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Biomedical subjects

B B Toner

Publications and source records attributed to B B Toner.

32 records · Page 2Linked to original sources
PubMed1990

Psychological factors in irritable bowel syndrome.

This paper describes the prevalence and incidence of psychiatric disorders in IBS patients using a standardized psychiatric interview, and proposes a psychological model for investigating one aspect of IBS. Forty-four IBS patients and 28 nonclinical participants received a psychiatric interview (Diagnostic Interview Schedule) and completed the Lie Scale of the Eysenck Personality Inventory (L-EPI). Results indicated that a significant percentage (59%) of the IBS group met DSM-III criteria for a psychiatric disorder within the last year, far more than occurred in the matched nonclinical comparison group. Relative to the comparison group, the IBS group also had significantly higher lie scores on the EPI indicating a response style of social desirability. On the basis of these findings, together with earlier work by Latimer's group, a conceptual model was formulated on the notion that some IBS patients may have a self-schema (i.e. knowledge of self, stored in memory) characterized by social desirability. We suggest that the construct of self-schema may be helpful in differentiating IBS from psychiatric groups both conceptually and therapeutically.

Adult↗
PubMed1990

Self-report symptoms that predict major depression in patients with prominent physical symptoms.

The diagnosis of depression in patients presenting with both depressive and physical symptoms is potentially confounded and problematic. The present study of 271 patients with four types of illness all with prominent physical symptoms--end-stage renal disease (n = 99), irritable bowel syndrome (n = 21), post-infectious neuromyasthenia (n = 25) and eating disorders (n = 126)--investigates if there are a group of symptoms on the Beck Depression Inventory (BDI) which predict the diagnosis of major depressive episode (MDE) made using the Diagnostic Interview Schedule (DIS). Discriminant function analysis of BDI responses yielded a four item function--self-hate, indecisiveness, loss of appetite and suicidal thoughts--which maximally discriminated between patients with and without a current MDE and correctly classified 75 percent of subjects.

Adolescent↗
PubMed1990

The neuropsychological dimensions of postinfectious neuromyasthenia (chronic fatigue syndrome): a preliminary report.

Postinfectious neuromyasthenia (PIN) is a clinical syndrome of protracted and incomplete recovery after an apparent viral-like illness. Medical investigation yields few abnormalities which might account for the symptomatology. A substantial number of PIN patients complain of cognitive changes. Specific complaints include impaired attention, concentration and abstraction skills. This study was designed to systematically investigate whether the aforementioned subjective complaints could be quantified objectively using standard neuropsychological instruments. Results indicated that on all tests but one, the subjects' performances were significantly higher than those of their age matched groups in the normative data. Specifically, PIN patients scored significantly better than their age matched norms on tests of concentration, attention and abstraction. What is most striking is the discrepancy between the subjective complaints of cognitive impairment and the objective results of the subjects' performances on all tests. These findings suggest that psychological factors may play an important role in the cognitive functioning of individuals diagnosed with postinfectious neuromyasthenia.

Adult↗
PubMed1988

Affective and anxiety disorders in the long-term follow-up of anorexia nervosa.

This study investigated the incidence and onset of affective and anxiety disorders in women who were diagnosed with anorexia nervosa five to fourteen years earlier. Based on the clinical outcome of anorexia nervosa, patients were classified as asymptomatic, improved or symptomatic. Affective and anxiety disorders were assessed by a structured psychiatric interview (Diagnostic Interview Schedule). Results indicated that affective and anxiety disorders developed frequently, regardless of outcome of anorexia nervosa. Major depression and anxiety disorders developed before the eating disorder in one-half and three-quarters of these cases respectively. The symptomatic group had a significantly higher incidence of anxiety disorders prior to the development of their eating disorder compared with the asymptomatic group.

Anorexia Nervosa↗
PubMed1987

Cognitive style of patients with bulimic and diet-restricting anorexia nervosa.

Recent studies have reported that subjects with bulimic anorexia nervosa are more behaviorally impulsive than those with diet-restricting anorexia nervosa. This study found that bulimic anorexic patients made significantly more errors on the Matching Familiar Figures Test than restricting anorexic and comparison groups. This preliminary finding leads to the speculation that bulimic patients are more cognitively impulsive than restricting anorexic patients.

Adult↗
PubMed1987

Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis).

Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and incomplete recovery phase following viral-like illnesses. There are few significant physical findings or abnormal laboratory determinations. Although depressive symptoms have been observed in individuals with neuromyasthenia, systematic psychological investigations based on a standardized interview technique have not been reported. This study was designed to investigate the prevalence of psychiatric disorders and psychiatric symptoms in a group of patients presenting with neuromyasthenia. The study consisted of three parts: a structured psychiatric interview (The National Institute of Mental Health Diagnostic Interview Schedule), a self-report measure (The Beck Depression Inventory) and Dexamethasone Suppression Test. Results indicated that relative to a matched comparison group of non-clinical volunteers, a significant percentage (67%) of neuromyasthenic patients met criteria for major depression. Even more striking was the observation that 50 percent of the sample had a major depressive episode prior to the development of neuromyasthenia. These findings suggest that sporadic neuromyasthenia may be the result of an organic illness in psychologically susceptible individuals.

Adult↗
PubMedDate not supplied

Development, use, and factor analysis of a self-report inventory for mania.

This report describes the development and initial psychometric evaluation of a 47-item self-report inventory for mania developed by the authors. Twenty-five subjects with a diagnosis of mania and 82 subjects with other diagnoses were tested during a hospital admission. The manic group scored significantly higher than the nonmanic group. The questionnaire correctly classified 71% of subjects. Manic patients who lacked insight endorsed as many items as manic patients with insight. A reliability analysis indicated that the items comprising the questionnaire are homogeneous. Test-retest reliability was high. A rotated factor analysis produced two factors, energized dysphoria and hedonistic euphoria. The authors discuss diagnostic, research, and clinical implications and applications of the Self-Report Manic Inventory.

Adult↗
PubMedDate not supplied

Psychosocial issues for women with trichotillomania.

Trichotillomania, the compulsive urge to pull out one's hair, is a poorly studied chronic condition affecting 2 to 8 million people, 90% of whom are women. Significant gains have been made about the nature and clinical presentation of this disorder, and yet conceptualizations of trichotillomania remain inconsistent and controversial. Consequently, treatments for trichotillomania have proven to be largely ineffective. Anecdotal case studies have provided us with preliminary data about the impact of this condition on emotional, psychological, and social well-being. To date, there are no empirical studies that focus on patients' subjective experiences with their disorder. The purpose of this report is to identify and discuss the concerns of women with trichotillomania. We have also provided clinical examples to highlight how these concerns are evident in the lives of these women. A total of seven women participated in focused interviews which asked them to reflect on their experiences with compulsive hair pulling. The interview transcripts were analyzed for themes using techniques from the constant comparative method. Additionally, women were asked to complete a demographic self-report. Our analysis identified themes pertinent to negative affects, control, and triggering precipitants. We argue that identifying and integrating these themes in current treatment protocols is the first step to improving the efficacy of treatment for trichotillomania.

Adolescent↗
PubMedDate not supplied

Long-term follow-up of anorexia nervosa.

This study compared the long-term outcome of restricting and bulimic anorexic women using standardized psychometric instruments in addition to global clinical ratings. Results indicated that, in general, restricting and bulimic anorexic subtypes did not differ in their long-term outcome according to clinical ratings and standardized assessments of anorexic symptoms, psychiatric diagnoses, and psychosocial functioning. The only exception to this pattern was that the bulimic group had a higher incidence of substance use disorders during the last year compared with the restricting group. Findings also indicated that relative to a matched comparison group of women of average weight, a significant percentage of anorexics from both subtypes met DSM-III criteria for an affective or anxiety disorder at some point in their lives as well as at long-term follow-up. Results are discussed in terms of theoretical and methodologic issues involved in the long-term follow-up of anorexia nervosa.

Adult↗
PubMedDate not supplied

Self-schema in irritable bowel syndrome and depression.

Some investigators have suggested that irritable bowel syndrome (IBS) represents a physiologic expression of an affective disorder. This study investigated whether IBS patients differed in their self-schema from depressed patients. Self-schema refers to a cognitive framework of the individual's beliefs, attitudes, and self-perceptions which is stored in memory and which influences incoming information. The sample consisted of 21 IBS patients, 21 psychiatric outpatients with major depression (MD), and 19 normal controls. All groups were age matched. Subjects completed a structured psychiatric interview (Diagnostic Interview Schedule (DIS) and a Beck Depression Inventory (BDI), in addition to a test of self-schema, which involved rating and recall of a variety of "depressed" and "nondepressed" content adjectives. Consistent with previous work on self-schema, the MD group recalled significantly more depressed adjectives rated under the self-referent task than the Control group (p less than 0.05) and, also, the IBS group (p less than 0.05). Most striking was the finding that a subgroup of IBS patients who met criteria for MD (43% of the sample) recalled significantly more self-referent nondepressed words (and less self-referent depressed words) than the MD group (p less than 0.05). In other words, IBS patients with MD do not view themselves as depressed. These findings suggest that while some IBS and depressed psychiatric outpatients may share depressive symptoms, these groups can be differentiated by their self-schema.

