Neglected symptoms of migraine attack.
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Biomedical subjects
Publications and source records attributed to J Passchier.
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The emotional reactions of women (N = 29) after perinatal loss were evaluated over a four-year period by means of standardized questionnaires and a semi-structured interview. Eleven women (38 per cent) displayed a level of general psychological distress which is clinically significant. Grief reactions declined significantly during this period, except for difficulties with coping and despair concerning the loss, and a quarter of the women still showed a clinically significant high level of distress for intrusive images. The disposition for feelings of inadequacy (i.e. feeling anxious, insufficient, depressed and having low self-esteem) was strongly and positively related to the intensity of stress, grief and general psychological distress after four years. Our findings emphasize the importance of psychosocial screening of those women identified as showing signs of inadequacy in the face of (threatened) pregnancy loss with the objective to offer them additional psychological support.
In a comparative study on the effects of predictive DNA testing for late onset disorders, pre-test psychological distress was assessed in people at risk for Huntington's disease (HD, n = 41), cerebral haemorrhage (HCHWA-D, n = 9), breast and ovarian cancer (HBOC, n = 24), and polyposis coli (FAP, n = 45). Partners, if available, also participated in the study. Distress was measured with the subscales Intrusion and Avoidance of the Impact of Event Scale. People at risk for the neurodegenerative disorders reported more avoidance than those at risk for the cancer syndromes. People at risk for FAP and partners of those at risk for HBOC reported less intrusion than the others at risk and the other partners. Subjects who were more distressed reported more experiences with the disease in close relatives, the disease having a great impact on their lives, having considerations against predictive testing, expecting that being identified as a gene carrier would have adverse effects, and expecting relief after being identified as a non-carrier. Test candidates who expected an increase of personal problems showed higher avoidance, whereas those who could better anticipate future life as a carrier had higher intrusion levels. Generally, subjects with high distress levels are of more concern to the healthcare professional than those with low distress levels. However, high distress may reflect worrying as a mental preparation for the test result, whereas low distress may indicate denial-avoidance behaviour and poor anticipation of the test outcome. In pre-test counselling sessions, this should be acknowledged and addressed.
The relation between modification of physical activity, a risk factor for coronary heart disease, and personality characteristics was assessed in 166 survivors of a first myocardial infarction (MI). Physical activity was assessed before MI in retrospect and again 5 months after MI. Patients were divided into 3 categories according to their current daily-life physical activities: less active than before MI (n=24), equally active as before MI (n=82), or more active than before MI (n=60). A significant differentiation was found between patients who became less physically active than before MI and the other 2 categories. This less active category was characterized by feelings of disability, a low level of vigor, and feelings of anxiety. In addition, this patient group was on average older and more often female. The results were adjusted for participation in a cardiac rehabilitation program. Finally, the discussion recommends involving psychological intervention in the exercise program for the less active category of patients to diminish feelings of anxiety and disability and to improve vigor.
We evaluated the outcome of a behavioral treatment package in a clinical setting with a group of young (age: 12-22) headache patients, suffering from migrainous or nonmigrainous. Comparison between the experimental (n = 24) and the waiting-list control group (n = 15) showed a treatment effect on headache frequency and on the headache index. Using a 50% reduction in the headache activity as a criterion for clinical improvement, 52% of the participants in the experimental group had improved clinically at the end of the treatment. The treated participants were found to have maintained significant improvement at 1-year follow-up. The treatment effect was significantly high for nonmigrainous headache patients than for migraineurs. The most important background predictor of outcome was duration of headache history: youngsters with a longer headache history profited less by the treatment than youngsters with a shorter headache history. Family predictors of pre-post improvement were maternal rewarding of illness behavior and mother-child relationship Those youngsters who reported more rewarding and/or a more positive mother-child relationship profited less by the treatment than those who reported less rewarding and/or a less positive mother-child relationship. We conclude that therapists treating young headache patients should be alert to pain-rewarding patterns in the family.
21 women with one infant each born subsequent to the loss of a late pregnancy were invited to complete the State Trait Anxiety Inventory, and two Dutch mother-child adaptation scales one month after delivery. Scores on trait anxiety appeared to be significantly related to maladaptive behavior of the mother to her child in the first four weeks following the birth, suggesting that women with high anxiety and a past of lost pregnancy are at risk for the development of an unfavorable mother-child relation.
