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Comparison of the psychosocial effects of epilepsy and narcolepsy/cataplexy: a controlled study.

A questionnaire survey compared the psychosocial effects of epilepsy in 60 patients without major organic pathology (selected cases with temporal lobe epilepsy or primary generalized epilepsy) with those of matched (duration of illness, sex) patients with narcolepsy/cataplexy and with those of age- and sex-matched controls. Comparing epileptic patients with controls, we confirmed the well-documented marked deleterious effects of epilepsy upon work, education, occupational and household accidents, recreation, personality, interpersonal relations, and other parameters. Comparisons of epileptic and narcoleptic patients, however, showed that, in general, persons with narcolepsy are even more psychosocially impaired. The narcoleptic patients showed greater frequencies of disease-attributed reduced performance at work, poorer driving records, higher accident rates from smoking, greater problems in planning recreation, and other significant differences. Rather dissimilar profiles of psychosocial impairment were found to characterize the two conditions, and these were largely understandable as a function of their symptoms. The only areas in which epileptic patients showed greater problems than those with narcolepsy were in educational achievement and in ability to maintain a driving license. Most of the intergroup differences remained significant even for smaller groups matched also for age. The somewhat greater psychosocial impact of narcolepsy appears to be due to the continuous excessive daytime sleepiness that persists between the diagnostic attacks, whereas persons with epilepsy are relatively alert between seizures.

Accidents↗

An empirical comparison of natural-father and stepfather family systems.

This study examined the family system differences between 40 volunteer natural-father and stepfather families. Family triads consisting of the husband, the wife, and a child whose age ranged from 12 to 15 years were studied. Four instruments were used: (a) the Family Concept Q-Sort; (b) a Semantic Differential; (c) a demographic questionnaire; and (d) an interaction-reaction questionnaire. Analyses of variance on the data obtained from the Q-sorts and the Semantic Differentials indicated that stepfather family systems are different from natural-father family systems along several salient dimensions including psychological adjustment, satisfaction with family, reciprocal understanding, and perceived goodness and potency. It was concluded that the differences between the family systems in terms of their interpersonal relations and perceptions affect the entire stepparent family system and its ability to function adequately.

Adaptation, Psychological↗

Transforming narratives: a change event in constructivist family therapy.

One important clinical task in family therapy involves transforming the client's construction of the presenting problem from an individual, intrapersonal view to an interpersonal, relational, or systemic one (Sluzki, 1992). To study the transformation process in initial sessions, we sampled 8 families in which the referring parent requested help for a child's problem. The 8 therapists, trained and experienced in Sluzki's (1992) narrative approach, attempted to facilitate a transformation in the parents' initial construction of the problem. In 4 sessions, the transformation was independently judged to be successful by the therapist and observers, while in 4 other sessions the transformation was judged to be unsuccessful. Videotapes of the 8 interviews were analyzed qualitatively, and the parents' verbatim descriptions of the problem were coded using the Cognitive Constructions Coding System (Friedlander, 1995). We compared the successful and the unsuccessful sessions and developed a conceptual model of the successful transformation process that included client performances as well as therapist operations (Greenberg, 1986). While many elements in the model were consistent with Sluzki's (1992) "blue-print" transformation, several new elements were added. Practical implications are described, along with limitations and recommendations for future research.

Adolescent↗

Intergenerational transmission: individuation and intimacy across three generations.

This study examined the transmission of intergenerational family processes across three generations, employing Williamson's construct of Personal Authority in the Family System (PAFS) as a theoretical back-drop. From a PAFS perspective, psychological health is viewed as directly related to the degree of individuation and intimacy (PAFS) experienced within the family of origin. Overall, the results provided a degree of support for the intergenerational transmission hypothesis. The strongest predictor of the transmission process was from the participant/parent relationship to the participant/spouse relationship (spousal fusion/individuation). Separate male and female analyses of the Spousal Fusion/Individuation model found a moderate effect for females and a large effect for males. A small effect was found in predicting nuclear family triangulation from parent and spouse variables, although there was no gender effect. The findings suggest that degree of individuation and its related constructs are more critical in the transmission process than is intimacy.

