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PubMed1999

[Acute peri-traumatic dissociative experiences: assessment and course].

Previous research has identified acute stress symptoms, particularly peri-traumatic dissociative symptoms (the distortion of consciousness, depersonalization, derealization, automatic movements, flashbacks with illusions or hallucinations), as risk factors for the development of later posttraumatic stress disorder. Numerous retrospective assessments and current prospective studies confirm these findings. It is suggested that peri-traumatic dissociation be assessed immediately after traumatic exposure and during the weeks following. But traumatized victims may present other categories of acute reactions; panic attacks, acute depression, conversion reaction, excessive emotional expression, and psychotic reactions. Brief reactive psychosis is a major differential diagnosis with peri-traumatic dissociative experiences. During emergency interventions it may be difficult to distinguish between dissociative and psychotic symptoms. It is cautioned that these disorders be evaluated with a follow-up of several months.

Depression↗
PubMed1999

[Biological approaches to acute psychoses].

According to the ICD 10 only acute psychotic disorders and transitory acute disorders are specified, whereas DSM IV index, in the same class, schizophreniform disorder, schizoaffectif disorder and atypical psychosis. State biological markers of these disorders are present during the acute episode and disappear with it. A few studies concerns trait predispositional markers of these acute psychotic disorders. In addition, several studies of acute psychotic states are indexed as a partition of usual schizophrenic disorder, as a simple occurrence of that chronic disease. From the biological point of view, dysfunctions of norepinephrine and dopaminergic metabolisms are reported within these acute schizophrenic disorganisation, especially hyperdopaminergia, causality, consequence or evidence of the state syndrome. Those kinds of data are also reported in mood disorder with delusional symptoms. A hypothetic dysregulation of the balance between oxydation and antioxydation system has been searched in these acute states of schizophrenia. From the electrophysiologic perspective, no abnormalities are found for ocular movement functions during these acute psychotic disorders. Besides the clouding of consciousness of confusional states, neuropsychological abnormalities are reported: attention disorders, lack of inhibition of non relevant informations, abnormalities of working memory. Brain imaging can substantiate a diminution of the caudate nucleus size and a possible increase of D2 receptors number. Also, in these acute psychotic states abnormalities of humoral and cellular immunologic system have been found. Lastly, street drugs can originate confusional states and depersonalization, through their serotoninergic, dopaminergic and anticholinergic properties. Ethical drugs can also create an acute psychosis disorder: individual vulnerability and somatic disease cooccurrence act as risk-factors.

Acute Disease↗
PubMed1999

A study of the consistency of burnout over time.

Burnout over time in teachers in examined in this study using the three subscales of the Maslach Burnout Inventory, Emotional Exhaustion, Depersonalization, and Lack of Personal Accomplishment. Measures were obtained twice, one year apart. LISREL structural equation analysis was used to test a model which predicted specified relationships among burnout components from time one to time two. Results showed that burnout components were consistent over time. Additional data suggest that one of the burnout components, emotional exhaustion, is a mediator between environmental demands and other burnout components.

Burnout, Professional↗
PubMed1976

Emotional response to intravenous delta9tetrahydrocannabinol during oral surgery.

The administration of delta9THC intravenously as a premedicant to oral surgery resulted in acute pronounced elevations in anxiety states, a predominance of dysphoria over euphoria, and varying degrees of psychotic-like paranoiac thought. Neural effects that appeared to promote these effects included distortions of perception with sensory delusions, and heightened sensory receptiveness including antalgesic impressions of surgery; autonomic and visceral arousal greater than control or placebo levels; lack of overt behavioral signals of distress due to depersonalization; and time disintegration leading to fear-inducing misinformation about real surgical events. Introverted subjects who generally were inclined to rely on drug solutions to their problems tended to respond poorly to surgical pain and anxiety with delta9THC. These results, obtained from subjects considered to have levels of presurgical apprehension that were average or below average, suggest that the environment in which high doses of cannabinols are experienced is a potent factor in determining the quality of the emotional response. A surgical environment containing even the mild stress of outpatient oral surgery appears to have the potential to precipitate undesirable emotional responses among cannabinol-intoxicated patients. There is continued high-level social use of cannabinols inour society, with an estimate of 40% to 55% among the college-age group seen frequently by oral surgeons. Results of this study suggest that clinicians should be prepared to detect the subtle signs of marijuana intoxication to protect their patients from further psychophysiologic complications during surgery.

