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Biomedical subjects

L Coyne

Publications and source records attributed to L Coyne.

102 records · Page 6Linked to original sources
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Indications for extended psychiatric hospitalization: a study of clinical opinion.

The authors previously developed a conceptual model of factors bearing on length of stay from clinicians' vignettes describing patients considered ideal candidates for various lengths of stay. The previous study was conducted at The Menninger Clinic, the present study at Harding Hospital. The two hospitals provide a worthwhile contrast because Menninger specializes in long-term (LT) stays (averaging 1 year) and Harding in intermediate-term (IT) stays (averaging 2 to 3 months). The Harding findings generally replicated and complemented the Menninger results, and the authors used the combined data to generate a hypothesized set of general indications for various lengths of stay in these private psychiatric hospitals.

Aftercare↗
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Do clinicians agree about who needs extended psychiatric hospitalization?

This report examines the level of agreement among 194 staff members of The Menninger Clinic and Harding Hospital about the optimal length of stay for 71 types of patients selected on the basis of hypothesized suitability for various lengths of hospitalization. There were differences of opinion associated with hospital affiliation and professional discipline, but there was sufficient consensus to enable the development of comprehensive criteria for predicting required length of hospitalization. The validity of these criteria will be tested in a future treatment outcome study.

Attitude of Health Personnel↗
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Assessing need for extended psychiatric hospitalization.

The authors developed a set of rating scales to assess a wide range of variables believed by clinicians to influence the optimal length of hospital stay. They report the results of interrater reliability studies, a factor analysis of the scales, and a correlational study of the factors with actual length of stay. They describe the potential applications of the scales to clinical practice and research.

Female↗
PubMedDate not supplied

Dissociative detachment relates to psychotic symptoms and personality decompensation.

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from one's own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Adult↗
PubMedDate not supplied

The analgesic effect of odour and music upon dressing change.

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain.

Aged↗
PubMedDate not supplied

Psychosocial aspects of oncology: challenges and problems of research in a radiotherapy center of a community hospital.

This paper describes the vicissitudes of psychosocial research in a radiotherapy center. The project described evaluates the efficacy of counseling techniques in patients with early stage breast cancer receiving radiotherapy. The problems involved are discussed. They include the effects of: 1) introducing a psychosocial program into a medical setting; 2) research, specifically psychological, on staff and treatment in a nonresearch center; 3) asking patients to participate in a project the relevance of which is not immediately apparent; and 4) working under such conditions on the research itself. Conclusions and recommendations derived from this experience are made.

Adaptation, Psychological↗
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Transference interpretation in the psychotherapy of borderline patients: a high-risk, high-gain phenomenon.

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.

Adult↗
PubMedDate not supplied

Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications.

Data are presented that describe the clinical characteristics of 96 patients treated at the C.F. Menninger Memorial Hospital, Topeka, Kansas, from November 1983 to June 1989. Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders or eating disorders not otherwise specified; and 2 had a diagnosis of psychological factors affecting physical conditions. Seventy-three percent of the cohort were found to have either Axis I or Axis II disorders or both, comorbidity. Borderline personality disorder was found in 46% of the sample, although 20% of the patients with borderline disorders were diagnosed retrospectively. Depression was the largest comorbid Axis I diagnosis. Patient variables for sexual abuse, drug and alcohol addiction, purgative behaviors, and interpersonal relationships are also described. The authors conclude that a substantial subpopulation of eating disordered patients are significantly comorbid for other psychiatric illnesses. This high incidence of comorbidity may help explain the frequency of refractoriness of many eating disordered patients who do not respond to outpatient or short-term inpatient hospitalization. The authors recommend that additional research studies address the problems of the comorbid eating disordered patient and suggest that the findings be taken into account by clinicians and payers.

Borderline Personality Disorder↗
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Fine needle aspiration cytology of talc granulomatosis in a peripheral lymph node in a case of suspected intravenous drug abuse.

A fine needle aspiration (FNA) specimen of an epitrochlear lymph node from a 22-year-old suspected intravenous drug abuser was submitted for cytologic examination, which revealed numerous granulomatous tissue fragments, histiocytes, lymphocytes and giant cells. Polarizing microscopy revealed strongly birefringent material of varying shapes and sizes, including anisotropic crystals with the Maltese cross configuration characteristic of starch. A cytologic diagnosis of talc granulomatosis in the lymph node was made. This case emphasizes the value of FNA biopsy in the differentiation of inflammatory versus neoplastic processes; this appears to be the first case of peripheral talc granulomatosis diagnosed by FNA biopsy.

Adult↗