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PubMed1999

Acute myocardial infarction: psychosocial and cardiovascular risk factors in men.

BACKGROUND: Controversy still exists over the independent role of psychosocial factors in acute myocardial infarction (AMI). This study aimed to compare psychometric indices in Portuguese patients surviving a first episode of AMI and a community sample free of AMI. DESIGN: A community-based, case-control study. The study sample included 153 male patients with a first episode of AMI and 156 male controls randomly selected from the community. METHODS: Information on demographic, social, medical and behavioural characteristics was obtained using a structured questionnaire; anthropometric, blood pressure, and serum measurements were performed, and the psychometric evaluation was obtained using a self-evaluation questionnaires (Bortner scale, Beck Depression Inventory, SCL-90-R, Psychological General Well-Being and the Nottingham Health Profile). RESULTS: Cases of AMI more often exhibited type A behaviour (15.4 +/- 3.0 versus 14.7 +/- 2.7, P = 0.041), had more depressive symptoms (10.8 +/- 8.0 versus 8.6 +/- 8.0, P = 0.005) and showed worse scores on general well-being (68.4 +/- 17.7 versus 76.6 +/- 16.2, P < 0.001) than controls. Cases were significantly different from controls in terms of years of education (6.7 +/- 4.4 versus 9.0 +/- 4.7 years, P < 0.001), hypertension (43.1% versus 30.1%, P = 0.024), dislipidaemia (43.8% versus 34.0%, P = 0.038), type I obesity (53.6% versus 42.3%, P = 0.045), smoking (54.1% versus 26.5%, P < 0.001), no practise of exercise (68.5% versus 50.3%, P = 0.002) and presence of non-insulin-dependent diabetics (16.3% versus 6.4%, P = 0.010). After adjusting for such factors a similar set of significant psychometric results was found. CONCLUSION: Type A behaviour, depression and lower levels of well-being and quality of life, independent of other cardiovascular risk factors, were significant features of AMI cases.

Adult↗
PubMed2004

Methods for assessment of cognitive failure and delirium in palliative care patients: implications for practice and research.

The most commonly encountered clinical conditions presenting with cognitive failure (CF) are delirium, dementia and amnestic disorders. Of these, delirium is probably the most prevalent in palliative care, and it is potentially reversible. Thus, improvement in diagnostics seems warranted. The objectives of this review were to examine the methods for assessment of CF and delirium in palliative care. Twenty-two studies were reviewed: 64% were published in 2000 or later. Twelve reports focused on delirium, six on CF, while the remaining four assessed confusion (2), hallucinations and general psychological morbidity. Median sample size was 100 (20393). Ten different instruments were used: The Mini Mental State Exam was used in 13 studies. Five studies were validation reports of new or existing instruments. The term CF is an imprecise description of a loss in one or more of the cognitive functions. The interchangeable use of CF as a description of specific diagnoses should be avoided, as this contributes to prevalence rates that are not representative. Assessment tools that discriminate between the different diagnostic entities presenting with CF should be used in future studies.

Cognition Disorders↗
PubMed1993

The factor structure of the Rorschach for adolescent inpatients.

The factor structure of the Rorschach inkblot test was examined using a sample of 268 adolescent inpatients (including 105 with conduct disorders and 105 with depressive disorders). An initial analysis found a four-factor solution for both the conduct-disordered and depressive-disordered groups. However, examination of the factor patterns suggested that these groups did not yield significantly different factor structures. Thus, for the final analysis all inpatients were combined, and a single three-factor solution was found. These factors were substantively similar to the initial analysis and were interpreted as consisting of (a) struggles with affective expression, (b) general psychological health, and (c) perceptual organization.

Adaptation, Psychological↗
PubMed1994

Unidimensionality of the Brief Symptom Inventory (BSI) in adult and adolescent inpatients.

This study investigated the factor structure of the Brief Symptom Inventory (BSI; Derogatis, 1992) for adult and adolescent psychiatric inpatients. The BSI was administered to 217 adults and 188 adolescents at admission and discharge from a private psychiatric hospital. Principal components factor analyses revealed that most variance among dimension scores was accounted for by one unrotated factor. Factorial invariance was evident across adult and adolescent samples for admission and discharge scores. Our findings are consistent with previous research on the BSI and Symptom Checklist-90-R (Derogatis, 1977), suggesting that both instruments measure primarily a unidimensional construct of general psychological distress.

