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S M Consoli

Publications and source records attributed to S M Consoli.

40 records · Page 3Linked to original sources
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[Psychiatric disorders in intensive care units].

The diagnosis and treatment of psychiatric disorders in intensive care patients have been for a long time neglected. They are nowadays better recognized and managed. These disorders are mainly: delirium; anxiety disorders, from simple anxiety to panic disorder with agitation; adaptation disorders with depressive mood; brief psychotic disorders with persecution ideas. The manifestations of psychiatric disorders occur not only during the stay in intensive care unit (ICU) but also after transfer from ICU and several months after discharge from hospital. Part of psychiatric disorders is caused by organic or toxic causes (metabolic disturbances, electrolyte imbalance, withdrawal syndromes, infection, vascular disorders and head trauma). Nevertheless some authors estimate that they are due to the particular environment of ICU. The particularities of these units are: a high sound level (noise level average between 50 and 60 dBA), the absence of normal day-night cycle, a sleep deprivation, a sensory deprivation, the inability for intubated patients to talk, the pain provoked by some medical procedures, the possibility to witness other patients' death. Although most patients feel secure in ICU, some of them perceive ICU's environment as threatening. Simple environmental modifications could prevent the apparition of some psychiatric manifestations: efforts should be made to decrease noise generated by equipment and staff conversations, to provide external windows, visible clocks and calendar, to ensure adequate sleep with normal day-night cycle and to encourage more human contact. Psychotropic drugs are useful but a warm and empathetic attitude can be very helpful. Some authors described specific psychotherapeutic interventions in ICU (hypnosis, coping strategies.). To face anxiety, many patients have defense attitudes as psychological regression and denial. Patient's family is suffering too. Relative's hospitalization causes a crisis in family. Unpredicted illnesses often force family members to reorganize in order to regain their equilibrium. Every family should be proposed a psychological support. Caregivers can be distressed as well. This stress is due to their high responsibility and the fact that they face disease and death. Simple measures can lessen stress'effect and prevent the burn-out syndrome . In conclusion, the importance of a liaison psychiatrist-intensive care physician collaboration must be emphasized in order that patients and their family have a better psychological support. Psychological management should be proposed during the hospitalization and after discharge from hospital.

Adaptation, Psychological↗
PubMedDate not supplied

[French validation study of the levels of emotional awareness scale].

According to a thesis based on the idea of an influence of cognitions in the structuring of internal reality, emotional awareness, ie the capacity of representing your own emotional experience and that of others, is a cognitive process that goes into maturation. Defining this concept, Lane and Schwartz present a cognitivo-developmental model in five stages of the processes of symbolization, accounting for the differences in levels of emotional awareness observed in individuals. The organization of these cognitive processes would thus be structured in well differentiated stages, in which the development of the emotions would be inseparable from the development of ego and of the relation to others. These authors focus on the capacity of representing in a conscious way the emotional experience and consider that verbal representations used to describe the contents of what is experience constitute a good reflection of the organization structural of the emotional awareness. Therefore, they worked out an instrument of evaluation: the Levels of Emotional Awareness Scale (LEAS), which measures the capacity to describe your own emotional experience and the one you allow to others, in an emotional situation. The system of quotation of this scale is based on the analysis of the verbal contents of the provided answers, in direct reference to the authors' theory of the levels of differentiation and integration of the emotional experience. It is therefore an empirical measurement which is centered specifically on the structural organization of the emotional experience. The various studies of validation of this instrument show that it presents solid metrological properties. This work presents the validation of the French version of Lane and Schwartz's LEAS. Validity and fidelity were studied in a group of 121 healthy subjects. This setting is part of a larger clinical evaluation, also including a collection of socio-demographic and clinical data, and other instruments of self-evaluation (Beck Depression Inventory, BDI, Hospital Anxiety and Depression Scale, HAD, and Toronto Alexithymia Scale, TAS). The face validity appears correct: the questionnaire was well accepted and seemed easy to complete. A principal components analysis of the correlation matrix of the set of items was used as the method of extraction of the various factors and made it possible to confirm the unidimensionality of the instrument. The number of factors to be retained was given according to Kaiser and Cattell criteria. The internal consistency was evaluated through computation of the Cronbach coefficient, whose value is 0.75 for the scale's global score. The confidence interval of the margin of error of LEAS scores was also measured; for the global score it is IC=[m 6.1]. The measure given by this rating scale may therefore be considered sufficiently accurate, since this interval is weak. A study of the frequency of quotation of each item of the instrument was carried out, in order to check the homogeneity and the uniformity of quotations, as well as a diagram of distribution of the score, showing that it follows a law which is close to a normal law. The concurrent validity could only be studied via the similar concept of alexithymia, measured with the TAS, for there is not other instrument validated in French evaluating the levels of emotional awareness, and these two instruments seem to measure different notions, because none of the correlations between the scores of these two questionnaires are significant. Concerning discriminant validity, the Pearson correlation coefficients between the global score for the LEAS, the BDI score and the HAD sub-scores for depression and anxiety were measured; it is clear that the level of emotional awareness is independent from negative affects. Furthermore, the study of the reliability made it possible to highlight excellent intra-class correlation coefficients (r=0.993). The French version of the Levels of Emotional Awareness Scale thus appears to be valid and accurate and should allow the study of levels of emotional awareness on psychopathology. It is about an easily acceptable and simple questionnaire of use in varied clinical circumstances.

