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PubMed1965

FORCE GRADIENTS IN STIMULUS GENERALIZATION.

Pigeons were trained to peck with differing force requirements on a key specially designed to measure and control force of pecking without changes in the mechanical threshold. Following training on a key illuminated by a single wavelength, a generalization test was given. Force and rate gradients were obtained. Force gradients were shown to have a form similar to rate gradients. The slope of the force gradients was a direct function of the force of responding at the conclusion of training. Rate gradients were independent of the force of responding.

Animals↗
PubMed2004

Waiting for elective general surgery: physical, psychological and social consequences.

BACKGROUND: Long surgical waiting lists are common and receive serious consideration. To evaluate the positive and negative effects of waiting lists, insight into the consequences of waiting is needed. The present study aims to assess what insight the current literature provides into the effects of delayed surgery for varicose veins, inguinal hernia in adults, gallstones, and breast cancer in terms of physical, psychological and social aspects. METHODS: Searches of Medline and Embase, for the period January 1985-September 2003, were performed to identify articles providing direct or indirect insight into the consequences of waiting for surgery for each disorder. Reference lists of retrieved reports were examined for relevant articles. RESULTS: Seven studies were identified with direct data on consequences of delay in elective surgery. Relevant indirect data were found in 32 reports. Results indicated that delayed varicose vein surgery or inguinal hernia repair involves marginal physical, psychological or social suffering, and that severe deterioration is unlikely. The impact of delayed cholecystectomy seems more profound by suffering on all three health aspects. Complications while waiting do occur, with a higher risk for patients with previous complications. Longer delays for breast cancer surgery seem to adversely affect prognosis, although it is unclear which interval is associated with such an effect. Moreover, having breast cancer undoubtedly affects psychological health. CONCLUSIONS: There is a remarkable paucity of studies addressing the consequential impact of waiting for elective surgery on patients' health for each of the four studied disorders. Current literature permits merely general estimation of this consequential impact. As specific assessment of these consequences is important for daily practice and for policy, further research is required.

Elective Surgical Procedures↗
PubMed1986

Psychological deviance in children attending general practice.

Parental questionnaires identified 22% of children aged 7-12 years attending 8 general practices as psychologically deviant. Most attended for physical complaints. A comparison with general population rates showed that deviant children were over-represented among surgery attenders, particularly in the more socially advantaged areas. This finding may be explained through an excess of somatic symptoms in deviant children; increased parental concern about the child's health as an extension of concern about his behaviour; family stress. These possibilities are discussed.

Child↗
PubMed1999

New areas for psychological assessment in general health care settings: what to do today to prepare for tomorrow.

Unique roles of the professional psychologist are outlined with respect to increasingly restrictive utilization practices of managed care. Suggestions of how to develop less traditional venues of practice, the types of instruments to use, and report formats, along with ways to persuade primary care physicians (PCPs), managed care organizations, and facilities to utilize psychological assessment services are provided. Medical cost offsets, cost-efficient quality of care, and models of practice are also discussed.

Cost-Benefit Analysis↗
PubMed1990

Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care.

A sample of 101 patients with generalized anxiety disorder were randomly allocated to one of five groups--diazepam, placebo, cognitive-behaviour therapy, diazepam plus cognitive-behaviour therapy, or placebo plus cognitive-behaviour therapy--and treated over 10 weeks in a primary care setting. All groups received a similar amount of contact with the psychologist and general practitioner. The greatest improvement in ratings of severity of symptoms and overall change in symptoms occurred with cognitive-behaviour therapy combined with diazepam; cognitive-behaviour therapy alone also performed well and cognitive-behaviour therapy plus placebo performed slightly less well. Diazepam alone showed improvement relative to placebo alone. There was a high level of agreement between ratings by the general practitioners, psychologist, and the patients of the response to treatment. At six months follow-up there was no difference between treatment groups in the proportion of patients receiving psychotropic medication after the end of the study. However, cognitive-behaviour therapy, either alone or in combination with drug or placebo, showed the lowest incidence of referral for psychological or psychiatric treatment at six months follow-up.

