A BRIEF STRUCTURED PSYCHOLOGICAL EVALUATION INTERVIEW WITH ADULTS.
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Adult↗
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Effect of spiritual healing on chronic idiopathic pain: a medical and psychological study.
OBJECTIVE: To study over a period of one and a half years the effect of spiritual healing on patients with idiopathic pain syndrome using several psychological and medical parameters. DESIGN: Randomized clinical trial. SETTING: Outpatient pain clinic. PATIENTS: Twenty-four patients with idiopathic chronic pain who had passed a pretreatment psychological interview were allocated randomly to receive spiritual healing or no active treatment. MAIN OUTCOME MEASURES: Medical interview (Visual Analog Scale and Pain Clinic Investigation Formula); International Association for the Study of Pain (IASP) Data Base Outline; psychological interview (Hopkin's Symptom Checklist, Middlesex Hospital Questionnaire, Beck's Depression Inventory, Coping Strategy Questionnaire, Health Locus of Control scale). Patients were evaluated at baseline and at 2 weeks posttreatment. Final assessment at 1 year posttreatment was done with a modified form of IASP Data Base Outline. RESULTS: There was a minor decrease in analgesic drug intake and an improvement in sleep patterns in patients treated by the healer. Generally, clinical variables remained unchanged. Attitudes toward spiritual healing improved. There was a decrease in the feeling of hopelessness (p < 0.05) and an increased acceptance of psychological factors as reasons for pain (p < 0.05). Other scores of the psychological tests were unaffected by the healing. However, half (n = 6) of the treated patients felt that spiritual healing gave them some relief. CONCLUSION: Spiritual healing appears harmless and was subjectively helpful to some patients suffering from idiopathic chronic pain syndrome.
Adult↗
Stress debriefing after childbirth: a randomised controlled trial.
OBJECTIVE: To test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders. DESIGN: Randomised single-blind controlled trial stratified for parity and delivery mode. SETTING: Two large maternity hospitals in Perth. PARTICIPANTS: 1745 women who delivered healthy term infants between April 1996 and December 1997 (875 allocated to intervention and 870 to control group). INTERVENTION: An individual, standardised debriefing session based on the principles of critical incident stress debriefing carried out within 72 hours of delivery. MAIN OUTCOME MEASURES: Diagnosis of stress disorders or depression in the 12 months postpartum, using structured psychological interview and criteria of the Diagnostic and statistical manual of mental disorders, 4th edition. RESULTS: Follow-up information was available for 1730 women (99.1%), 482 of whom underwent psychological interview. There were no significant differences between control and intervention groups in scores on Impact of Events or Edinburgh Postnatal Depression Scales at 2, 6 or 12 months postpartum, or in proportions of women who met diagnostic criteria for a stress disorder (intervention, 0.6% v control, 0.8%; P = 0.58) or major or minor depression (intervention, 17.8% v control, 18.2%; relative risk [95% CI], 0.99 [0.87-1.11]) during the postpartum year. Nor were there differences in median time to onset of depression (intervention, 6 [interquartile range, 4-9] weeks v control, 4 [3-8] weeks; P = 0.84), or duration of depression (intervention, 24 [12-46] weeks v control, 22 [10-52] weeks; P = 0.98). CONCLUSIONS: There is a high prevalence of depression in women during the first year after childbirth. A session of midwife-led, critical incident stress debriefing was not effective in preventing postnatal psychological disorders, but had no adverse effects.
Crisis Intervention↗
The specificity of psychological characteristics of adolescent suicide attempters.
Using a semistructured interview, psychological characteristics were gathered from three groups of adolescents: 48 suicide attempters, 66 depressed, and 43 nondepressed adolescents who never attempted suicide. Various characteristics reported in literature discriminated the attempters from the normal group but not from the depressed group. These characteristics probably are not specific for adolescent suicide attempters. Even when a discriminant analysis was applied, the suicide attempters showed many similarities with the depressed adolescents, although both these groups could be separated from the normal group. Using follow-up data, the quadrants created by the axes appeared to have more implications for prevention than for the a priori group membership.
Adolescent↗
Self-ratings of graduating family practice residents' psychological medicine abilities.