Adult↗

A rating scale of phobic disorders.

Scales were constructed for the rating of phobic disorders, taking into account both behaviour therapeutic and psychodynamic aspects. The scales rate phobic behaviour with regard to anxiety (situational and anticipatory) and coping (avoidance and escape). The target phobia as well as seven common phobias are rated, the former being divided into: fairly easy, moderately difficult, and very difficult situations. The scales also include free anxiety (10 items), ego-restriction (11 items), and social function (six items with regard to interpersonal relations, and one each for capacity to work and leisure activities), and finally, a global rating. The inter-rater reliability was good (mostly around 0.90). Construct validity was supported by the result in effect studies of short-term psychotherapy.

Anxiety↗

Social conditions in a total population with long-term functional psychosis in three different areas of Stockholm County.

A number of social conditions regarding interpersonal relations, housing and employment were studied in a total population of individuals with long-term functional psychosis (n = 341) drawn from the population aged 18-64 years inhabiting three different areas of Stockholm County, altogether about 57,000 inhabitants. Individuals were included irrespective of whether they had a psychiatric treatment contact or not. They were mostly unmarried (57%) and living alone (64%). Most were unemployed (69%) and over half received a disability pension. However, 76% had their own flat and a reasonable financial standard, not deteriorating with illness duration. The diagnosis of schizophrenia led to poorer social conditions, as did early age at onset, male sex and co-morbidity of substance abuse. A larger number of individuals lived in an institution in the urban area while a greater number lived with relatives in the rural area.

Adolescent↗

The quality of hospital-based antenatal care in Istanbul.

The aim of this study was to gather comprehensive data from three hospitals in Istanbul, Turkey, in order to gain in-depth understanding of the quality of antenatal care in this setting. The Bruce-Jain framework for quality of care was adapted for use in evaluating antenatal care. Methods included examination of hospital records, in-depth interviews, exit questionnaires, and structured observations. The study revealed deficiencies in the quality of antenatal care being delivered at the study hospitals in all six elements of the quality-of-care framework. The technical content of visits varied greatly among the hospitals, and an overuse of technology was accompanied by neglect of some essential components of antenatal care. Although at the private hospital some problems with the technical content of care were identified, client satisfaction was higher there, where the care included good interpersonal relations, information provision, and continuity. Providers at all three hospitals felt constrained by heavy patient loads and a lack of resources. Multifaceted approaches are needed to improve the quality of antenatal care in this setting.

Adult↗

From chaos to complex order: personal values and resources in the process of psychotherapy.

TOPIC: Chaos as a scientific metaphor for the therapeutic relationship. PURPOSE: To provide an approach to psychotherapy of a psychotic experience through aspects of a single case. SOURCES: Selective literature review and author's clinical work. CONCLUSIONS: Appreciation of the water metaphor, and its deployment within Eastern philosophy and psychology, may help Western therapists develop further traditional interpersonal relations today.

Adult↗

Are young adults' suicides psychologically different from those of other adults? (The Shneidman Lecture).

This Shneidman Lecture addresses the question: Are young adults' suicides psychologically different from those of other adults? Eight clusters (or patterns) as possible predictors of suicide notes and, by implication, suicide are discussed to address this question. The eight clusters are as follows: unbearable psychological pain, interpersonal relations, rejection-aggression, inability to adjust, indirect expressions, identification-egression, ego, and cognitive constriction. Comparisons between young adults (aged 18-25) and other adults indicate that young adults' suicides do differ psychologically in a number of patterns, but that considerable commonalities exist across the adult life span. The presentation emphasizes that a life span developmental perspective is essential when one is attempting to understand the suicides of young adults. A number of genuine suicide notes of young adults are presented to illustrate, from an idiographic view, what it might have been like for these individuals in the last moments of their lives.

