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PubMed1984

Surgery and the GMENAC report: a reality test.

Concern for a possible oversupply of physicians caused the Secretary of Health and Human Services to create the Graduate Medical Education National Advisory Committee (GMENAC) to analyze the nation's supply and requirements for physicians. Issued in 1980, the GMENAC Report projected an aggregate surplus of 70,000 physicians in 1990. Surgeons in particular were projected to exceed requirements by 40%. I evaluated the GMENAC parameters using the quantitative methodology initially developed for the 1970 Study on Surgical Services for the United States. This assessment of the GMENAC projections indicated increased population-based use of surgical intervention and projected wide interspecialty variation in average surgeon productivity with an even larger excess of surgeons than that projected for 1990 by GMENAC.

General Surgery↗
PubMed1979

A comparison of Rorschach developmental level and form-level systems as indicators of psychosis.

Psychotic and nonpsychotic psychiatric inpatients were tested on the Rorschach. "Reality-testing" was measured by four form-level scoring systems designed by Beck, Mayman, Becker, and Wilensky. The psychotic subjects were dichotomized on three diagnostic dimensions: schizophrenia, paranoia, and premorbid social adjustment. No significant differences were found for the Beck system. With the other systems, psychotics showed significantly poorer reality testing than nonpsychotics. No differences were found for the schizophrenic and paranoid dimensions. The Phillips premorbid adjustment score was negatively correlated with all four measures of "reality-testing." The conclusion drawn was that Rorschach measures of "reality testing" are associated with psychotic and poor premorbid functioning, but do not differentiate schizophrenic from nonschizophrenic psychotics or paranoid schizophrenics from nonparanoid schizophrenics.

Adult↗
PubMed1995

A case study of female genital self-mutilation in schizophrenia.

A case of deliberate genital self-mutilation in a woman with familial schizophrenia is presented. Such behaviour, though well recognized in females with severe personality disorders, is extremely rare in female psychotics. The genital mutilation may be partially understood as a consequence of delusionally motivated action against a background of low self-esteem, premorbid body-image preoccupation, forced early sexual activity and hence profound ambivalence towards adult sexuality. Dealing with this constructively was hampered by a cognitive style characterized by impaired reasoning and reality testing. Tests of reasoning, judgement and reality testing showed deficits, and computed tomography revealed dilatation of the left frontal ventricular system. Both neuropsychological and psychodynamic factors appeared to be of relevance in this case.

Adult↗
PubMed2001

13C breath tests: visions and realities.

Breath tests have been used in research laboratories for over 25 y. Originally, the tests were based on the use of (14)C, rather than on the nonradioactive isotope, (13)C. When (13)C became widely available at a reasonable cost, research groups in the United States and Europe developed methodologies to measure (13)C abundance in samples of CO(2). The tests used a variety of substrates and measured pancreatic function, fat absorption, bacterial overgrowth and P(450) mixed-function oxidase. Thus far, the only test to be approved by the Food and Drug Administration is the (13)C-urea breath test. This manuscript describes the process by which approval is gained, and indicates the steps necessary for other tests to receive Food and Drug Administration approval.

Breath Tests↗
PubMed1983

Drugs and homicide: a theory.

In this paper we report our experience with 24 cases in which there was a homicide or homicides committed in association with use of large amounts of psychoactive drugs. Many, if not most of these homicides, would not have occurred without drug effects, for frequently there was evidence of grossly illogical thinking in close temporal association with use of intoxicants and in many cases there was no previous history of violence, no evidence of premeditation, no plan to avoid arrest and little or no discernible motivation. Usually there were multiple losses or other severe stress in the lives of the persons committing the homicide in the months preceding the crime. The stress increase was accompanied by increased and extraordinary intake of psychoactive substances. We theorize that high doses of psychoactive drugs impaired severely the brain systems upon which the mental functions of reality testing and judgment depend. Drug induced impairment of reality testing and judgment is frequently uncritically equated with hallucinations, disorientation, changes in time perception or other drug induced mental phenomena. Impairment of reality testing and judgment are basic criteria for linking drug effects with the behavior of homicide in the cases reviewed.

Adult↗
PubMed1981

Conjoint therapy of psychiatric problems in the elderly.

In treating elderly psychiatric patients, interviewing spouses together may be the most useful setting. Data gathering, reality testing and reality orientation can all be enhanced by the "well" spouse. The physician also can assess the value of the "well" spouse as a co-therapist. Two case reports illustrate this method of aiding treatment.

Aged↗
PubMed2003

The 'mad scientists': psychoanalysis, dream and virtual reality.

The author explores the concept of reality-testing as a means of assessing the relationship with reality that prevails in dream and in virtual reality. Based on a model developed by Jean Laplanche, she compares these activities in detail in order to determine their respective independence from the function of reality-testing. By carefully examining the concept of hallucination in the writings of Freud and Daniel Dennett, the author seeks to pinpoint the specific modalities of interaction between perceptions, ideas, wishes and actions that converge in the 'belief' and in the 'sense of reality'. The paper's main thesis consists of the distinction that it draws between immediacy-testing and reality-testing, with the further argument that this distinction not only dissipates the conceptual vagueness that generally surrounds the latter of the two concepts but also that it promotes a more precise analysis of the function of reality in dream and in virtual reality.

Dreams↗
PubMed2000

Status of point-of-care testing: promise, realities, and possibilities.

Point-of-care testing (POCT) has evolved from the demand for analytical information more rapidly than is available from central laboratories. By bringing the analysis closer to the patient several process steps have been eliminated, facilitating a shorter time to result and faster management response with improved outcomes. Thus benefits include better therapeutic turnaround times, decreased blood loss as a result of reduced phlebotomy secondary to clinical improvement, and diminished resource utilization. These advantages depend on acceptable analytical performance in comparison with central laboratory methods and in relation to clinical criteria. Generally these requirements are met but there are problems particularly with atypical specimens. Outcomes and cost-benefit analyses have been difficult to perform and evaluate. Given the multitude of participants, quality assurance and program management are recognized as resource intensive. However, recognition of problem areas is driving continuous improvement and we envisage expansion of this paradigm.

Blood Specimen Collection↗
PubMed1980

Is aesthetic judgment impaired by neuroticism?

If aesthetic aspects of art are objective and reside in the art, as Arnheim (1954) argues, then perceiving them may be akin to any other kind of reality testing. Further, if neurosis impairs reality testing, it would also impair aesthetic judgment, especially if aesthetic cues are vital and relevant to the human experience as Arnheim maintains. This hypothesis was investigated by administration of personality tests to measure neuroticism, especially Cattell's Sixteen Personality Factor Questionnaire (16PF), and art judgment tasks, especially Child's slide comparisons, to 105 University of Michigan undergraduates. The hypothesis was supported by a high negative correlation between the 16PF's neuroticism scale and art judgment, r = -.48; t(103) = -.5.61, p less than .0001. The results are discussed in terms of growth versus adjustment models of mental health, and the possible inhibiting role of verbalization over visualization in aesthetic perception.

Adolescent↗