Plasma levels of the beta-carboline norharman, concentration of platelet 5-HT, trait measures of anxiety, and measures of coping and defense mechanisms were compared for 15 patients with panic disorder and 24 healthy volunteers. Patients indicated that they made less use of the defense mechanism of principalization than control subjects. No other differences between patients and controls were significant. Platelet 5-HT concentration was positively correlated with the subjectively reported anxiety. Plasma norharman concentration was negatively correlated with the defense mechanisms of principalization and repression and positively correlated with coping strategies involving palliation. The positive correlations of norharman levels with projection and self-comforting fell short of significance and existed in the patient group only. No correlation was apparent between levels of plasma norharman and scores on anxiety. It was concluded that norharman is not a marker for panic disorder or trait anxiety, but that it might reflect intrapsychic and coping processes.
Pregnant women with (n = 24) and without (n = 26) a previous pregnancy loss (> 16 weeks) due to congenital anomalies were compared on quality of life and anxiety. Pregnant women with a previous loss were divided into those with and those without a normal livebirth since the loss [cases+ (n = 6) and cases- (n = 18), respectively]. Psychological measurements were carried out before and after an ultrasound scan in the second trimester of the pregnancy. Women with a previous loss who had not delivered a healthy infant between the loss and the present pregnancy showed a lower quality of life as revealed by feelings of social isolation, negative emotional reactions, and pain than the other groups. In addition, they showed more pregnancy-related anxiety. The negative emotions were particularly present just before the anomaly scan. Feelings of social isolation, negative emotional reactions, pain, and pregnancy-related anxiety were significantly positively related to trait anxiety, irrespective of having experienced late pregnancy loss. The implications of this study are that the referring gynaecologist, physician, or midwife should be aware of the strong emotions and major concerns of women in a pregnancy subsequent to a late pregnancy loss. In addition, they should offer these women the opportunity to express their emotional distress.
Evidence coming from several studies into memory and awareness during general anesthesia suggests that in surgical patients who seem to be adequately anesthetized (i.e., unaware of what happens in the operating theater), some form of cognitive functioning is preserved. This finding has important implications both for clinical practice and for memory research. In order to give the methodological background of the present situation in this field of research, this article deals, on the basis of recent experiments, with important methodological aspects of studies into perception and memory during general anesthesia.
The relationship between personality characteristics and spontaneous modification of smoking habits was assessed in 164 patients after their first myocardial infarction (MI). Smoking habits before the MI were investigated in retrospect and 5 months later. Smoking appeared to have decreased significantly. Persistent smokers could be differentiated from nonsmokers and exsmokers by a significantly high level of state-anxiety and depression. Young persistent smokers had a high level of depression; elderly persistent smokers were highly anxious and had a low level of somatization. The relationship between smoking behaviour modification and personality characteristics is discussed in association with intervention programmes.
In this study the psychological profiles of 67 patients with noncardiac chest pain (NCA) and 47 patients with coronary artery disease (CAD) were analyzed to construct an empirical-psychological model that would be able to discriminate these two groups. All patients were suffering from chest pain at the time of referral by their general practitioner. The noncardiac patients were significantly younger, more often female, single, and nonsmokers. The two groups differed significantly on anxiety, somatization, obsessive compulsive behavior, psychoneuroticism, and hyperventilation. Logistic regression analysis on the variables jointly, showed that age, gender, anxiety, and hyperventilation contributed significantly to the model for discriminating between the two groups. Crossvalidation showed that the constructed model was stable.
We developed a generic Quality of Life (QL) measurement scale for adolescents between 12 and 18 years of age, primarily for use on youngsters with chronic headaches or migraine. The Quality of Life Headache in Youth (QLH-Y) is a 71 item (69 multiple choice items and two visual analogue scales) QL measurement scale. It assesses an individual's QL in six QL subdomains. Study 1 (n = 223) was aimed at item selection and scale construction. Thirteen subscales were developed to cover the four QL subdomains Psychological Functioning, Functional Status, Physical Status and Social Functioning. The QL subdomains Satisfaction with Life in General and Satisfaction with Health were covered by two visual analogue scales. Internal consistency of nearly all the subscales was satisfactory. Study 2 (n = 159) was conducted to evaluate the validity and stability of the QLH-Y. Indications for parent-youth agreement, construct validity and sensitivity for headache and migraine were obtained. Stability coefficients were between 0.47 and 0.72 for the 1-week interval and between 0.31 and 0.60 for the 6-month interval. Nearly all of the QLH-Y subscales appeared to be more sensitive to differences between subjects with headaches and headache-free subjects, while the QL subdomain Functional Status was most sensitive for subjects who had suffered from a recent headache.
