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PubMed1995

Treatment of Spasticity in Spinal Cord Injury with Dronabinol, a Tetrahydrocannabinol Derivative.

Spinal-cord-injured patients and the medical literature have increasingly reported anecdotes regarding tetrahydrocannabinol (THC)-induced spasmolysis. These reports motivated this trial of dronabinol, a THC derivative, for the treatment of spasticity in the spinal-cord-injured population. Five made quadriplegic patients were given oral dronabinol in escalating doses from 5 mg BID to 20 mg TID in addition to their current, but ineffective, spasmolytic regime. The pendulum drop test was used to quantify spasticity (stiffness) in the knees. The Weschler Memory Scale (WMS), Profile of Mood States (POMS), and personal interviews were administered by the clinical psychologist to evaluate any changes in the subjects' cognition and/or emotional states. Spasticity was markedly improved in two of the five subjects, unchanged in a third, fluctuated in a fourth and made progressively worse in a fifth. The WMS revealed improvement in memory skills of two subjects and no change in the other. Psychological interviews and the POMS indicated decreased vigor in all subject, but otherwise demonstrated highly individualized emotional changes as indicated by increases and/or decreases in the dysphoric mood scales.

Journal Article↗

PubMed1998

The relationship between fatigue, psychological and immunological variables in acute infectious illness.

OBJECTIVE: The aim of this paper is to explore the longitudinal relationships between physical and psychological symptoms and immunological factors following acute infective illnesses. METHOD: Preliminary data from a prospective investigation of patients with serologically proven acute infectious illnesses due to Epstein-Barr virus (EBV), Ross River virus (RRV) or Q fever are reported. Patients were assessed within 4 weeks of onset of symptoms and then reviewed 2 and 4 weeks later. Physical illness data were collected at interview. Psychological and somatic symptom profiles were assessed by standardised self-report questionnaires. Cell-mediated immune (CMI) function was assessed by measurement of delayed-type hypersensitivity (DTH) skin responses. RESULTS: Thirty patients who had been assessed and followed over the 4-week period (including 17 patients with EBV, five with RRV and eight with Q fever) were included in this analysis. During the acute phase, profound fatigue and malaise were the most common symptoms. Classical depressive and anxiety symptoms were not prominent. Initially, 46% of cases had no DTH skin response (i.e. cutaneous anergy) indicative of impaired cellular immunity. Over the 4-week period, there was a marked improvement in both somatic and psychological symptoms, although fatigue remained a prominent feature in 63% of subjects. The reduction in reported fatigue was correlated with improvement in the DTH skin response (p = 0.001) and with improvement in General Health Questionnaire (GHQ) scores (p < 0.01). CONCLUSIONS: Acute infectious illnesses are accompanied by a range of nonspecific somatic and psychological symptoms, particularly fatigue and malaise rather than anxiety and depression. Although improvement in several symptoms occurs rapidly, fatigue commonly remains a prominent complaint at 4 weeks. Resolution of fatigue is associated with improvement in cell-mediated immunity.

Adaptation, Psychological↗

PubMed1999

Psychological distress in victims of elder mistreatment: the effects of social support and coping.

The objective of the study was to examine psychological distress in victims of elder mistreatment and to determine whether social support, coping style, mastery, and perceived self-efficacy favorably influence the psychological health of these victims. The study sample consisted of 77 subjects who reported recent chronic verbal aggression, physical aggression, or financial mistreatment, and a control group of 147 subjects who had not been mistreated. All participants were elderly persons who were over 65 years of age and living independently in the community. Social support, coping style, mastery, and perceived self-efficacy were measured by means of a standardized home interview. Psychological distress was measured by means of the General Health Questionnaire (GHQ-12). Victims of elder mistreatment had significantly higher levels of psychological distress than nonvictims. Social support showed a favorable effect on the level of psychological distress in victims, but not in nonvictims; victims who received more social support showed less psychological distress. A lower sense of mastery, a negative perception of self-efficacy, and a passive reaction pattern were associated with higher levels of psychological distress in victims as well as in nonvictims. The beneficial role of social support, locus of control, and perceived self-efficacy on the level of psychological distress could be of importance in the development of future intervention programs.

Adaptation, Psychological↗

PubMed2004

Family caregiver burden in the context of the long-term care insurance system.

