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Biomedical subjects

C Bass

Publications and source records attributed to C Bass.

At least 91 records · Page 5Linked to original sources
PubMed1984

Type A behaviour: recent developments.

This paper discusses: (1) the difficulties associated with description and assessment of Type A behaviour (TAB); (2) the association between measures of TAB and psychopathology; (3) new approaches to the measurement of TAB; and (4) the results of recent studies that have attempted to modify the behaviour pattern, using (a) psychological treatment, (b) exercise, and (c) drug treatment. The psychological dimensions underlying Type A behavioral characteristics have not been identified, and attention is drawn to the very small overlap between the main instruments used to measure the behaviour pattern. An examination of the association between the different measures of TAB and psychopathology suggests that both the Framingham Type A scale and the Bortner scale show high correlations with neurotic manifestations of personality. A case is made for exploring the relationship between the behavior pattern and other psychosocial variables that have been shown in both retrospective and prospective studies to be associated with CHD risk. The paper describes a new method of conceptualising and describing TAB, derived from cognitive social learning theory. This model asserts that assessment of the individual's personal beliefs and fears is essential if the observable behaviours associated with pattern A are to be modified. In the Recurrent Coronary Prevention Project, attempts to modify TAB using techniques derived from cognitive behaviour therapy have produced encouraging results. Future large scale studies of CHD prevention should take account of psychosocial and personality variables as well as more traditional risk factors.

Amiloride↗
PubMed1984

Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity.

Ninety-nine patients with chest pain and a presumptive diagnosis of coronary heart disease were assessed blindly within 24 hours of angiography, using standardized psychiatric and social interviews and a personality inventory. Thirty-one patients had normal coronary arteries (NCA), 15 had slight disease and 53 had significant coronary obstruction. Twenty-eight (61%) of the 46 patients with insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity. Associations between the overall severity of psychiatric morbidity and measures of social maladjustment were strongest in the patients with normal coronary arteries. The 26 men with insignificant coronary artery disease had higher scores of neuroticism and extraversion than the 41 with important coronary occlusions. No differences were observed when the same comparisons were made for the women. The findings indicate that approximately two thirds of patients with normal and near-normal coronary arteries have predominantly psychiatric rather than cardiac disorders: the symptoms in these patients are more likely to represent the somatic manifestations of anxiety and overbreathing than the consequences of underlying cardiac disease. Physicians should be aware of the ways in which neurotic illness may present with symptoms mimicking cardiac disease, especially when cardiovascular symptoms are accompanied by phobic symptoms and unexplained shortness of breath.

Adult↗
PubMed1984

Psychosocial outcome after coronary artery by-pass surgery.

Thirty-six patients with obstructive coronary artery disease were interviewed before by-pass graft surgery, and again a mean period of 12.3 months (n = 34) after the operation. The operation was successful in providing relief from chest pain in 31 patients. Psychiatric outcome was related to preoperative mental state, social maladjustment, neuroticism, Bortner Type A score, and previous psychiatric history. One quarter of those employed preoperatively failed to return to work after operation, even though they were improved in terms of symptoms and functional capacity. No association was found between measures of either psychiatric morbidity, or employment status at follow-up, and pre-operative physical variables.

Adult↗
PubMed1983

Patients with angina with normal and near normal coronary arteries: clinical and psychosocial state 12 months after angiography.

The clinical and psychosocial states of 46 patients (26 men and 20 women) who had undergone cardiac catheterisation were examined prospectively. All of the patients had insignificant (less than 50%) coronary lesions and had been told that no limitation of activity was necessary. Twelve months after angiography 19 of the patients continued to complain of chest pain. Twenty one reported phobic symptoms, and 13 were found by standardised clinical interview to have psychiatric morbidity. This had been evident at the time of catheterisation in 28. Twenty three patients had evidence of unexplained breathlessness, 13 were taking psychotropic drugs, 29 were continuing to consult a doctor, and 11 were unable to work because of their symptoms. Patients initially assessed as having high levels of psychiatric morbidity and raised neuroticism scores were more likely to complain of chest pain one year after angiography. The 19 patients with persistent pain also had significantly higher levels of psychiatric and social morbidity at one year than the 27 patients whose chest pain had lessened during the follow up period. Those patients who fail to improve after being told that they have normal or nearly normal coronary arteries tend to be a chronically neurotic and socially maladjusted group in whom psychiatric disorder presents with predominantly somatic symptoms.