Adolescent↗
PubMed2000

Further support for the concept of a G-LOC syndrome: a survey of military high-performance aviators.

METHODS: Some 329 military high-performance pilots were anonymously surveyed to determine the occurrence rates for a symptom complex of acceleration-induced neurologic manifestations. The premise for this symptom complex is the theory that acceleration-induced neurologic effects are not always an all-or-none phenomenon with G-LOC as the operational endpoint. RESULTS: A significant number of aircrew in selected types of aircraft reported symptoms such as euphoria, apathy, displacement, depersonalization, poor response to auditory stimuli, immediate memory difficulties, sensory abnormalities, motor abnormalities, confusion, and dream-like state without loss of consciousness. CONCLUSION: These findings may signal a need for alterations in G-awareness training.

Adult↗
PubMed2000

[The professional burnout syndrome in resident physicians in hospital medical specialties].

BACKGROUND: To evaluate the existence of burnout among medicine residents of hospitality specialties, and the relationship with sundry factors. METHODS: A transversal study was made among internal medicine residents of La Fe Hospital with more than one year in their job. For this purpose two questionnaires were used: a) the Maslach Burnout Inventory and a general questionnaire about social, demographic, residency, laborer and economic factors. RESULTS: Fifty-six (81.1%) internal medicine residents participated. Comparing with Spanish sample established with medical specialists, we found 7.1% or the residents with high scores on emotional exhaustion, while 17.8% scored high on depersonalization and 23.2% scored low on personal accomplishment. But the levels were lower on residents sample than in the medical specialties sample. Factors associated with burnout were social and demographic compass (be single), like on residency compass (the chosen specialty was not the first option), like properly laborer (low laborer satisfaction, to feel low recognition from boss or patients). We didn't find relationship with economic factors. CONCLUSIONS: There are hospitality internal medicine residents who suffer burnout and exist relationship with social, demographic, residency and laborer factors.

Adult↗
PubMed2000

Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction.

BACKGROUND: Cancer Care Ontario's Systemic Therapy Task Force recently reviewed the medical oncology system in the province. There has been growing concern about anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their work hours. However, no research has systematically determined whether there is evidence to support or refute these reports. To this end, a confidential survey was undertaken. METHODS: A questionnaire was mailed to all 1016 personnel of the major providers of medical oncology services in Ontario. The questionnaire consisted of the Maslach Burnout Inventory, the 12-item General Health Questionnaire, a questionnaire to determine job satisfaction and stress, and questions to obtain demographic characteristics and to measure the staff's consideration of alternative work situations. RESULTS: The overall response rate was 70.9% (681 of 961 eligible subjects): by group it was 63.3% (131/207) for physicians, 80.9% (314/388) for allied health professionals and 64.5% (236/366) for support staff. The prevalence of emotional exhaustion were significantly higher among the physicians (53.3%) than among the allied health professionals (37.1%) and the support staff (30.5%) (p < or = 0.003); the same was true for feelings of depersonalization (22.1% v. 4.3% and 5.5% respectively) (p < or = 0.003). Feelings of low personal accomplishment were significantly higher among physicians (48.4%) and allied health professionals (54.0%) than among support staff (31.4%) (p < or = 0.002). About one-third of the respondents in each group reported that they have considered leaving for a job outside the cancer care system. Significantly more physicians (42.6%) than allied health professionals (7.6%) or support staff (4.5%) stated that they have considered leaving for a job outside the province. INTERPRETATION: The findings support the concern that medical oncology personnel are experiencing burnout and high levels of stress and that large numbers are considering leaving or decreasing their work hours. This is an important finding for the cancer care system, where highly trained and experienced health care workers are already in short supply.

