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PubMed1995

Changes in pathological narcissism.

OBJECTIVE: This study investigated types of change that occur over time in the psychopathology of narcissistic patients. METHOD: Baseline scores on the Diagnostic Interview for Narcissism of 20 patients, clinically diagnosed as having narcissistic personality disorder, were contrasted with their scores 3 years later by means of t tests and chi-square statistics. The authors then compared these changes in narcissism with the patients' accounts of their life events during the interval between the two assessments. RESULTS: A significant decrease in the overall level of pathological narcissism was found, particularly in the areas of interpersonal relations and reactiveness. At follow-up, 60% of the subjects had reached the cutoff score on the diagnostic interview that indicated significant improvement, and 40% remained unchanged, with a high level of pathological narcissism. A high baseline level of narcissism in interpersonal relations was associated with absence of change at follow-up. Examination of life events in the interval between assessments suggests that changes in pathological narcissism are related to three kinds of experiences: achievements, new durable relationships, and disillusionments. CONCLUSIONS: The instability of narcissistic psychopathology found in this study raises questions about the construct validity of narcissistic personality disorder as a diagnostic category and about the core construct of pathological narcissism.

Adult↗
PubMed2004

Psychosocial functioning in patients with treatment resistant depression.

BACKGROUND: Depression is a disorder that causes disability, with a profound adverse impact on all areas of psychosocial functioning. This is particularly true for those with treatment resistant depression (TRD). However, to date, no systematic assessments of psychosocial functioning for patients with TRD have been conducted. METHODS: In the present study, we used the Longitudinal Interval Follow-up Evaluation (LIFE) scale to measure psychosocial functioning in 92 patients with TRD. These patients met formal criteria for TRD and were part of a clinical trial examining the efficacy of lithium augmentation of nortriptyline. RESULTS: Clinicians rated this sample of patients as experiencing mild to moderate impairment in work-related activities, good to fair interpersonal relations, poor level of involvement in recreational activities, and mild impairment of ability to enjoy sexual activity. Patients and clinicians rated global social adjustment as poor. CONCLUSIONS: Patients with formally defined TRD experience significant impairment in psychosocial functioning. In this sample a tendency existed for both clinicians and patients to assign more severely impaired global ratings when compared with ratings for specific functional areas.

Adolescent↗
PubMed2002

School and class environments are differently linked to future smoking among preadolescents.

BACKGROUND: There are few observational studies of school and class risk factors for smoking behavior in preadolescence. METHODS: A cohort study of 2,883 children recruited in the fifth grade with follow-up in sixth grade was undertaken. Information on school and class factors was collected from principals and teachers of 91 schools. RESULTS: A decreased risk of smoking uptake was associated with exposure to short antitobacco education prior to the fifth grade (compared to no education). Problematic interpersonal relations in the class were associated with a relative risk of smoking initiation of 1.42 (confidence interval 1.05, 1.93) compared to positive interpersonal relations. This excess risk was not mediated by class smoking prevalence in the fifth grade. School policy and school characteristics were not significantly associated with preadolescents' smoking. CONCLUSIONS: Class-related, rather than school-related, characteristics were associated with smoking initiation and progression. Changes in microenvironmental factors might be useful in smoking prevention among preadolescents.

Child↗
PubMed1999

Psychological approach of non-epileptic to epileptic patients: the dynamics of attitude changes during hospitalization.

Measures of interpersonal relations of non-epileptic patients to epileptic patients were studied in search of answers to two questions: what is the initial attitude of non-epileptic patients to epileptic patients; and, do any changes in attitude occur during time spent together in hospital? In order to study these personal relations, a formal analysis of preferences was carried out. Twenty-two non-epileptic patients admitted to the Neurology and Epileptology Department, Medical Centre for Postgraduate Education, Warsaw were studied. Subjects were asked to rank-order (from 1 to 9 points) suggested ways of distributing the profits of a hypothetical joint (e.g., with a room-mate) money-earning venture. The experimental procedure for each patient was repeated for all three room-mates. Preferences were assessed three times - the day after admission to hospital, after 11 days and after 21 days in hospital. Following this procedure, it was possible to trace the dynamics of the patients' interpersonal relations. The data were correlated (Spearman's r(s)) and submitted to analysis of variance (MANOVA) with repeated measures. Analysis of the attitudes of patients with non-epileptic neurological disorders towards epileptic patients revealed a dynamic tendency - from negative (measures one and partly two) to positive attitudes after three weeks spent together in hospital (measure three).