This paper covers our recent work regarding family caregiver burden for elderly. The topics are as follows: cross-sectional studies on caregiver burden; changes in caregiver burden; appropriateness of the Long-Term Care insurance assessment scheme; attitude towards caregiving among caregivers; and the development of the short version of the Japanese version of the Zarit Caregiver Burden Interview.

Aged↗

PubMed2004

Weight cycling in treatment-seeking obese persons: data from the QUOVADIS study.

OBJECTIVE: To determine parameters of weight history useful for the assessment of weight cycling and their association with psychological distress and binge eating. DESIGN: Cross-sectional. SUBJECTS: A total of 1889 treatment-seeking obese subjects, enrolled by 25 Italian centers (78% female subject), aged 20-65 y (median 45); 1691 reported previous efforts to lose weight (median age of first dieting, 30 y). MEASUREMENTS: The number of yearly attempts to lose weight, weight gain since age 20 y, cumulative weight loss and gain were checked by a predefined structured interview. Psychological distress was tested by means of Symptom Check-List 90 (SCL-90), Binge Eating Scale (BES) and Three Factor Eating Questionnaire (TFEQ). RESULTS: Differences in anthropometric, clinical and psychological parameters were observed in relation to previous attempts to lose weight. Patients in the upper quartile of parameters of weight history were considered weight cyclers. In multivariate logistic regression analysis, after correction for age, sex and BMI, a high BES score was the only factor systematically associated with a high frequency of dieting (OR, 1.70; 95% confidence interval, 1.22-2.36; P=0.022), with higher cumulative weight loss (1.42; 1.12-1.80; P=0.003) and cumulative weight gain (1.38; 1.06-1.79; P=0.017). However, the sensitivity, specificity and positive predictive value of a high BES score were very low to detect cyclers. Weight cycling did not carry a higher risk of complicating diseases. CONCLUSIONS: Weight cycling is associated with psychological distress, and binge eating independently increases the risk, but cannot be used to predict cycling. Also, obese patients who do not experience overeating as a loss of control discontinue treatment or regain weight following therapy.

Adult↗

PubMed1991

A model of clinical judgment processes in psychiatric nursing.

This study addressed judgment processes in psychiatric nursing by analyzing reported use of clinical cues cited as being relevant in the process of making a nursing judgment. Using an exploratory, qualitative approach, data were collected by interviewing 15 subjects who provided 36 in-depth interviews upon completion of an intake interview. Comparative content analysis was used to determine the underlying structure in subject reports. A model depicting judgment processes is presented and discussed. Results suggest that although judgments were highly context-dependent, all subjects assessed data labeled as universals in the psychiatric nursing assessment: suicidality, depression, drug and alcohol use, and patient functional abilities. Similarities among subjects were noted in that presenting behaviors were most salient, a categorization process occurs within the judgment process, and patients are included in the judgment process. Finally, nursing judgments uncovered an action orientation rather than a labeling function.

Adult↗

PubMed1993

Validity of the Family APGAR in patients with irritable bowel syndrome.

BACKGROUND: This study explores the validity of the Family APGAR (adaptability, partnership, growth, affection, and resolve), a test of family function, in persons with irritable bowel syndrome (IBS). Previous studies have reported increased stress in persons with IBS in the form of marital and interpersonal relationships. METHODS: The Family APGAR and the MMPI were completed by 198 persons, including 58 who sought care for IBS, 67 with IBS who did not seek care, and 73 who did not have the disorder. Family APGAR scores were compared for the three groups using analysis of variance. Multiple regression analysis was used to compare Family APGAR scores with both IBS group status and MMPI K and L scales. An odds ratio was calculated for the two groups with IBS. RESULTS: Mean Family APGAR scores were in the normal range for all three groups and differed by less than 1 point among the groups. The Family APGAR score did not differentiate among persons with IBS but was strongly related to the MMPI K score, a measure of defensiveness in test taking. CONCLUSIONS: The failure of the Family APGAR to detect the family dysfunction found by psychological interviewing and the strong relationship with the MMPI K scale lead us to question the construct validity of the APGAR. More sophisticated test construction is necessary to measure family dysfunction in patients who may tend to respond defensively.

Adult↗

PubMed1996

Preferences for intracytoplasmic sperm injection versus donor insemination in severe male factor infertility: a preliminary report.

