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PubMed1999

Psychiatry by videophone: a trial service in north west England.

In this paper we report on the use of a video link between two general practices and a hospital based mental health team in North West England to provide a trial telepsychiatry service for individuals with depression and anxiety related disorders. Patients (n = 16) took part in an evaluation of the service by both structured questionnaire and semi-structured interview. The results of the evaluation study suggest that patients may be highly critical of telemedicine systems and that they do so not simply on the grounds of the technical quality of video links, but also because the remote link increases the difficulty that the patient faces in expressing deep scated emotional and existential problems. It is not, therefore, simply a matter of technical quality in the link, but also a question of the quality of interpersonal relations perceived by the patient.

Adult↗
PubMed1991

The utilization of the durable power of attorney for health care among hospitalized elderly patients.

OBJECTIVE: To explore the potential use of the durable power of attorney for health care (DPAHC), considerations in executing a DPAHC, and influences in making decisions related to it. DESIGN: Interview with follow up. SETTING: A teaching hospital. SUBJECTS: 37 males, 60 females, aged 64-97. METHODS: Interview of ninety-seven hospitalized patients and followup telephone interview of those who had not originally executed a DPAHC after 3 months. Patients were asked whom they would appoint as an agent for health care decisions, how this person was related to them, and why they chose this person. Patients' cognitive functioning and level of depression were assessed. RESULTS: Most patients (65%) chose their closet relative to make health care decisions for them if they were unable to. Reasons for choosing this person included: the agent knew the patient best, was the closest relative, and was most accessible geographically. Over half of the participants had not discussed their feelings about health care decisions with anyone. Sixteen percent had previously executed a durable power of attorney for health care, and 46% said they intended to execute one. Executing a durable power of attorney for health care was associated with higher levels of cognitive functioning but not with level of depression. CONCLUSIONS: Both an understanding of advanced directives and a general outlook on matters of life and death seem to affect people's utilization of the DPAHC. The ability to execute a DPAHC and the choice of an agent are affected by individuals' interpersonal relations.

Aged↗
PubMed1992

Stability of therapeutic alliance and its relationship to outcome in short-term inpatient psychiatric care.

The relationship of therapeutic alliance to patient and treatment characteristics and to outcome, was studied in a sample of 106 patients consecutively admitted to a short-term psychiatric ward. The main finding was that a better therapeutic alliance at discharge was related to a greater improvement in symptoms during treatment. A multivariate model for prediction of outcome revealed a significant contribution from therapeutic alliance at discharge but not from alliance at admission or from changes in alliance during treatment. Improvement in alliance was seen in 41.5% of the patients, no change in 28.3% and a deterioration in 30.2%. Patients who improved their alliance did not differ from the others in background characteristics, but were more often subject to psychopharmacological treatment and were more often treated in a basic activation group. Patients with a stable poor alliance more often stated physically oriented target complaints at admission while patients with a stable satisfactory alliance more often presented interpersonally related complaints. It is concluded that further research in the field would benefit from a closer description of the change in the alliance and its relationship to treatment characteristics and outcome.

Female↗
PubMed1975

Group therapy for kidney transplant patients.

A short-term, open membership group therapy program for kidney transplant patients and their families is described. The content and process of this group is related to the ten curative factors described by Yalom for psychiatric patients. The primary benefits for the patients seemed to be the opportunity to observe others cope with similar problems and to learn of the adaptive strategies used by others. The patients were able to offer advice to others, to overcome their tendency toward seclusion and in general, experience a feeling of hope for the future. The family members gained more from a sense of group cohesiveness than did the patients. Both family and patients utilized the meetings to ventilate their anger and frustrations associated with chronic illness and to learn more about transplantation. A more realistic expectation of the future was provided. The group did not seem long enough to measurably improve the interpersonal relations between patients and their families nor did the group members comment upon maladaptive behaviors exhibited between family members within the meetings.

Adult↗
PubMed1998

Desire for help among drug-using Mexican-American arrestees.

In a sample of 88 drug-using Mexican-American arrestees, we examined demographic factors, drug-problem severity indicators, and personal and social resources as correlates of self-reported desire for help with problems related to drug use. Ethnicity-related attitudes, perceptions, and experiences were among the factors tested. Among 35 potential correlates in this dataset, recognition of drug-related interpersonal problems was the sole significant correlate of desire for help in a multivariate regression analysis. This finding was interpreted in comparison to previously identified correlates of Mexican-American drug users' desire for help specifically in the form of drug user treatment. We derive implications regarding drug-use-associated problem recognition and other potential determinants of help-seeking and success in drug user treatment among Mexican-American drug users.