Adolescent↗
PubMed2003

Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.

BACKGROUND: Disturbed interpersonal relations and emotional dysregulation are fundamental aspects of borderline personality disorder (BPD). The amygdala plays important roles in modulating vigilance and generating negative emotional states and is often abnormally reactive in disorders of mood and emotion. The aim of this study was to assess amygdala reactivity in BPD patients relative to normal control subjects. We hypothesized that amygdala hyperreactivity contributes to hypervigilance, emotional dysregulation, and disturbed interpersonal relations in BPD. METHODS: Using functional magnetic resonance imaging, we examined neural responses to 20-sec blocks of neutral, happy, sad, and fearful facial expression (or a fixation point) in 15 BPD and 15 normal control subjects. The DSM IV-diagnosed BPD patients and the normal control subjects were assessed by a clinical research team in a medical school psychiatry department. RESULTS: Borderline patients showed significantly greater left amygdala activation to the facial expressions of emotion (vs. a fixation point) compared with normal control subjects. Post-scan debriefing revealed that some borderline patients had difficulty disambiguating neutral faces or found them threatening. CONCLUSIONS: Pictures of human emotional expressions elicit robust differences in amygdala activation levels in borderline patients, compared with normal control subjects, and can be used as probes to study the neuropathophysiologic basis of borderline personality disorder.

Adult↗
PubMed2003

[Psychological health status and personality of the recruits in relation with their injuries during military training].

OBJECTIVE: To analyze the relationship of the psychological status and personality to the injuries arising from military training among the recruits. METHODS: The Symptom Checklist 90 (SCL-90) and Eysenck Personality Questionnaire (EPQ) were used to evaluate the psychological health status of the recruits in an army force unit participating in the basic military training in 2002. RESULTS: The annual incidence of the injuries during the training was 9.6%. Before the training commenced, the scores of SCL-90 showed no significant difference between injured group and non-injured group (P>0.05), while measurement after the training revealed significantly higher score for psychosis in the injured group than non-injured group (P<0.01). The most frequent psychological problems before training were obsession, interpersonal relations and depression, while after training, interpersonal relations, obsession and psychosis were highlighted as the major problems. The number of recruits with the total score no less than 160 and personality type distribution were similar between the two groups. CONCLUSION: The incidence of the injuries in relation to military training are significantly decreased after the implementation of the new training protocol, and no relations of psychological problems and personality was identified with the training.

Adolescent↗
PubMed2000

Determinants of health-promoting behavior among women ages 65 and above living in the community.

This study utilized Pender's Health Promotion Model to investigate through canonical correlation analysis the role that select cognitive-perceptual factors (health self-determinism, learned helplessness, self-esteem, and perceived health) and modifying factors (age, race, marital status, education, and income) play in understanding participation of community-living older adult women (age > or = 65) in the health-promoting behaviors of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. These were measured by the Health-Promoting Lifestyle Profile II in a convenience sample of 107 community-living older adult women (mean age 76.7 years). Gender-specific benefits and barriers to participating in health-promoting behaviors were also explored using open-ended questions. Two significant canonical variates were demonstrated. These indicated that age, marital status, race, education, and self-esteem and the two health-related factors of perceived health and health self-determinism made statistically significant contributions to the health-promoting behaviors of physical activity, nutrition, spiritual growth, and interpersonal relations. Benefits identified included better psychological well-being, coping with the general issues of aging, social interaction, improved function, and management of existing health problems. Internal barriers focused on perceived physical difficulties with all types of health-promoting behaviors; external barriers included aspects of the activity itself, lack of support from others and structural barriers. Study results suggest that older adult women (age > or = 65) participate in health-promoting behaviors for both health enhancement and health management reasons and that barriers may be a more important determinant of older women's health-promoting lifestyle behaviors than previously described in the model.

Aged↗
PubMed1990

[Selected medico-sociologic aspects of contact behavior in an urban population with special reference to the relation of neurotic disorders].

