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PubMed2001

Brain sources of EEG gamma frequency during volitionally meditation-induced, altered states of consciousness, and experience of the self.

Multichannel EEG of an advanced meditator was recorded during four different, repeated meditations. Locations of intracerebral source gravity centers as well as Low Resolution Electromagnetic Tomography (LORETA) functional images of the EEG 'gamma' (35-44 Hz) frequency band activity differed significantly between meditations. Thus, during volitionally self-initiated, altered states of consciousness that were associated with different subjective meditation states, different brain neuronal populations were active. The brain areas predominantly involved during the self-induced meditation states aiming at visualization (right posterior) and verbalization (left central) agreed with known brain functional neuroanatomy. The brain areas involved in the self-induced, meditational dissolution and reconstitution of the experience of the self (right fronto-temporal) are discussed in the context of neural substrates implicated in normal self-representation and reality testing, as well as in depersonalization disorders and detachment from self after brain lesions.

Brain Mapping↗
PubMed1996

A Survey of Patient Response to Office Surgery

Over 3 years, 407 women (mean age 32 yrs, range 20-57 yrs) were selected to be interviewed before, immediately after, and 8 weeks and 6 months after surgery performed in the office. All patients had undergone both in-hospital and outpatient gynecologic procedures at least once in the past. A questionnaire elicited information on 10 common emotional responses to office surgery: surrender of control, depersonalization, helplessness, anxiety, fear of pain, fear of loss of identity, emotional lability, regression or dependency, feeling of illness, and grief. Of 407 patients, 382 completed the study to the 6-month interview. Office surgery resulted in overall decreases in all 10 categories compared with hospital-based surgery. Women's feelings concerning confidentiality, decreased paperwork, and a familiar environment were significant. Office surgery was clearly well accepted compared with the hospital, and 90% of women said they would choose this setting again if offered. Further study with control groups will be performed to evaluate these initial findings for statistical significance.

Journal Article↗
PubMedDate not supplied

Analysis of the medical use of marijuana and its societal implications.

OBJECTIVE: To review the pharmacology, therapeutics, adverse effects, and societal implications of the medical use of marijuana. DATA SOURCES: MEDLINE and manual searches of English-language marijuana literature, supplemented with interviews of scientists currently conducting cannabinoid research. Search terms included pain OR palliative care AND cannabis or ALL marijuana; cachexia OR appetite OR appetite stimulants; muscle spasticity OR spasm; immune system and cannabis; nausea and vomiting and cancer and cannabis. MEDLINE search terms: cannabis OR marijuana smoking OR marijuana abuse; all glaucoma; multiple sclerosis AND cannabis OR marijuana smoking OR marijuana abuse. STUDY SELECTION: Studies on pharmacology, risks, and medical potential of marijuana. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: The most prominent effects of marijuana are mediated by receptors in the brain. Acute intoxication is characterized by euphoria, loss of short-term memory, stimulation of the senses, and impaired linear thinking. Depersonalization and panic attacks are adverse effects. Increased heart rate and reddened conjunctivae are common physical effects. Chronic, high doses may cause subtle impairment of cognitive abilities that are appear to be long-term, but of unknown duration. Marijuana may be a risk factor for individuals with underlying mental illness. It causes dependence, but compared with cocaine, alcohol, heroin, and nicotine, marijuana has little addictive power and produces only mild withdrawal symptoms. Marijuana shows clinical promise for glaucoma, nausea and vomiting, analgesia, spasticity, multiple sclerosis, and AIDS wasting syndrome. CONCLUSION: As a recreational drug, marijuana poses dangers, particularly to social and emotional development during adolescence and young adulthood. As a medical drug, marijuana should be available for patients who do not adequately respond to currently available therapies.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Patient health record on a smart card.

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

Computer Security↗
PubMed1989

The role of provocative visual stimuli in agoraphobia.

Three studies examine the role that provocative visual stimuli have in eliciting anxiety reactions in people with agoraphobia. Such stimuli elicit more anxiety in agoraphobic patients than control subjects. The effect of visual stimulation appears to be specific: (1) non-visual stimulation is without comparable effect; (2) both control and agoraphobic groups show similar effects of visual stimulation on another reaction such as headache. The anxiety effects of visual stimuli are correlated with the extent to which subjects experience depersonalization and somatic symptoms of agoraphobia, but not correlated with depression or the behavioural or cognitive aspects of agoraphobia. Alternative accounts of the possible role of visual stimulation in the anxiety reactions of agoraphobic patients are discussed.

Agoraphobia↗
PubMed1989

Classification of depression by grade of membership: a confirmation study.

