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PubMed1983

The impact of technology on the future of health/illness education.

The impact of technological advancement and societal pressure for comprehensive, cost effective health care are two current trends which will determine the future of health/illness education. This article predicts a future of health/illness education based on these trends. The issues of depersonalization, cost, privacy, and control involved in the use of computers in health care are identified and discussed.

Attitude of Health Personnel↗
PubMed2005

The validity of DSM-IV dissociative disorders categories in south-west Uganda.

There is little systematic research on the cross-cultural validity of the dissociative disorders, especially in non-western countries. This study evaluates the fit of the DSM-IV classification and concepts of these disorders with local concepts, experiences and local presentations in south-west Uganda. We conducted focus group discussions with medical students, traditional healers, religious leaders, counselors, community members and other health workers (n=48). They were supplemented by key informant interviews with religious people, traditional healers and leaders (n=11). The responses were subjected to thematic analysis. Dissociative amnesia and depersonalization were generally recognized and seen as the result of traumatic experiences and were useful categories in Uganda. However, dissociative fugue did not match local concepts and was confused with spirit possession and other conditions such as alcoholic fugues and dementia. The description of dissociative identity disorder was always interpreted as a possession trance disorder by the local healers. We found only partial support for the validity of the DSM-IV classification of dissociative disorders in Uganda.

Adult↗
PubMed2006

An exploration of job stress and health in the Norwegian police service: a cross sectional study.

BACKGROUND: Police work is regarded as a high-stress occupation, but so far, no nationwide study has explored the associations between work stress and health. AIMS: To explore physical and mental health among Norwegian police and associations to job stress. Comparisons were made with a nationwide sample of Norwegian physicians and the general Norwegian population. METHODS: Comprehensive nationwide questionnaire survey of 3,272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey with two factors (serious operational tasks and work injuries), the Job Stress Survey with two factors (job pressure and lack of support), the Basic Character Inventory, the Subjective Health Complaint questionnaire, the Hospital Anxiety and Depression Scale, the Maslach Burnout Inventory, and Paykel's Suicidal Feelings in the General Population. RESULTS: The frequency of job pressure and lack of support was mainly associated to physical and mental health problems. Females showed higher means on anxiety symptoms than males (4.2, SD 2.9 and 3.7, SD 2.9, respectively; p < 0.01), while males showed higher means on depressive symptoms (3.1, SD 2.9 and 2.4, SD 2.5, respectively; p < 0.001). Police reported more subjective health complaints, depersonalization and higher scores on three of four personality traits than physicians, but lower scores on anxiety and depressive symptoms than the general population. CONCLUSION: This is the first nationwide study to explore job stress and physical and mental health in police. The results indicate that Norwegian police have high levels of musculoskeletal health problems mainly associated to the frequency of job pressure and lack of support. However, also frequent exposure to work injuries was associated to health problems. This may indicate that daily routine work as well as police operational duties must be taken into consideration in assessing job stress and police health.

Journal Article↗
PubMed2006

Level of burnout among nurses working in oncology in an Italian region.

PURPOSE/OBJECTIVES: To estimate the level of burnout among nurses working on oncology wards and to identify the risk factors of burnout and the strategies used to prevent and deal with stress. DESIGN: Descriptive study. SETTING: Oncology wards in public hospitals in a northeastern Italian region. SAMPLE: 100 nurses working on oncology wards. METHODS: Head nurses of the oncology wards were personally informed about the aims of the study and were asked to distribute a questionnaire among the staff nurses and collect them after completion. The questionnaire had 58 items divided into three parts: sociodemographic and job characteristics of the population, the Maslach Burnout Inventory modified for Italian healthcare workers, and the respondents' perceptions about coping mechanisms and strategies adopted by the organization to help the nurses cope with stress. MAIN RESEARCH VARIABLES: Levels of burnout according to the Maslach Burnout Inventory. FINDINGS: The global response rate was 71% (100 of 140); 35% of the nurses had a high level of emotional exhaustion, 17% had a high level of depersonalization, and 11% had a high level of personal achievement. Significantly high levels of emotional exhaustion were found in nurses older than 40 with a working seniority of more than 15 years, those who had chosen to work on an oncology ward, and those who wanted another work assignment. The mean emotional exhaustion in subjects who identified lack of coordination (disorganization) as an important cause of stress was 24.5 (SD = 10.6), whereas the mean score in the nurses who did not cite disorganization as a cause of stress was 18.3 (SD = 12.0). CONCLUSIONS: An important cause of stress reported by nurses is poor organization; therefore, hospitals should focus attention on specific organizational aspects. IMPLICATIONS FOR NURSING: Knowledge of the mechanisms of burnout and strategies to prevent and deal with them are important for nurses' psychophysical health and constitute a fundamental requirement in a policy that aims to improve quality in health services.