Adult↗
PubMedDate not supplied

[Job stress perceived by hospital medical staff].

OBJECTIVE: To identify the psychosocial risk factors related to psychological demands perceived by specialist physicians from six public hospitals in the province of Valencia in Spain. METHODS: A qualitative study was carried out. The population studied comprised the hospitals' specialist medical staff (Oncology, Internal Medicine, Traumatology, Radiology and Intensive Care). A trained interviewer performed 47 individual, face-to-face, semi-structured interviews. To select the participants, the following structural variables were taken into account: gender, age, family responsibilities, medical specialty, professional standing, length of service, and type of contract. Interviews were tape recorded and subsequently transcribed. Finally, the content of the interviews was analyzed. RESULTS: The main psychosocial risk factors mentioned by the participants were workload and lack of staff, mainly due to the characteristics of work organization in the hospital. Another job stressor was daily contact with suffering and death, and feeling responsible for human life. Other significant job stressors were interpersonal relations in the work environment, in the case of patients' relatives, uncertainty about diagnosis and treatment, the possibility of being sued for malpractice, and communicating bad news. CONCLUSIONS: Hospital physicians report a large number of psychosocial risk factors. Some involve the characteristics of the medical profession (contact with suffering and death, responsibility for human life, uncertainty about diagnosis and treatment) and others concern work organization (workload and staffing shortages).

Adult↗
PubMed1989

[Psychosocial and socio-medical problems in the medical profession].

Under conditions of contemporary highly developed medicine and allied disciplines of the new scientific concept of health care it is essential that doctors and other health workers should be harmoniously developed personalities. One of the main characteristics of such a personality is the overall health potential. Doctors should not only propagate a healthy lifestyle but should in this respect serve as an example. Unfortunately in many instances paradoxical behaviour in relation to their own health is found. The problem of health protection of doctors must be conceived comprehensively not only in conjunction with the general social environment but also in conjunction with his specific working environment. In the contemporary medical literature in the world we encounter in connection with investigations of health protection, and in particular the morbidity of doctors and other health workers, the term morbus medicus. This involves a complicated and specific complex of factors ensuing from the complexity of the medical profession and its risks which does not cause specific but nevertheless increased sequelae in certain areas of morbidity. At present the majority of occupations is associated with neuropsychic stress. In the medical profession neuropsychic stress is much greater than in other occupations. Therefore prevention of negative stress in the medical profession must ensue from an endeavour to neutralize these negative factors - i.e. to create optimal working conditions and optimal interpersonal relations, and from improving the standard of the personality profile of doctors.

Czechoslovakia↗
PubMed1999

Should we consider mood disturbance in schizophrenia as an important determinant of quality of life?

BACKGROUND: The main objective in the treatment of schizophrenia should be to optimize individual patient functioning and quality of life. Little is known about the possible relationship of concurrent mood symptoms and quality of life. We hypothesized that the quality of life for people with schizophrenia would be inversely related to the severity of concurrent mood disruption. METHOD: We conducted a post hoc analysis of an international, multicenter, double-blind, 28-week study of 339 patients who met DSM-IV criteria for schizophrenia, schizophreniform, or schizoaffective disorder and were randomized to treatment with either olanzapine or risperidone. Quality of life data were collected at baseline, 8, 16, 24, and 28 weeks or at early discontinuation; Positive and Negative Syndrome Scale (PANSS) data were collected at each visit (weekly to week 8 and monthly thereafter). Correlations were calculated between changes in quality of life (quality of life scale [QLS] total and subscales) and PANSS mood score. Regression models were used to determine the proportion of variability in the QLS total and subscores accounted for by changes in PANSS positive, PANSS negative, and PANSS mood scores. Finally, path analysis was performed to determine the mechanisms used by the PANSS mood scores to affect the QLS total and subscores. RESULTS: Olanzapine demonstrated a significantly greater therapeutic effect on the PANSS mood item than risperidone did. However, mood improvements with either therapy demonstrated correlations of PANSS mood on the QLS total and subscores which were statistically significant, with the strongest correlation against the interpersonal relations (QLS-IPR) subscore. The path analysis results indicate that the PANSS mood item's most significant path in affecting the QLS total and QLS-IPR is direct. CONCLUSION: Changes in the quality of life of schizophrenic patients is inversely related to changes in the concurrent mood disruption. Early therapeutic interventions directed at a broader constellation of schizophrenic symptomatology, including mood, may be helpful in improving an individual patient's quality of life. The possible relative advantages of introducing novel antipsychotic agents earlier in the course of illness for restoration of individual quality of life merit further investigation.