Adult↗
PubMedDate not supplied

The development of a cognitive scale for functional bowel disorders.

OBJECTIVE: The importance of psychosocial factors in patients with Functional Bowel Disorders (FBD) has been well-established. However, most psychosocial measures used in research with FBD patients were not designed or validated on this population. A recent international team report recommended that psychosocial measures be developed to increase our understanding and treatment of FBD. The purpose of this study was to develop a reliable and valid instrument designed specifically to assess cognitions of patients with FBD. METHOD: An initial set of 204 scale items was generated from a large pool of thought diaries from patients diagnosed with FBD. Items were additionally refined using several methods, including consultation with a multidisciplinary team of international experts on FBD. The remaining 95 items were administered, along with a set of validating questionnaires, to a new sample of 75 FBD patients in Canada and the United States. RESULTS: The findings indicate that the final 25-item scale has high reliability (Cronbach's alpha = .93; inter-item correlation = .36); high concurrent criterion validity evidenced by the correlation of the scale with a global rating of life interference caused by bowel symptoms (r = .71; p<.001); acceptable convergent validity evidenced by the correlation of the scale with the Dysfunctional Attitudes Scale (r = .38; p<.01); high content validity and face validity; and minimal social desirability contamination (r = .15; NS). CONCLUSIONS: The Cognitive Scale for Functional Bowel Disorders is a valid and reliable scale that can be used as an outcome measure in evaluating the efficacy of different forms of psychotherapeutic intervention for FBD, and can also serve as a helpful assessment tool for health professionals working with patients diagnosed with FBD.

Canada↗
PubMedDate not supplied

Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome.

OBJECTIVE: The purpose of this study was to investigate the presence of emotional abuse and two psychosocial constructs (self-blame and self-silencing) in a sample of women diagnosed with irritable bowel syndrome (IBS) relative to a comparison sample of women diagnosed with inflammatory bowel disease (IBD). METHODS: Women diagnosed with IBS (N = 25) were compared with women diagnosed with IBD (N = 25) on measures of history of abuse, self-blame, and self-silencing. RESULTS: It was found that women in the IBS sample scored significantly higher on emotional abuse, self-blame, and self-silencing than did women in the IBD sample. These three variables were also found to be significantly intercorrelated in both the IBS and IBD samples. Finally, emotional abuse was significantly higher in IBS patients than in IBD patients beyond the differences accounted for by physical and/or sexual abuse history. CONCLUSIONS: These findings empirically demonstrate an association between IBS and emotional abuse, as well as a possible connection with psychosocial variables, that may mediate the connection between emotional abuse and functional bowel symptoms. We suggest that these variables be further evaluated in the context of clinically relevant research on IBS.

Adaptation, Psychological↗
PubMedDate not supplied

Health-related concerns of people who receive psychological support for inflammatory bowel disease.

BACKGROUND: People with inflammatory bowel disease (IBD) cope with a number of disease-specific concerns, which may result in referrals for supportive counselling. OBJECTIVE: To determine differences between the health-related concerns of people with IBD who seek counselling or are referred for psychiatric assessment and those who have no recent contact with counselling or psychiatry. METHODS: Forty-five consecutive patients with IBD referred for psychiatric consultation and 31 IBD out-patients who had recent counselling were compared with 190 IBD out-patients at the same hospital with no recent history of counselling. Disease-related concerns, demographic data and perceived symptom severity were assessed with self-report instruments. RESULTS: Counselling patients had greater overall intensity of concern. Counselling patients differed from noncounselling patients on several measures related to illness severity and were more likely to be female. Correcting statistically for illness severity and sex, the counselled patients had significantly higher levels of concern about being a burden, pain and suffering, feeling out of control, financial difficulties, feeling alone, sexual performance, feeling dirty or smelly and being treated as different. CONCLUSIONS: Beyond the intensity of their physical suffering, patients who seek counselling report a pattern of concern in which interpersonal and emotional concerns are prominent compared with those of out-patients who do not seek counselling. Clinicians should be aware of interpersonal concerns, which may increase the need for empathic support. Psychosocial interventions in IBD may be indicated without respect to psychiatric comorbidity.

Adaptation, Psychological↗