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PubMedDate not supplied

Health care applications of complexity science. Life at the edge of chaos.

The authors explore complexity science, a relatively new field of inquiry, which holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches to health and medical care-both its provision and its organization. Two case studies are presented to illustrate how complexity theory can provide health care leaders with a new perspective on how to address the myriad challenges they confront daily: (1) a patient with dissociative identity disorder; and (2) a physician task group charged to advise on hospital medical staff reorganization and governance. These case studies help clinicians and leaders of health care organizations understand how complexity: (1) may be relevant, even helpful, as they consider difficult challenges in both patient and organizational management; and (2) might emerge as a synthesizing force as they face the extraordinarily complicated task of jointly creating integrated health care systems. A resource section is provided for those who may wish to further pursue the topic.

Adult↗
PubMed1989

Autoscopic phenomena with seizures.

We report the cases of 10 patients with seizures and autoscopic phenomena, which include seeing one's double and out-of-body experiences, and review 33 additional cases of autoscopic seizures from the literature. Autoscopic phenomena may be symptoms of simple partial, complex partial, or generalized tonoclonic seizures. Autoscopic seizures may be more common than is recognized; we found a 6.3% incidence in the patients we interviewed. The temporal lobe was involved in 18 (86%) of the 21 patients in whom the seizure focus could be identified. There was no clear lateralization of lesions in patients with ictal autoscopy. The response of autoscopic episodes to treatment usually paralleled that of the underlying seizure disorder. Autoscopic phenomena are likely to be discovered only on specific questioning of patients with epilepsy and may be an important, distressing feature of a chronic seizure disorder.

Adult↗
PubMed2001

Predictors of post-traumatic stress disorder following severe injury.

The chronicity and morbidity of established post-traumatic stress disorder (PTSD) has stimulated interest in recognizing and understanding the early development of the disorder. Acute stress disorder, a new diagnosis intended to facilitate early case detection, rests on the occurrence of dissociative reactions. It remains uncertain whether dissociation is a universal or unique early predictor of subsequent PTSD. Traumatic injury is an important and relatively understudied antecedent of PTSD. The objective of this study was to preliminarily identify which previously implicated early reactions and risk factors would apply to the prediction of PTSD following severe traumatic injury. Patients admitted to a regional Level I trauma center following life threatening events who had recall of the incident and did not have signs of traumatic brain injury or recent psychopathology were enrolled. Comprehensive assessments were conducted during hospitalization and after discharge approximately 2 months after the traumatic event. At follow-up, 24% of the available 50 subjects met full criteria for PTSD and an additional 22% met criteria for two of three symptom clusters. Early symptoms of heightened arousal and coping with disengagement were independent predictors of PTSD severity at follow-up. Relationships to initial dissociative reactions and a diagnosis of ASD were not significant. These early predictors found in a setting of severe injury only partially overlap findings from previous PTSD studies.

Adaptation, Psychological↗
PubMed1998

Clinical and polysomnographic features of sleep-related eating disorder.

BACKGROUND: Sleep-related eating disorder is a recently described clinical syndrome that combines characteristics of both eating and sleep disorders. Nocturnal partial arousals are followed by rapid ingestion of food and subsequent poor memory for the episode. Only two case series examining this disorder have been published, and both are from the same sleep disorders center in a general hospital. METHOD: The author describes 23 consecutive cases of sleep-related eating disorder that presented to the Sleep Disorders Center at McLean Hospital. All patients were administered at a standardized clinical sleep disorders evaluation followed by a semistructured interview to elicit information regarding characteristics of sleep-related eating disorder. Polysomnographic evaluation was performed on all patients with clinical histories of sleep-related eating disorder. RESULTS: Eighty-three percent (N = 19) of the 23 patients were female. For most of the patients, the disorder had begun in adolescence (mean +/- SD = 21.6 +/- 10.9 years) and had been chronic, with a mean duration of 15.8 +/- 11.2 years. Nearly all patients reported eating on a nightly basis (1-6 times per night), and all episodes followed a period of sleep. All patients described their eating as "out of control," and two thirds stated that they "binged" during the night. Over 90% (21/23) reported their state at the time of nocturnal eating as "half-awake, half-asleep" or "asleep", and over 90% reported "consistent" or "occasional" amnesia for the event. Nearly half (11/23) of the sample were given a polysomnographic diagnosis of somnambulism. Thirty-five percent (8/23) had a lifetime eating disorder diagnosis. CONCLUSION: Sleep-related eating disorder appears to be a relatively homogeneous syndrome combining features of somnambulism and daytime eating disorders. However, no current nosology accurately characterizes these patients. Physicians should be aware of the existence of the disorder and the value of referring patients with sleep-related eating disorder to a sleep disorders center.

Adult↗
PubMed1988

Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder.