With the advent of intracytoplasmic sperm injection (ICSI), our programme noted a drop in the number of couples using donor insemination (DI) for severe male factor infertility. Over the first 8 months in which our infertility programme offered both treatments, 27 consecutive couples scheduled for ICSI and 15 consecutive couples scheduled for DI were evaluated Since all patients in our infertility programme beginning in-vitro fertilization (IVF) with planned ICSI or starting DI undergo a semi-structured psychological interview, the psychologist's clinical notes as well as the medical chart were reviewed and coded retrospectively to determine factors related to a couple's treatment choice. Couples who chose IVF-ICSI over DI had a higher occupational status and included husbands with higher educational levels. Their most common motivation was to have the husband's biological child (93% of couples in the ICSI group). The most common motivation for choosing DI (60% of DI couples) was that IVF was not financially affordable. Choice of treatment was not related to psychological adjustment, the husband having prior biological children, or his risk of passing on a genetic defect to offspring. These preliminary data raise the concern that, with the success of ICSI, DI may change in the USA from being an option dictated by semen quality to a second choice treatment utilized for economic reasons.

Adult↗

PubMed1998

[Psychological aspects of pain experience in amniocentesis].

UNLABELLED: This study describes the psychological aspects and the experience of pain in 2 groups of women undergoing amniocentesis in relation to the different indication for the procedure and duration of gestation in the respective groups. METHODS AND SUBJECTS: Data were collected after amniocentesis from 100 pregnant women, 50 of whom underwent age-related amniocentesis (14 weeks of gestation) and 50 for measurement of amniotic fluid insulin levels (30 weeks of gestation). A semi-structured psychological interview was used to collect information concerning experience of pain, cognition before amniocentesis, knowledge about the procedure and the most distressing aspects of amniocentesis. Visual analog scales (VAS, 0 to 10) were used to assess the degree of pain and emotional mood state. RESULTS: The results showed that emotional mood state before amniocentesis was fair (mean = 4.6) and increased after amniocentesis (mean = 8.1) The degree of pain during amniocentesis was assessed at a mean value of 2.9 measured on the 10-point visual analog scale. Fifty per cent of the sample considered the physical, the other 50% the psychological (anxiety and uncertainty) aspects as the most distressing factor of amniocentesis. Although women were given prior detailed information about amniocentesis they overestimated the degree of pain, related risk factors, and duration of the medical procedure. There were no differences in the investigated variables between the two different indications for amniocentesis or the weeks of gestation. CONCLUSION: The findings of the study indicate the psychological distress associated with amniocentesis, which is limited to a short period of time, and is independent of the indication for amniocentesis.

Adaptation, Psychological↗

PubMed1990

Issues in the identification of premenstrual syndromes.

Lack of information about the natural history of the premenstrual syndromes may make efforts regarding classification and treatment misguided. Thus, we report a naturalistic and noninstrusive approach to the problem of identification of the premenstrual syndromes, with particular focus on the issue of compliance with 2 months of daily prospective recordkeeping. Seventy-nine patients presenting for treatment of severe premenstrual symptoms were evaluated with a structured interview, psychological tests, and 2 months of daily prospective ratings of their symptoms. Weekly group follow-up meetings were held to foster compliance with recordkeeping. The typical woman seeking treatment for premenstrual symptoms in this study was middle-aged, highly educated, highly functioning, living in an urban setting, either married with children and family responsibilities or single and living alone, and supporting herself by a high-level job. She was anxious and depressed with multiple medical and gynecological problems. Despite a highly stressful life, she functioned at a very high level, but had consulted mental health professionals in the past. In general, she did not want medication. Consistent with other reports, only 20% of women seeking treatment for premenstrual symptoms had a premenstrual syndrome prospectively confirmed on the basis of 2 months of daily ratings. However, 81% of those with a prospectively confirmed premenstrual syndrome stated that after the 2-month evaluation period their symptoms no longer interfered with their functioning.

Adolescent↗

PubMed1994

Psychological factors associated with chronic dizziness in patients aged 60 and older.