Adolescent↗
PubMed2004

The characteristics of quality of life impairment in adult growth hormone (GH)-deficient survivors of cancer and their response to GH replacement therapy.

We studied 50 (27 women and 23 men) GH-deficient (GHD) cancer survivors and 47 (24 women and 23 men) GHD patients with pituitary pathologies. All GHD patients were considered for GH replacement on the basis of subjectively poor quality of life (QOL). Primary outcome measures were scores of QOL instruments psychological general well-being schedule (PGWB) and assessment of GH deficiency in adults (AGHDA) at baseline and early (6-13 months) and long-term (24-77 months) treatment follow-up. Of secondary interest were six PGWB domains. Linear mixed effect regression was used to model each QOL outcome. The groups differed with respect to three covariates: age, gender, and body mass index. These variables were included in all fitted models. Baseline scores for PGWB and AGHDA were not different between groups. Ranking of PGWB domains were similar between groups at baseline (lowest domain, vitality). The pattern of change in mean scores for all outcome measures from baseline did not differ between groups (P = 0.86). All QOL variables improved significantly with treatment [estimated mean change +/- se: PGWB, 16.2 +/- 1.7; AGHDA, -6.2 +/- 0.6; PGWB domains (transformed percentage scales): anxiety, 12.4 +/- 1.7; depression, 14.1 +/- 2.1; health, 12.4 +/- 1.7; self-control, 11.3 +/- 2.0; well-being, 15.2 +/- 1.7; vitality, 22.5 +/- 2.0 (vitality, greatest change)]. There was no evidence of group difference in early follow-up or long-term follow-up means for any outcome variable. The QOL in adult GHD cancer survivors was comparable to that in GHD adults with pituitary pathologies and improved with GH replacement in a similar manner. We conclude that QOL impairment in adult GHD cancer survivors appears mainly related to GHD rather than cancer diagnosis and treatment.

Adenoma↗
PubMed2005

Quality of life (QOL) in patients with acromegaly is severely impaired: use of a novel measure of QOL: acromegaly quality of life questionnaire.

Acromegaly Quality of Life Questionnaire (AcroQoL) is a new disease-generated quality of life (QOL) questionnaire comprising 22 questions covering physical and psychological aspects of acromegaly and subdivided into "appearance" and "personal relations" categories. We have performed a cross-sectional study of QOL in 80 patients [43 male (mean age, 54.2 yr; range, 20-84); median GH, 0.93ng/ml (range, <0.3 to 23.7); IGF-I, 333.1 ng/ml (range, 47.7-899)] with acromegaly. In addition to AcroQoL, patients completed three generic QOL questionnaires: Psychological General Well-Being Schedule (PGWBS), EuroQol, and a signs and symptoms score (SSS). All three generic questionnaires confirmed impairment in QOL [mean scores: PGWBS, 69.6; EuroQol, visual analog scale, 66.4 (range, 20-100) and utility index, 0.7 (range, -0.07 to 0.92); and SSS, 12 (range, 0-27)]. There was no correlation between biochemical control and any measure of QOL. AcroQoL (57.3%; range, 18.2-93.2) correlated with PGWBS (r = 0.73; P < 0.0001); and in patients with active disease, AcroQoL-physical dimension correlated with SSS (r = -0.67; P < 0.0003). In all questionnaires, prior radiotherapy was associated with impaired QOL. In conclusion, these data underline the marked impact that acromegaly has on patients' QOL and provide the first evidence validating AcroQoL against well-authenticated measures of QOL. This indicates the potential of AcroQoL as a patient-friendly measure of disease activity.

Acromegaly↗
PubMed1995

Quality of life in adults with growth hormone (GH) deficiency: response to treatment with recombinant human GH in a placebo-controlled 21-month trial.

