We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotional-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measure coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies.

Assessing Coping Strategies: A Theoretically Based Approach

Objective To develop and validate a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings. Design Prospective validation study. Setting Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University (site 1) and in general medicine wards at the University of Chicago (site 2). Patients The study included 56 subjects, ranging in age from 65 to 98 years. At site 1, 10 patients with and 20 without delirium participated; at site 2, 16 patients with and 10 without delirium participated. Measurements and main results An expert panel developed the CAM through a consensus building process. The CAM instrument, which can be completed in less than 5 minutes, consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). An a priori hypothesis was established for the diagnostic value of four criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion. At both sites, the diagnoses made by the CAM were concurrently validated against the diagnoses made by psychiatrists. At sites 1 and 2 values for sensitivity were 100% and 94%, respectively; values for specificity were 95% and 90%; values for positive predictive accuracy were 91% and 94%; and values for negative predictive accuracy were 100% and 90%. The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium. The CAM was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination. The interobserver reliability of the CAM was high (kappa = 0.81 - 1.0). Conclusions The CAM is sensitive, specific, reliable, and easy to use for identification of delirium.

Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such con- cepts is described and illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capa- ble of translating concepts from cultural anthropology into clinical language for practical application. The implemen- tation of this approach in medical teaching and practice requires more support, both curricular and financial.

https://focus.psychiatryonline.org/doi/pdf/10.1176/foc.4.1.140

Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research

Context.—Research both in the United States and abroad suggests that significant
numbers of people are involved with various forms of alternative medicine.
However, the reasons for such use are, at present, poorly understood.Objective.—To investigate possible predictors of alternative health care use.Methods.—Three primary hypotheses were tested. People seek out these alternatives
because (1) they are dissatisfied in some way with conventional treatment;
(2) they see alternative treatments as offering more personal autonomy and
control over health care decisions; and (3) the alternatives are seen as more
compatible with the patients' values, worldview, or beliefs regarding the
nature and meaning of health and illness. Additional predictor variables explored
included demographics and health status.Design.—A written survey examining use of alternative health care, health status,
values, and attitudes toward conventional medicine. Multiple logistic regression
analyses were used in an effort to identify predictors of alternative health
care use.Setting and Participants.—A total of 1035 individuals randomly selected from a panel who had agreed
to participate in mail surveys and who live throughout the United States.Main Outcome Measure.—Use of alternative medicine within the previous year.Results.—The response rate was 69%.The following variables emerged as predictors
of alternative health care use: more education (odds ratio [OR], 1.2; 95%
confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI,
1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having
had a transformational experience that changed the person's worldview (OR,
1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR,
3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain
(OR, 2.0; 95% CI, 1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5);
and classification in a cultural group identifiable by their commitment to
environmentalism, commitment to feminism, and interest in spirituality and
personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with
conventional medicine did not predict use of alternative medicine. Only 4.4%
of those surveyed reported relying primarily on alternative therapies.Conclusion.—Along with being more educated and reporting poorer health status, the
majority of alternative medicine users appear to be doing so not so much as
a result of being dissatisfied with conventional medicine but largely because
they find these health care alternatives to be more congruent with their own
values, beliefs, and philosophical orientations toward health and life.

https://jamanetwork.com/journals/jama/articlepdf/187543/JOC71141.pdf

Why patients use alternative medicine : results of a national study

Sidney C. Smith, Jr, MD, FACC, FAHA, FESC, Chair; Alice K. Jacobs, MD, FACC, FAHA, Vice-Chair; Cynthia D. Adams, MSN, APRN-BC, FAHA; Jeffery L. Anderson, MD, FACC, FAHA; Elliott M. Antman, MD, FACC, FAHA[‡][1]; Jonathan L. Halperin, MD, FACC, FAHA; Sharon Ann Hunt, MD, FACC, FAHA; Rick Nishimura,

/pdf/acc-aha-esc-2006-guidelines-for-the-management-of-patients-5fc8py53ut.pdf

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society

Somatization, a tendency to experience and communicate somatic distress in response to psychosocial stress and to seek medical help for it, poses a major medical, social, and economic problem. It is most often associated with depressive and anxiety disorders and constitutes the core of somatoform disorders. Its persistent form is especially costly and difficult to prevent and manage. The author discusses the prevalence, clinical manifestations, etiology, and treatment of somatization and presents a critical review of somatoform disorders.

Somatization: the concept and its clinical application.

Letter: Psychosomatic medicine.

Delirium (acute confusional states), a common and often overlooked psychiatric disorder, can occur at any age, but elderly persons are especially prone to develop it. In later life, it is often a conspicuous feature of systemic or cerebral disease and drug (notably anticholinergic) toxicity, and it may constitute a grave prognostic sign. Its development in a hospitalized patient may interfere with his or her management, disrupt ward routine, and cause medicolegal complications as a result of patient injury. Acute onset of a fluctuating level of awareness, accompanied by sleep-wake cycle disruption, lethargy or agitation, and nocturnal worsening of symptoms, are diagnostic. Early recognition of delirium and treatment of its underlying cause are essential. ( JAMA 1987;258:1789-1792)

https://jamanetwork.com/journals/jama/articlepdf/368487/jama_258_13_041.pdf

Delirium: Acute Confusional States

TRANSIENT global disorders of cognition and attention, usually referred to as delirium or acute confusional states, are one of the most common and important forms of psychopathology in later life.1 2 3 4 5 6 Hodkinson has stated, "Acute mental confusion as a presenting symptom holds a central position in the medicine of old age. Its importance cannot be overemphasized, for acute confusion is a far more common herald of the onset of physical illness in an older person than are, for example, fever, pain or tachycardia."7 The elderly, especially the very old, are uniquely prone to delirium as a consequence of almost any physical . . .

Delirium in the elderly patient.

Growing interest in the psychological and social aspects of physical illness and disability has extended to all facets of the behavior of patients. The ways in which people cope with the stress and challenges of disease is the subject of this paper. The writer presents a tentative framework for conceptualization of this aspect of illness behavior. A brief discussion of the major determinants of coping is given. The latter include intrapersonal, disease-related and environmental variables. Coping behavior is a resultant of multiple factors reflecting a patient's specific dispositions as well as characteristics of his total situation during a given episode of illness and its different phases. The way in which the patient copes with his illness spells the difference between optimum recovery or psychological invalidism. It is the doctor's task to recognize his patient's mode of coping and help him employ the most adaptive and effective coping strategies.

Zbigniew J. Lipowski

Papers

Somatization: the concept and its clinical application.

Letter: Psychosomatic medicine.

Delirium: Acute Confusional States

Delirium in the elderly patient.

Physical illness, the individual and the coping processes.