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Biomedical subjects

D Spiegel

Publications and source records attributed to D Spiegel.

At least 127 records · Page 7Linked to original sources
PubMed1992

A case of probable dissociative disorder.

The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.

Adult↗
PubMed1992

Argon laser trabeculoplasty: long-term follow-up of at least 5 years.

This retrospective study evaluates the long-term follow-up of 331 eyes of 219 patients treated with argon laser trabeculoplasty (ALT). A total of 258 eyes were included with a follow-up of at least 5 years. Success was defined as an intraocular pressure of under 22 mm Hg with a stable visual field and optic nerve head. Overall, 22% (58/258) were regulated after 5 years (glaucoma chronicum simplex 26%, pigment dispersion glaucoma 31%, pseudoexfoliation glaucoma 19%, angle-closure glaucoma 14%, secondary glaucoma 7%). Filtration surgery was performed in 13% (33/258) mainly (73%) in the first 3 years after ALT. Repeat ALT was done in 43% of the eyes, and 60% of these eyes with repeat ALT underwent filtration surgery in the first year. With repeat ALT the overall success rate increased to 38%. High initial intraocular pressure and the stage of glaucoma documented by the visual field loss correlated with the failure of ALT. These results indicate that ALT and re-ALT were effective in glaucomatous eyes, yet there was a substantial diminishing effect as time progressed. Therefore, close follow-up on ALT-treated patients is necessary.

Adolescent↗
PubMed1992

Anterior chamber tube shunt to an encircling band (Schocket procedure) in the treatment of refractory glaucoma.

We reviewed a series of 42 eyes in patients with refractory glaucoma who had undergone a Schocket procedure. The mean follow up was 17.5 months; the minimal follow up, 8 months. The success rate was 81%, with "success" defined as either (1) an intraocular pressure less than 21 and greater than 5 mm Hg, with a pressure reduction of at least 10%, and less or no medication; or (2) a pressure reduction of at least 30%, with no change of medication. When eyes with a loss of more then one Snellen line of visual acuity were interpreted as failures, the success rate dropped to 61%. Forty percent of all cases required revision. In four cases, the shunt had to be removed (three cases due to hypotony and one secondary to conjunctival erosion). These results are in the range of those obtained by other investigators using this technique or other tube-shunt procedures.

Adolescent↗
PubMed1991

Disintegrated experience: the dissociative disorders revisited.

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Depersonalization↗
PubMed1991

New aspects in the laser treatment of glaucoma.

Over 50 papers, appearing between October 1989 and September 1990, were reviewed. Among these, 17 were found to be of interest and 2 of outstanding interest. Structural and molecular effects and prevention of postcoagulative pressure rises are discussed under the category of argon laser trabeculoplasty. Papers concerning the size of laser iridotomies and the assessment of their success are also reviewed. A size of at least 150 to 200 mum is recommended. The majority of recommended papers concern parameters for cyclophotocoagulation, clinically and experimentally. Papers on the topic of sclerostomy include one presenting clinical results of treatment with a neodymium:yttrium-aluminum-garnet laser ab interno and another presenting experimental investigation of a partial external trabeculectomy using the excimer laser.

Glaucoma↗
PubMed1990

Facilitating emotional coping during treatment.

Patient resources for coping with breast cancer can be enhanced by attention to cognitive, affective, psychosomatic, and social components of the illness. The diagnosis and treatment of breast cancer constitutes an immediate confrontation with mortality, and sympathetic but direct examination of the patient's vulnerability and means of coping with it will reduce rather than amplify death anxiety. The development and pursuit of realistic goals influenced by the prognosis can help patients adjust constructively. Extremes of emotion are to be expected at times, but persistent depression and/or anxiety should be vigorously treated, including the use of appropriate psychoactive medication when the symptoms are primarily somatic (e.g., sleep disturbance and reductions in energy). Physical symptoms such as pain, nausea, and vomiting can be controlled by teaching patients such techniques as self-hypnosis, biofeedback, and systemic desensitization. Finally, a feeling of social isolation is the rule, not the exception, with cancer patients. Group and family treatment can effectively counter this. Systematic studies of such treatment interventions have shown favorable results, including significant reductions in mood disturbance and pain.

Adaptation, Psychological↗
PubMed1990

Minding the need for specialists in brain diseases.

A recent call for a new speciality in biologically based brain diseases is questioned on historical, empirical, and theoretical grounds. Psychiatry has oscillated between biological and psychosocial explanations for mental illness since its inception. Training in the biological basis of mental illness is and should be incorporated into psychiatric training, along with a balanced appreciation of the utility of psychotherapeutic and social intervention. Emphasis on only one aspect resurrects Cartesian dualism. Any disease, however biological in origin, is best treated by a clinician adept at multiple levels of understanding and intervention.

Biological Psychiatry↗
PubMed1990

New uses of hypnosis in the treatment of posttraumatic stress disorder.

Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.

Dissociative Disorders↗
PubMed1990

Recombinant alpha-interferon may be efficacious in acute hepatitis B.

Whereas, in chronic type B hepatitis, the therapeutic effect of alpha-interferon has been studied extensively, data on the effect of interferon on the course and prognosis of acute hepatitis B are scarce in the literature. We report a case of acute type B hepatitis complicated by life-threatening extrahepatic manifestations where recombinant alpha-interferon facilitated clinical, biochemical, and serological recovery.

Acute Disease↗
PubMed1989

Effect of psychosocial treatment on survival of patients with metastatic breast cancer.

The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.

Actuarial Analysis↗
PubMed1989

Modulation of gastric acid secretion by hypnosis.

The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs. 2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.

Adult↗
PubMed1989

Joiners and non-joiners in worksite smoking treatment: pretreatment smoking, smoking by significant others, and expectation to quit as predictors.

Treatment joiners were differentiated from non-joiners when examined across six worksite clinic locations in the Los Angeles area. Predictors examined included preprogram smoking, demographic variables, smoking by significant others, behavioral expectations to quit, and self-efficacy regarding completing treatment and resisting urges to smoke. Non-joiners reported higher preprogram smoking levels and more friends and children who smoked.

Adult↗