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Biomedical subjects

L Coyne

Publications and source records attributed to L Coyne.

At least 19 recordsLinked to original sources
PubMed1998

Complex posttraumatic stress disorder in women from a psychometric perspective.

Herman's (1992a) formulation of complex PTSD was not incorporated into the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), but finds ample confirmation in personality assessment of women in inpatient treatment for trauma-related disorders. This study relates MCMI-III and Adult Attachment Scale scores to a self-report measure of childhood abuse and neglect, the Childhood Trauma Questionnaire. Consistent with Herman's formulation, the data reveal a wide array of symptoms coupled with two facets of relationship disturbance: (a) enmeshment in ambivalence (depressive, dependent, and self-defeating personality as well as ambivalent attachment), and (b) more profound isolation (avoidant and schizoid personality coupled with profoundly insecure attachment). We present a model for using such psychometric findings in patient education and diagnostic evaluations.

Adult↗
PubMed1998

Trauma pervasively elevates Brief Symptom Inventory profiles in inpatient women.

The Brief Symptom Inventory was administered to 228 women (M age: 37) consecutively admitted to specialized inpatient treatment for trauma-related disorders. Subsamples of patients were administered different posttraumatic stress disorder scales, the Impact of Events Scale-Revised, the Posttraumatic Stress Diagnostic Scale, and the PTSD scale of the Millon Clinical Multiaxial Inventory-III, as well as a measure of child abuse and neglect, the Childhood Trauma Questionnaire. In this severely traumatized group, every scale of the Brief Symptom Inventory was significantly more elevated than the inpatient female norms, with the five most highly elevated scales being Depression, Obsessive-Compulsive, Anxiety, Interpersonal Sensitivity, and Psychoticism. Different indicators of trauma (Childhood Trauma Questionnaire, PTSD scales, and PTSD diagnosis) show different patterns of relationships with the individual scales of the Brief Symptom Inventory. There is no simple relationship between trauma and BSI symptoms, but clinicians should consider severe interpersonal trauma to be one pathway to pervasively elevated profiles of the Brief Symptom Inventory.

Adult↗
PubMed1997

Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome.

To what extent do personal constructs affect the relationship between doctor and patient when the ill patient does not readily recover with treatment? Questionnaires were returned anonymously by 609 patients with a self-reported diagnosis of chronic fatigue syndrome, who were considered chronically ill. Findings were compared with those of an earlier study of a population of 397 general medical patients. The chronically ill patients lost an average of 65 days of work per year due to illness compared to general medical patients who missed six or fewer days per year because they were ill. The chronically ill patients also reported a 66% higher frequency of iatrogenic illness, spent more money on health care, took more medication, saw more specialists, and were more litigious than the general medical population. Research suggested several patterns of relationships between doctors and patients, and attitudes to health and illness, which may alert doctors to patients' perceptions, beliefs, encoded constructs, and patterns of relating that affect responses to treatment. More attention by doctors to patients who are experiencing the stress of chronic illness is indicated.

Adolescent↗
PubMed1995

Dissociation and vulnerability to psychotic experience. The Dissociative Experiences Scale and the MMPI-2.

Prior research on the MMPI has cautioned against misdiagnosing schizophrenia in patients with dissociative identity disorder. The present study examined the full spectrum of the dissociative experience in relation to MMPI-2 profiles. Ninety-eight women in treatment for trauma-related disorders completed the Dissociative Experiences Scale and the MMPI-2 in routine inpatient diagnostic evaluations. Consistent with prior research, severe dissociation was associated with high elevations on MMPI-2 scales typically associated with psychotic symptoms. Contrary to hypotheses, the ostensibly most benign form of dissociation, absorption and imaginative involvement, was somewhat more strongly related to MMPI-2 scores than the more pathognomonic forms of dissociation, depersonalization and amnesia. Although it should not be misdiagnosed, severe impairment on the MMPI in conjunction with dissociation should be taken seriously as suggesting vulnerability to psychotic experience. The dissociative retreat from the stressors of outer reality opens the door to the inner world of traumatic images and affects, along with compromised reality testing and disorganized thinking.

Adult↗
PubMed1995

Some interpersonal and attitudinal factors characterizing patients satisfied with medical care.