Adolescent↗

Criteria for psychotherapeutic outcome.

In an attempt to investigate the results of a variety of psychotherapies offered in the psychiatric clinic of the Beth Israel Hospital, we have used twelve outcome criteria for improvement. Findings on 53 patients treated by 14 therapists are presented, and a tentative comparison is made between a homogeneous group of patients who received short-term and long-term psychotherapies. Although a somewhat higher percentage of the long-term patients obtained symptomatic improvement compared to the short-term ones, impressive changes in motivation for change, self-esteem and interpersonal relations seem to have taken place in the short-term psychotherapy group.

Evaluation Studies as Topic↗

Comprehensive management of persistent somatization: an innovative inpatient program.

Psychiatry has been largely unsuccessful in developing effective treatment strategies for patients with chronic somatization. They continue to utilize a disproportionate share of health care resources and experience personal distress and significant social and occupational dysfunction. The Psychosomatic Medicine Unit at the Clarke Institute of Psychiatry is attempting to treat these patients with a comprehensive treatment program that takes into account the multifactorial etiology of the disturbance. The unit is in a tertiary care facility and the patient population is heterogeneous with respect to the underlying psychiatric diagnosis and the duration of symptoms. All patients are significantly dysfunctional and have typically failed other treatment approaches. The treatment process begins with an assessment phase in which the patient is comprehensively evaluated from the physical and psychiatric perspectives. The rehabilitation phase consists of a variety of treatment modalities including group programs in goal-setting, life skills and interpersonal relations, group therapy, individual psychotherapy, family therapy, occupational therapy and vocational rehabilitation, biofeedback and physiotherapy. Psychotropic medications play an important role in some patients. This paper will describe the unit and its program in detail.

Combined Modality Therapy↗

Selection criteria for brief dynamic psychotherapy: reliability, factor structure and long-term predictive validity.

Forty outpatients were evaluated for psychotherapy with a modified version of Sifneos' selection criteria for brief dynamic psychotherapy. Reliabilities were acceptable for most items when the ratings of 4 clinical judges were averaged. A factor analysis of the reliable items produced four of the five dimensions of suitability proposed by Sifneos and others: circumscribed focus, motivation, flexible interaction, quality of interpersonal relations. A combination of these dimensions were more significant predictors of long-term dynamic change than background and DSM-III axis I-V variables. Problem solving capacity (use of self-understanding) before treatment could not be reliably rated and was accordingly not tested as a possible fifth dimension of suitability.

Anxiety Disorders↗

Impressions of psychiatric problems and their management: China, 1977.

The authors, who visited the People's Republic of China in October 1977, describe the treatment methods used there, particularly in the Shanghai Mental Hospital, a 1,000-bed hospital for acutely ill patients. Psychiatric treatment there appears to be a blend of Western pharmacology, traditional Chinese medicine, and group therapy. The authors also speculate on the possible cultural sources of stress-related and interpersonal problems, provide a review of the literature regarding psychiatry in modern China, and outline the history of psychiatric treatment there.

Adolescent↗

The diagnostic interview for borderline patients.

The authors describe the content, administration, reliability, construct validity, and training requirements for a semistructured diagnostic interview for borderline patients. The interview is composed of operationally defined and scored variables that assess five areas of functioning considered most characteristic of borderline patients--social adaptation, impulse/action patterns, affects, psychosis, and interpersonal relations. Their results show that the interview provides a reasonably constructed and reliable method for researchers and clinicians interested in identifying the syndrome of borderline personality disorders. Although existing research supports the clinical utility of defining borderline patients with the diagnostic interview for borderline patients, both the diagnosis and the content of the interview may require revisions.

Borderline Personality Disorder↗

Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30.

OBJECTIVE: The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. METHOD: Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. RESULTS: At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. CONCLUSIONS: Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.

Adaptation, Psychological↗