Adult↗
PubMed1996

Parasuicide in the county of Sør-Trøndelag, Norway. General epidemiology and psychological factors.

During the period 1 October 1988 to 31 December 1993, 2068 episodes of parasuicide involving 1543 persons were registered in the county of Sør-Trøndelag, Norway. Parasuicide rates decreased in the area compared with 1987, more for females than for males. Rates were higher for divorced females and separated males than for those of other marital statuses, but these rates were lower than previously found in the same area. The proportion of unemployed patients remained fairly stable, while the rate of unemployment increased in the general population. Compared to males, female parasuicide patients more often reported family problems and economic inactivity, and more often had been victims of violence or sexual abuse. Male parasuicide patients more often than females were living alone, were unemployed, abused alcohol, had financial problems, and had been engaged in criminal activity. Compared with older parasuicide patients, the young of both sexes were more often unemployed and abused drugs, but had less often been in contact with the health or social services. In addition, young female parasuicide patients more often had experienced family problems and suicidal behaviour among family or friends. The results were generally considered to be consistent with theories of sex role stereotypes, which emphasize expressive traits in an affiliative context for females and instrumental traits in a public or economic context for men.

Adolescent↗
PubMed2000

Psychological morbidity in general practice managers: a descriptive and explanatory study.

BACKGROUND: Proposals to establish an occupational health service for primary care should be informed by knowledge of the health needs of general practice employees. AIM: To determine the prevalence and occupational correlates of stress, anxiety, and depression among practice managers in two contrasting health authorities in England. METHOD: A postal questionnaire, soliciting information about stress induced by work-related activities, which contained the General Health Questionnaire (GHQ) and Hospital Anxiety and Depression Scale (HADS), was sent to all 149 practice managers in two health authorities areas of south-east England. RESULTS: Completed questionnaires were returned by 111 (75%) managers; 41/111 (37%) achieved GHQ case status with scores on HADS indicating that 49/111 (44%) classified themselves as anxious and 19/111 (17%) as depressed. The likelihood of being a case was found to be higher in managers from practices with larger numbers of GP partners (P = 0.02) and in managers from practices not in receipt of deprivation payments (P = 0.03). Multiple logistic regression showed that managers' perceived difficulties with general practice administration duties (relative ratio [RR] = 3.27, 95% confidence interval [CI] = 1.22-8.75) and dealings with GPs (RR = 1.86, 95% CI = 1.03-3.34) were the most powerful predictors of case status. CONCLUSION: The questionnaire uncovered high prevalences of self-reported stress, anxiety, and depression in general practice managers. Although the vast majority of National Health Service (NHS) employees have access to an occupational health service, no such source of support exists for those working in general practice. The NHS needs to establish an occupational health service that caters to the needs of clinical and non-clinical members of primary health care teams.

Administrative Personnel↗
PubMed1999

General health and psychological symptom status in pregnancy and the puerperium: what is normal?

OBJECTIVE: To identify normative changes in psychological and physiologic health status associated with pregnancy and the puerperium. METHODS: Self-administered surveys containing Ware's Short Form-36 and Derogatis's Brief Symptom Inventory were completed by 393 pregnant women during their third trimester. Of those, 253 completed the same survey during the puerperium. Results were compared between periods and with those of samples of women from standardized community samples. RESULTS: On the Short Form-36, pregnant women in the third trimester had significantly poorer levels of functioning (P<.01) than community controls with regard to bodily pain (51.86 versus 79.61), physical functioning (62.91 versus 89.12), social functioning (74.0 versus 84.06), vitality (47.24 versus 58.04), and functional limitations resulting from physical health problems (45.0 versus 86.73) subscales. Those differences persisted into the puerperium. Compared with pregnancy, scores on social functioning and functional limitations caused by emotional problems decreased during the puerperium. Women reported improved perceptions of their general health in the puerperium compared with community controls (80.22 versus 74.80). On the Brief Symptom Inventory, pregnant women reported significantly higher levels of emotional distress on the three global measures and on the somatization (0.75 versus 0.35), obsessive-compulsive (0.70 versus 0.48), and hostility (0.59 versus 0.36) subscales than controls; those changes normalized in the puerperium. CONCLUSION: Pregnancy and the puerperium are associated with significant changes in psychological and physiologic health status. Documentation of those changes is important if the Short Form-36 and Brief Symptom Inventory are to be used in health outcomes research with this population.