This research investigated the extent to which interpersonal and attitudinal factors affect the doctor-patient relationship. A questionnaire survey of people living in northeastern Kansas who had experience with medical care was conducted. Dependent measures were over-all patient satisfaction, patient's attitude toward death of self or others, causality orientation, attitude toward health and disease, and perception of the doctor-patient relationship. The majority of test subjects (92%) reported satisfaction with their medical care. A significant correlation between fear of death of significant others and scores on causality scales reflects feelings of not being in control of one's life. Other associations indicate that people who do not feel in control of their lives depend on traditional and folk remedies. Scores showing low fear of own death correlated significantly with the rated greater sense of responsibility for own health and treatment. Patients who rated themselves as more needy were unsatisfied with their care and those whose doctors called them by first name tended to be more content. Even in populations satisfied with their medical care, we suggest that the quality of care could be improved by attention to interpersonal and attitudinal factors.

Adolescent↗
PubMed1994

Child abuse and treatment difficulty in inpatient treatment of children and adolescents.

This study examined the associations between abuse and staff perceived treatment difficulty in sixty-nine hospitalized children and adolescents. Subjects were rated on a treatment difficulty scale, and clinical charts were reviewed for evidence of physical abuse, sexual abuse, abuse between parents, and parental history of abuse. Subjects with histories of abuse were not rated as more difficult or less responsive to treatment than other patients. Physically abused youngsters were rated as more self-destructive and more accessible to treatment than non-abused children, while sexually abused youngsters were self-destructive and demanding, and their families were seen as more distant and unavailable.

Adolescent↗
PubMed1994

Age and sex modulate effects of stress on the immune system: a multivariate analysis.

Multivariate analyses indicate that both age and sex can modulate examination stress effects on immune factors. Stress lowered eosinophil counts in females but raised them in males. Age modulated stress effects on CD4 and CD8 cells, hemoglobin, and erythrocytes. CD4 decreased more in older subjects; CD8 increased in older and decreased in younger subjects; hemoglobin decreased in younger but not older subjects; erythrocytes increased in older and decreased in younger subjects. Initial age and/or sex differences in levels of neutrophils and lymphocytes were not statistically altered by stress. Stress effects not modulated by age or sex increased serum IgA and IgM, CD19, and stimulated phagocytic activity but decreased serum IgG, CD3, basophils, and unstimulated phagocytic activity. The immunological effects of stress are multiple and are influenced by variations in age and sex of the person.

Adult↗
PubMed1994

Rorschach correlates of treatment difficulty and of the therapeutic alliance in psychotherapy with female psychiatric hospital patients.

The authors examined the relationship of Rorschach-based rating scales to treatment difficulty and to the therapeutic alliance in the psychotherapy of severely disturbed psychiatric hospital patients. They also examined how the Rorschach measures were related to specific impediments in the patients' ability to form a therapeutic alliance and to improve in the alliance. The statistically significant correlations appear primarily for women. The findings of central interest are: (1) Female patients with better thought organization and object relations capacities, as measured by the Rorschach, tend to be more difficult to treat; (2) those women who manifest higher Aggression-Malevolence scores on the Rorschach tend to have better therapeutic alliances; and (3) improvement in the therapeutic alliance with female patients is significantly related to higher severity of psychological disturbance on the Rorschach test.

Female↗
PubMed1993

The effect of attention/information processing impairment of tardive dyskinesia and neuroleptics in chronic schizophrenics.

In this article we report the results of a test of the hypothesis that a form of attention/information processing dysfunction, attentional set impairment, is exacerbated by facial-oral tardive dyskinesia in schizophrenics. This hypothesis was tested in the context of a study that was aimed at determining whether the Reaction Time Crossover Effect, a well-established form of attentional set impairment in schizophrenia, was "affected" by neuroleptic treatment. Our results indicate that the crossover effect is resistant to modification by neuroleptics, but that it is exacerbated by facial-oral tardive dyskinesia. We speculate that neurophysiological mechanisms underlying tardive dyskinesia interact with or are similar to those underlying attentional set impairment.

Adolescent↗
PubMed1993

Psychiatric treatment of Roman Catholic religious patients: a pilot follow-up study.