We examined the effect of GH supplementation on the psychological capacity and sense of well-being in 36 patients with adult-onset GH deficiency (GHD). Recombinant human GH was given in a 21-month cross-over, double blind trial, and quality of life was assessed by using three self-rating questionnaires: the Hopkins Symptom Check List (HSCL), the Nottingham Health Profile (NHP), and the Psychological General Well-Being index. In addition, at the final examination the spouses completed a short questionnaire concerning their partner. Before treatment, the patients had lowered quality of life as determined by the HSCL and NHP inventories, and a correlation between the duration of GHD and the reported symptoms was observed. Upon treatment, the HSCL score was lower (better) after placebo administration (mean +/- SD, 84 +/- 21.3) than at baseline (89 +/- 18.9; P = NS) and fell to 80.2 +/- 18.5 (P < 0.001) when active drug was given. The subscales regarding anxiety, fearfulness, and cognition were the most sensitive. It was apparent that the effect determined after GH therapy in part was due to a placebo effect. With NHP, the dimensions of energy and emotions responded most to treatment. Further, the spouses observed their partners to be improved in several aspects of mood and behavior (P < 0.05 to P < 0.0001) when active drug was given. The data thus demonstrate that GH, which is known to have multiple somatic effects, produces an improvement in the quality of life of adults with GHD.

Adult↗
PubMed2002

GH-deficient survivors of childhood cancer: GH replacement during adult life.

Childhood survivors of cancer are prone to a number of adverse sequelae related to the therapeutic interventions undertaken to achieve remission. The endocrine system is frequently affected; hypothalamo-pituitary dysfunction, in particular GH deficiency, is common after cranial irradiation. It is unclear to what extent GH deficiency contributes to the abnormalities observed in adult survivors of childhood cancer, and whether GH replacement reverses these anomalies. We compared 27 GH-deficient survivors of childhood cancer with 27 adult age- and sex-matched controls and went on to replace GH in the patient group to determine whether GH resulted in improvements of the baseline abnormalities. The GH-deficient survivors of childhood cancer had an adverse lipid profile (total cholesterol, 5.4 vs. 4.6 mM, P = 0.004; high-density lipoprotein cholesterol, 1.05 vs. 1.6 mM, P < 0.001; and triglycerides, 1.3 vs. 1.0 mM, P < 0.001) and were osteopenic (lumbar spine z-score, -1.53 vs. -0.31 SD score, P < 0.001; femoral neck z-score, -1.23 vs. -0.27 SD score, P = 0.02); additionally, the female subgroup had an increased percentage body fat (43.6 vs. 32.8%, P = 0.016). In keeping with the selection criterion, quality of life in the patient cohort, relative to the healthy controls, was severely impaired [adult GH-deficiency assessment (AGHDA), 15.5 (range, 8-25) vs. 1 (range, 0-19), P < 0.0001; psychological general well-being schedule, 67.5 (range, 18-86) vs. 89.0 (range, 51-104), P < 0.0001]. After 12 months of GH replacement, small (but significant) improvements were observed in body composition in the male subgroup (waist-hip ratio, 0.871 vs. 0.863, P < 0.05); and in the female cohort, total cholesterol (6.0 vs. 5.2 mM, P = 0.01) and triglyceride (2.1 vs. 1.4 mM, P = 0.01) levels fell. Bone mineral density improved in only one of the four sites studied (ultradistal radius, -1.21 vs. -1.09, P = 0.048) after a median duration of GH therapy of 18 months. Quality of life improved dramatically by 3 months (AGHDA, 15.5 vs. 10.0, P < 0.001), and the improvement was maintained at 12 months (AGHDA, 15.5 vs. 9.0, P < 0.001). Importantly, there was no clinical suggestion of tumor recurrence during the 12 months of GH replacement. The minor improvements observed in body composition, the lipid profile, and bone mineral density in GH-deficient adult survivors of childhood cancer after 12-18 months of physiological GH replacement suggest that GH deficiency may not be the major etiological factor in their pathogenesis; the converse seems to be true for the quality of life status of these individuals. We propose that, as in patients with hypopituitarism caused by pituitary disease, the main indication for GH replacement in GH-deficient survivors of childhood cancer should be severe impairment of quality of life.

Adolescent↗
PubMed1998

Self-care and psychosocial adjustment of patients following cardiac surgery.