Burnout, Professional↗
PubMed2000

[Burnout among Spanish pediatricians specialized in intensive care].

BACKGROUND: The burnout syndrome is characterized by emotional exhaustion, depersonalization and decrease or loss of the feeling of personal accomplishment. It is frequent in the helping professions where an intense involvement with people needing assistance occurs. In its origin, the work policy factors seem to be important. METHODS: 68 pediatric intensive care physicians of the Intensive Care Section of the Spanish Pediatric Association participate in the study. A general questionnaire and a Spanish version of the Maslach Burnout Inventory was used. The statistical analysis includes: a descriptive analysis, the Student t-test, and the analysis of the variance. RESULTS: Burnout scores were in the average range (41,9 +/- 7,5), with a more important grade in the decrease of personal accomplishment dimension (18,9 +/- 3,5). The 55,9% of the responders attributed to the conflict with the managing policy, their work unsatisfaction and the 58,8% planned to leave the job in the future. CONCLUSIONS: The importance of burnout and its three dimensions in the health professions and in the hospital setting is stated. It is enhanced that even though the burnout scores were in the average range more than half of the population studied were considering to leave their work in the future.

Adult↗
PubMed1999

The impact of market-based 'reform' on cultural values in health care.

The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks. Just what form their involvement ought to take is being tested as "managed care" attempts to control the costs. What limits are acceptable to providers?: lower profit margins? quality controls? acceptable risk levels? To patients?: restricted choice? restricted mobility? restricted access to high tech? And to the general public?: decreased access to high tech? higher taxes? underserved populations? Abandonment of the sick or poor? Which "techniques" are acceptable, and which are not?: risk-sharing with providers? financial incentives for decision makers? rationing access? imposing behavioral parameters? The issues posed by market-based managed care cannot be adequately addressed merely in terms of social resources, nor will answers be found in subordinating human rights to practical materialism. Negotiating ethical guidelines for the "safe" handling of such problems to the good of individuals and of society requires a revitalization of the "old" values: the old commitment to master craftsmanship and altruism, the old emphasis on patient advocacy and human rights. However, these old values must be applied with the "new" knowledge of lifestyle choices (and thus personal responsibility), likely outcomes (and thus reasonable options), and the limits of success (and thus fair redeployment of health resources).

Attitude to Health↗
PubMed2000

Burnout: caring for the caregivers.

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Burnout describes the end result of stress in the professional life of a physician or caregiver and combines emotional exhaustion, depersonalization and low personal accomplishment. This problem is common in health care workers in every specialty and may affect not only personal satisfaction, but also the quality of care delivered to patients. Burnout is particularly relevant in oncology where caregivers work closely with patients who have life-threatening illnesses and therapy often has only a limited impact. Burnout was discussed in the rounds with an emphasis on factors which precipitate or prevent stress among health care workers. Presentations were made by Dr. Canellos of the Dana Farber Cancer Institute, and Dr. Picard of the Institute for Health Professions. Staff discussed the main issues contributing to burnout including the health care system, lack of time and inadequate training. They considered preventative measures including psychological support of the health care team, communication and management skills, and effective coping mechanisms.

Adaptation, Psychological↗
PubMedDate not supplied

Job stress and burnout among Canadian managers and nurses: an empirical examination.

This study examined the relationship of job stress with burnout and its three dimensions (emotional exhaustion, lack of accomplishment and depersonalization), job satisfaction, organizational commitment and psychosomatic health problems. Data were collected by means of a structured questionnaire from Canadian managers (N = 67) and nurses (N = 173). Pearson correlation and moderated multiple regression were used to analyze the data. Job stress was significantly correlated with overall burnout and its three dimensions and job satisfaction in both samples. In the nursing sample, job stress was also significantly correlated with psychosomatic health problems and organizational commitment. Moderated multiple regression only marginally supported the role of gender as a moderator of stress-burnout relationship.

Burnout, Professional↗
PubMed2000

[It is time to think about patient's rights. An introduction].