The pilot follow-up study reported here was undertaken to determine the treatment outcome of Roman Catholic religious priests, sisters, and brothers treated at The Menninger Clinic during a 10-year period. The authors stress the importance of involvement by the religious community in treatment and follow-up, and of opportunities in treatment to address spiritual and vocational issues. The extremely low response rate requires that the findings be regarded as tentative and as a pilot study for further research. However, the data do suggest some general conclusions for treatment of this population.

Catholicism↗
PubMed1992

Optimal length of stay in child and adolescent psychiatric hospitalization: a study of clinical opinion.

Factors contributing to clinical recommendations for length of hospitalization for children and adolescents were investigated. Diagnosis, chronicity, severity of symptoms, response to prior treatment, and family resources were found to relate strongly to length-of-stay recommendations. Guidelines representing the consensus of experienced clinicians are proposed.

Adaptation, Psychological↗
PubMed1992

Alterations in EEG amplitude, personality factors, and brain electrical mapping after alpha-theta brainwave training: a controlled case study of an alcoholic in recovery.

A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation. Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity. At 4 months post-treatment the patient's wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol. Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.

Adult↗
PubMed1991

Perceived treatment difficulty and therapeutic alliance on an adolescent psychiatric hospital unit.

On an 8-bed adolescent psychiatric unit, 69 patients were rated over the course of more than one year [corrected]. A set of rating scales was used to determine the relationships of treatment and therapeutic alliance difficulties with staff ratings of patient qualities, family issues, and treatment outcome. Findings underscore the clinical relevance of treatment difficulty and therapeutic alliance in conceptualizing the therapeutic action of the hospital treatment.

Adolescent↗
PubMed1991

Effects of extended hospitalization: a one-year follow-up study.

The C. F. Menninger Memorial Hospital is conducting an ongoing follow-up study of the effects of extended hospitalization. The authors report key indicators of outcome at one year postdischarge for 110 patients hospitalized on extended care units for at least 180 days. Outcome is determined by postdischarge rates of rehospitalization, postdischarge suicide attempts, and occupational functioning at the time of the one-year follow-up interview. After comparing these areas with preadmission levels of symptomatology and functioning, the authors report significant improvement in each category at the time of follow-up.

Adaptation, Psychological↗
PubMed1990

Outcome at discharge for patients in an ongoing follow-up study of hospital treatment.

Methodological and practical difficulties have limited the growth of knowledge about outcome of psychiatric hospital treatment. The authors report on outcome at hospital discharge for 103 long-term and 93 short-term patients treated at the C. F. Menninger Memorial Hospital, part of an ongoing follow-up study of hospital treatment. Discharge outcome is based mainly on ratings of symptoms, global functioning, and therapeutic alliance as well as on patients' reports of satisfaction. At discharge both long- and short-term patients were found to have low levels of symptoms (based on the Brief Psychiatric Rating Scale) and a relatively adequate level of functioning (in the 51-to-60 range on the Global Assessment Scale) and to have been highly satisfied with treatment.

Adult↗
PubMed1990

Scales for assessing family intervention during psychiatric hospitalization.

Because ample evidence from both clinical and research realms has demonstrated that family intervention can be crucial for the process and outcome of psychiatric hospital treatment, greater attention should be given to assessing the extent and content of such interventions. The authors present their rating system for assessing the focus of family interventions during psychiatric hospitalization; they also provide results of a study of the interrater reliability of the scales and a factor analysis of the scales. These Family Intervention Scales are designed for application in hospitals that vary widely in structure, setting, staffing patterns, and program emphasis. The factor analysis yields four factors that make good clinical and conceptual sense: Information-Education, Family System Approach, Family Therapeutic Alliance, and Spouse Involvement.

Combined Modality Therapy↗
PubMed1990

Assessing difficulties in the hospital treatment of children and adolescents.

There are few studies of treatment difficulty with children and adolescents. The authors describe a preliminary phase of research in this area, specifically the development of a set of rating scales to assess factors in treatment difficulty, a study of interrater reliability, and factor analyses of the content of these scales. The next steps in this ongoing research project are outlined.

Adolescent↗