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Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.

Adolescent↗

A pilot study of effects of cardiopulmonary resuscitation training on participants' self-concepts.

The administration of cardiopulmonary resuscitation (CPR) was taught to a group of 12 adults. The Tennessee Self-concept Scale Form-C and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B) were administered before and after their training. A control group of 12 was administered both scales twice with one day between administrations. Analysis indicated both groups showed significant differences between the pre- and posttest administrations on expressed affection on the FIRO-B. However, participants in a brief CPR course did not score significantly differently from a control group on these measures, as expected.

Humans↗

[The premenstrual syndrome frequency and the intensity of its symptoms in young women and teenagers living in the Upper Silesian Industrial region].

Contemporary home and world medical literatures deal at length with somatic and psychopathologic symptoms connected with changes taking place during the menstrual cycle. The symptoms bring about changes in women's behaviour, life activities and interpersonal relations. The majority of women suffer during the premenstrual period from mood disorder and somatic pains. Nevertheless, the presence of the pains does not diagnose PMS. Over many years PMS has not been clearly defined. Nowadays, making use of precisely-defined criteria, we are able to specify the number of women suffering from the syndrome. Applying the criteria compiled by American Psychiatric Association, we analyse the frequency of PMS occurrence. On the basis of the criteria 180 young women ages 17-25 living in the Upper Silesia Industrial Region have been interviewed. Besides PMS clearly-defined diagnostic criteria the survey included also questions about how the intensity of disorders related to the course of menstrual cycle influences the women's feelings of well-being. The questionnaire scores demonstrate that only few women suffer from PMS defined by American Psychiatric Association, but its symptoms have considerable effects on the women's lives. Simultaneously, many women suffer from numerous pains and disorders which have not been diagnosed as PMS, but which should be examined separately.

Adolescent↗

Clinical supervision: a three-way mirror.

The principles and process of a model of clinical supervision for psychotherapy are presented and described through two cases. The model draws heavily from Bowen's family systems theory and Peplau's theory of interpersonal relations. The relationships in the client-family, client-therapist, and therapist-supervisor systems mirror each other, and changes in self-definition, and in the management of anxiety of persons in one system catalyzes changes in parallel systems. Two cases illustrate the model. In the first case, anxiety needed to be raised to levels optimal for learning. In the second case, no learning occurred until levels of anxiety were reduced.

Anxiety↗

Group processes of decision making for hospital-based technology assessment committees.

There are a variety of group-judgment methods to resolve controversial issues in health care. Meta-analysis and group judgment methods such as consensus conferences are attempts to bring diverse elements of information together for synthesis. Leape notes that a significant body of literature exists regarding the techniques used to elicit opinions from groups. Organizational structures and functions of groups vary in terms of the natures of interactions among group members and the manners in which final conclusions are reached and expressed. The introduction of the process of technology assessment into the hospital setting introduces a problem inherent in the introduction of somewhat academic processes into the operational real world of interpersonal relations, administrative and medical staff interactions, staff costs, and institutional priorities. Hospital administrative processes are based on the committee approach. Medical staff credentialing, drug formularies, and administrative policies are all developed, approved, and implemented through committees. It would seem logical that if technology assessment is to be effective in the hospital setting, then those same group decision processes inherent in committees should be used in technology assessment. Relatedly, if technology assessment is to be successful in the hospital setting, then how can the limited resources of hospital-based staff be best utilized to carry through the assessment of elected technologies? This paper discusses group decision processes, particularly as they relate to technology assessment. The processes of particular interest are those that focus on group interactions rather than theory-based decision processes. The purpose for the paper is to provide to clinical engineering management and senior hospital management background information to use in the formulation of the operating parameters of a hospital-based technology assessment committee.

Biomedical Engineering↗

Neglected aspects of the superego.

Topics covered in this essay on neglected aspects of the superego include the overemphasis on the harsh superego and the neglect of the range of activities of ordinary people that involve issues of moral responsibility; the need for a more complete developmental schema for different types of superego and for the benign, mature superego; the neglect of the complexities of moral responsibility and of the importance of conflicting value systems; the neglect of the central role played by the superego in interpersonal relations. Causes of the neglect of the superego include a concern with neutrality on the part of the analyst that leads to an overemphasis on other analytic perspectives at the expense of superego analysis; the assumption that what is moral is self-evident; a lack of familiarity with concepts of moral responsibility; and a need for greater familiarity with current research studies into moral education and superego development. Based on these causes, remedies are suggested for the neglect of the superego.

Female↗

Some correlates of trust.

