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Biomedical subjects

G d'Elia

Publications and source records attributed to G d'Elia.

At least 19 recordsLinked to original sources
PubMed2001

Attachment: a biological basis for the therapeutic relationship?

When faced with loss, illness, distress, or threat, we tend to seek out an attachment figure from which we can obtain comfort and protection. The attachment theory, an evolutionary biosocial theory of development, postulates that the propensity to make strong emotional bonds to a differentiated and preferred person, conceived as stronger and or wiser, is a basic component of the human nature, distinct from feeding and sexuality. Attachment behaviour is present in germinal form in the neonate and continues to be present "from the cradle to the grave". On the basis of day-to-day experience of the responsiveness and accessibility of caregivers, children build internal working models of attachment figures and of themselves. Expectations about the likely behaviour of others, initially preverbal, characterize the approach of the individual to other persons. Internal working models are successively modified on the basis of recent experience. The therapeutic relationship can be viewed as the seeking of a secure base, from which the patient and the therapist, in a joint effort, explore the patient's attachment history and the painful feelings associated with it. The therapist, responsive to the patient's verbal and non-verbal attachment signals, is viewed as a supplementary attachment figure.

Emotions↗
PubMed1999

[To know that the physician is really listening].

Communication is a central feature of patient-doctor interaction, and one that is often problematic. Listening is so basic that we tend to take it for granted. Unfortunately, most of us think ourselves better listeners than we really are. Especially distressing are deaf ears among those we count on for understanding. Doctors are powerful social figures, expected to manifest appropriate skills in encountering anxious, unhappy, disappointed, angry or even hypochondriac patients. The article consists in a review of an interview method based on cognitive principles, specially designed to promote the patient's feeling of being listened to, and to establish a working relationship. Such skills as non-verbal communication, reflection, summation, and self-disclosure are essential components of the method. The patient's emotional response to health problems is viewed as being valid, and investigation is initiated on the basis of the patient's perception of the problem rather than on the doctor's professional knowledge. Through Socratic questioning, the doctor helps patients to reach their own conclusions and to reformulate axiogenic hypothesis.

Clinical Competence↗
PubMed1998

[Cognitive therapy has been shown to be effective in panic disorder].

Cognitive therapists suggest panic disorder to result from 'catastrophic' misinterpretation of bodily sensations. The patient suffering from panic disorder consistently misinterprets normal anxiety responses, such as racing heart, breathlessness or dizziness, as indicating impending disaster. Cognitive therapists, who challenge the traditional view of anxiety as 'free-floating' and irrational, argue that the patient's anxiety is an understandable response to their misinterpretations, and advocate a treatment method based on the patient's specific cognitive make-up and on the principle of collaborative empiricism. The patient is gently guided to identify and challenge idiosyncratic cognitions, and to consider alternative interpretations of danger signs. The article provides an outline of the treatment method and its empirical support.

Cognitive Behavioral Therapy↗
PubMed1998

Are dysfunctional attitudes in depressive disorder trait or state dependent?

The aim of this study was to investigate whether euthymic patients in remission on lithium prophylaxis score higher on the Dysfunctional Attitude Scale (DAS) than healthy subjects, thus indicating a trait quality of dysfunctional attitudes in unipolar depression. A total of 79 patients with recurrent unipolar depressive episodes and 79 individually matched healthy controls were compared using a Swedish version of the DAS. The results indicate that DAS score is a state-dependent variable in depressive disorder.

Adaptation, Psychological↗
PubMed1994

The antidepressant efficacy of high-dose nondominant long-distance parietotemporal and bitemporal electroconvulsive therapy.

While unilateral electroconvulsive therapy (U-ECT) is generally considered to induce negligible disturbances of memory as compared with bilateral bitemporal ECT, its relative antidepressant efficacy has been questioned. The aim of the present study was to compare, in a double-blind design, clinicians' ratings of global clinical impression of the antidepressant efficacy of the two treatment modalities. The treatment technique included avoidance of benzodiazepines, prolonged hyperventilation with oxygen, intermittent unidirectional pulses distributed in a long pulse train, permitting individualized and relatively high doses of electrical charge at each treatment occasion, and non-dominant long-distance (12-13 cm) parietotemporal (d'Elia) electrode placement in the U-ECT group. The results indicated no therapeutic advantage for either treatment modality, which was also in accordance with the symptom ratings by an independent nonblinded rater. The findings encourage the continued use of nondominant long-distance parietotemporal ECT with a treatment technique that induces fully generalized seizures as the modality of choice in the convulsive treatment of depression.

Depressive Disorder↗
PubMed1993

The hypothalamic-pituitary-thyroid axis in depressive patients and healthy subjects in relation to the hypothalamic-pituitary-adrenal axis.

Serum levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), free T3 index (fT3i), thyroxine (T4), and free T4 index (fT4i) were measured before and after administration of 1 mg of dexamethasone in 54 depressive patients and 54 matched healthy subjects. A followup study at a mean of 2 years was performed in 28 patients in remission. Basal TSH levels were lower and fT4i levels were higher in major depressive patients compared with healthy subjects. After dexamethasone administration, there was no significant change in any of the hormones in a subgroup of 46 major depressive patients in contrast to matched healthy subjects, who showed a significant decrease in the levels of TSH, T3, and fT3i. The magnitude of the TSH response to dexamethasone in the major depressive patients was related to the level of nocturnal urinary cortisol excretion and pathological dexamethasone suppression test results. The level of TSH in depressive patients during remission did not return to levels similar to those found in the healthy subjects.