The quality and quantity of interpersonal relations were investigated by a special questionnaire to discover the connexion of psychonervous disorders with the contact behaviour. The psychonervous disorder was measured by a screening method, which examines the neurotic status. 361 patients of an urban population were asked by the questionnaire. 309 questionnaires of the probably neurotic patients and non neurotic patients were analyzed with respect to the differences between the two groups patients. Probably neurotic patients felt more stressed. They are more directed to the family members. The contact behaviour of the probably neurotic patients is more restrained in profession and also in free time than the behaviour of the non neurotic patients. The fewer agreement between reality and desire of the contact behaviour is typical for the probably neurotic patients. The intention of the conclusions was to help them to develop a feeling of interpersonal contentment.

Adult↗
PubMed1991

What is autism?

In a speculative and somewhat incautious frame of mind, I have tried to explore the question: What is autism? My suggestion has been that the essence of autism is, as Kanner indicates, an impairment in affectively patterned intersubjective personal relations. Such impairment usually has a predominant and often sufficient basis in biologic deficits intrinsic to the affected children. I have tried to indicate how such deficits might on the one hand be caused by heterogeneous physical afflictions and, even in some more broadly handicapped cases, a mixture of lower-order psychological impairments, and on the other hand give rise to the constellation of cognitive, linguistic, and motivational deficits that are characteristic of the syndrome. I have also referred to the dangers of circularity in defining too much of the clinical picture as essentially rather than characteristically autistic, and also in supposing that all children with this presentation are equally constrained in their developmental potential when selected patients might have an underlying psychopathology that allows for some recovery in cognitive as well as social functioning. I have not had space to give due acknowledgment to the ways in which many autistic children circumvent, compensate for, or otherwise overcome a number of their disabilities. Ultimately, it will be as great a challenge to explain what autistic children do achieve in their social relations, their thinking, and their language as to explain their characteristic deficits. In the meantime, autism may already reveal the degree to which human existence and human development pivot upon the capacity for genuinely interpersonal relations and interpersonal understanding. To inquire "What is autism?" is also to ask "What are the essence and implications of interpersonal life?"

Autistic Disorder↗
PubMed1998

What does quality mean to lay people? Community perceptions of primary health care services in Guinea.

The success of strategies to revitalize primary health care services such as those advocated by the Bamako Initiative requires a response adapted to the expectations of the population, especially in terms of quality. The goal of this study, conducted in two rural communities in Guinea, was to identify, characterize, and classify the criteria that the public uses to judge the quality of primary health care (PHC) services. This study included 180 participants in 21 focus group discussions. Forty-four main criteria were identified. These criteria vary depending on the respondents' sex and age, and their ability to access primary health care services. Some of the criteria correspond to those used by health care providers, while others do not. The general public places considerable emphasis on outcomes, but little emphasis on preventive services. The users appear very sensitive to aspects of the interpersonal relations they have with professionals and the technical quality of the care provided. A taxonomy of perceived quality is developed, which includes the following five categories: (1) technical competence of the health care personnel; (2) interpersonal relations between the patients and care providers; (3) availability and adequacy of resources and services; (4) accessibility and (5) effectiveness of care. It is a major challenge to refocus on quality in the development of health care services. This will require considerable changes for which training may be an effective, but certainly not a sufficient means. Promoting professionalism and changing the relations between public authorities and the general public are the only means of improving the quality of health care services as well as user perception.

Adult↗
PubMed1998

Women HIV sexual risk takers: related behaviors, interpersonal issues, and attitudes.

HIV and AIDS is a growing health risk for heterosexual women, particularly women of color (Centers for Disease Control and Prevention, 1997). Our research identified 5 types of HIV sexual risk taking in 3 independent samples of adult women from a New England Community: Group A women were noted by low to moderate levels of the 4 risk markers (i.e., unprotected vaginal sex, perceived partner-related risk, number of sexual partners, and unprotected anal sex); Group B women reported very high frequency of unprotected vaginal sex; Group C women were characterized by unprotected anal sex; Group D women had high perceived partner risk; and Group E women reported extremely high levels on all 4 HIV risk markers. Sexual risk groups were validated by demonstrating significant differences among groups on relevant behaviors, interpersonal experiences, and attitudes. Compared to other women, higher risk types reported greater behavioral risk practices (substance use, prostitution, diverse sexual experience), interpersonal risk experiences (sexual abuse, violence), initiation sexual assertiveness, and attitudinal risks (psychosocial distress). They reported less interpersonal assurance (surety of own and partner's HIV status), sexual assertiveness (for condom use and partner communication), psychosocial strengths (sexual self-acceptance), and transtheoretical readiness for change (condom use efficacy, readiness to consider condoms). Results provide additional support for the multifaceted model of HIV risk and the transtheoretical model. Suggestions for specifically focused interventions are given, depending on the pattern of sexual risk taking.