Adolescent↗
PubMedDate not supplied

[Development and validation of a perceived stress questionnaire recommended as a follow-up indicator in occupational medicine].

This work was originated from the concern for the availability of a short, acceptable and reliable instrument for self-assessment of perceived stress. The questionnaire was designed to be routinely applied within a visit at an Occupational Medical Center. A new questionnaire was developed with this aim, consisting of 9 subscales presented in a Lickert form, with 4 modes of answer, scored from 0 to 3. The content of the 9 items covers the multiple facets of perceived stress and its consequences: "feeling of being under pressure", "impatience", "irritability", "intrusive thoughts about work", "inability to entertain", "discouragement", "morning fatigue", "food compensation", "compensation by smoking". Stress global score is defined as the sum of the 9 elementary scores. The first 7 items are similar in their construct to the 7 factor solutions of the principal component factor analysis performed on Levenstein Perceived Stress Questionnaire (1993). On the other hand, in comparison with Cohen Perceived Stress Scale (1983), our instrument keeps an important place for affective, physiologic and behavioral impact of stressing situations. A study on the homogeneity of the scale, its factorial structure, and its time reproducibility after 6 weeks of interval, was carried out on a first population of 91 subjects seen during an occupational medical visit in several companies of Paris district (PCV-Metra group). The coefficient of internal consistency is very high (Cronbach's alpha = 0.82). Principal component analysis extracted two factors, which were unchanged after a Varimax rotation and respectively represented 42% and 13% of the total variance: they can be interpretated as a general perceived stress component (being overwhelmed, loss of control) and a behavioral bipolar component opposing food compensation to smoking, whilst facing stressing situations. Test-retest correlation coefficient is 0.88 (Pearson r as well as intraclass correlation coefficient), without any significant gap between the first and the second assessment. A second study was carried out on 761 working individuals seen in the same conditions during an occupational medical visit in the same companies (596 males and 65 females, aged 40.1 +/- 8.8 years). Socio-demographic data analysis showed higher stress scores in females (10.2 +/- 4.0), than in males (8.5 +/- 3.7) (p < 0.0001). Detailed analysis showed differences related to gender in the same direction for the items "irritability", "discouragement", "morning fatigue" and "food compensation". Highest stress scores, for both males and females, were found for the items "intrusive thoughts about work" and "morning fatigue". Stress global score was correlated with socioprofessional status (SPS): unskilled and skilled workers (n = 39) as well as technicians (n = 346) exhibited lower scores than clerical workers (n = 108) or engineers (n = 162) (ANOVA, p < 0.0001). The comparison between mean scores performed separately by gender, given the different sex-ratio according to SPS (employees were mostly females) confirmed the association between stress score and SPS only in males, with blue collars and technicians looking less under stress than engineers. Metrological properties of this Perceived Stress Questionnaire incite to perform studies focused on the associations between such a stress index measured in an occupational setting, and several other clinical or biological variables, especially those supposed to constitute classical cardiovascular risk factors.

Adult↗