Adult↗
PubMed1983

Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries.

Of 99 patients with chest pain undergoing coronary arteriography, 31 had normal coronary arteries, 15 slight disease, and 53 significant coronary obstruction. 28 (61%) of the 46 with haemodynamically insignificant disease and 12 (23%) of the 53 with significant obstruction had psychiatric morbidity, assessed by standard interview. 37 patients had several respiratory symptoms and signs not attributable to organic disease, designated unexplained breathing disorder (UBD). UBD was found in 65% of the patients without and 13% of those with significant coronary disease; it was associated with psychiatric morbidity in the former but not in the latter group. Spirographic measurements of tidal volume and frequency were not helpful in detecting UBD but an end-tidal pCO2 below 30 mm Hg was highly suggestive. In the absence of significant coronary disease the associations of chest pain with psychiatric morbidity and UBD are striking. However, coronary disease and UBD are not mutually exclusive, and diagnostic difficulties can occur when they coexist.

Angina Pectoris↗
PubMed1983

Angina with normal coronary arteriograms. Clinical status at one year.

Despite encouraging reports that patients with normal coronary arteries (NCA) have a benign prognosis in terms of progression of disease and mortality they suffer considerable functional disability following their arteriogram and continue to attend cardiac departments and general practitioners. Some may have coronary spasm and respond to calcium antagonists, others have abnormalities of lactate metabolism on atrial pacing and respond to beta blockade and nitrates. We have observed the psychosocial characteristics of 30 patients with NCA (17 women and 13 men). At one year only one patient was entirely free of chest pain, in 16 (54 p. 100) it had lessened, 10 (33 p. 100) noted no change and in 3 (10 p. 100) it was worse. 15 were initially unable to work at one year, 3 were still unemployed because of pain, 25 (84 p. 100) were reassured when told of NCA. At one year 16 (54 p. 100) were still attending clinics and 2 had sought further cardiac tests elsewhere. In spite of the NCA 7 (23 p. 100) attend casualty with pain and 2 (7 p. 100) were re-admitted. 7 (23 p. 100) had psychiatric morbidity and 6 (20 p. 100) were assigned a psychiatric diagnosis. 15 patients (50 p. 100) reported phobic symptoms at follow-up. 53 p. 100 reported symptoms of breathlessness that could not be explained on the basis of organic disease. This study shows that unexplained breathing disorders and psychiatric morbidity pursue a chronic course and can be detected in 53 p. 100 and 23 p. 100 of NCA patients one year post angiogram. These findings have implications for the management of patients with chest pain and NCA since breathing disorders and psychiatric morbidity are amenable to treatments already demonstrated to be effective.

Adult↗
PubMed1982

Type A behaviour: not specifically pathogenic?

99 patients who underwent coronary arteriography for the investigation of chest pain were interviewed by the use of the Bortner type A questionnaire. The 26 men with normal and minimally diseased arteries had significantly higher mean type A scores than the 41 men with important coronary occlusions. Socioeconomic class had a large influence on the type A score in men, but not in women. There was no significant association between type A score and the extent of coronary disease. These findings do not support a specific association between type A behaviour and coronary heart disease. They also question the value of the use of type A and coronary-prone behaviour as interchangeable terms.

Coronary Angiography↗
PubMed1978

Stuttering therapy: the relation between attitude change and long-term outcome.

