Biomedical subjects
Publications and source records attributed to M F Weiner.
Patients who have a concrete cognitive style are psychotherapeutically best treated by methods that take into account their cognitive style, whether it is defensive or results from a cognitive developmental arrest. Concrete thinking, while an obstacle to insight-oriented therapy, is no obstacle to changing attitudes and behaviors by means that do not involve the development of insight into unconscious conflict or motivation.
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The frequency of depressive symptoms in anorexic patients, the response of some anorexic patients to antidepressants or ECT, the occurrence of comparable physiologic abnormalities in major depression and anorexia nervosa, and family studies of incidence increasingly link depression and anorexia in the literature. A review of the problems in making this linkage shows that the possibility of anorexia nervosa as a depressive equivalent or a depressive spectrum disorder must be seriously questioned.
The relationship between hospitalization, recent life change, ability to cope with asthma and asthma severity was investigated in 51 hospitalized and nonhospitalized chronic asthmatics. Hospitalization correlated highly with severity of asthma, marginally with low ability to cope with asthma, and highly with life changes due to asthma. Hospitalization did not correlate with asthma-independent life change scores. These results confirm that life stresses cluster prior to exacerbations of asthma, but in this population, the asthma itself appears to cause that clustering, especially in persons with limited ability to cope with the disease.
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Effective patient care requires effective communication with patients. The creation of a "Patientspeak" dictionary is offered as a constructive exercise for facilitating communication between health care professionals and their patients.
We evaluated the impact of the Texas limited privilege statute, enacted in 1979, through a questionnaire study of 121 lay persons, 79 patients receiving psychiatric outpatient treatment, and 84 psychiatrists. An almost equal percentage of lay persons and patients knew or guessed correctly that the statute existed (26% v 27%), but only 45% of the psychiatrists knew or guessed correctly that it had been enacted. Lay persons indicated that they might disclose more to a psychiatrist or psychologist if they had statutory protection, but only a few of the patients said they would have sought treatment earlier or would have disclosed more had they known of a privilege statute. Patients reported that they relied more heavily on their psychiatrists' ethics than on the statute to protect their privacy.
A successful nurse support group was contrasted with two unsuccessful support groups. The authors concluded that support groups work best if they are initiated in response to a felt need by the nurses, if the nurses have experienced the group leader as helpful in the past, if the group is highly structured and does not allow early discharge of intense negative feelings, and if the group's problems are primarily interpersonal and can be dealt with in the group and not primarily environmental or administrative problems such as noise, overcrowding, or understaffing.
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Identification is a cornerstone of normal maturation, and the wish to identify is a strong force through life. Appropriate identification with the therapist may be a crucial aspect of the psychotherapy of patients who have mis-identified or were unable to make constructive identifications at crucial points in their emotional development.
The literature on stresses in ICU nursing is reviewed to help the liaison psychiatrist facilitate nurses' coping with the considerable stresses in their work environment. Excessive workloads and understaffing have been found to be the most intense stresses. Also important are intrapsychic and interpersonal issues such as emotional reaction to loss, conflicts between ICU personnel, and insecurity stimulated by great responsibility in patient care. The studies reviewed suggest that nurses cope with these stresses by talking things out, by active mastery of complex technical procedures, and by drawing on mutually shared past experiences. Based on the above findings, the authors suggest means to reduce stress and enhance ICU nurses' coping.
Intensive care units (ICU) of hospitals are characteristically stressssful environments with high turnover of personnel. Support groups to help nurses deal with the stresses of the ICU environment have been widely recommended as a means to raise morale and increase communication, but are infrequently reported. Data on these groups are fragmentary. A review of the literature and correspondence with the authors of published papers demonstrated that most nurse support groups are open-ended groups with open membership, usually meeting for an hour a week, occasionally attended by nursing supervisors and unit physicians, and usually conducted by a liaison psychiatrist or a psychiatric consultant. Such groups are reported as positive experiences by nurses and group leaders. The small amounts of available objective evidence of the impact of support groups is positive; further research is required to arrive at a more definitive evaluation.
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Explore the source record for details and available documents.
Conservation-withdrawal should be included in the differential diagnosis of the withdrawn, apathetic medical patient. The clinician's awareness of the conservation-withdrawal phenomenon can avert the unnecessary use of psychotropic medications and avoid the alienation that arises between the patient and his primary physician when an unwarranted psychiatric diagnosis is applied. Recognizing the distinction between conservation-withdrawal and clinical depression permits the primary physician to utilize his own skills in supporting his patient.