Adult↗
PubMed1993

Electrodermal activity in relation to basal and postdexamethasone levels of thyroid stimulating hormone and basal levels of thyroid hormones in major depressive patients and healthy subjects.

Electrodermal activity in 50 patients with major depression and 50 matched healthy control subjects was related to basal and postdexamethasone changes in levels of thyroid stimulating hormone (TSH), basal levels of thyroid hormones, and nocturnal levels of urinary cortisol. Levels of skin conductance and thyroxine were inversely correlated in the patients, but positively correlated in the healthy subjects. Patients with blunted postdexamethasone reduction of TSH showed high rates of nonevoked electrodermal fluctuations, low TSH levels, and elevated nocturnal urinary cortisol levels.

Adult↗
PubMed1993

Cardiovascular response and seizure duration as determined by electroencephalography during unilateral electroconvulsive therapy.

The effect of pulse unilateral electroconvulsive therapy (ECT) on heart rate, blood pressure and the product of heart rate and systolic blood pressure, an index of myocardial oxygen consumption, was studied during 48 ECT sessions in 7 patients with major depression. Intra-individually, hyperventilation-induced hypocapnia compared with normocapnia markedly augmented the ECT-induced increase in heart rate (47% vs 28%) and the product of heart rate and systolic blood pressure (82% vs 60%). Over all ECT seizures, the maximum and increase in heart rate and the product of heart rate and systolic blood pressure were significantly correlated with seizure duration as determined by electroencephalography. However, significant correlations were only present for the seizures during hypocapnia and not during normocapnia. Combining measures of magnitude and length of ECT-induced tachycardia to motor responses may increase the potential for clinical seizure evaluation.

Adult↗
PubMed1993

Handshaking, personality, and psychopathology in psychiatric patients, a reliability and correlational study.

A study of 29 psychiatric inpatients was performed to investigate the relation of handshaking variables (anatomical and physiological variables) with demographic data, personality traits, psychosocial functioning, and clinical diagnoses. Two psychologists rated patients' handshaking independently of each other according to four variables on an ordinal scale of five steps. The interrater reliability was satisfactory. Analysis showed that the handshaking procedure may in fact give some information about the personality make-up of the patients, most clearly through the relationship between low temperature and humidity of the palmar skin and social introversion, depression, and tendency towards symptom enhancement mainly in women. The handshaking procedure did not seem informative about psychosocial functioning and clinical diagnoses.

Adult↗
PubMed1993

Attitudes towards and observations of nonverbal communication in a psychotherapeutic greeting situation: III. An interview study of outpatients.

An interview study of 50 Swedish nonpsychotic outpatients treated by some kind of psychotherapy was performed to investigate their attitudes towards and observations of nonverbal communication in a greeting situation according to the Questionnaire on Nonverbal Communication (psychotherapy patients' version) in relation to background factors such as gender, age, education, and profession, interest in psychological matters, "reading articles and books in psychology," duration of professional help for psychological troubles, number of occasions waiting for a new therapist, and number of therapeutic sessions before the interview. The greeting situation was the first time a patient and a therapist met in a waiting room. Test-retest reliability of the questionnaire was larger for items about observation of nonverbal communication than for those about attitudes. Face communication (eye contact and smile) was considered by the subjects to constitute the most important nonverbal communication in the greeting process. The importance of the face in communication was stressed when the patient believed that such communication corresponded to more than 50% of the total communication in general, was female, was elderly, or reported special interest in nonverbal communication in the greeting situation. Some effects of bias were discussed. The analyses also showed a considerable consciousness and observation in the greeting situation by many psychotherapeutic outpatients.

Adult↗
PubMed1992

The 'diagnostic history' of schizophrenia. A retrospective study of 84 Swedish inpatients.

Since few studies have focused on the diagnostic process foregoing a case record diagnosis of schizophrenia, the present study was undertaken with the aims to examine the time interval between the onset of the illness, the first admission as inpatient, and the timepoint of a case record diagnosis of schizophrenia. Further, the study aimed at analyzing the influence of demographic and clinical variables on an 'early' or 'late' diagnosis of schizophrenia. The records of 84 inpatients treated during the calendar year 1986, were retrospectively analyzed. Only 21.4% of the patients had received a case record diagnosis of schizophrenia at their first admission into hospital, and additionally 16.7% after two admissions. Those patients with 'early' diagnosis differ significantly from patients with 'late' diagnosis, being more frequently men, having longer admission latency, higher frequency of Schneiderian first-rank and negative symptoms, a longer stay at hospital at their first admission, and lower levels of working capacity at the onset of the illness. The data suggest a propensity to include course and social functioning aspects of poor outcome in the diagnostic process. Confining the diagnosis of schizophrenia to the severe cases indicates a conservative, perhaps tautological, approach to this diagnosis.

Adjustment Disorders↗