Adult↗
PubMed1986

Psychological treatment in general practice: its effect on patients and their families.

Rates of consultations and prescriptions for patients referred to clinical psychologists, and for these patients' immediate families, were investigated for three-year periods both before and after referral. Patients and their children consulted more and had more medication prescribed before referral than control groups, this tendency being particularly prevalent in the year before referral. After the contact with the psychologist there was a decrease in all these indices in the short term, and there were long-term decreases in psychotropic drug prescriptions for patients and in both consultations and prescriptions for their children.

Child↗
PubMed1982

A general systems taxonomy for psychological defence mechanisms.

A taxonomy of psychological defence mechanisms based on general systems concepts is proposed. The personality system consists of the subsystems concerned with input, internal processing, and output of information. Psychological defence mechanisms can be classified according to the subsystem whose function is mainly altered. Defence mechanisms primarily altering the input apparatus function through changes in the perceptual process. These include diminution of perception (denial), distortion of the origin of the percepts (projection and introjection), and distortion of subjectively perceived direction of the feelings and thoughts (displacement). Defence mechanisms that primarily alter the functions of the internal processing apparatus include repression, rationalization, intellectualization, isolation, and fantasy/day-dreaming. These mechanisms alter associative and cognitive processes either directly (repression) or indirectly. In reaction formation, there may by a selective distortion to produce an opposite affect. Defence mechanisms that primarily affect the output apparatus include acting out, counterphobic activity, undoing, sublimation, and non-specific activity. Regression and identification are defence mechanisms that affect all the subsystems, input, internal processing and output, more or less uniformly producing effects throughout the personality system. The advantage of this classification scheme is that it relates primarily to directly observable phenomena that can be readily classified. Another advantage is that it may generate researchable neuropsychological hypotheses concerning possible neural substrates of defence mechanisms.

Defense Mechanisms↗
PubMed1994

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

OBJECTIVE: To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. DESIGN: A cross-sectional sample selected by two-stage sampling. SETTING: Primary health care facilities in 14 countries covering most major cultures and languages. PATIENTS: A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). MAIN OUTCOME MEASURES: Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. RESULTS: After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. CONCLUSIONS: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Adolescent↗
PubMed2004

[Why does the general practitioner overlooks psychological disorders in his patient?].

Physicians have a major screening function in the care of patients suffering from psychological disorders. Often, psychosocial disorders are overlooked in primary care. The study presented here investigates factors correlating with the identification of psychosocial disorders in primary care. Physician-patient consultations of 120 patients with psychological disorders of 16 primary care practices were analyzed with respect to doctor-patient interactions using Structured Analysis of Social Behavior (SASB). In addition, reported complaints, length of consultations and identification of psychological disorders by the physicians were analyzed. The physicians identified 60.8 % of the psychological disorders. There was a significant association between physician's identification of psychological disorders and (1) the severity of the disorder, (2) the number of complaints reported during consultation (3) the pattern of physician-patient interaction. A high frequency of interaction patterns referred to as complementary and controlling in terms of SASB categories, interferes with identification of psychological disorders. The study shows that the interactional process during primary care consultation is associated with physicians' identification of psychological disorders.

Adult↗