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PubMed2004

[The manner of care, self care and quality of life dialysis patients].

BACKGROUND: The aim of this cross-sectional study was to describe specific strategies used by ESRD patients to manage their illness on their own behalf in order to attain their health goals, promote personal development and well-being. METHODS: A representative sample of 178 patients on dialysis of the Swiss German-speaking population was selected. The participants were treated in-centre on hemodialysis (HD) or had ambulatory peritoneal dialysis (CAPD). Data collection procedure for specific self-care activities was structured interviews. Self-care capabilities were measured with the ASA-scale and well-being was rated on the Cantril's ladder. RESULTS: Both patient groups were comparable on demographics, severity of illness except for dialysis duration, social support and general self-care capabilities. Both patient groups scored their subjective well-being 7 or higher on a scale of 10. There was a significant positive correlation between amount of dialysis self-care and subjective well-being. There was no difference in effectiveness of dialysis self-care between in-centre HD and CAPD patients. CONCLUSION: The results demonstrate that patients in this study perform a substantial amount of self-care and perceive their subjective well-being as good. These findings indicate that treatment modalities both of HD and CAPD provide equal opportunities for quality of life if patient selection is based on history of renal disease, available social support and self-care capabilities.

Adaptation, Psychological↗
PubMed2001

Psychological impact of liver transplantation on children's inner worlds.

We carried out an in-depth evaluation of psychosocial status in a sample of 18 children (mean age 6.8 yr, range 4.4-10.8 yr) who had suffered from severe liver disease and undergone orthotopic liver transplantation (OLT). Mean age at OLT was 3.4 yr. The assessment was psychoanalytically oriented and included individual sessions and testing procedures for children--the Children Apperception Test (CAT), the Weschsler Intelligence Scale for Children (WISC-R), the Weschsler Preschool and Primary Scale of Intelligence (WIPPSI), and the Human Figure Test--and a semi-structured interview with a separate questionnaire for parents. Patients were compared with an age- and gender-matched control group. The main findings in patients compared with controls were: IQ 91.6 (range 70-117) vs. 118 (range 94-135) (p<0.0001); immaturity of ego and drives (72.2% vs. 27.7%; p=0.018), fear of death (61.1% vs. 11.1%; p=0.04), anxiety of loss (50%, vs. 27.7%; p=NS), and depressive feelings (61.1% vs. 22.2%; p=0.04); a mild defect of body image (44.4% vs. 33.3%; p=NS) associated with recurrent representations of motionless (72.2% vs. 38.8%; p=NS) and inexpressive (88.8% vs. 16.6%; p<0.0001) human figures. Fantasies about OLT as a 'magic rebirth' or a 'body transformation' were detected in few patients (30%). Although a recurrent set of feelings, conflicts, and fantasies about OLT were expressed by children, individual specific psychological responses to this experience were often detected. In spite of the fact that approximately 50% of the parents mentioned emotional or behavioral disturbances of their child, only three parents were seriously concerned about this problem. The theme of transplantation was most often absent from communication between the child and their parents. Our results suggest that psychic 'working through' of the chronic liver disease and OLT experience is difficult for children. Further studies are necessary to verify whether changes of parental attitude to OLT as a 'family secret' may facilitate integration of the OLT experience in the child's personality development.

Affective Symptoms↗
PubMed1997

Mothers' and toddlers' coordinated joint focus of attention: variations with maternal dysphoric symptoms.

This investigation compared the attention patterns of 40 toddlers and their mothers with or without dysphoric symptoms in a situation that allowed both common and independent foci of attention. Mother-toddler dyads with a dysphoric mother spent a smaller proportion of the session engaged in attention to an activity in common than did dyads with nondysphoric mothers. In addition, even when primarily attending elsewhere, nondysphoric mothers more extensively time-shared their attention between their child and a competing activity than did dysphoric mothers. Thus, dysphoric mothers appear to attend to an event in common with their children less frequently than do nondysphoric mothers in terms of both their primary focus of attention and their attentiveness to the child when primarily attending to a competing event.

Adult↗
PubMed1992

Clinical correlates of anhedonia and perceptual aberration in first-episode patients with schizophrenia and affective disorder.

We examined the association between scales measuring physical anhedonia, social anhedonia, and perceptual aberration and premorbid functioning, clinical state, and current level of adjustment in 91 psychotic subjects. The patients were examined at the onset of their first psychotic episode and again 18 months later. For patients with schizophrenia, anhedonia was significantly related to premorbid functioning. No association was found between the scales and clinical state or level of adjustment at intake or follow-up. In affective disorder patients, no correlation was found between premorbid functioning (a stable characteristic) and scale scores, but moderately large correlations emerged between the scales and clinical state and level of adjustment at both assessment times. These results suggest that schizophrenic and affective disorder patients endorse items on these scales for different reasons. We hypothesize that for patients with schizophrenia, the scales assess enduring personality characteristics, whereas for the affective disorder patients, they assess clinical condition at the time of testing.