The underlying purpose of the Hippocratic oath and most medical ethics codes dictated during the twentieth century, is patient protection. Nowadays, however, clients of health services do not conform themselves with ethical declarations of the medical profession but demand that the rights that arise from those declarations, become legal instruments that force professionals, health authorities and governments to satisfy their health needs and respect their individual rights. Probably this is a consequence of the depersonalization of medical care, the weakening of ethical bases of physician-patient relationship and the emergence of new economical and social philosophies. Now, clients also have more expectations and a better knowledge about medicine than in yesteryears. Citizen organizations to defend health rights should not be seen as a threaten to medical profession and health institutions but as an opportunity to improve health care and respect towards people. They should not either harm the mutual confidence between the physician and his patient, nor the beneficial spirit of medical act, two fundamental components of medical acts.

Bioethics↗
PubMedDate not supplied

Gender differences in the etiology of anxiety sensitivity: a twin study.

OBJECTIVE: To estimate the magnitude of genetic and environmental factors on anxiety sensitivity by gender. DESIGN: Classic twins reared-together study design. PATIENTS: A community sample of 337 twin pairs, including 179 monozygotic (45 brother and 134 sister pairs) and 158 dizygotic (28 brother, 94 sister, and 36 brother-sister pairs). METHOD: Twin pairs completed the Anxiety Sensitivity Index (ASI) using a postal survey design. The ASI is composed of three factors: (1) fear of anxiety-related somatic sensations; (2) fear of cognitive dyscontrol due to beliefs that sensations like depersonalization are signs of mental illness (e.g., fear of concentration problems); and (3) fear of publicly observable anxiety reactions (e.g., fear of trembling). Biometrical modeling techniques were used to estimate heritability of the ASI dimensions by gender. RESULTS: ASI factors are heritable only in women, accounting for 37% to 48% of the total variance (median, 44.5%). Environmental factors accounted for all the variability in men. CONCLUSIONS: These findings have implications for understanding the etiology of panic disorder. Previous research suggests that anxiety sensitivity is a risk factor or diathesis for this disorder, and that panic disorder is more prevalent in women than men. Our findings suggest the hypothesis that the increased prevalence in women may occur because anxiety sensitivity is heritable in women.

Anxiety↗
PubMed2001

Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia.

OBJECTIVE: To determine the prevalence of depression and burnout among family physicians working in British Columbia's Northern and Isolation Allowance communities. Current level of satisfaction with work and intention to move were also investigated. DESIGN: Cross-sectional, mailed survey. SETTING: Family practices in rural communities eligible for British Columbia's Northern and Isolation Allowance. PARTICIPANTS: A random sample of family physicians practising in rural BC communities. Initial response rate was 66% (131/198 surveys returned); excluding physicians on leave and in temporary situations and those who received duplicate mailings gave a corrected response rate of 92% (131/142 surveys returned). MAIN OUTCOME MEASURES: Demographics; self-reported depression and burnout; Beck Depression Inventory and Maslach Burnout Inventory scores; job satisfaction; and intention to leave. RESULTS: Self-reported depression rate was 29%; the Beck Depression Inventory indicated 31% of physicians suffered from mild to severe depression. About 13% of physicians reported taking antidepressants in the past 5 years. Self-reported burnout rate was 55%; the Maslach Burnout Inventory showed that 80% of physicians suffered from moderate-to-severe emotional exhaustion, 61% suffered from moderate-to-severe depersonalization, and 44% had moderate-to-low feelings of personal accomplishment. Depression scores correlated with emotional exhaustion scores. More than half the respondents were considering relocation. CONCLUSION: Physicians working in these communities suffer from high levels of depression and very high levels of burnout and are dissatisfied with their current jobs. More than half are considering relocating. Intention to move is strongly associated with poor mental health.

Adult↗
PubMedDate not supplied

[Apropos of atypical melancholia with Sustiva (efavirenz)].