This research examined the role of self-care behavior of 151 patients (aged 40 to 80) on general psychological distress at one year after coronary artery bypass graft (CABG) surgery. A tested hypothesis was that self-care practices would be associated with a lower level of distress one year after surgery. The results supported the beneficial effect of self-care on psychological adjustment, after controlling for the effects of the number of other chronic illnesses and post-CABG depression. The findings suggest that social work in health care and in-home care may help promote the psychosocial recovery process following surgery.

Adaptation, Psychological↗
PubMed2001

Experimental avoidance and high-risk sexual behavior in survivors of child sexual abuse.

While many long-term correlates of child sexual abuse (CSA) have been identified, theories to explain the development of these correlates have received little empirical validation. The process of experiential avoidance is one theory that has been proposed to account for many of the correlates of CSA. The purpose of the current study was twofold: (1) To attempt to develop a more complex measure of experiential avoidance in women with and without a CSA history, and (2) to explore variables related to two of the long-term correlates of CSA, general psychological distress and high risk sexual behavior. Levels of current distress, high-risk sex, and experiential avoidance were examined in 257 undergraduate females (mean age 20.0) using self-report questionnaires. The results of the current study indicate that CSA survivors report higher levels of experiential avoidance and high-risk sexual behavior with persons other than their primary partners. Implications of these findings for theory development, therapy with CSA survivors, and HIV prevention programs are discussed.

Adaptation, Psychological↗
PubMed2004

Interference and time: a brief review and an integration.

Contemporary theories of associative learning have been preoccupied with the phenomenon of stimulus competition (attenuated responding to a target stimulus-outcome association if another stimulus trained together with the target is a better or more reliable predictor of the outcome). In recent years, reports of associative interference between associations trained separately have challenged associative learning theories, which provide no mechanism to account for this type of interference. Moreover, the ever-growing reports of temporal relationships between stimuli being a variable that determines the occurrence of stimulus competition and associative interference call for a reformulation of associative theory that can account for both interference and temporal learning effects. Here, we briefly review some of the central findings in stimulus competition, associative interference, and temporal learning, as well as a recently-proposed integration of these three seemingly disparate families of phenomena.

Animals↗
PubMed2003

Psychache and suicidality in adult mood disordered outpatients in Brazil.

Shneidman (e.g., 1998) has theorized that psychache--general psychological and emotional pain that reaches intolerable intensity--is an important suicide-related variable, and indeed, represents a source of suicidal behavior. This conceptualization, while prominent and clinically and intuitively appealing, has received relatively little empirical scrutiny. In this study, we determined whether an index closely related to psychache, psychological quality of life, would display a special and resilient association to suicidality among 60 adult psychiatric outpatients in Brazil. All patients underwent structured clinical interviews and completed various clinical and quality-of-life measures. We found that the association between psychological quality of life and suicidality remained, even when depression, hopelessness, and other domains of quality of life were controlled. Psychache appears to deserve its place among key suicide-related variables, and deserves the attention of clinicians working with suicidal people.

Adolescent↗
PubMed1994

Adult daughters of alcoholics: are they unique?

To test the assertion in the clinical literature that adult children of alcoholics (ACOAs) are uniquely impacted by their parents' alcohol abuse, 25-35 year old daughters (N = 184) of alcohol-abusing, psychiatrically distressed, comorbid and normal parents were compared on measures of fear of intimacy, generalized psychological distress, perceived love inconsistency from parents and perceived interparental conflict. Neither fear of intimacy nor daughters' psychological distress differed across groups. Daughters of psychiatrically distressed and comorbid mothers recalled greater love inconsistency from mother than from father. Daughters of psychiatrically distressed and comorbid fathers recalled greater interparental conflict and daughters of comorbid fathers recalled greater love inconsistency from fathers than did daughters of alcoholic fathers. The proposed unique features of ACOA daughters and of the alcoholic family environment were not identified. The findings are discussed in terms of the clinical literature on ACOAs.

Adult↗
PubMed2005

Interdependence of lean body mass and total body water, but not quality of life measures, during low dose GH replacement in GH-deficient adults.

