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Biomedical subjects

R S Hallam

Publications and source records attributed to R S Hallam.

At least 37 records · Page 2Linked to original sources

Vestibular disorder and emotional distress.

A standardised test of psychopathology (CCEI) was administered to tinnitus sufferers some of whom also complained of dizziness. It was predicted that the complaint of dizziness would be associated with higher scores on the anxiety scales of the CCEI and this was confirmed. Subjects complaining of dizziness obtained much higher scores on 'phobic' and 'somatic' anxiety scales in particular. However, the complaint of dizziness was completely uncorrelated with objective assessments of balance and there was no effect of balance, objectively assessed, in moderating the association between the complaint of dizziness and 'anxiety'. The results highlight the complex relationship between vestibular dysfunction and complaint behaviour.

Adult↗

A factor analytical study of tinnitus complaint behaviour.

Two separate factor analyses were conducted on various self-rated complaints about tinnitus and related neuro-otological symptoms, together with audiometric measurements of tinnitus 'intensity' (masking level and loudness matching levels). Two general tinnitus complaint factors were identified, i.e. 'intrusiveness of tinnitus' and 'distress due to tinnitus'. 3 specific tinnitus complaint factors were also found, i.e. 'sleep disturbance', 'medication use' and 'interference with passive auditory entertainments'. Other neuro-otological symptoms and the audiometric measures did not load on these factors. An exception was provided by loudness matches at 1 kHz, which had a small loading on the 'intrusiveness of tinnitus' factor. Self-rated loudness had a high loading on this factor. Otherwise, the loudness (either self-rated or determined by loudness matching) was unrelated to complaint dimensions. The clinical implications of the multifactorial nature of tinnitus complaint behaviour are considered.

Affective Symptoms↗

The Crown-Crisp Experiential Index in patients complaining of tinnitus.

The Crown-Crisp Experiential Index (CCEI) was administered to 472 patients complaining of tinnitus who took part in a multi-centre study on tinnitus masking (Hazell et al., 1985). This inventory includes scales of anxiety, phobic anxiety, obsessionality, somatic anxiety, depression and hysteria. The scores on the CCEI scales for patients with and without 'dizziness' as an additional symptom were compared. In the non-dizzy patients, scores on the anxiety and depression scales were consistently elevated compared with the published normative values. In the dizzy patients scores on all scales except Hysteria were elevated. The most pronounced and consistent difference between the dizzy and non-dizzy patients was in the Somatic Anxiety scale. The presence of dizziness also obscured the relationship between the CCEI scales and measures of tinnitus. In contrast, however, hearing disability did not appear to influence the results.

Adaptation, Psychological↗

Agoraphobia: a critical review of the concept.

Phobic avoidance has been widely accepted as the central feature of the agoraphobic syndrome, and the presence of agoraphobia has been used to define groups of subjects for clinical research. A review of the evidence suggests that agoraphobia should not be classified with the phobias; several lines of inquiry point to the conclusion that it is a variable feature of patients suffering from anxiety neurosis. Implications for research and problems with the present classification of neurotic affective disorders are noted.

Agoraphobia↗

Nurse therapists in behavioural psychotherapy.

Five registered mental nurses (R.M.N.s) were trained over two years to become behavioural psychotherapists for adult neurotic disorders. They achieved results comparable to those obtained with similar patients and methods by psychologists and psychiatrists. Similar results were maintained when over a third year the therapists were seconded to work in four hospitals and a general practice. Patients were satisfied at being treated by nurses. After initial teething difficulties nurse therapists became valuable members of treatment teams during both training and secondment, becoming accepted by most nurses, psychologists, and psychiatrists with whom they came into contact. The training of further nurse therapists would facilitate treatment of many disabled neurotics who would otherwise go without effective treatment. Training nurse therapists takes less time and money than training psychologists and psychiatrists because less of their education is redundant to the skills involved. The pool of R.M.N.s suitable for training is much larger than that of psychiatrists and psychologists. The nurse therapists can be integrated relatively easily into treatment teams. The present nursing structure imposes restrictions on the advancement of clinical nurse specialists and a clinical tree is badly needed parallel with present administrative and teaching hierarchies. An 18-month course in adult behavioural psychotherapy has been recognized by the Joint Board of Clinical Nursing Studies for England and Wales so that nurse therapists seem destined to be a lasting feature of future treatment teams.

Adult↗

Psychiatric nurse as therapist.

Under supervision five nurse-therapists have treated phobic patients as successfully as have psychiatrists and psychologists using similar psychological treatments in comparable psychiatric populations. Nurses have also had good results in other neurotic disorders. Intensive training is required. Nurse-therapists find their work rewarding, but the present Salmon gradings make no provision for their advancement should they retain their clinical function. Results suggest that the use of selected psychiatric nurses as skilled therapists can ease the current critical shortage of treatment personnel in psychiatry.

Abreaction↗