This study evaluated the psychological medicine abilities of graduating residents in the Department of Family Practice and Community Health at the University of Minnesota Health Sciences Center (n = 41). Residents were asked to complete the Psychological Medicine Inventory, a series of nine-point rating scales, which measure level of interest in the psychological aspects of patient care, degree of confidence in dealing with the psychological problems of patients, and various psychological abilities. Behavioral science faculty members familiar with the residents also rated 20 of the residents' overall level of interest and ability in psychological medicine. Residents rated themselves highest on doctor-patient relationships and on recognizing patients in distress, and lowest on psychological interviewing and the ability to be psychologically therapeutic. Item intercorrelations and factor analysis suggested that two main dimensions were being evaluated: clinical psychological abilities (including interviewing, diagnosis, consultation, treatment decisions, and treatment) and psychological sensitivity (including doctor-patient relationships, awareness of patient's reactions, and awareness of own feelings.) Residents' self-ratings correlated positively with faculty ratings.
Clinical Competence↗
[Pluri-dimensional study of psychological factors in coronary disease].
To palliate certain criticisms levelled at workers studying psychological factors in coronary artery disease, the authors have applied a pluri-dimensional approach associating a semi-direct psychological interview, a self-evaluation test (Bortner scale), an Eysenck personality test and Sandler and Hazari's test of obsessional behaviour. This protocol was applied to 222 patients hospitalised for coronary artery disease and 522 random controls. The psychological interview and Bortner test showed a significantly higher proportion of A pattern and especially extreme A pattern behaviour in patients with coronary artery disease (32.6 % in coronary patients 9.7 % in controls). The personality questionnaire showed a greater tendency to neurotic behaviour in the coronary patients. These results were independant of age and sex. In the present study, psychological factors are given equal importance to other major risk factors (tobacco, hypertension, hypercholesterolaemia). They are independant of these other factors. A prospective study using the same protocol is being prepared.
Adult↗
[Risk factors in vasectomy--a comparison of satisfied vasectomized males with dissatisfied males seeking refertilization].
Ninety-two men were explored by depth psychological interviews before vasectomy and 12-15 months later. Eighty-six of them were completely satisfied with the operation. Six men were dissatisfied and would not undergo the operation again. Forty men requesting refertilization were also explored by depth psychological interviews one day before operation. The comparison of these two groups shows that vasectomy is problematic for men who are younger than 30 years, being in training, and whose partners are not willing to undergo sterilization as well. Men without partners and without children should reconsider their decision for vasectomy and particularly those who show the above-mentioned characteristics and/or those who make the decision without being able to use condoms and/or are unable to handle the situation in case of an abortion. The length of partnership is not important for the sequelae of vasectomy.
Abortion, Induced↗
Stress-induced changes in skin barrier function in healthy women.
Despite clear exacerbation of several skin disorders by stress, the effect of psychologic or exertional stress on human skin has not been well studied. We investigated the effect of three different stressors, psychologic interview stress, sleep deprivation, and exercise, on several dermatologic measures: transepidermal water loss, recovery of skin barrier function after tape stripping, and stratum corneum water content (skin conductance). We simultaneously measured the effects of stress on plasma levels of several stress-response hormones and cytokines, natural killer cell activity, and absolute numbers of peripheral blood leukocytes. Twenty-five women participated in a laboratory psychologic interview stress, 11 women participated in one night of sleep deprivation, and 10 women participated in a 3 d exercise protocol. The interview stress caused a delay in the recovery of skin barrier function, as well as increases in plasma cortisol, norepinephrine, interleukin-1beta and interleukin-10, tumor necrosis factor-alpha, and an increase in circulating natural killer cell activity and natural killer cell number. Sleep deprivation also decreased skin barrier function recovery and increased plasma interleukin-1beta, tumor necrosis factor-alpha, and natural killer cell activity. The exercise stress did not affect skin barrier function recovery, but caused an increase in natural killer cell activity and circulating numbers of both cytolytic T lymphocytes and helper T cells. In addition, cytokine responses to the interview stress were inversely correlated with changes in barrier function recovery. These results suggest that acute psychosocial and sleep deprivation stress disrupts skin barrier function homeostasis in women, and that this disruption may be related to stress-induced changes in cytokine secretion.
Adolescent↗
Comorbidity of psychiatric and behavioral disorders in pediatric migraine.