Previous research has indicated that attitude change generally follows behavior change in operant stuttering therapy programs. This study sought to examine the longterm therapy outcome of stutterers whose communication attitudes were not substantially normalized after fluency establishment and generalization. Posttransfer attitude scores of 20 stutterers were used to classify them into one of two groups: those whose communication attitudes had been modified to show less abnormality than the mean level for normal speakers, and those whose attitudes had not. Follow-up interviews with the 20 stutterers one year later indicated that those whose posttransfer attitudes were not substantially normalized stuttered significantly more. Theoretical and clinical implications are discussed.

Attitude to Health↗
PubMedDate not supplied

Survey of accidents in a university day-care center.

Accident reporting provides useful data for the analysis of injuries in day-care centers. This article reports the results of a survey study conducted to analyze accidental injuries in a large university day-care center in Southern California. Data were collected from individual student accident report forms filed by the teachers for the 1987 calendar year. A total of 103 accident reports were analyzed. Fifty-seven children ranging in age from 6 months to 6 years were involved in 103 accidents. The results of the study revealed that the highest number of accidents occurred among children 3 and 4 years of age. The majority of the accidents occurred during horseplay or while the children were running or fighting. Although no deaths or permanent disability occurred, this number of accidents do warrant the need for safety education.

Accidents↗
PubMedDate not supplied

Cognitive behavioral therapy for chronic fatigue syndrome in a general hospital--feasible and effective.

Cognitive behavior therapy (CBT) has been shown to be effective in recent randomized controlled trials for chronic fatigue syndrome (CFS). We examined the effectiveness of CBT in a general hospital setting in a retrospective questionnaire follow-up study of 94 patients offered CBT by liaison psychiatry services. The questionnaire response rate was 61%. Eighteen percent had returned to normal functioning at follow-up. For the group as a whole, there was a significant improvement in the functional and social impairment and the number of frequently experienced symptoms. Those in work or study at follow-up was 53% (29% pretreatment), and 65% of patients mentioned occupational stress as a contributory factor in their illness. There was a significant reduction in the frequency of attendance at primary care in the year after the end of CBT. We conclude that cognitive behavioral therapy is an acceptable treatment for most patients and can be used in a general hospital outpatient setting by a variety of trained therapists. However, a proportion of patients do not benefit and remain significantly disabled by the condition.

Adult↗
PubMedDate not supplied

Frequent attenders without organic disease in a gastroenterology clinic. Patient characteristics and health care use.

We used a hospital computer to identify 50 patients (35 women, 15 men) satisfying research criteria for "frequent attenders" at a gastroenterology outpatient clinic (four or more visits to a general hospital clinic in the previous 12 months). Their mean duration of symptoms was 5 years, and 80% reported fatigue as a significant complaint. Thirteen (37%) of the women were also consulting a gynecologist, and in nine of these their status was normal. Seven (21%) of the 35 women who were interviewed had a history of childhood sexual abuse, and these patients reported significantly more lifetime somatic symptoms (9.7, SD = 3.8) than those without such a history (5.4, SD = 3.5, p = < 0.01). The 50 patients reported high levels of disability and psychological distress, and were more likely to rate the probability of their symptoms as being due to "bowel disease" than to "stress" or "other problems." Forty-five patients had at least one current psychiatric diagnosis and 24 at least two, with somatoform disorders being the most common. Nineteen (38%) reported infrequent panic attacks, but only three had somatization disorder. The mean number of lifetime somatic symptoms was 5.9 (SD = 3.6; range 1-14). Seventeen patients (35%) also satisfied criteria for frequent attending in primary care (> 12 visits over the previous 12 months), and the patients reported a mean number of 5.7 (SD = 2.1) specialist appointments in the previous year. There may be a case for using the hospital computer to identify frequent attenders proactively at an earlier stage of their hospital visits so that appropriate management can be instituted. If such patients can be identified in this way, their assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff.

Adult↗