Adult↗
PubMed2005

'If only I manage to get home I'll get better'--interviews with stroke patients after emergency stay in hospital on their experiences and needs.

OBJECTIVE: To find out about the experiences of stroke patients concerning their falling ill, their stay in hospital, discharge and homecoming. DESIGN: Qualitative methods using in-depth interviews. SUBJECTS AND SETTING: Nine strategically chosen patients and in five cases near family members were interviewed in their homes four months post stroke and following care at the Stroke Centre, University Hospital of Northern Sweden, Umeå. RESULTS: Three main categories with subcategories were brought to the fore from the interviews: 'Responsible and implicated', 'Depersonalized object for caring measures' and 'The striving for repersonalization and autonomy'. The patients got the most important insights and understanding about their state and the consequences when they came home. CONCLUSION: The three main categories that were found mirror the crisis which becoming ill entails and the process gone through when the individual takes control again of his or her life. The patients saw coming home as an important factor for their recovery and rehabilitation. The health care system needs to develop strategies to make use of the power of this attitude with the patients and to use the patients' own milieu in rehabilitation after stroke.

Adaptation, Psychological↗
PubMed2000

Caregivers' predispositions and perceived organizational expectations for the provision of social support to nursing home residents.

This article presents the results of an investigation of caregivers' provision of supportive communication to nursing home residents. Five primary conclusions are drawn from the data: (a) Caregivers value providing affective over instrumental support; (b) caregivers believe they place more importance on supportive communication than their organizations; (c) role conflict is emotionally exhausting, but does not affect caregivers' self-evaluations or perceptions of residents; (d) caregivers' depersonalization of patients is related to their desire to communicate instrumental support; and (e) caregivers feel more accomplished when they believe their organization values supportive communication with patients. The implications of these findings for social support, caregivers' burnout, and nursing homes are discussed.

Attitude of Health Personnel↗
PubMed1998

Dissociative symptomatology in children and adolescents as displayed on psychological testing.

The purpose of this study was to investigate psychological testing features of children and adolescents with dissociative disorder diagnoses to provide diagnostic information that might facilitate early intervention. The psychological testing protocols of 30 children diagnosed with dissociative disorders were compared with the testing protocols of 30 consecutive admissions to the Sheppard Pratt Hospital who did not receive a dissociative identity disorder (DID; formerly termed multiple personality disorder) or dissociative disorder not otherwise specified (DDNOS) diagnosis. A rater, blind to the diagnosis, scored these protocols for the presence or absence of behavioral and testing response variables hypothesized to discriminate between the dissociative patients and the mixed group of other diagnoses. Behavioral features significantly more common in the dissociative group included forgetting, staring, unusual motor behaviors, dramatic fluctuations, fearful and angry reactions to stimuli, physical complaints during testing, and expressions of internal conflict. Significant indications of dissociation in the test responses included images of multiplicity, malevolent religiosity, dissociative coping, depersonalized imagery, emotional confusion, extreme dichotomization, images of mutilation and torture, and magical transformation. A combination of these behavioral and response variables was able to select 93% of the dissociative sample. These results add support to the discriminant validity of DID and DDNOS as diagnostic categories in childhood and provide clinical information that may be useful for early diagnosis of traumatized children with dissociative pathology.

Adolescent↗
PubMed2003

Justice and identity: changing perspectives on what is fair.

Most research on justice has aimed to describe abstract, depersonalized models that could apply to anyone. However, much of this research has involved identity, if only implicitly. We argue that justice needs to be contextualized to take into account the powerful effects of identity in determining when justice matters. The complexity and fluidity of identity need to be considered to understand when, why, and how strongly people care about justice, and how people choose among competing models of justice. We review existing research on distributive, procedural, and inclusionary justice and describe their connection to identity. We illustrate the intersection of justice and identity in environmental issues, a context in which these constructs have significant implications for individual, community, and planetary well-being. We conclude with 4 points to stimulate further research on the intersections of identity and justice.

Conflict, Psychological↗
PubMed1989

Dissociative states and epilepsy.

Since symptoms of chronic dissociative disorders such as multiple personality disorder (MPD) may be shared by patients with seizure disorders, we investigated the possible relationship between dissociative states and epilepsy. We monitored 6 MPD patients with intensive video-EEG recordings to determine whether epileptic phenomena have any correlation to the dissociative symptoms experienced by these patients. Previously, physicians had diagnosed epilepsy in all 6 patients; however, none proved to have epilepsy. In addition, we studied dissociative symptoms in 71 epileptic patients with the aid of a standardized questionnaire, the Dissociative Experiences Scale, and compared them with age-matched controls. While the group median score of cases with complex partial seizures was higher than that of normal controls, it was significantly lower than that of the psychiatric patients with MPD. Partial seizure patients with dominant hemisphere foci had higher depersonalization subscale scores than those with nondominant foci. Our data suggest that epilepsy is not a primary pathophysiologic mechanism for developing dissociative symptoms.

