[Basic clinical training in psychiatry].
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Education, Medical, Graduate↗
Biomedical subjects
Toshihiko Maruta
Publications and source records attributed to Toshihiko Maruta.
Optimism-pessimism assessed in the 1960s and self-reported health status 30 years later.
OBJECTIVE: To study the association between explanatory style, using scores from the Optimism-Pessimism (PSM) scale of the Minnesota Multiphasic Personality Inventory (MMPI), and self-reported health status, using scores from the 36-Item Short-Form Health Survey (SF-36). PATIENTS AND METHODS: A total of 447 patients who completed the MMPI between 1962 and 1965 as self-referred general medical outpatients and also completed the SF-36 thirty years later compose the current study sample. The associations between the scores on the SF-36 and the MMPI PSM scale were evaluated by analysis of variance and linear regression analysis. RESULTS: Of 447 patients, 101 were classified as optimistic, 272 as mixed, and 74 as pessimistic. Scores on all 8 health concept domains from the SF-36 were significantly poorer in the pessimistic group than in both the optimistic and the mixed group. CONCLUSION: A pessimistic explanatory style, reflected by higher PSM scale scores, was significantly associated with a self-report of poorer physical and mental functioning on the SF-36 30 years later.
Adolescent↗
Three year follow-up of patients with chronic pain who were treated in a multidisciplinary pain management center.
Between September 1979 and October 1982, 408 patients with chronic benign pain were evaluated for admission to a pain management program. Of the 408 patients, 249 completed the program; the success rate at the time of dismissal was 70% among these 249 patients. Of the 239 patients who entered the follow-up study, 87% responded to either a mailed questionnaire or a follow-up telephone call by an independent reviewer at the time of 3 year follow-up; the improvement had been maintained by 46.6% of the successfully treated patients (or a third of the original participants). The present finding is strikingly similar to that in a previous study from this institution - an indication of the long-term efficacy of the multidisciplinary pain management program. Further search for modifications for the existing program is indicated to accommodate the needs of patients who fail initially or cannot maintain the improvement.
Adolescent↗
Pain management as an antidepressant: long-term resolution of pain-associated depression.
Of 100 consecutive patients admitted to a pain management program for patients without malignant disease who had chronic pain, 54 were definitely or probably depressed and 46 were not depressed by Research Diagnostic Criteria. As a result of 98% improvement of depression and low frequency (2%) of new development of depression, 98 of the original 100 patients were not depressed at the time of dismissal. This progress was maintained at long-term follow-up (average, 11.6 months): 89 of 100 patients remained non-depressed.
Adolescent↗
Substance dependence and chronic pain: profile of 50 patients treated in an alcohol and drug dependence unit.
Fifty adult patients with chronic pain and substance dependence were admitted to an inpatient unit for treatment of addiction without primary emphasis on treatment of pain. As a group they had received considerable medical attention for their pain, but relatively little for their addictions. When compared with a group of general medical patients, the study population showed MMPI evidence of considerably more psychopathologic characteristics. MMPI data and family histories of substance dependence did not differentiate the study group from a comparable group in a Pain Management Center.
Adult↗
Substance dependence and chronic pain: experience with treatment and follow-up results.
Fifty patients with chronic pain and substance dependence were admitted to the hospital for treatment of substance dependence. Sixteen patients left treatment prematurely and were noted to have been less flexible in seeking treatment options for relief of pain. Most patients experienced an improved sense of well-being with abstinence, but this was not reflected in pain rating scales. At 1 and 3-4 years follow-up, the group that completed treatment was more outstanding in its commitment to a course of abstinence from drugs and alcohol than the group that had not completed treatment and seemed to experience a greater improvement in overall functioning.
Chronic Disease↗
Ancient pain.
In a group of about 1000 patients with chronic pain, approximately 4% had pain of very prolonged duration--25 years or longer. These subjects were similar in general to other chronic pain patients but they did differ significantly in the following: a higher incidence of face and head pain, greater dependency on analgesics and sedatives, more frequent diagnoses of depression, and a greater elevation of nearly all clinical MMPI scales.
Adult↗
Failure of a predictive scale in identifying patients who may benefit from a pain management program: follow-up data.
A 7-item scale to identify patients who may benefit from a pain management program was prospectively studied. The patient group consisted of 217 patients. The duration of follow-up was 2-3 years. Although an item-by-item analysis revealed some differences between successes, partial successes, and failures, the overlap was such that the total score was not predictive of outcome. Although this finding precludes clinical use of the 7-item scale in its present form, future modifications are suggested that may improve its predictive ability.
Adult↗
Prescription medication dependence and neuropsychologic function.
The abuse of prescription drugs is an insidious complication among patients with chronic pain. This study examines cognitive intellectual functions in patients with chronic pain who are using prescribed analgesics, sedatives and hypnotics. A comprehensive battery of psychologic tests measuring intelligence, learning, memory, sensory-perceptual integrity, motor skills and general adaptive abilities was administered to 47 subjects. The subjects were patients admitted to a chronic pain management program, and they were divided into drug-dependent, drug-abusing and non-drug-abusing groups according to strictly defined criteria. Findings indicated that the prescribed use of these medications for pain over a prolonged time is detrimental to the cognitive function of such patients and complicates their clinical management.
Adult↗
The family's viewpoint of chronic pain.
An indentical questionnaire are administered separately to 100 chronic pain patients and a close family member of each. The majority of patients and relatives agreed on the answers to these questions about the pain problem. Highest congruency between patient and relative was associated with cases in which there were management problems and an ultimately poor treatment result. Rather than reflecting excellent communication between patient and relative, this appears to indicate an undesirable mutuality. Patient answers indicate to us as examiners that their pain is greater than they have revealed to relatives, yet the relatives say the patient is showing more than he realizes.
Adult↗
Chronic pain: which patients may a pain-management program help?
To ascertain whether chronic-pain patients who are likely to benefit from a pain-management program can be identified before treatment, we studied for differences discernible at the beginning of treatment a group who succeeded and did well at 1-year follow-up (n = 34) and a group who failed (n = 35). The two groups differed significantly (P less than 0.01) in regard to duration of pain, work time lost, number of operations, subjective pain level, and drug dependency. Deviations on the MMPI were greater in failures than in successes; but the differences were not statistically significant. A 7-item rating scale based on these data differentiated a favorable group (including 71% of the successes) from an unfavorable group (including 86% of the failures). This scale should be helpful in selection of candidates for a pain-management program, even though it needs further validation.
Chronic Disease↗
The dissatisfied patient with chronic pain.
Patients with chronic pain may become dissatisfied because of their lack of improvement. Thirteen such patients, encountered in a pain-management program, registered formal complaints of their dissatisfaction. From their histories they were found to be the most chronic and treatment-refractory patients encountered, with problems of medication dependency, accident proneness, and dissatisfaction with previous treatment efforts. During hospitalization they opposed psychologic approaches, further manifested their dependency on medication, and some of them had circumscribed delusions. The pain-management program was difficult to apply to these patients; and further, they resisted other recommendations for treatment and even resisted discharge in in some instances. Further psychiatric screening is necessary to avoid the complications presented by this type of patient.
Adult↗