OBJECTIVE: To identify the prevalence and character of psychological disorders accompanying chronic dizziness in older patients. DESIGN: Case series of patients from a geriatric dizziness clinic, with comparison data from age- and sex-matched healthy community controls. Both cases and controls received screening psychological testing; all cases were evaluated by a clinical psychologist as part of the dizziness clinic evaluation. SETTING: Multidisciplinary Geriatric Dizziness Clinic. PARTICIPANTS: Fifty six consecutive patients with chronic dizziness, evaluated by a multidisciplinary Geriatric Dizziness Clinic, and 68 healthy volunteers whose age and sex distribution matched that of the dizziness clinic patients. MEASUREMENTS: Standardized questionnaire for medical, functional, and demographic data; the anxiety, depression, somatization, and phobic anxiety subscales of the Symptom/Checklist-90 (SCL-90-R); the Tinetti gait and motor screen; a physical therapy evaluation; selected laboratory tests; evaluation by a geriatrician; and a formal evaluation by a clinical psychologist, including a semistructured interview. Psychological diagnoses were assigned based on DSM-III-R criteria. MAIN RESULTS: Of these patients with chronic dizziness, 37.5 percent had a psychological diagnosis causing or contributing to their dizziness problem. Of these, only 3 were felt to have a primary psychological cause of their dizziness, and 18 had secondary psychological diagnoses. Anxiety disorders, depression, and adjustment reactions were the most common diagnoses. On multivariate analysis, factors predicting a psychological diagnosis were a positive response to hyperventilation testing, a high score on the SCL-90 anxiety subscale, and fatigue as a precipitant of dizziness. In addition, dizziness clinic patients scored significantly higher (P < 0.001) on all 4 subscales of the SCL-90 when compared with the healthy elderly, suggesting a greater degree of psychological distress among these elderly with chronic dizziness. CONCLUSIONS: Psychological disorders are rare as primary causes but are common as contributing or modulating factors in older persons with dizziness.

Age Factors↗

PubMed1990

[A psychological study, using interviews and projective tests, of patients seeking anonymous donor artificial insemination].

A Thematic Aperception Test was used with 13 male and 16 female patients who were requesting A.I.D. The following main psychological reactions were found in women: anxiety and depression (fear of rejection by their family and friends; lowering the image of the husband--the donor being considered as a rival), aggression (the narcissistic woman "demands" A.I.D.; the donor is esteemed highly); mother is protective ("true" paternity comes through love of the child and the need to forget the donor). They found, in men: an inability to abandon fertility as lost (with denial of sterility); ambivalence, castration anxiety and a feeling of being excluded from the mother-child symbiosis with later acceptance of loss of fertility and (sometimes excessively) identification with the "mother". Most subjects studied were not intending telling the child about his true origin; because disclosure would be tantamount to transgressing twice over the laws of paternity and the rules against Oedipus behaviour. There is often a great difference between the ways the partners view the matter and inter-relate. We strongly recommend that psychological advice should be taken before treatment with A.I.D. is started.

Aggression↗

PubMed1984

A prospective investigation into the orthopaedic and psychologic predictors of outcome of first lumbar surgery following industrial injury.

One hundred sixteen patients randomly selected by officers (authors excluded) of the Workers' Compensation Board of Ontario were studied over a 3-year period. The selection criteria used were no previous back surgery and first back operation now scheduled. The purpose was to establish a battery of clinical and psychologic tests to be used in arriving at a prognosis for preoperative patients. The tests included orthopaedic examination, 10-minute Hendler questionnaire, nonorganic component assessment, psychologic interview, Minnesota Multiphasic Personality Inventory, pain drawing, locus of control, McGill Pain Questionnaire. The most striking of the many computer results obtained was an 82% prognosis success rate. The five predictor variables that most significantly predicted outcome were English proficiency, the nonorganic signs test, back pain versus leg pain, hypochondriasis scale of the MMPI, and the pain drawing.

Adult↗

PubMed1995

Abstinence in late adolescence--antecedents to and covariates of a sober lifestyle and its consequences.

The purpose of this study was first to compare 18-19-year-old male abstainers with alcohol consumers, and especially light consumers, regarding degree of sociability as indicated by their (in)security in the company of others, their number of close friends, intimate conversations with friends and their popularity in school. Secondly, we analysed the importance of antecedents to and covariates of abstinence. In addition, the significant antecedents and covariates gave us information as to abstinence patterns. The study was based on a survey of all Swedish males, 18-19 years old, conscripted for military service in 1969-70. Data had been collected by means of questionnaires and psychological interviews, giving measures of each respondent's social background, psychiatric/psychological and psychosomatic health status, substance use, deviant behaviour and degree of sociability. Poor sociability was more common among the abstainers than among all the other categories of drinkers, including the light consumers. The conscripts' social background, and especially their fathers' drinking habits, had the strongest effects in explaining abstinence. Sixty-two per cent of all abstainers had non-drinking fathers, compared to 28% of the light consumers. As to the majority of abstainers, this indicates a link between the social background of temperance and their own reported abstinence. Their poor sociability could be a consequence of abstaining at a young age when abstinence is uncommon. Those who abstained despite a drinking father showed a worsening psychological status, suggesting a link between psychologically impaired health, poor sociability and abstinence. Though the abstainers were the least sociable, the difference between the abstainers, the light consumers and the moderate consumers in other categories were generally small.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Attachment representation and illness behavior in somatoform disorders.