Adult↗
PubMed1989

Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography.

A retrospective review of colloid cysts diagnosed from 1974 to 1986 emphasizes the presenting symptoms of these lesions, their surgical management, and the contribution of modern imaging techniques to their diagnosis and therapy. In this 12-year period, 84 patients (45 men and 39 women) had a colloid cyst diagnosed. The patients' mean age was 46 years (range, 7-82 years). Surgery was performed in 55 patients, 7 of whom had undergone prior surgery elsewhere. The surgical approaches used were transfrontal-transventricular, transcallosal, computer-assisted stereotactic aspiration and resection by stereotactic craniotomy, and shunting of cerebrospinal fluid without removal of the lesion. There was no operative mortality, but complications occurred in 15 patients (27%). Preoperative imaging showed hydrocephalus in 93% of the patients: severe in 43%, moderate in 36%, and mild in 14%. In the surgically treated group, the most common presenting symptoms were headache, change in mental status, ataxia, nausea and vomiting, visual disturbance, emotional lability/inappropriate affect, depersonalization, and hypersomnolence. Twenty-four patients for whom surgery was not recommended are being followed up closely. Most of these patients had normal ventricles. The symptoms in this group included headache, anxiety/nervousness, ataxia, memory impairment, visual disturbance, and seizures. Five autopsy cases of patients with colloid cysts were available during this period and were reviewed. Direct removal of colloid cysts can be accomplished with low morbidity and mortality, avoiding the frequent revisions and complications related to shunt procedures. There is a subgroup of colloid cysts that can be operated upon electively or followed up closely with serial imaging studies.

Adolescent↗
PubMed2003

The technical and interpersonal aspects of telemedicine: effects on doctor-patient communication.

The influence of telemedicine on the nature and content of doctor-patient communication stems from both its technical and its interpersonal aspects. While the technical aspects are concerned with the communication technologies used and the clinical processes enabled by those technologies, the interpersonal aspects are concerned with relationships between system personnel, providers and patients, and the way in which those relationships are organized. On the one hand, this paper posits that the influence of the technical environment stems from depersonalization of the doctor-patient relationship, participatory enhancements and impediments, and sensory and non-verbal limitations. On the other hand, it posits that the influence of the interpersonal environment stems from third-party participation, social and professional distancing, and underdeveloped norms and standards. A combined positivist and interpretivist evaluation strategy would enable researchers to make better-informed connections between telemedicine, medical encounter behaviour and health outcomes.

Communication↗
PubMed1998

[The development of the Japanese version of the Maslach Burnout Inventory and the examination of the factor structure].

This article presents an evaluation of the factor structures of the Japanese version of the Maslach Burnout Inventory (MBI). The MBI is a widely used psychometric instrument for measuring 'burnout' developed by Maslach and her co-workers. The MBI consists of four subscales: Emotional Exhaustion, Personal Accomplishment, Depersonalization, and Involvement. The MBI was translated into Japanese along with a back-translation and was administered to a sample of 267 nurses. Various psychometric analyses showed that the Japanese version of the MBI has high reliability for the 22 items scored for the frequency dimension. The factor analysis using principal factoring with an oblique rotation resulted in three factor structures that had different implications from the MBI: Emotional Exhaustion/Depersonalization, Personal Accomplishment, and Physical Exhaustion. The correlationship between the MBI and the General Health Questionnaire (GHQ), measures of depression, showed that burnout was a unique phenomenon.

Adult↗
PubMed1992

Researcher-participant relationships in journal reports on gay men and lesbian women.

To assess the ethical nature of research relationships between investigators and gay and lesbian participants we reviewed 351 reports on homosexuality in three major and 75 miscellaneous journals from 1974 to 1988. We found that authors rarely involved participants beyond the role of providing data, generally did not report conditions of consent, rarely reported feedback, and almost never indicated using data to promote social action. In addition, authors typically relied on the term "subjects" and on a depersonalized, decontextualized writing style. There were some differences among journals, over time, and among authors' disciplines. Male authors tended to study men exclusively, whereas female authors' relation to participants' gender was more varied. Believing that research with gay men and lesbian women should not detract from their emancipation, we offer some recommendations for research practice and report-writing which are designed to better protect research participants and to produce more valid knowledge.

Adult↗
PubMed2005

Serious psychiatric symptoms after chloroquine treatment following experimental malaria infection.