Trust has been variously defined by behavioral scientists and not very thoroughly investigated. In this study trust was defined as an expectancy held by an individual that the behavior of another person or a group would be altruistic and personally beneficial. An attempt was made, using this conceptual definition, to identify some personality and behavioral correlates of trust. Seven interpersonal relations groups with approximately 10 male and female undergraduates per group were studied with use of the Janis and Field self-esteem inventory, Schutz's FIRO-B scale, and the Rotter internal-external scale. It was discovered that a trusted person is one who is highly influential, has an internal locus of control, a low need to control others, high self-esteem, and is open to being influenced by others.

Altruism↗

Prognostic factors with four treatment methods for phobic disorders.

The associations between prognostic factors and outcome with four treatment methods for phobic disorders were studied in 103 women. The prognostic factors were sociodemographic, intelligence, personality, early interpersonal relations, aspects of previous and current mental disorder, and intensity of symptoms at start of treatment. All patients received basal therapy, which implied information, advice on exposure in vivo, and anxiolytics. One group received this treatment only (B), while others received supplementary treatment, with therapist-directed prolonged exposure in vivo (PE), supportive therapy (ST) of dynamic type, or relaxation (R). The patients were treated for 3 months, with a 9-month follow-up period. Factors associated with a better outcome were: PE: greater needs for succourance and lower avoidance; ST: higher social class, better relations between parents and with father during childhood, inner conflicts as cause, and lower levels of free anxiety; R: satisfaction with contact when aged 15, bereavement as a cause, and lower levels of several symptoms; B: greater needs for order, stress at the onset, shorter duration and satisfaction with work. There were thus interactions between prognostic factors and type of treatment. The prognostic factors should be taken into account in the choice and design of treatment.

Adult↗

Ethnic variation in depressive symptoms in a community sample in Hawaii.

A modified CES-D was administered to a community sample of 176 European Americans (EA), 209 Native Hawaiians (NH), and 357 Japanese Americans (JA), yielding measures of depression, positive affect, depressed affect, somatic disturbance, and disturbed interpersonal relations. Positive affect was lower in JA relative to EA, consistent with findings among Native Japanese, a pattern attributed to cultural variation in emotion regulation. NH reported lower positive affect than EA, accompanied by elevated negative affect and somatic disturbance, suggesting generally higher levels of depressive symptoms. The three ethnic groups varied in mental health care usage with differing associations between depressive symptoms and experiences of stressful life events. Taken together, these results suggest ethnic variation in depressive symptoms may arise from differing cultural beliefs.

Adult↗

Reliability and validity of generalizable skills instruments for students who are deaf, blind, or visually impaired.

The study examined the validity and reliability of four assessments, with three instruments per domain. Domains included generalizable mathematics, communication, interpersonal relations, and reasoning skills. Participants were deaf, legally blind, or visually impaired students enrolled in vocational classes at residential secondary schools. The researchers estimated the internal consistency reliability, test-retest reliability, and construct validity correlations of three subinstruments: student self-ratings, teacher ratings, and performance assessments. The data suggest that these instruments are highly internally consistent measures of generalizable vocational skills. Four performance assessments have high-to-moderate test-retest reliability estimates, and were generally considered to possess acceptable validity and reliability.

Blindness↗

How effective is outdoor-based training in improving management behaviors: a health care application.

This study explores the impact of an outdoor-based training program on management behaviors at a major regional medical center. Sixteen managers attended a combination high and low "ropes" training course given in three phases over a one-year period. This program was designed to increase trust and improve communications within the hospital. A number of group measures from previous research are examined, including trust, group awareness, group effectiveness, self-esteem, and bonding of the group. Empirical evaluations of these items were done prior to training and three months after training. Scales that tapped both interpersonal relations and communications were developed from interviews with previous participants, and were evaluated prior to training and six months after training. Behavioral observations were also used to evaluate the effectiveness of the program. Results indicate that the outdoor-based training program was effective in improving certain key behaviors within the group. While stressing the need for future research, this study strongly supports the further use of outdoor-based training programs in health care settings.

Behavior Therapy↗

[One cannot be careful enough in the choice of one's parents--on the biopsychosocial development of adaptation systems for distress in Homo sapiens].

Actual results of brain research show that we might have more than one system to cope with distress. The most archaic one might be the system freeze/dissociation. The second one is the system attachment/relationship/herd/support. Articles by Allan N. Schore show that the central regulation of the self, the affects, and the interpersonal relations are impaired permanently by relational traumata/attachment traumata during early childhood. Jaak Panksepp differentiates the distress systems panic versus fear. On the one side we find the cluster panic--periaqueductal gray PAG--lateral septum--gyrus cinguli--glutamate--opioids--attachment--parasympathetic autonomic nerve system--trophotorphic state--hypometabolism--freeze reaction--dissociation, on the other side the cluster fear--enemy--sympathetic autonomic nerve system--ergotrophic state--hypermetabolism--fight and flight--cognition and learning. It can be helpful for therapy strategies to differentiate these systems.