Three patients with multiple personality disorder and three with obsessive-compulsive disorder were compared on a variety of self-report measures and on two structured interviews. Amytal Sodium interviews had been conducted on the obsessive patients; alter personality-like entities claiming responsibility for the obsessions and compulsions were contacted in two patients. The one obsessive patient with no alter personality differed markedly from the other five on the SCL-90, the Lynfield Inventory, and the Dissociative Experiences Scale. Structured interviews with the Anxiety Disorders Interview Schedule and the Dissociative Disorders Interview Schedule also clearly differentiated this patient from the other five. It appears that there is a phenomenological overlap between multiple personality disorder and some cases of obsessive-compulsive disorder. Obsessive patients with prominent dissociative features may be a psychologically and biologically distinct subgroup.

Adult↗
PubMed1989

Dissociated nystagmus as a common sign of ocular motor disorders in HIV-infected patients.

In order to determine if ocular motor disturbances due to brainstem and cerebellar dysfunction provide a frequent and early marker for HIV infection of the brain, neurological examination was performed in 133 HIV-infected persons who were consecutively admitted to our hospital. In 22 patients (17%) we found no other reason for cerebellar or pontomesencephalic signs than HIV encephalopathy. Ocular motor disorders accounted for the most frequent signs of cerebellar and pontomesencephalic dysfunction. Ocular motor disorders mainly consisted of dissociated nystagmus (n = 12), gaze-evoked nystagmus (n = 10) and impaired smooth pursuit (n = 6). Cerebellar ataxic gait and dysmetria were present in 3 patients. Since dissociated nystagmus was the primary ocular motor disorder, we assume that the medial longitudinal fasciculus may be a predilected circumscribed area for HIV infection of the brain. We suppose that cerebellar and pontomesencephalic disorders may be an early marker for HIV encephalopathy because they were the only neurological signs found in 12 patients.

AIDS Dementia Complex↗
PubMed1984

Multiple personality as a post-traumatic stress disorder.

This article examines multiple or dissociative personality syndrome as a multiple post-traumatic stress disorder, discussing these patient's developmental histories, their high hypnotizability, and their profound capacity to dissociate spontaneously to protect themselves from emotional and physical pain.

Adolescent↗
PubMed1996

Psychological responses to a marine disaster during a recoil phase: experiences from the Estonia shipwreck.

The sinking of the car ferry, Estonia, was one of the world's most devastating marine disasters that has ever occurred in peace time. Altogether 138 passengers and crew members were rescued, and 38 of them were taken to the Turku University Central Hospital in Finland. The present article describes the various psychological reactions among the survivors during the first three days of the recoil phase.

Adjustment Disorders↗
PubMed1999

Posttraumatic stress disorder: cerebellar regulation of psychological, interpersonal, and biological responses to trauma?

Alteration in the sense of time is the most commonly reported peritraumatic dissociative symptom. A case report of a trauma victim illustrates the posttraumatic alteration in the sense of time as well as loss of spatial memory. Recent studies of cerebellar function indicate the cerebellum may be critical to both spatial memory and the sense of time. Identifying regulators of psychological, interpersonal, and biological responses to traumatic events is important in advancing our understanding of the effects of trauma. The cerebellum may be part of the initial posttraumatic response.

Adaptation, Psychological↗
PubMed1996

Depression and dissociation as features of borderline personality disorder in hospitalized adolescents.

26 adolescents showing Borderline Personality Disorder were compared with 12 carrying other diagnoses to clarify associated features of these conditions. In line with recent literature, the borderline adolescents evidenced significant depression and dissociation, suggesting the importance of evaluating instability of mood (versus thinking) and weak continuity in self-experience when identifying and treating this disorder.

Adolescent↗
PubMed2001

Peritraumatic dissociation, acute stress, and early posttraumatic stress disorder in victims of general crime.

OBJECTIVE: To compare the relation between peritraumatic dissociation and acute stress and the early development of posttraumatic stress disorder (PTSD) in victims of general crime. METHOD: A total of 48 subjects were assessed within 24 hours of the trauma, using the Peritraumatic Dissociative Experiences Questionnaire Self-Report Version (PDEQ-SRV). They were followed longitudinally to assess acute stress (2 weeks after the assault,) using the Standford Acute Stress Reaction Questionnaire (SASRQ), and posttraumatic stress (at 5 weeks), using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES). RESULTS: Among PTSD subjects mean PDEQ scores were significantly higher (mean 3, SD 0.9) than in those without PTSD (mean 2.3, SD 0.7) (t = 2.78, df 46, P = 0.007). Among PTSD subjects, mean SASRQ scores were significantly higher (mean 97.9, SD 29.2) than in those without PTSD (mean 54.8, SD 28.2) (t = 4.9, df 46, P = 0.00007). CONCLUSIONS: High levels of peritraumatic dissociation and acute stress following violent assault are risk factors for early PTSD. Identifying acute reexperiencing can help the clinician identify subjects at highest risk.

Acute Disease↗