being and dimensions of NHP were found according to the presence of an increasing number of cardiovascular risk factors. CONCLUSIONS: The study shows that the clustering of multiple biomedical risk factors does not result in additive deleterious psychological effects and that psychometric indexes are mainly dependent on gender and education, common confounders in most studies evaluating cardiovascular risk factors.

Adult↗

Differences in aspects of personality and sexuality between perimenopausal women making different choices regarding prophylactic oophorectomy at elective hysterectomy.

BACKGROUND: Retrospective studies have indicated differences in sexuality and general psychological well-being between women who have undergone hysterectomy only and those undergoing hysterectomy and oophorectomy. These differences may be the result of dissimilarities in the groups of women who choose the respective operation. OBJECTIVE: To compare the preoperative characteristics of women who choose to undergo prophylactic oophorectomy with the corresponding characteristics of those who choose to retain their ovaries when undergoing hysterectomy on benign indication. POPULATION: Perimenopausal women (aged 45-55), scheduled for hysterectomy on benign indication, were evaluated within 2 months before surgery. A total of 217 women chose hysterectomy only and 106 women chose hysterectomy with concomitant prophylactic oophorectomy. METHODS: Socioeconomic and health data, personality (Karolinska Scale of Personality), sexuality (McCoy's Female Sexuality Questionnaire), well-being (Psychological General Well-Being index), the prevalence of climacteric symptoms (modified Kupperman's index) and the women's attitude to hormone replacement therapy were investigated. RESULTS: Women who later underwent prophylactic oophorectomy in addition to hysterectomy had higher anxiety-related scores, lower sexual variable scores and poorer emotional partner relationships. This group was also characterized by more episodes of irregular bleeding, a greater prevalence of climacteric symptoms and a more extensive use of hormonal replacement therapy, in comparison with women who later underwent hysterectomy only. CONCLUSION: Personality, sexuality and the nature and severity of preoperative symptoms in women who chose prophylactic oophorectomy differ markedly from the same variables in those who chose to keep their ovaries at elective hysterectomy. These differences must be taken into consideration when evaluating studies comparing these aspects of quality of life after hysterectomy or hysterectomy with concomitant oophorectomy. Furthermore, psychosexual aspects such as sexuality and well-being can not be reliably studied with a retrospective design in these patient groups.

Anxiety Disorders↗

What is the impact of genetic counselling in women at increased risk of developing hereditary breast cancer? A meta-analytic review.

Meta-analytic methods were used to determine the impact of genetic counselling on women with a family history of breast cancer. Published studies with prospective designs and randomized controlled trials were included in the review, and the psychological outcomes assessed were generalized psychological distress, generalized anxiety, depression, and breast cancer anxiety. Other outcomes investigated were the accuracy of perceived risk of developing breast cancer, breast cancer genetics knowledge and breast cancer screening uptake. A meta-analysis was performed to estimate effect size, where sufficient data were available. A total of 12 studies, most of which measured several outcomes, met at least one of the inclusion criteria. A sufficiently large number of studies were available to assess the magnitude of effects on three outcomes: generalized psychological distress, generalized anxiety and accuracy of perceived risk of developing breast cancer. The quantitative synthesis showed that genetic counselling leads to statistically significant decreases in generalized anxiety, with an average weighted effect sizes of r = - 0.17 (p<0.01). In contrast, the reduction in psychological distress exhibited a trend towards statistical significance only, with r = -0.074 (p = 0.052). The impact of genetic counselling on the accuracy of perceived risk was associated with an effect size of r = 0.56 (p<0.01). Thus in this meta-analysis, we demonstrated the efficacy of genetic counselling in meeting two of its objectives: reducing women's anxiety levels and improving the accuracy of their perceived risk. This review highlighted that most research so far focused on generalized distress and anxiety and accuracy of perceived risk, to the exclusion of other, perhaps equally important, types of outcomes. Future studies are likely to lead to more comprehensive assessments if additional emotional, cognitive and behavioural outcomes are included in the assessment.

Adult↗

Paediatric psychology in general hospital practice.

The concept of paediatric psychology is relatively recent, having evolved in 1967 in the USA, largely within general hospitals, where paediatricians were faced with numerous childhood problems requiring comprehensive medical/psychological treatment approaches. The rationale was that psychological services should be focused where the majority of problems first present, i.e. in a medical setting rather than a psychiatric hospital. Against this background, the prevalence of childhood psychopathology, as encountered at a Pietermaritzburg general hospital, is discussed. However, the increasing demand for psychological consultations raises the issue of management of these children at other general hospitals, since very few employ psychologists.

Adolescent↗

Auditory perception during general anesthesia: psychologic consequences.

Since the introduction of general anesthesia in the middle of the 19th century, incidents of auditory perception during general anesthesia have been reported in the medical literature. Most of these reports have dealt with purely medical issues, and surprisingly little has been written on the psychologic sequelae of these instances of auditory perception. We discuss the possible psychologic consequences of such perception, and suggest methods of treatment and prevention of the negative aspects of auditory perception during general anesthesia.

