Showing papers by "David Spiegel published in 1991"

Disintegrated experience: the dissociative disorders revisited.

Abstract: We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: a blind comparison of DSM-III diagnoses.

Abstract: OBJECTIVE The major purpose of this study was to compare the frequency of the occurrence of DSM-III diagnoses in patients with primary fibromyalgia syndrome, patients with rheumatoid arthritis, and subjects without pain. METHOD Thirty-five patients with primary fibromyalgia, 33 patients with rheumatoid arthritis, and 31 nonpatients without pain were blindly assessed for psychiatric diagnoses with the Psychiatric Diagnostic Interview. RESULTS Data from this interview revealed no group differences in terms of lifetime history of any psychiatric disorders, including major depression, somatization disorder, or anxiety-based disorders. Analysis of the auxiliary symptoms of depression on the Psychiatric Diagnostic Interview revealed that the patients with fibromyalgia did not report a higher frequency of vegetative signs of depression. However, analysis of the somatization scale revealed an interaction between medical and psychiatric diagnoses: patients with primary fibromyalgia syndrome and a psychiatric history endorsed significantly more somatic symptoms than did patients with rheumatoid arthritis or subjects without pain, and fibromyalgia patients without a psychiatric history were no more likely to endorse somatic symptoms than were arthritis patients or subjects without pain. CONCLUSIONS The Psychiatric Diagnostic Interview data failed to discriminate in any major way between primary fibromyalgia syndrome (a disorder with no known organic etiology) and rheumatoid arthritis (a disorder with a known organic etiology). Therefore, these data do not support a psychopathology model as a primary explanation of the symptoms of primary fibromyalgia syndrome.

Determinants of survival and recovery in acute renal failure patients dialyzed in intensive-care units

Abstract: The survival rate of critically ill patients who develop acute renal failure is extremely low, in spite of the sophisticated support systems, including dialysis. Therefore, it would be advantageous to identify, early in the disease course, those few survivors. We reviewed the clinical course of 43 consecutive critically ill patients who developed acute renal failure and were first dialyzed in an intensive-care unit setting to define comorbid conditions, present at the time of first dialysis, that were predictive of outcome. Mortality rate was 88%. Adult respiratory distress syndrome (p less than 0.05), requirement for antibiotics (p less than 0.01) and ventilatory failure (p less than 0.01) impacted negatively on recovery of renal function. The most powerful predictor of mortality was the need for ventilatory support (p less than 0.001). The presence of ventilatory failure at the initiation of dialysis predicted a 100% mortality (89-100%; 95% confidence limits). The initiation of dialysis in intensive-care unit patients with acute renal failure requiring ventilatory support did not alter the uniformly fatal outcome.

Neurophysiological correlates of hypnosis and dissociation.

Abstract: One of the major advances in psychiatry in recent years, in my opinion, is the growing understanding of the psychopathological consequences of childhood trauma, especially sexual and physical abuse. Multiple personality disorder, for example, has a uniform association with these childhood antecedents. Is it then a retrograde step to look for cerebral dysfunction in dissociative states? Is hypnosis, as David Spiegel suggests in the article to follow, a window on brain processes, or is neuro physiology an escape hatch from uncomfortable psychological phenomena? The neuropsychiatric perspective holds that an integration of psychology and neurophysiology can occur only with adequate understanding in each sphere. As a neurophysiologic understanding of hypnosis and dissociation comes into being, we may be able to grasp the characteristic patterns of brain function that arise from particular life experiences. This is a distant but worthy goal. Dr. Spiegel, who is Professor of Psychiatry and Behavioral Sciences at Stanford, brings us a step closer to its attainment with this review of the neurophysiological correlates of hypnosis and dissociation, an area of inquiry to which he has made major contributions.

Physiologic and psychobehavioral research in oncology.

Abstract: A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

Air-exposed urine dipsticks give false-positive results for glucose and false-negative results for blood.

Abstract: Urine dipstick jars often are left uncapped, which led the authors to wonder what effect prolonged air exposure might have on dipstick accuracy. Unexpired Ames Multistixs (Miles Inc., Elkhart, IN) were exposed to ambient air for intervals of up to eight weeks and were used to test urine for the presence or absence of blood, protein, and glucose. Multistixs were read by a blinded participant. A urine sample reading negative for glucose with unexposed (control) Multistixs tested trace positive with three of three Multistixs exposed for 7 days, and 1+ (three of six) or trace positive (three of six) (P less than 0.05) with Multistixs exposed for 28 days. A urine sample reading 1+ for blood with controls tested negative with five of six (P less than 0.05) and six of six (P less than 0.05) Multistixs exposed for 28 and 56 days, respectively. Protein detection was accurate up to 56 days. The authors conclude that urine dipstick jars should be recapped to avoid prompting needless evaluations of glucosuria or delaying detection of important causes of microscopic hematuria.

Psychosocial aspects of cancer

Abstract: Psychological, psychiatric, and social variables are examined in relation to cancer onset and progression. Recent research indicates that effective coping is enhanced by a sense of control over the course but not the cause of the disease. Depression is unrelated to cancer incidence, except among smokers, but elevated among cancer patients. Anxiety predisposes to side effects, such as nausea and vomiting. Recent studies suggest that psychosocial intervention may extend survival time among cancer patients.

Second Thoughts on Personality, Stress, and Disease

Abstract: (1991). Second Thoughts on Personality, Stress, and Disease. Psychological Inquiry: Vol. 2, No. 3, pp. 266-268.