Adolescent↗
PubMed1992

Characteristics of the frequent nightmare sufferer.

Previous research has found that persons who experience frequent nightmares score highly on scales that measure psychotic symptomatology. Neurotic symptoms have also been implicated as correlates of nightmare frequency. In this study, 30 adult lifelong nightmare sufferers were compared with 30 control subjects, matched for age, sex, and socioeconomic status. Subjects were asked to record all dreams for 1 month and to complete the Minnesota Multiphasic Personality Inventory (MMPI) and the Eysenck Personality Questionnaire (EPQ). Nightmare subjects scored significantly higher on the EPQ Neuroticism scale and on 8 MMPI clinical scales than did the control group. These scales also best discriminated between the groups in a direct discriminant analysis. The results are interpreted as a reflection of global maladjustment rather than of specific psychotic symptomatology.

Adolescent↗
PubMed1992

Ambivalence and defense: effects of a repressive style on normal adolescents' and young adults' mixed feelings.

Ambivalence has been associated in theoretical works with psychopathology and with defenses against conflict. Ambivalence was operationalized as mixed feelings. Seventy-five 9th graders (27 boys and 48 girls), 50 12th graders (19 men and 31 women), and 80 Yale University undergraduates (38 men and 42 women) completed questionnaires assessing ambivalence, psychopathological symptoms, and repressive and nonrepressive styles. Compared with nonrepressive subjects, repressive subjects at all grade levels reported lower levels of mixed feelings and relatively less uncertainty about their feelings. Whereas the absence of felt anxiety was sufficient for lower self-reported psychopathological symptoms, a repressive style was necessary for lower self-reported ambivalence.

Adolescent↗
PubMed1992

Relations among self-reported depressive symptoms in clinic-referred children versus adolescents.

Although there is consensus regarding the existence of childhood depression, disagreement remains as to whether symptoms are developmentally isomorphic. Previous studies focused on developmental differences in symptom levels; analyses of relations among symptoms may be more appropriate, however. Here both approaches were used to compare the Children's Depression Inventory responses from 1,030 clinic-referred children and adolescents. Four of nine symptom categories showed significant developmental differences in their correlations with total score. Externalizing behavior and guilt were more strongly related to depression in children than adolescents; affective symptoms and concerns about the future showed the reverse pattern. Results illustrate the importance of considering relations among symptoms as well as differences in symptom levels when evaluating theoretical claims about developmental differences in the nature of clinical syndromes.

Adolescent↗
PubMed1992

Dissociative experiences, psychopathology and adjustment, and child and adolescent maltreatment in female college students.

Thirty-three female college students who scored in the upper 15% on the Dissociative Experiences Scale (DES) were compared with 33 female students who scored below the mean on the DES on measures of psychopathology (Symptom Checklist-90), college adjustment (Student Adaptation to College Questionnaire), and child and adolescent maltreatment. Compared with controls, high-DES subjects reported more psychopathology, poorer college adjustment, and a greater extent of psychological, physical, and sexual maltreatment. On the basis of the Dissociative Disorders Interview Schedule, 2 high-DES subjects but none of the control subjects met criteria for a dissociative disorder (i.e., multiple personality and psychogenic amnesia). Despite the sensitivity of the DES, 8 subjects who scored in the upper 2% of the population on the DES failed to meet criteria for a dissociative disorder.

Adaptation, Psychological↗
PubMed1993

Dimensions of perfectionism, daily stress, and depression: a test of the specific vulnerability hypothesis.

We tested whether perfectionism dimensions interact with specific stressors to predict depression. A depressed patient sample (N = 51) and a general psychiatric sample (N = 94) completed measures of perfectionism, hassles, and depression. Subjects in Sample 2 also completed other personality measures to assess the amount of unique variance in depression. Partial support was obtained in that in both samples self-oriented perfectionism interacted only with achievement stressors to predict depression. Socially prescribed perfectionism interacted with interpersonal stress in Sample 1 and with achievement stress in Sample 2 to predict depression. Several personality variables, including socially prescribed perfectionism, accounted for unique variance in depression. The results suggest that perfectionism dimensions are associated with depression and may constitute specific vulnerability factors.

Achievement↗
PubMed1993

Control-related beliefs and self-reported depressive symptoms in late childhood.

Research thus far links depressive symptoms in children to one type of control-related belief: low levels of perceived personal competence. However, child research, unlike adult research, has not supported a linkage between depressive symptoms and another theoretically important control-related belief: perceived noncontingency of outcomes. Here we reexamined the issue, adjusting for limitations in previous methodology by using (a) psychometrically stronger measures of control beliefs, and (b) a general population sample rather than children being treated in mental health clinics. In contrast to previous results, we found that both perceived incompetence and perceived noncontingency were strongly related to children's depression, together accounting for 40% of the variance in Child Depression Inventory scores. We also found, as in previous research, that depressive symptoms were correlated with uncertainty as to the causes of outcomes, especially successes. The findings suggest that children may be susceptible to both "personal helplessness" and "universal helplessness" forms of depression.