One hundred and thirty out-patients with depression were studied by grade of membership multivariate (GOM) analysis. Five depressive types were generated. Pure Type I represented a mild form of melancholia in older, stable males, who showed a modest drug response. Pure Type II included obsessive-anxious symptoms in older patients who responded well to an MAOI drug, but poorly to placebo. Pure Type III was a mildly symptomatic form of depression which responded well to placebo. Pure Type IV included features of agitation, mood worsening later in the day, anorexia and depersonalization; it was commonly precipitated by external stress and MAOI treatment was more effective than placebo. In Pure Type V depression, patients were mostly younger females with high levels of symptomatology, atypical vegetative symptoms, unstable life-styles, disadvantaged backgrounds and a poor response to MAOI and placebo. These results resemble in many ways our earlier GOM study of depression, as well as other multivariate studies of depression in the literature.

Adult↗
PubMed1984

Endocrine changes and clinical profiles in depression: II. The thyrotropin-releasing hormone test.

Thirty-one (43%) of 68 patients with primary depression were found to have a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH). Increased thyroid activity, as measured by the free thyroxine index (FTI), was present in 16 (24%) of the patients. Patients with blunted responses had a higher mean FTI level than those with normal responses. Patients with blunted responses were significantly more likely to exhibit the symptoms of depersonalization, derealization and agitation. There was no clear association between blunting and any particular diagnostic category of depression. Patients with blunted responses and high FTI values were more likely to report significant long-term environmental difficulties than patients with blunted responses and normal FTI values. It is suggested that there may be more than one mechanism responsible for blunting of the TSH response in depressed patients. In some patients blunting may be due to negative feedback from increased output of thyroid hormones, possibly released as part of a stress response. In other patients blunting may be due to a different mechanism, possibly involving pituitary gland dysfunction. These mechanisms would not necessarily be mutually exclusive in any one patient.

Adult↗
PubMed1991

The use of the Clinical Interview Schedule for the evaluation of mental health in the aged community.

As a part of a survey to study the health and living conditions of the elderly population, a random sample of residents aged 65 and over are examined using the Clinical Interview Schedule (CIS) in order to evaluate their psychiatric status. The aim of this study is to evaluate this standard method of assessment as a case-identification instrument in our country. The schedule was completed by 91 subjects. It is easily administered, easily scored, and economical on time. Its completion rate is high. The weighted total scores (WTS) range from 0 to 48. Using the case criteria defined by Cooper & Schwarz (1982), 27 subjects (30%) are considered cases and 64 (70%) are regarded as non-cases. The sensitivity coefficients for the WTS are examined against the overall severity rating at different cut-off points. The optimum cut-off can be anywhere between 16 and 20 points. The WTS has higher validity coefficients to detect the following diagnostic categories (sensitivity, specificity): normals (100%,-); personality (100%, 92%) and affective disorders (100%, 75%). In general the CIS items are given low ratings. Psychotic symptoms are rarely found in this sample. One main problem arose: the item depersonalization is misunderstood by some patients probably because of interpreting it as an upsetting memory disturbance.

Aged↗
PubMed2002

Elderly people's accounts of home care rationing: missing voices in long-term care policy debates.

Fundamental shifts in state intervention in recent years have resulted in steady curtailment in public provision of community and social care. A longitudinal study of elderly women receiving home care in Ontario explored the reverberations of these shifts in the texture of frail elderly people's lives. Three distinct accounts of negotiating unstable and rationed home care were discernible. "Taking charge" was an active account of women successfully impressing their particular needs and identities on home care provision. "Pushed over the edge" was a vulnerable account of insufficient and depersonalized care in which participants felt themselves practically and emotionally out of control. In "Restraining expectations", women adjusted silently to the shortcomings of home care, stoically making themselves smaller as they found their previous orbits and identities unsupported. Home care's front line emerged as a complex site of struggle for identity and agency--a struggle in which elderly people engage with inventiveness and determination but also with dwindling support, few witnesses and in mounting isolation.

Aged↗
PubMed1995

Biological medicine and the survival of the person.

The status of the person is analyzed as represented by the life sciences under the influence of modern physico-chemical and molecular biology. At the same time the linguistic structure of reality as seen through formalized scientific discourse is not that of a language, but rather that of operational symbolisms, so that the Judeo-Greek tradition of Verb as creating and Logos as procreating--which is probably at the origin of the surprising confidence in the possibility of dominating nature through words and formulae--could be successful only through the depersonalization of language. Notwithstanding appearances, the phenomena of structural and functional self-organization do not really change this situation. In this context the question of the status of the person and of the intentional subject has to be dealt with pragmatically, giving up the notion of a unified scientific theory that would take into consideratiion at the same time the experimental sciences (physics, chemistry, biology and "ojective" human) and the human sciences as linking subjectivity and intentionality.