Adolescent↗
PubMed2002

Stress and stressors of myocardial infarction patients in the early period after discharge.

BACKGROUND: The period immediately following discharge after hospitalization for a first-time myocardial infarction (MI) is stressful. Recovery-related stressors include anticipation of or actual difficulties in resuming social and physical activities, and adopting recommended health actions. RATIONALE: Stress level and sources of stress in the early discharge period need to be evaluated. Identifying patient charcteristics that contribute to high stress is essential to facilitate patients' adjustment. AIMS: To evaluate stress level, identify sources of stress, and examine the significance of sociodemographics and health characteristics in predicting stress in MI patients in the early discharge period. METHODS: In this cross-sectional study, data were collected from 84 MI patients 2-16 weeks after discharge. The patients, aged 20-70 years, were attending cardiology clinics of four Jordanian public hospitals and had experienced myocarial infarction for the first time. INSTRUMENTS: A structured interview guide including a stress discharge assessment tool was used to identify stress level and sources of stress experienced after discharge. FINDINGS: Most patients experienced a moderate level of stress, with 20% reporting high stress levels. They perceived 'having many persons to provide care to, worrying about having another heart attack, and my partner worries too much about me' as their most important concerns. Age, gender, income, frequency of chest pain episodes, and physicians' recommendations to quit smoking were the most significant predictors of stress. CONCLUSION: The findings suggest that in the early discharge period MI patients worry about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care.

Adult↗
PubMed1999

Age and anesthetic practice: a regional perspective.

STUDY OBJECTIVE: To obtain information about practitioners' behaviors, perceptions, and perspectives concerning issues related to advancing age and anesthetic practice. DESIGN: Questionnaire survey mailed to 1,208 active and retired American Society of Anesthesiologists (ASA) members in Northern New England. Topics included hours worked, practice policies, stress level of activities, observed in colleagues and personally perceived errors and problems associated with performance, and plans, preparation, and reasons for retirement. SETTING: Practicing respondents worked in academic, community, or federal hospitals, and in ambulatory surgical facilities. MEASUREMENTS AND MAIN RESULTS: For descriptive analysis, counts and frequency distributions were calculated for each question. Statistical methods were used to test differences across age groups and to identify sources of differences. Approximately 40% of respondents in each age group worked an average work week of 50 to 59 hours. Respondents aged 40 to 49 years worked the longest work weeks and duty periods and were more concerned about liability issues than other age groups. Respondents age 60+ tended to work shorter average and maximum work weeks, although 5% of them continued to work 70- to 79-hour weeks. There was no statistically significant difference in hours worked among men and women. Approximately 20% to 30% of respondents relieved older colleagues of late night or call duties, and asked them to restrict or to stop practice out of concern for patient safety. Night call was equally stressful for all age groups. Economic uncertainty, production pressure, and interpersonal relations were more stressful for younger respondents. In preparation for retirement, shifting away from complex cases and phased reduction in clinical activity were increasingly prevalent with each advancing age group. Important reasons for retirement included attitude changes, physical limitations, and declining health. CONCLUSIONS: Despite modest age-associated trends, chronological age per se is not a strong correlate of an individual's practice pattern, behaviors, or perceptions about performance.

Adult↗
PubMed1976

Length of hospitalization on a short-term therapeutic community. A multivariate study by sex across time.

Patient length of hospitalization was examined in a private short-term therapeutic community unit using a longitudinal, multimethod, -ultivariate approach, with data analyzed separately by patient sex. Patient data were entered into stepwise linear regression analyses for weeks 1, 2, and 4 of an average seven-week hospitalization for male and female patients separately. Results for men were not specifically replicated among the women. Longer-staying men were diagnosed more frequently as "personality disorders," tended to be somewhat aloof, perceived the ward as encouraging denial, facade, order, and organization. Among women, verbal behavior, interpersonal relations, discontentedness with family, and other variables were related to length of hospitalization. Shorter-staying male and female patients tended to exhibit characteristics at the "feminine" end of a hypothetical masculinity-femininity continuum. Conforming, accepting behavior seemed reinforced for all patients.