OBJECTIVE: To determine whether behavioral and psychiatric disorders occur more frequently in school-age children with migraine headache. To also elucidate treatment response related to comorbid psychiatric or behavioral diagnosis. BACKGROUND: Recurrent migraine headaches are common in school-age children. Concurrent behavioral or psychiatric diagnoses could significantly impact headache frequency, severity, and response to treatment. METHODS: Healthy children from 6 to 17 years of age presenting to our headache clinic with migraine headache according to International Headache Society (IHS) criteria were identified. Parents/guardians were asked to complete the Child Symptom Inventory, 4th edition (CSI-4) after written informed consent. Children with positive rating scales underwent psychological interviews for confirmatory diagnosis. Results were compared to controls. Headache patients were assigned our usual treatment paradigm. Response regarding headache frequency was assessed at 3 months. RESULTS: A total of 47 patients were diagnosed with migraine headaches. The mean age was 10.55 years. Thirty controls were identified. After completing the CSI-4 and confirmatory psychological interview, 14 of 47 headache patients fulfilled Diagnostic and Statistical Manual (DSM-4) criteria for a psychiatric or behavioral disorder. Oppositional defiant disorder (ODD) was significantly represented among children with migraine compared to the control group of children. Headache patients improved significantly post-treatment regarding their headache frequencies regardless of comorbid psychiatric or behavioral disorder. No significant differences were noted between boys and girls regarding diagnoses or treatment outcome. CONCLUSION: ODD was a significant comorbidity in our headache population. Although families complained of significant behavioral symptomatology in their children, most of these symptoms did not qualify their children for a psychiatric diagnosis and may be related to the stressors of headache on social/school disruption.
Adolescent↗
[Psychological approach to hyperemis gravidarum].
INTRODUCTION: Hyperemesis gravidarum is a phenomenon that concerns only 1 or 2% of pregnant women who require hospitalization if their anorectic behavior does not cease. The treatment consists in complete isolation, anti-vomit drugs and rehydration therapy. OBJECTS: Isolation has been practiced existed since 1914, and is based on the belief that these women were simulating pain in order to obtain abortion. By isolating them from their family environment, the medical staff hopes this secret desire will be revealed. We tried to evaluate the reality of this analysis. MATERIAL AND METHOD: Two psychological interviews were conducted by a questionnaire addressed to 23 pregnant women at the time of their hospitalization for hyperemesis gravidarum in a level 3 gynecology-obstetric unit. All patients were submitted to the described treatment. RESULTS: Four groups were found. In the first group (n=6) women were submerged by a present and conscious conflict concerning their pregnancy, which found and easy solution. In the second group (n=7), the women had lost a pregnancy a short time before the present one. These patients were suffering from this loss and could not easily accept their new baby. The third group (n=6) concerned women who were afraid of a living a dramatic event that their mother had experienced in the past. This worry, held far from their consciousness, could be recalled during the interviews. In the last group (n=4), the women had passed through major difficulties in their relationship with their mothers during childhood. Becoming a mother themselves, they feared they would reproduce the same attitudes toward their own babies. Within this group, only one woman finally asked for an abortion that was performed. CONCLUSION: It would not appear that the patients have to be isolated for them to reveal their desire for abortion. Conversely, a psychological interview allows better understanding of the ambivalent attitudes of pregnant women and thus can be useful in avoiding systematic abortion.
Abortion, Induced↗
Early diagnosis of vulnerability in cancer patients.
The newly diagnosed CA patient faces psychosocial as well as physical problems. To assess the impact of diagnosis, and to find significant clues for later emotional distress, 163 new patients with CA of the breast, colon, lung, Hodgkin's disease, and malignant melanoma were evaluated by interviews, psychological testing, and personality inventories, then followed regularly for six months. Vulnerability was but one parameter that measured emotional distress and faltering capacity to cope with concurrent problems. It was found that the more vulnerable patients had more symptoms when first diagnosed, and that systemic symptoms were more significant than the type of CA or the staging. High vulnerability patients were generally pessimistic, anticipating little recovery and practically no support from significant others. They had more marital problems, tended to suppress feelings, but often had a history of depression. Denial in itself did not mean vulnerability. Indecision about treatment and regrets about the past were more indicative of future emotional problems than was delay. Most patients showed little denial throughout the period of observation, but more vulnerable patients tended to vacillate between denial and acceptance. By learning to listen and ask tactful questions, this information can be elicited by the physician who can then intervene effectively.
Adaptation, Psychological↗
The selection of candidates for psychoanalytic training: on the use of interviews and psychological tests.
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Humans↗
A psychological study of patients undergoing cosmetic surgery.
This is an investigative study of the personality of patients requesting cosmetic rhinoplasty. Analysis of data obtained from objective projective tests and psychological interviews indicated that patients seeking cosmetic surgery are not as psychologically disturbed as often as described. Comparative studies showed certain personality characteristics to be associated with patients who seek cosmetic surgery. While evaluations 18 months after surgery showed no major personality change, self-concept was improved. Certain disturbing personality patterns indicative of psychological risk were identified. These fell more in the range personality disorders, exemplified by the infantile-narcissistic and the manipulative controlling personalities rather than in somatic ranges. We recommend a simple interview question method of counseling designed to identify underlying psychological manifestations and to control the potential problem patient.
Adolescent↗
Assessment of patients with phobic dental anxiety.