Biochemistry↗
PubMed2000

The role of local knowledge in medical practice: a trans-historical perspective.

This article explores the role of participant-observation and ethnographic writing in the shaping of medical practice since Hippocrates. Drawing on a range of historical sources and genres that include the 17th- and 18th-century medical topographies and medical geographies, 19th-century medical ethnography and folklore, and their marginal persistence into the 20th century in the form of Mexican pasante reports, I argue that these writings should not be approached as part of the history of anthropology, but as specifically medical genres related to medical practice. The abandonment of these ethnographic practices by modern biomedicine is, I conclude, a consequence of two related developments: the hegemony of clinical epistemology and the depersonalization and depoliticization of physicians' commitment to their patients.

Anthropology, Cultural↗
PubMed2001

The neurophysiology of dissociation and chronic disease.

Dissociation as a clinical psychiatric condition has been defined primarily in terms of the fragmentation and splitting of the mind, and perception of the self and the body. Its clinical manifestations include altered perceptions and behavior, including derealization, depersonalization, distortions of perception of time, space, and body, and conversion hysteria. Using examples of animal models, and the clinical features of the whiplash syndrome, we have developed a model of dissociation linked to the phenomenon of freeze/immobility. Also employing current concepts of the psychobiology of posttraumatic stress disorder (PTSD), we propose a model of PTSD linked to cyclical autonomic dysfunction, triggered and maintained by the laboratory model of kindling, and perpetuated by increasingly profound dorsal vagal tone and endorphinergic reward systems. These physiologic events in turn contribute to the clinical state of dissociation. The resulting autonomic dysregulation is presented as the substrate for a diverse group of chronic diseases of unknown origin.

Animals↗
PubMed1999

Dissociative symptoms in acute stress disorder.

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.

Accidents, Traffic↗
PubMed2001

Gender-related differences in the onset of panic disorder.

OBJECTIVE: To investigate gender-related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD). METHOD: One hundred and eighty-four out-patients with a principal diagnosis of PD (DSM-IV) were evaluated with a semi-structured interview to generate Axis I and Axis II diagnoses according to DSM-IV, to collect family history of psychiatric disorders and life events. The statistical analysis was performed comparing men and women. RESULTS: Men and women showed similar age at onset of PD. A family history of mood disorders characterized females. Men had higher rates of cyclothymia, body dysmorphic disorder and depersonalization disorder preceding PD, while women had higher rates of bulimia nervosa. Dependent and histrionic PDs were more common among women, while borderline and schizoid PDs were more common among men. Life events showed a significant role in precipitating PD onset in women. CONCLUSION: Premorbid clinical conditions of PD seem to differentiate between males and females in the role of precipitating events.

Adult↗
PubMed1998

The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors.

Motor vehicle accident survivors (n = 92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n = 71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of relieving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision.

Accidents, Traffic↗
PubMed2007

Take care! The evaluation of a team-based burnout intervention program for oncology care providers.

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time.

Adult↗
PubMed2006

The interactive effects of positive affect and conscientiousness on strain.

The purpose of our study was to more fully investigate a combination of personal resources, namely positive affect (PA) and conscientiousness, on emotional exhaustion, depersonalization, and job tension. We examined a sample of nurses employed by a metropolitan hospital and found that the combination of high positive affect and high levels of conscientiousness was associated with lower levels of all strain variables. Our findings suggested that conscientiousness strengthened the negative relationship between PA and job strain. Our results were consistent with the view that some dispositions can act as resources protecting individuals from experienced stress. Implications of these results, strengths and limitations, and directions for future research are discussed.

Affect↗
PubMed2004

Customer-related social stressors and burnout.

Although almost all literature on burnout implicitly assumes that burnout is primarily caused by stressful employee-customer interactions, only a few studies have addressed this empirically. A principal-components analysis of a newly developed instrument assessing various forms of customer-related social stressors (CSS) in 3 different service jobs (N = 591) revealed 4 themes of CSS: disproportionate customer expectations, customer verbal aggression, disliked customers, and ambiguous customer expectations. These 4 CSS predict burnout beyond a variety of control variables. Contrary to other predictors of burnout analyzed in previous studies, the amount of variance explained in exhaustion (14%) by the 4 CSS scales is not higher than for personal accomplishment (14%) and is considerably lower than for depersonalization (23%).

Adult↗