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Questions to be answered by this study were: (1) what is the health-related quality of life (HRQL) of migraine and tension headache patients who consult their general practitioner, and (2) what are the unique contributions of the perceptual and emotional components of headaches to the HRQL. The Nottingham Health Profile (NHP) was used to measure the HRQL of patients with migraine (n = 27), tension headache (n = 25), both migraine and tension headache (n = 17), and two reference groups. Perceptual components of the pain (intensity, frequency, and duration) were measured with a headache diary, while emotional components were measured with five visual analogue scales (for tension, depression, frustration, anger and fear). The NHP dimensions of pain, sleep, energy, and social isolation revealed that each headache patient group had a lower HRQL than the healthy reference group. There were no differences in HRQL between the headache groups. Regarding the second question: it was found that the greater the patient's emotional pain, the more problems he or she had with physical mobility and social isolation. Neither the type of headache nor the headache index were related to the HRQL of the patient. We recommend to increase the research efforts concerning tension headache and to measure the emotional component of pain in clinical trials.
BACKGROUND: From the literature it appears that there may be two types of injection phobia, (1) the 'vasovagal' type, and (2) the 'resistant' type. The first type is characterized by a diphasic cardiovascular response during or after injection and by a tendency to react in a passive, nonresisting way when injected. The second type is characterized by strong, sometimes violent resistance and no vasovagal reaction to an injection. Characteristics of blood injury phobia apply to the first type, but not to the second. The possibility is considered that exposure may be an effective treatment in the first type, and participant modelling in the second type. METHOD: A single case study was carried out with a case of injection phobia of the second type in which exposure with modelling, followed by participant modelling of the injection, was applied. Measures of state anxiety (STAI) and heart rate were obtained. RESULTS: According to expectation, participant modelling of injections was effective in eliminating the fear of injections in a patient of the second type of injection phobia. CONCLUSIONS: The results of this study warrant further investigation of the model in a group design in which the differential treatment effects of exposure and participant modelling are tested.
13 couples who lost an infant due to a major congenital anomaly were assessed using the Perinatal Grief Scale. Contrary to the research findings of generally less intensity of grief in men, couples did not differ significantly in this respect one-half year after the loss of their infant. On the other hand, there was no strong relationship between the scores of women and men, indicating that, apart from intensity they grieve differently.
The aim of the current study was to investigate the effects of psychosocial variables on well-being and on pregnancy-related complaints throughout pregnancy. Three hundred and ninety-six nulliparous women completed questionnaires on number of daily stressors, social support, gestational factors and mental and physical work load in each trimester of pregnancy. In addition, the following dependent measures were assessed: depression, anxiety, somatic complaints, and the pregnancy-related complaints fatigue, nausea and back pain. The independent variables predicted depression best (r2 = 42-44%), followed by anxiety (R2 = 13-20) and somatic complaints (R2 = 16-21%). Number of daily stressors explained most of the variance. Satisfaction with social support and maternal age were negatively correlated with depression. In contrast, pregnancy-related complaints could be less accurately predicted by psychosocial factors. The amount of explained variance for fatigue ranged between 6 and 10%, for nausea between 2 and 6%, and for back pain between 5 and 7% for the three trimesters. It is concluded that depressive symptoms during pregnancy are associated with negative psychosocial factors, particularly the number of daily stressors and low satisfaction with received social support. To a lesser degree, this is also the case with anxiety and somatic complaints. Pregnancy-related complaints, on the other hand, appear to be relatively independent of psychosocial conditions.
Memory for words presented during general anesthesia was studied in two experiments. In Experiment 1, surgical patients (n = 80) undergoing elective procedures under general anesthesia were presented shortly before and during surgery with words via headphones. At the earliest convenient time after surgery (within 5 h) and 24 h later, memory was tested by asking patients to complete auditorily presented word stems with the first word that came to mind and to leave out words they remembered having heard earlier (exclusion task). Moreover, patients were requested to perform a "yes/no" forced-choice recognition task to assess recognition memory for both the pre- and intraoperative words. Memory for the material presented during anesthesia was demonstrated immediately after surgery and 24 h later by means of both tasks. In a second similar experiment (n = 80), the results were replicated. These findings show that anesthetized patients can process information that was presented intraoperatively.