OBJECTIVE: To report serious psychiatric symptoms after standard chloroquine treatment following human malaria infection induced for research. CASE SUMMARY: A 34-year-old healthy woman volunteered to participate in a study of malaria treatment. She was infected on day 0 with a chloroquine-susceptible strain of Plasmodium falciparum and was treated with a standard 3-day course of chloroquine from day 9 onward, following a positive blood smear (parasitemia 0.001%). On day 10, the blood smear became negative. On day 11, she developed a psychotic disorder not otherwise specified, most probably caused by chloroquine use, with symptoms of depersonalization and anxiety. The diagnosis of delirium was considered but ruled out because of clear consciousness with lack of diurnal fluctuations. She refused to take antipsychotic medication. Three weeks later, the woman still encountered serious concentration problems. All complaints gradually subsided over the next 4 months, after which she felt completely recovered. Plasma chloroquine concentrations were within the therapeutic range. DISCUSSION: Chloroquine may achieve high concentrations in the brain and has a long half-life. As quinolines, the antimalarials may have the same pathologic activity as the fluoroquinolone antibiotics in acting as N-methyl-d-aspartate agonists and gamma-aminobutyric acid antagonists. Application of the Naranjo probability scale indicated that, in this patient, chloroquine was the probable cause of the serious psychiatric symptoms. CONCLUSIONS: Our unique observation demonstrates that serious psychiatric symptoms can emerge as a rare occurrence during standard chloroquine therapy. This adverse effect may persist for several months.

Adult↗
PubMed2002

Psychometric validation of the State Scale of Dissociation (SSD).

Although dissociative phenomena are often transient features of mental states, existing measures of dissociation are designed to measure enduring traits. A new present-state self-report measure, sensitive to changes in dissociative states, was therefore developed and psychometrically validated. Fifty-six items were formulated to measure state features, and sorted according to seven subscales: derealization, depersonalization, identity confusion, identity alteration, conversion, amnesia and hypermnesia. The State Scale of Dissociation (SSD) was administered with other psychiatric scales (DES, BDI, BAI, SCI-PANSS) to 130 participants with DSM-IV major depressive disorder schizophrenia, alcohol withdrawal, dissociative disorders and controls. In these sample populations, the SSD was demonstrated as a valid and reliable measure of changes in and the severity of dissociative states. Discriminant validity, content, concurrent, predictive, internal criterion-related, internal construct and convergent validities, and internal consistency and split-half reliability were confirmed statistically. Clinical observations of dissociative states, and their comorbidity with symptoms of depression and psychotic illness, were confirmed empirically. The SSD, an acceptable, valid and reliable scale measuring state features of dissociation at the time of completion, was obtained. This is a prerequisite for further investigation of correlations between changes in dissociative states and concurrent physiological parameters.

Adult↗
PubMed2004

The paradox of "detachment disorders": binding-disruptions of dissociative process.

This case is discussed in the contexts of affect theory, attachment theory, and dissociative experience. Dissociative adaptations to living that become entrenched resistances during psychotherapeutic inquiry give way to a scrupulous attention to the characteristics of dissociative experiencing. Somatosensory free association and appreciation of experiential aspects of depersonalization, derealization, and dissociative amnesia open new areas of negotiation between patient and therapist. Paradigms from infant attachment and adult attachment research parsimoniously explicate psychodynamic formulations. "Conflicted interest" and "conflicted disinterest" are proposed to flesh out appreciation of the child's inner experience during Type A and Type C attachment experiences. The Type D attachment style is consistent with a dissociative phenotype. The concept of "isolated subjectivity" can help explain the extent to which individuals both know and don't know about their experience, in the same moment, and without conscious conflict or anxiety.

Affect↗
PubMed2000

W.H.R. Rivers Graduate Prize Essay (1996). "Imperfect angels" : narrative "emplotment" in the medical management of children with craniofacial anomalies.

This article uses the paradigm of "therapeutic emplotment" to investigate the medical management of children with facial disfigurements at a craniofacial anomalies center in Northern California. Data are observations of, and semistructured interviews with, plastic surgeons, nurses, geneticists, orthodontists, and other medical professionals who composed the craniofacial anomalies team. Team members perceived that children feel socially stigmatized by their disfigurements. These medical professionals adjusted their own behavior according to these perceptions. They "emplotted" their actions, using the theme that disfigured children are attractive and worthy of attention and affection. Medical professionals attempted to depersonalize and neutralize the symbolically loaded disfigurements through the use of clinical language in an attempt to "separate" the child from his or her facial anomaly. The range of styles and approaches to interaction was diverse and varied in effectiveness, suggesting that some medical professionals were more skilled at emplotment than others.

Anthropology↗
PubMed2002

Acute psychotic disorders induced by topiramate: report of two cases.

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

Acute Disease↗