[Psychological adaptation to sterilization (proceedings)].
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Eighteen children and adolescents who survived two years or longer in an attempt to manage their end-stage renal failure by transplantation were studied. The psychological adaptation of the young person to this form of management of renal disease was assessed by a semistructured interview of the patient and his parents. Fifty percent of the patients functioned at school or on the job and did not have depression. The remaining half did less well. In our institution a satisfactory quality of life required a successful transplant.
One hundred cases of attempted suicide were followed up after three years. Only 50 records were recovered and of these 26 subjects were personally contacted. There had been only one subsequent suicide and three suicide attempts after three years. The possible relationship between psychiatric intervention and the low incidence of subsequent suicide attempts was discussed. The psychological adaptation after a suicidal attempt was also discussed.
The present follow-up period of cardiac surgery allows assessment of the long-term consequences of valvular prostheses, the short-term consequences having already been the object of many studies. 50 patients of both sexes, operated on for aortic or mitral valve disease between 1973 and 1974 were interviewed to assess their degree of psychological adaptation with regard to their cardiac status and the principal factors of adaptation. The position of the prosthetic valve (aortic or mitral) seemed to be of little importance and the prognosis depended rather on sex, age at operation, previous personality, intelligence quotient, postoperative psychiatric complications and the interval between diagnosis of the disease and operation.
Recent research on the physiology of REM sleep has supported the hypothesis that it serves processes of psychologic adaptation. This study examines the relationship between physiologic parameters of REM sleep and evidence in analytic material of the need for adaptation. Significant correlations were found between defensive strain before sleep and REM latency, and between change in defensive strain from evening to morning and total REM time.
With respect to the preoperative ophthalmic patient, anticipatory guidance is a technique of informing the patient in a detailed way about all aspects of the upcoming intervention, including the need for surgery, the degree of pain and disability to be expected, type of anesthesia to be used, some information about the postoperative course, and the expected disability following surgery on either a temporary or a permanent basis. The purpose of anticipatory guidance is to permit the patient to make a better psychologic adaptation to a crisis situation and to relieve preoperative anxiety through information, resulting in easier postoperative recovery. In addition, anticipatory guidance and improved understanding between physician and patient may go far to reduce those misunderstandings that lead to malpractice actions subsequent to surgical procedures.
Social and psychological frameworks used to explain adaptation are examined. Findings from a study of three ethnic groups, Irish, Italian, and Polish Americans, aged forty to eighty are presented to test the effects of life stage, social surround, and personality on adaptation.
The effects of five major life events, and of three types of resources, on the physical and social-psychological adaptation of 375 participants in a longitudinal study were examined. As expected, medical events had the most impact on physical adaptation, but they had surprisingly little impact on social-psychological adaptation. Retirement had the most negative social-psychological effects, but had little effect on physical adaptation. The other three events had even less effects, although multiple events tended to cumulate in impact. Better physical resources helped only physical adaptation, and better psychological and social resources mainly helped satisfaction. It appears that most of these potential stressors have less serious long-term outcomes than the crisis orientation would suggest.
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The author describes 4 patients in whom radically new symptoms appeared after intensive behavior therapy. He suggests that fresh symptoms are most likely to develop in a small minority of patients who are unable to learn more adaptive psychological defense mechanisms during or after behavior therapy and that psychoanalytic theory may help predict the nature of such symptoms.
A 10-year longitudinal study of the age-identities of persons 70 and older revealed that many rejected the possibility that they were, in fact, "old." Although there was increased acknowledgment in the restudy of being old, a majority of respondents continued to define themselves in other ways (i.e., as middle-aged or elderly). The importance of comparative reference groups for aging denial was tested. As hypothesized, favorable self-evaluations versus age peers were positively correlated with younger self-images. These comparative evaluations were shown to be as useful as "positional" variables in explaining age-identity. The findings demonstrate the utility of a reference-group perspective in explaining diverse psychological adaptations to late-life role changes.
Up to now, there is in France no rehabilitation program after pneumonectomy but social security and kinesitherapy. Medical, functional and economical survey of 219 subjects operated 1 to 20 years earlier shows that, as far as return to work and psychological adaptation are concerned, these factors weight at least as much as severe respiratory insufficiency. Before setting up a program of rehabilitation one should study these factors and others that may eventually influence psychological equilibrium.
The influence of exogenous and environmental factors on metabolic control was studied in 58 insulin treated juvenile diabetics, 6-17 years of age. Duration of diabetes varied between 3-14 years and age at onset of diabetes between 1-13 years. The social situation as well as knowledge about and attitudes towards diabetes among the patients and their parents were estimated by interviews, questionnaires and special tests. The quality of the diet, exercise and insulin treatment was assessed. An index of diabetic control was calculated on the basis of the patients daily urinalysis made at home. Multiple regression analysis and a special statistical "instrumental" variable technique were used in an effort to analyse the correlations between all variables. The social situation of the diabetic children was comparable with that of other Swedish children, but many parents felt the economic burden of the diabetic treatment as a problem. Knowledge tests showed that 25% of the parents and 62% of the patients above 12 years had unsatisfactory knowledge about diabetes. However, 93% of the patients seemed to have predominantly positive attitudes towards the treatment. Severe psychological problems had occurred in 7 cases. Food habits were appropriate among 21% of the patients and 26% had very regular exercise customs. Physical exercise seemed to be the most important of the exogenous factors for the diabetic control (p less than 0.001). Among teenagers knowledge was positively correlated to positive attitudes which in turn were positively correlated to physical exercise. Instrumental variable technique gave further indications of a positive influence of knowledge on control, and the correlation between diabetic control on one hand and knowledge combined with positive attitudes on the other was significantly positive. The results emphasize the importance of assisting young diabetic patients and their families in their socio-psychological adaptation to the strains of diabetic therapy.
The paper takes issue with the traditional view of Darwin's influence on psychology; namely, that it is he who passed on to psychology the concept of individual adaptation. Three arguments are presented: a) that Darwin, qua scientist, was only interested in species adaptation, an entirely different concept from that of individual adaptation, b) that Darwin's writings on individual adaptation are so unexceptional that it is inconceivable that psychologists should have been influenced by them and c) that the two concepts are logically incompatible since species adaptation presupposes a strict hereditary determinism, while individual adaptation conceives of the organism either as free and undetermined or else as determined by the environment.
Psychological and physical adaptation to jejunoileal bypass surgery for obesity was evaluated in 55 patients observed 15 months to 6 1/2 years postoperatively after a weight loss of about 50 Kg. The response to weight loss, as assessed by a comprehensive, structured questionnaire was an improvement in working capacity, interpersonal relationship, leisure time activity and adjustment to daily life. Sexual activity improved, particularly in men, and irregular menstruation normalized. Body image improved. Major postoperative psychiatric complications were not seen, which may be due to meticulous selection of the proper patients.