Child↗
PubMed1993

Self-esteem and vulnerability to depression: the concurrent validity of interview and questionnaire measures.

In a cross-sectional study of 146 women, we examined the association of M. Rosenberg's (1965) self-esteem questionnaire and the Self-Evaluation and Social Support Instrument (SESS), an interview measure of self-esteem, with two major risk factors for depression--early adversity and negativity in current close relationships. Although both measures were related to the risk factors, only the SESS accounted for unique variance when the two measures were considered together and current depression was controlled. The results suggest that the reason the SESS has previously been more effective in predicting depression (G. W. Brown, B. Andrews, T. O. Harris, Z. Adler, & L. Bridge, 1986) is because it taps specific areas of self-dissatisfaction in real-life situations and is therefore less vulnerable to mood-state effects than the more global questionnaire measure.

Adolescent↗
PubMed1993

Negative cognitions and attributional style in depressed adolescents: an examination of stability and specificity.

Despite recent findings that the prevalence of unipolar depression is as high in adolescents as it is in adults, relatively little is known about the applicability of cognitive theories of depression to adolescents. The present study examined the nature, specificity, and stability of cognitive dysfunction in male and female depressed, remitted, and psychiatric control adolescents. Factor analysis of a diverse set of measures yielded two factors, labelled Negative Cognitions and Attributional Style. Scores on both these factors were related to a current diagnosis of depression. Results also indicated that there may not be complete recovery of cognitive functioning (or of depressed mood) with diagnostic remission of depression. Finally, whereas elevated scores on the Negative Cognitions factor appeared to be specific to depression, the depressed and psychiatric control adolescents did not differ with respect to their scores on the Attributional Style factor.

Adolescent↗
PubMed1994

Culture, personality, and psychopathology.

Culture needs to be made more central to the understanding of personality and psychopathology. New anthropological views describe cultural influences on personality and psychopathology by focusing on the effect of social change in local contexts on sociosomatic and sociopsychological processes. This view discloses the cultural biases built into dominant North American professional models of diagnosis and contrasts with past uses of culture in cross-cultural research. Examples from Chinese and Puerto Rican societies illustrate how indigenous interpersonal models of personality and psychopathology that focus on social processes can augment the cross-cultural validity of clinical formulations.

Cross-Cultural Comparison↗
PubMed1996

Personality traits are differentially linked to mental disorders: a multitrait-multidiagnosis study of an adolescent birth cohort.

The authors assessed the relation between personality and mental disorder in a representative birth cohort of 897 men and women. Personality was assessed at age 18 with the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982), and 4 types of mental disorder (affective, anxiety, substance dependence, and conduct disorder) were assessed at ages 15, 18 and 21, using age-appropriate standardized diagnostic interviews. All disorder groups had MPQ profiles that were very different from those of controls. When comorbid cases were excluded, fewer significant differences between diagnosed cases and controls remained. Relations between personality and mental disorder were not affected by the measurement of disorder as continuous versus discrete, gender, or the age at which disorder was diagnosed. Relations between personality and mental disorders appear to be robust, and individual personality differences may be particularly relevant to understanding the most severe (comorbid) expressions of psychopathology.

Adolescent↗
PubMed1996

Heritability of MMPI personality indicators of psychopathology in twins reared apart.

This report presents Minnesota Multiphasic Personality Inventory (MMPI) findings from the Minnesota Study of Twins Reared Apart. Data from 65 unique pairs of monozygotic twins reared apart (MZA) and 54 unique pairs of dizygotic twins reared apart (DZA) were analyzed. As in other results from this sample, MZA twins evidenced substantial similarity, highlighting the influence of shared genes. Biometric modeling yielded estimates of heritability for the MMPI's standard validity and clinical scales and for the Wiggins content scales ranging from .26 to .62 (M = .44), echoing previous findings from the twin and adoption literature on personality. The pattern of MZA and DZA correlations suggested nonadditive genetic effects for 3 MMPI scales. Multivariate profile analyses also suggested genetic influence on both profile elevation and shape.

Adolescent↗
PubMed1996

Relation of depressive symptoms to the structure of self-knowledge in childhood.

Measures of positive, negative, and total self-complexity (or self-concept differentiation), self-compartmentalization, self-reported negative events, and self-reported symptoms of depression, anxiety, and conduct disorder were completed by 4th-, 6th-, and 8th-grade public school students. Measures of self-complexity and self-compartmentalization related positively to depression. Results were consistent across grade level. Controlling for anxiety and conduct disorder did not attenuate these effects. Results for positive and negative self-complexity were essentially equivalent to those for total self-complexity. Interactions between self-complexity and negative event and between self-compartmentalization and differential importance were not significant. The authors propose that self-complexity in childhood constitutes a response to negative self-relevant information sometimes conveyed by negative events. The authors conjecture that self-complexity does not buffer the impact of negative events in childhood but may serve as a buffer later in life.

Adolescent↗