Adaptation, Psychological↗

Hepatitis B virus in patients undergoing hemodialysis: transmission risks and psychosocial reactions.

Thirteen patients undergoing hemodialysis who were carriers of hepatitis B virus (HBV) were screened for inappropriate reactions to HBV transmission risks and for emotional reactions to their renal and viral diseases. Four patients underreacted to HBV transmission risks through denial or misunderstanding. The nine remaining patients reported that their HBV, as compared with their renal disease, resulted in substantially greater restrictions in interpersonal relations and significantly greater feelings of not being accepted by others. In contrast, the nine patients reported that their renal disease, as compared with their HBV, resulted in substantially greater restrictions in leisure and work activities. Thirteen control patients undergoing hemodialysis but not having HBV did not differ from the patients with HBV in psychosocial reactions to renal disease. As shown in a one-month follow-up, counseling was effective in enhancing awareness of HBV transmission risks and in improving emotional adjustments to the renal and viral diseases.

Attitude to Health↗

Children's understanding of their emotionally disturbed peers. I. The concept of emotional disturbance.

Study of the interpersonal relations of emotionally disturbed children has focused largely on relationships within the family. Theories of childhood psychopathology focus almost exclusively on the parent-child triad as the etiological core of childhood emotional disturbance (Frank, 1965). Far less attention has been paid to the role of extra-familial attitudes and relationships in childhood psychopathology. In a general way, the increasing importance of the peer group during childhood has been recognized, but researchers have hardly begun to consider whether and how the manifold aspects of relationships between the emotionally disturbed and their normal peers might bear on the course of the disturbance or its refractoriness to treatment (e.g., Solomon and Wahler, 1973). Nor have they considered peer group influences on the development of the emotionally disturbed child's perception of the world and his place within it. Despite increasing recognition of the early importance of peer relations, virtually no systematic information exists on the ways in which normal children view their emotionally disturbed peers. Our purpose in this paper is to report the first of several analyses of data from an initial investigation of children's understanding of their emotionally disturbed peers. Specifically, we wish to examine whether there is evidence that normal children do, in fact, perceive as emotionally disturbed the symptomatic and distressing behavior of peers that mental health professionals would recognize as indicative of psychopathology. Further, we wish to study these issues with respect to grade and sex differences.

Affective Symptoms↗

[The characteristics of the personality interrelations of adolescents with different forms of secondary arterial hypertension].

Interpersonality relations and conflict situations were studied in patients who need psychological correction. In patients with symptomatic arterial hypertension, the degree of dissatisfaction was estimated according to the following three scales: educational ("Conflict Situations at School" including conflicts with friends); family and household ("Conflict Situations in the Family"); and "Internal Disputed Matters". The patients with symptomatic arterial hypertension of the nephrogenous and endocrine genesis may turn out more conflicting since they are trying to discover the cause of their life failures in their social surrounding rather than in their personal inability to cope with them because of the disease.

Adolescent↗

Profiles of mod revivalists: a case study of a reemerging adolescent group.

This exploratory study examined the characteristics and interpersonal relations of a relatively small group of adolescents who identified themselves as members of a revived "mod movement." In-depth interviews were conducted with 13 members (45%) of this peer group in order to: identify the main features of the members, determine their similarity to earlier British mods, and assess gains from group affiliation. Results suggested that adolescents who joined this unique and somewhat extreme group were more similar than dissimilar to their contemporaries in their efforts to establish an identity and be accepted as individuals. Implications for interacting with members of such adolescent groups, and suggestions for future research are presented.

Adolescent↗

Relationship between clinical symptoms and EEG findings in borderline personality disorder.

Borderline personality disorder (BPD) was diagnosed in female patients (N = 41) between the ages of 18 and 30 using the Diagnostic Interview for Borderline Patients (DIB) and DSM-III. Comparing the EEG findings of BPD (N = 18) and non-BPD (N = 21) groups, there were no EEG findings characteristic of BPD. We also assessed the relationship between the EEG findings and DIB items. Positive spikes appeared in patients with high scores for Impulse Action Patterns, while wave and spike phantoms were observed in patients with high scores for Interpersonal Relations. Dividing the patients into BPD and non-BPD groups, a similar tendency to that observed from an analysis of all patients was observed in the non-BPD group, but no such tendency was observed in the BPD group. The results suggest that BPD patients include those in whom vulnerability of cerebral function plays an important role in the development of these two clinical symptoms as well as those in whom vulnerability of cerebral function plays almost no pathogenic role.

Adult↗

Fundamental elements of the quality of care: a simple framework.

This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.

Contraception↗