Adolescent↗
PubMed1978

[Clandestine places: illegal sale of alcohol for urban worker populations].

The authors have studied the illegal commerce of alcohol in popular urban communities. This sale is done in so called clandestine places. The study was approached from a cultural-anthropological point of view and its objective is a descriptive-exploratory study based on observation and interview techniques. A definition and a tipology of these places was attempted, emphasizing group dynamics and interpersonal relations between the owner of the place and the customer; among the customers; among the place itself and the rest of the community organizations, formal and informal ones. A primary analysis was done, according to which these clandestine places appear legitimized by nets of interpersonal relations, critical economic situations and places that satisfy recreational needs of the inhabitants. In order to eliminate the former, adecuate substitutes for recreation and social interaction ought to be considered.

Aged↗
PubMed2005

Female patients' preferences related to interpersonal communications, clinical competence, and gender when selecting a physician.

PURPOSE: In obstetrics and gynecology (ob-gyn), a physician's gender can affect patients' access to care as well as medical education curricula and career counseling. The authors focused on the importance that female patients place on various physician characteristics, and how this importance varied by patients' characteristics and compared for family practitioners, obstetrician-gynecologists, and surgeons. METHOD: In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit at six community campuses of Michigan State University College of Human Medicine. The first section of the questionnaire listed 16 physician characteristics and asked patients to rate the importance of each using a six-point scale (1 = not at all important, to 6 = very important). The items were presented three times, in reference to the patients' choice of a family physician, ob-gyn, and surgeon. The questionnaire also asked for patients' demographic information. Descriptive statistics were used to summarize patient demographics and ratings. Multivariate relationships were tested using analyses of variance (repeated-measures analysis of variance [ANOVA]) and multiple regression. RESULTS: In the 1,059 completed questionnaires, items related to physician gender were among the lowest rated, regardless of specialty. A factor analysis resulted in a three factor solution: Interpersonal Communications, Clinical Competence, and Gender. Interpersonal Communications ratings varied least by physician specialty and patient characteristics; Gender ratings varied most. Physician behaviors rather than physician attributes play an important role in women's choices. CONCLUSIONS: For most women, physician gender was one of the least important characteristics, regardless of specialty. Excellent skills might give all physicians an edge in patients' choice decisions, a finding contrary to widely held beliefs about more limited future opportunities for men in some specialties.

Adult↗
PubMed2006

Spirituality of African-American women: correlations to health-promoting behaviors.

The purpose of this study was to investigate how spirituality relates to health-promoting behaviors in African-American women. Using Burkhart's theoretical framework for spirituality, a descriptive cross-sectional correlational design was used. A group of 260 (N=260) women completed Rosenbergh's Self-Esteem Scale, the Health Promoting Lifestyle Profile II, the Spiritual Perspective Scale, the Brief Block 2000 Food Frequency Questionnaire (FFQ). These women also provided the researchers with their socio-demographic data. Canonical correlation analysis identified a significant pair of canonical variables which indicated that those individuals with good nutrition (.95), physical activity (.79), and healthy eating (.42) were positively associated with stress management (.88), health responsibility (.67), spiritual growth (.66), interpersonal relations (.50), education (.49), and self-esteem (.33). This set of variables explained 56% of the variability (p < .001). Practitioners should incorporate the message of spirituality by focusing on strategies to improve health responsibility, interpersonal relations, and self-esteem, along with health-promoting behaviors.

Adolescent↗
PubMed2000

The functional relevance of affect recognition errors in schizophrenia.