Somatoform disorders are characterized by high health care utilization and conflictual interactions with health care providers. The aim of the present study was to explore whether patterns of insecure attachment are a prominent feature of somatoform disorder. In addition, the links between insecure attachment and health care utilization were evaluated. Thirty-seven patients with an International Classification of Diseases, 10th Revision diagnosis of somatoform disorders and 20 healthy control subjects matched for age, sex, and education were administered the Adult Attachment Interview. Psychological symptoms and health care utilization were assessed using various self-report measures. There was a clearly higher incidence of insecure attachment in the somatoform group compared with the nonclinical control subjects. In the somatoform group, dismissing attachment occurred approximately twice as frequently as the preoccupied pattern of attachment. The results provide evidence for an association between health care utilization and insecure attachment. Insecure attachment in somatoform disorder may underlie problems in interpersonal functioning and in health care behavior.

Adolescent↗

PubMed1986

Psychomaintenance of childhood asthma: a study of 34 children.

Following the study on psychomaintenance of asthma by Kinsman, Dirks, and Jones (1977), we adapted the Battery for Asthma Illness Behavior (BAIB) to children. Thirty-four children aged 9.3 to 15.4 years were tested with this modified BAIB. They were scored simultaneously on a semistructured psychological interview. Three groups emerged out of these data: low-, medium-, and high-panic-fear personalities. Patients were also rated with regard to their pulmonary function and clinical status, including medication prescribed. The high-panic-fear personality was significantly associated with a higher intensity of prescribed medication, in particular corticosteroids. These results were independent of spirometric pulmonary measurements. We conclude that doctors may overreact to the exaggerated distress of high-panic-fear patients. Psychotherapy could be of help for this group.

Adolescent↗

PubMed1994

[Video-feedback therapy with the flexible nasopharyngoscope. The potentials for modifying velopharyngeal closure and phonation deficiencies in cleft patients].

Psychological interviews with cleft palate patients have revealed why a number of these patients do not profit, or do so only on a limited basis, from conventional speech therapy. They don't control articulation by means of the auditory canal. To treat these patients the video feedback therapy with the nasopharyngoscopy (Witzel et al.) was employed as the initial step. The next step was to expand on this method by establishing indication criteria, necessary diagnostic techniques, and an efficient therapy plan. In this paper a single case study is employed to discuss this method and show the results attained by its use.

Adolescent↗

PubMed1989

The adult cancer survivor: psychosocial consequences of cure.

This article has summarized the psychosocial sequelae identified for the adult cancer survivor. The themes that have been identified relate to loss, compromise, and uncertainty. There is, as yet, no evidence of increased psychopathology in this population. Research on this subject is sparse and difficult to interpret. Consistent definitions of survival across studies is needed in order to compare findings. Although no specific length of time is precise for a given individual, information does exist that would assist in defining long-term survival for a given disease. The use of sensitive measures and appropriate comparison groups is an important consideration in future studies. Instruments that measure psychopathology have often been used; however, these instruments appear not to be sensitive to the more subtle levels of psychological distress and problems associated with long-term survival. Schipper and Levitt have emphasized the need for more discriminating tools. Spitzer and colleagues propose the use of in-depth psychological interviews as optimal in this regard. Comparison groups have varied from neighbors, friends, college students, psychiatric patients, and national surveys. In addition to a lack of consistency among these groups, questions have been raised in the literature as to what degree these groups represent the general population. Schipper and Levitt suggest that patients might best be used as their own controls and followed over time. Through increased understanding, strategies for prevention and intervention can be designed. An editorial in the newsletter for the National Coalition for Cancer Survivorship states, "the strength of the survivorship movement can be measured, in part, by the fact that these activities have developed independently, without coordination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