Aged↗

Double-blind, placebo-controlled clinical trial of a mixture of gangliosides ('Cronassial') in post-herpetic neuralgia.

A double-blind, parallel-group clinical trial was carried out in 25 patients with post-herpetic neuralgia to determine the efficacy and tolerability of a mixture of gangliosides ('Cronassial') compared with placebo. Patients were allocated at random to receive treatment with either 'Cronassial' (100 mg in 2 ml buffered solution) or placebo given by 11 subcutaneous injections over a period of 27 days, and their symptoms assessed on entry and after 2, 4 and 8 weeks. The four aspects of pain considered (overall pain, hyperaesthesia, stabbing pain and constant ache) all showed maintained reductions in severity with 'Cronassial' treatment, but not with placebo. In the case of hyperaesthesia, this difference between treatments was statistically significant (both during and after the course of injections), even with the relatively small number of patients in this study. Sleep patterns showed significant sustained improvements with 'Cronassial', but not with placebo treatment. Other psychological assessments (general psychological state, appetite and mood) showed little difference between 'Cronassial' and placebo treatment. Although 'Cronassial' was well tolerated systemically, 1 of the 12 patients was withdrawn because of general malaise, and 5 patients had local pain at the injection sites. Two of these 5 patients were withdrawn from the study. There were no withdrawals in the placebo group. It is suggested that further studies employing greater numbers of patients should be carried out to confirm the efficacy of gangliosides in improving symptoms of patients with post-herpetic neuralgia.

Aged↗

Stress debriefing and patterns of recovery following a natural disaster.

Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire: GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required.

Disasters↗

A naturalistic study comparing the efficacy of a memory enhancement course to a general academic course.

OBJECTIVE: The goal of this study was to compare the effectiveness of a memory improvement course to a course in general psychology. METHODS: Thirty-four healthy elderly persons enrolled in a college memory improvement course for senior citizens, and 33 who enrolled in a parallel course, Introduction to Psychology, were tested on verbal and visual memory prior to and after completing the course. Before they took the course, they were also assessed on subjective memory (self-assessment scale of memory efficacy) and psychological distress (General Health Questionnaire). Changes within and between groups were examined using multivariate analysis of covariance to control for baseline scores. RESULTS: Both groups had similar improvements on all cognitive measures. The memory improvement course group showed very significant correlations between objective and subjective memory. CONCLUSIONS: It appears that participation in academic courses is associated with improvement in certain aspects of cognitive functioning. Awareness of objective memory functioning may be a natural selection factor or a significant motivating factor for healthy elderly to enroll in memory enhancement courses.

Aged↗

The relevance of hierarchies, territories, defeat for depression in humans: hypotheses and clinical predictions.

BACKGROUND: Hierarchical and territorial behaviour are widespread in animals and humans. The consequences of defeat have been linked to depression in humans. However, hierarchical and territorial behaviours are not mentioned in ICD10 or DSM1V. I therefore investigated the coverage in relevant textbooks. METHOD: I searched the indices of books on Animal Behaviour, General Psychology and General Psychiatry for entries on Hierarchy, Territory and Dominance. RESULTS: A paradox is revealed. Hierarchical and territorial behaviour are widespread in both animals and humans but are neglected in textbooks of human behaviour and mental problems. Four hypotheses are put forward to explain this paradox and explore its implications. 1. That hierarchical and territorial behaviours evolved before human consciousness. They are available to consciousness but not in the forefront of awareness. 2. That human hierarchical and territorial behaviour are overlaid by a cultural veneer of manners, which conceal the true state of affairs. 3. That humans have internal, mental, hierarchical aims in addition to external physical hierarchical aims. 4. That failure to achieve internal hierarchical aims may produce diminution of well being and changes in behaviour by the same biological mechanisms that are active in external hierarchical defeat. Three testable predictions follow from these hypotheses. 1. That there are common genetic factors and similar patterns of brain activity in homologous structures during hierarchical and territorial behaviour in man, primates and lower vertebrates. 2. That brain structures involved in external hierarchical conflict, consciousness and imagery will be active during internal hierarchical conflict. 3. Defeat of internal hierarchical aims produce depressed mood and satisfying alternative hierarchical aims are protective. Case examples are given to illustrate the existence of, and the consequences of defeat on, internal hierarchies. LIMITATIONS: These hypotheses and predictions are theoretical and require confirmation or refutation by neuroimaging and prospective studies. CONCLUSIONS: A neglect of human hierarchical behaviour by clinicians is suggested and discussed. The concept of internal hierarchies, if confirmed, may throw light on human striving, the emotions of defeat and the therapy of depression.

Adult↗

Self-perceived physical, psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment.

Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health. The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years). The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.

Adaptation, Psychological↗