Adult↗
PubMed1980

Diagnosing borderline patients with a semistructured interview.

As a part of an ongoing effort to provide operational criteria for a diagnosis of borderline personality disorder, the Diagnostic Interview for Borderlines (DIB) has been developed. The DIB is an hour-long, semistructured interview that evaluates five areas of borderline pathologic features--social adaptation, impulse/action patterns. affects, psychotic symptoms, and interpersonal relations. The DIBs were administered to 70 hospitalized patients and compared with clinical diagnoses made at the time of discharge. The DIB discriminates borderline patients from others, especially from schizophrenic and neurotic depressives. It reflects clinical diagnosis, yielding higher scores for patients on whom there is more agreement on the diagnosis of borderline. The instrument can be used flexibly to identify populations of borderline patients for research purposes.

Adjustment Disorders↗
PubMed1990

The diagnostic interview for narcissistic patients.

This report describes the content and development of a semistructured interview, the Diagnostic Interview for Narcissism. The interview evaluates 33 features of pathological narcissism covering five domains of function: grandiosity, interpersonal relations, reactiveness, affects and moods, and social and moral adaptation. Its utility is established by reliability studies and by developing a scoring system from a sample of 24 prototypic narcissistic patients who were compared with 58 others. Because narcissistic personality disorder is a widely used diagnosis whose inclusion in DSM-III-R was without reference to an empirical base, this instrument offers a method for doing much-needed research.

Ambulatory Care↗
PubMed1976

Advancement to independent living: a model behavioral program for the intermediate care of adults with behavioral and emotional problems.

This article describes and evaluates the treatment effectiveness of a behaviorally oriented intermediate day-care clinic for adults with psychiatric disturbances. The goals of the program included reducing the number of psychiatric hospital admissions and readmissions, providing a community-based controlled environment to assist patients in the modification of specific problem behavior, improving interpersonal relations with "significant others" in the natural environment, teaching patients how to use community resources, and preparing them for employment and/or continued outpatient treatment. The program was structured so that patients advance through a series of four achievement levels for a variety of extrinsic and intrinsic reinforcers. While in the program, patients were introduced to available community resources, and were gradually phased into follow-up services. Results showed that 79% of all patients thus far treated partially, if not completely, advanced through the levels. There was also a high probability that a patient would advance from any given level. Outside-clinic behavior showed sustained improvement, with the authors concluding that the day-care clinic offered promise for the future.

Adult↗
PubMed2002

Improvement and recovery from eating disorders: a patient perspective.

This study presents a patient perspective on improvement and recovery from eating disorders. Forty-eight women recruited from patient organizations and a university eating disorder unit participated in the study. Participants completed standard questionnaires and a qualitative interview. "A wish to change," professional treatment, nonprofessional care, and important persons in the women's lives were identified as important recovery factors. Recovery included improved acceptance of oneself, interpersonal relations, problem solving, and body satisfaction, which was not entirely dependent on symptom absence. The patient perspective concurred with clinical reasoning about recovery.

Journal Article↗
PubMed2004

A falsifying adolescent.

The author describes an adolescent patient who, while often speaking factual truths, maintained an aura of falsity in her life, and in two interludes of psychoanalytic psychotherapy, that functioned as a barrier to psychological insight. To match her falsity, the analyst at times modified his functioning as a "real" therapist and took on her personification of neglectful and false adults. Eventually, the analyst became an object that the adolescent could trust and rely on. In discussing the case, the author introduces and applies Bion's ideas regarding truth and falsity, and three variations of container-contained relationships-symbiotic, commensal, and parasitic-in the context of the case's relational perspective.

Adolescent↗
PubMed2005

Deployment stressors, gender, and mental health outcomes among Gulf War I veterans.

Findings indicate that war-zone exposure has negative implications for the postdeployment adjustment of veterans; however, most studies have relied on limited conceptualizations of war-zone exposure and focused on male samples. In this study, an array of deployment stressors that were content valid for both female and male Gulf War I military personnel was examined to elucidate gender differences in war-zone exposure and identify gender-based differential associations between stressors and mental health outcomes. While women and men were exposed to both mission-related and interpersonal stressors and both stressor categories were associated with mental health outcomes, women reported more interpersonal stressors and these stressors generally had a stronger impact on women's than on men's mental health. Exceptions are described, and implications are discussed.

Anxiety Disorders↗