To evaluate the clinical and ecological validity of affect recognition (AR) measures in a sample of community-dwelling schizophrenic outpatients (N = 40), we analyzed the relation of facial and vocal AR to intellectual, symptomatic, and quality-of-life criteria. Facial and vocal AR showed virtually identical patterns of association with these criteria, suggesting that both modalities of AR draw on the same underlying heteromodal capacity. Specifically, AR was correlated with a subset of intellectual abilities (verbal-semantic, executive-attentional), but was unrelated to age, education, or neuroleptic dose. In terms of clinical and ecological criteria, AR errors correlated with more severe psychotic symptoms (positive and disorganized) and with lower quality of life (relationships, community participation, and richness of intrapsychic experience). Even after controlling for subjects' intellectual abilities and illness severity, inaccurate AR was associated with bizarre behaviors (involving sociosexual interactions, clothing, appearance) and with impoverished interpersonal relations. Thus, while difficulty identifying basic affective cues is related to general cognitive and illness-severity factors, it appears to have specific functional implications that do not depend on generalized impairment. Assessment of AR may identify a subgroup of schizophrenic patients who have a central defect in the heteromodal monitoring of emotional-social displays, associated with dysregulation of social behaviors and disruption of interpersonal relations.

Adult↗
PubMed1997

Insurance type and satisfaction with medical care among HIV-infected men.

Patient satisfaction is a valuable indicator of the quality of medical care. We assessed the impact of type of health insurance on satisfaction with seven aspects of medical care among 593 HIV-infected men without AIDS, drawn from three sites in San Francisco, California and Denver, Colorado. After adjustment for site of medical care, patient age, race, income, education, and CD4 lymphocyte count, there were few differences in satisfaction between men with fee-for-service and those with managed care insurance. Men with fee-for-service insurance were significantly more satisfied with their interpersonal relations with their clinicians (p = 0.01) but less satisfied with their finances (p = 0.0001) than persons with managed care. Uninsured men were significantly less satisfied with several aspects of care than insured persons. There were no significant differences in satisfaction between men with managed care and those with public insurance. HIV-infected persons who have a choice of insurance should carefully weigh their options, recognizing the implicit trade-offs between types of insurance. Those who choose fee-for-service insurance can expect to be more satisfied with interpersonal relations with their medical providers but less satisfied with financial aspects of their plans. Efforts to address the low satisfaction of uninsured persons are needed.

Adult↗
PubMed1999

[Quality of contraception services in El Alto, Bolivia].

The objective of this study was to evaluate the quality of contraception services in the city of El Alto, Bolivia. In the study design, four components were considered: 1) interpersonal relations between service providers and users, 2) the availability of various contraceptive methods, 3) conditions in the service centers, and 4) user satisfaction. The opinions of three groups were taken into account: service providers, service users, and nonusers. The service centers were classified as either governmental or nongovernmental, depending on the management of the institution to which the service center belonged. The study data came from a situation analysis of the services and from comments gathered from study participants in 1995. The study found that providers held a more favorable view than did service users of the interpersonal relations and personal treatment that physicians provided. Nonusers had an unfavorable perception of physicians' treatment of users. Users' perceptions of receiving egalitarian treatment correlated with their style of dress. With regard to the availability of contraceptive methods, 15 of the 36 centers surveyed did not have modern methods, despite there being a national policy to provide them to the public. The supply of contraception services for couples and for adolescents is limited, especially in the governmental institutions. The analysis of the conditions in the service centers demonstrated that some institutions had serious difficulties providing services of at least a minimum quality. Finally, the study describes how most of the service limitations in El Alto can be corrected through moderate-cost strategies.

Bolivia↗
PubMed2004

Nonvocal ventilated patients perceptions of being understood.

This metasynthesis presents an enlarged interpretation and understanding of nonvocal mechanically ventilated patients' experiences with communication. Peplau's interpersonal relations theory provided the theoretical framework for the metasynthesis. The final sample included 12 qualitative studies, for a total of 111 participants. The data, methods, and theoretical frameworks were critically interpreted. Common threads detected across study participants' individual experiences were synthesized to form a greater understanding of nonvocal ventilated patients' perceptions of being understood. Five overarching themes were divided into two groups. The first group of themes was categorized as the characteristics of nonvocal ventilated patients' communication experiences. Nonvocal individuals were often not understood, which resulted in loss of control and negative emotional responses. The second group of themes was categorized as the kind of nursing care desired by nonvocal patients in order to be understood. Nonvocal patients wanted nursing care that was delivered in an individualized, caring manner. This facilitated positive interpersonal relations between the patient and the nurse. Findings are discussed in relation to the current state of knowledge on this topic.

Emotions↗