Lean body mass (LBM) and total body water (TBW) are reduced in GH-deficient (GHD) adults and alter with GH replacement. Whether these parameters are interdependent and whether alterations in their homeostasis contribute to the perceived quality of life (QOL) deficit in GHD remains unclear. In this study, IGF-I, body composition by whole-body dual-energy X-ray absorptiometry, TBW by deuterium dilution (D(2)O) and two validated QOL instruments - psychological general well-being schedule (PGWB, generic, 6 domains; lower score worse QOL) and assessment of GH deficiency in adults (AGHDA, disease orientated; higher score worse QOL) were studied at baseline and after 3 and 6 months of GH replacement in thirty GHD adults. Patients with diabetes insipidus, and cardiac and renal failure were excluded. Median age-adjusted IGF-I standard deviation score increased from -3.40 (-6.40 to -1.60) to -0.2 (-1.88 to 0.78) (P < 0.0001) at a median daily GH dose of 0.4 mg. During treatment, LBM increased from 47.4 +/- 10.7 kg at baseline to 49.5 +/- 10.8 kg at 6 months (P = 0.0008), and fat mass decreased from 28.0 +/- 12.1 kg at baseline to 27.2 +/- 12.6 kg at 6 months (P = 0.0004). A non-significant trend towards an increase in TBW was observed (mean 1.7 kg, P = 0.08). The PGWB score increased from 62.9 +/- 20.6 to 73.7 +/- 21.7 (P = 0.0006). The AGHDA score decreased from 13.7 +/- 7.3 to 8.75 +/- 7.75 (P = 0.0002). At each time point, a linear correlation between LBM and TBW was demonstrated, defined by TBW = (0.972 x LBM)-10.6. However, only a weakly positive correlation existed between the percentage changes in these variables (R = 0.40, P = 0.04). No correlations were demonstrated between QOL measures and body composition. The change in LBM with physiological GH replacement correlates weakly with change in TBW, therefore factors other than TBW may also contribute to the LBM changes. Improved QOL with GH replacement is not explained by favourable changes in body composition.

Adult↗
PubMed1985

Teaching between-class generalization of toy play behavior to handicapped children.

In this study, young children with severe and moderate handicaps were taught to generalize play responses. A multiple baseline across responses design, replicated with four children, was used to assess the effects of generalization training within four sets of toys on generalization to untrained toys from four other sets. The responses taught were unique for each set of toys. Across the four participants, training to generalize within-toy sets resulted in complete between-class generalization in 11 sets, partial generalization in 3 sets, and no generalization in 2 sets. No generalization occurred to another class of toys that differed from the previous sets in that they produced a reaction to the play movement (e.g., pianos). Implications for conducting research using strategies based on class interrelationships in training contexts are discussed.

Child↗
PubMed1966

The role of discrimination training in the generalization of punishment.

Pigeons were trained to respond equally to various orientations of three parallel lines projected on a response key. One group was then punished for responding to the vertical lines, but not punished in a line-absent condition. Two other groups were also punished but had no opportunity to make such a discrimination. Orderly generalization gradients were obtained from the discrimination group during recovery from punishment, with least responding to the vertical lines and higher rates to other orientations. Gradients obtained from the non-discrimination groups were flat. A discrimination of punishment contingencies appears to be necessary for a stimulus correlated with punishment to acquire control over its reductive effects.

Animals↗
PubMed1968

The peak shift in stimulus generalization: equivalent effects of errors and noncontingent shock.

Terrace suggested that the peak shift in stimulus generalization occurs because the training stimulus not correlated with reinforcement has become aversive. This hypothesis is plausible in the light of instances where the peak shift is obtained compared with those where it fails to appear. The present experiment attempted to test implications of this hypothesis. Two groups of pigeons learned the same two-stimulus discrimination between colors by different training methods in a free-operant situation. When the discrimination was trained with many errors, a large peak shift was obtained in a subsequent generalization test of wavelength; after discrimination training with few errors, a negligible shift was observed. Half of each group then received noncontingent aversive shock during presentations of the stimulus not correlated with reinforcement in continued discrimination training. After this treatment, the errorless-shock subgroup showed a large peak shift and the error-shock subgroup tended to show a larger shift than before. Nonshocked control groups showed little change in the peak shift. It was concluded that pairing aversive shock with a stimulus not correlated with reinforcement is sufficient to produce or enhance a peak shift. In their effect on the peak shift, aversive shock and large amounts of nonreinforced responding appear to be equivalent.

Analysis of Variance↗