This study investigated a screening procedure for psychologic distress in adult patients with dental phobia before treatment of dental fear. The screening procedure was performed among 191 individuals in consecutive steps and included a medical/dental history, psychologic interviewing, and testing. Data collected during this process were analyzed and compared with SCL-90(R) data. The screening process was successful in selecting individuals without major psychologic distress problems. Among the excluded patients 91% had general symptoms scores on the SCL-90(R) exceeding a normative population mean, and 95% of included patients had a mean lower than an average for psychiatric outpatients. There were statistically significant differences between included and excluded patients on all subdimensions of the SCL-90. Thus, excluded patients had higher levels of psychologic distress, poorer psychosocial background, and more psychosomatic symptoms. This was accompanied by higher levels of negative attitudes toward dentists and their performance of dentistry, whereas no significant differences were found among the dental fear measures used.
Adult↗
Psychological evaluation of Japanese astronaut applicants.
In 1991, a new psychological selection procedure was employed during the selection of Japanese Space Station astronauts. It was based on international selection criteria developed by an international psychological/psychiatric working group. A total of 372 individuals--fewer than expected--submitted applications for Space Station astronaut in Japan. Of the applicants, 233 were given several psychological written tests [Anxiety Scale, Performance Test, General Aptitude Test Battery, and Environmental Adjustment Test Battery (EATB)] in Phase I of the selection. Forty-five applicants went on to take the General Aptitude Test Battery (GATB), Human Assessment Method (a group test), a semi-structured psychological interview and an intelligence test in Phase II of the selection. All applicants were found to be highly intelligent. Interestingly, an unexpectedly large number of candidates were disqualified by the newly developed EATB. Assessment of individual functioning in a group (the Human Assessment Method) resulted in no applicant being ranked in either the "qualified with reservation" (QR) or "disqualified" (DQ) category. Much has been learned from this initial application of psychological "select-in" testing, but further efforts are needed to improve both psychological criteria and evaluation methods and to determine their reliability and validity.
Adaptation, Psychological↗
The clinical utility of the Safe Times Questionnaire.
PURPOSE: To evaluate a valid, reliable self-report health behavior screening instrument, the Safe Times Questionnaire (STQ), in a clinical setting. METHODS: One hundred and fifty-two patients at a primary care health center completed the STQ and were randomized into two groups; physicians in the "STQ group" (79 patients) used the STQ while physicians in the "interview group" (73 patients) were blinded to the STQ. Physicians rated each patient on their need for intervention in nine topic areas. Patients then had a psychological interview and were rated on the same topic areas. RESULTS: The total time of the patient visit was significantly longer in the interview group than in the STQ group. Physicians in the STQ group had significantly higher accuracy in identification of subjects at risk for depression and family conflict. CONCLUSIONS: The Safe Times Questionnaire is a potentially useful instrument to efficiently screen adolescents.
Adolescent↗
[A psychosomatic approach to perennial allergic rhinitis].
The objective of this investigation is to study the involvement of the psychological process in the etiology of perennial allergic rhinitis. Thirty patients with perennial allergic rhinitis, submitted to a Program of Hyposensibilization to Home Dust at the ENT Department, were selected. All patients were studied through psychological interviews and Pfister Colored Pyramid Test. Our results were compared to those obtained by Robert Heiss in his studies of standardization parameters (non rhinitic sample). The study revealed that our patients present intrinsic psychological difficulties characteristic of failures in the affective--emotional development and points out to a neurotic line of personality structuration.
Adult↗
Traumatic stress in HIV-infected women.
This study assesses the prevalence of specific traumatic stressors that meet criterion A for the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) diagnosis of posttraumatic stress disorder (PTSD) and symptoms of PTSD in a representative sample of HIV-infected women. The study also assesses the impact of these stressors and symptoms on the clinical progression of HIV infection. The Life Stressor Checklist and the Impact of Events Scale-Revised were administered via interview to 67 Africa-American women beyond the initial stages of HIV infection. The ratio of CD4 t-cells to CD8 t-cells were abstracted from medical records at dates that approximated psychological interviews and were examined at two points in time 12 to 14 months apart. The prevalence of traumatic stressors and PTSD symptoms were high among HIV-infected women. Traumatic stressors were significantly associated with a lower CD4 to CD8 ratio at the 1-year follow-up. Among women who reported a traumatic event, those who also met criteria for PTSD evidenced a lower CD4 to CD8 ratio at the follow-up assessment. The study concludes that prevention and treatment efforts targeted at HIV-infected women must take into account traumatic stressors and PTSD symptoms and their potential impact on the course of the disease.
Adolescent↗