The treatment of HIV infection has changed dramatically in recent years as a result of the development of new drugs which allows a variety of multitherapy combinations more adapted to patients' needs and thereby improving compliance. Efavirenz is a non-nucleoside reverse transcriptase inhibitor. In addition to a potent antiretroviral activity, efavirenz is an easy-to-take drug with once-daily dosing and is usually well tolerated. Efavirenz, however, may induce psychic alterations which are variable and atypical in both their clinical presentation and severity. As early as the first days of treatment, efavirenz may provoke surprising phenomena such as nightmares, vivid dreams, hallucinations or illusions, and twilight states. Depersonalization and derealization episodes, personality alterations, stream of thought troubles and unusual thought contents, atypical depression and cognitive disorders have also been observed. These phenomena may occur either early or later on treatment. The prevalence of severe psychic disorders is less than 5%, but they are often responsible for harmful treatment discontinuations. Psychiatric side effects are heterogeneous and probably not related to pre-existing psychologic weakness. We do not have enough data to evaluate these side effects and their etiopathogeny. The drug could act directly on the central nervous system since it crosses the blood-brain barrier, on the serotoninergic and dopaminergic systems. Some authors have compared efavirenz-induced psychic effects to those associated with LSD and found structural similarities between the two molecules. However, the heterogeneity and low prevalence of the psychiatric side effects of efavirenz suggest and individual sensitivity. In order to improve patient care, a better clinical approach, neuropsychological evaluation, and functional brain imagery should be used to progress in the analysis and comprehension of these disorders. We discuss in this paper the case of Mister H. This HIV-infected person presented with two severe melancholic episodes associated with marked cognitive disorders which resisted two successive antidepressant treatments (viloxazine and citalopram, respectively) prescribed at effective doses and for sufficient time duration. Mister H. had no personal or family psychiatric antecedent. His psychic condition improved only when efavirenz was discontinued. However, drug discontinuation may not be an obligatory step to improve the patient's condition since antidepressant treatment has been found effective in some similar situations. Actually, each case should be discussed with the clinicians taking care of the patient.

Alkynes↗
PubMed2001

Medical migration.

The issue of professional migration, however emotional it may have become, ought not to be regarded in moralizing terms. The history of western medicine is the history of migrating physicians. A doctor who moves from a locality to another to take up a new assignment there cannot be said to have "abandoned his patients". This emotional bond has become the victim of specialization and of depersonalization of medical services and not of medical migration, brain drain or otherwise. The primary reason for medical migration is not financial; the desire to migrate usually begins with the desire to learn. Professionals crave in the first line for professional satisfaction. The migration of medical manpower cannot be stopped with administrative measures and will not be stopped by exhortations and appeals, moralization and condemnations. Brain drain is a global phenomenon and has always been so. A country which loses its professionals, its doctors, should examine the social relationships within the profession and should investigate whether the opportunities for deriving professional satisfaction from everyday work exist or whether these have been thwarted by the hierarchy, conservatism, cronyism and the general lack of comprehension of what good medical care is about.

Emigration and Immigration↗
PubMed1975

[Psychic alienation, a main link in the formation of the psychopathology of schizophrenia].

The psychopathological basis of schizophrenia is psychic alienation which is understood as a complex of interrelated syndromes of psychosensory pathology, phobic obsessions, forcible states, depersonalization, psychic automatism and halluconatory-delusional disorders. Manifestations of psychic alienation in the premorbid period, in the initial stage and in the psychotic stage are considered, as well as the genesis and significance of psychic alienation.

Automatism↗
PubMed2001

[Sense of personal control and the level of occupational stress and related effects].

There is opinion that the sense of personal control at workplace is an important factor determining the occupational stress and related effects. The group of 160 policemen were studied to verify empirically the above-mentioned opinion. The subjects assessed their level of sense of personal control, occupational stress, burnout and mental health. Statistical analysis revealed following significant correlation coefficients between the sense of personal control and stress (r = -0.33); job satisfaction (r = -0.44); emotional exhaustion (r = -0.28); depersonalization (r = -0.26); and feeling of personal accomplishment (r = -0.25); total score in GHQ-28 (r = -0.16). The results of the study let us draw a practical conclusion. In order to diminish the level of job stress it is required to introduce proper organizational changes enhancing the sense of personal control among workers.

Adult↗