Showing papers in "International Journal of Psychiatry in Medicine in 1982"
TL;DR: A therapeutic approach is suggested that is aimed specifically at modifying the patient's faulty beliefs about her body while coping with her refractory self-misperceptions, with data indicating a relationship between self-overestimation, body satisfaction and self-esteem.
Abstract: Clinical manifestations of body image disturbance in anorexia nervosa are described including size misperceptions and faulty beliefs about shape. The empirical investigations of body image aberrations in anorexia nervosa are critically reviewed. Methodological issues such as reliability, validity subject selection and sources of experimental bias are discussed with recommendations for further research. Theoretical explanations for the mechanisms determining self-overestimation are presented with data indicating a relationship between self-overestimation, body satisfaction and self-esteem. Finally, a therapeutic approach is suggested that is aimed specifically at modifying the patient's faculty beliefs about her body while coping with her refractory self-misperceptions.
347 citations
TL;DR: Fifteen anorectic individuals were compared with a group of other psychiatric disorders with respect to the incidence of deviation in cognitive performance on a neuropsychological screening battery.
Abstract: Fifteen anorectic individuals were compared with a group of other psychiatric disorders with respect to the incidence of deviation in cognitive performance on a neuropsychological screening battery. A significant incidence of deviations in cognitive performance was found for the anorectic patients. The results are discussed in terms of possible neuropsychological implications that warrant future investigation.
72 citations
TL;DR: This manuscript reviews over 100 articles, papers, and books written between 1960 and 1980 on the psychossocial impact of cancer on the adult patient and on methods of psychosocial treatment providing a “state of the art” appraisal of the area.
Abstract: Up until several years ago, little systematic effort was directed at developing an empirically based understanding of issues pertinent to psychosocial aspects of living with cancer. Recently, howev...
71 citations
TL;DR: The authors suggest that a central (perhaps anticholinergic) mechanism of action is responsible for the therapeutic efficacy of amitriptyline in irritable bowel at dosages subtherapeutic with regard to depression.
Abstract: The therapeutic efficacy of amitriptyline in irritable bowel was studied in a cross-over double-blind trial, employing fourteen patients whose symptoms were rated as Class II or worse on an arbitrarily-defined interval scale and who had not benefited from previous trials of anticholinergics, anticholinergic-sedative combinations, and bulk-forming agents. During the study, patients rated their own symptoms and the interviewer rated their symptoms using the same scale. Average scores for the patients while on drug showed significant improvement compared to pre-test level. No placebo or drug carry-over effects could be demonstrated. Inasmuch as amitriptyline is effective in this context at dosages subtherapeutic with regard to depression, the authors suggest that a central (perhaps anticholinergic) mechanism of action is responsible.
64 citations
TL;DR: In abnormal normal weight control there is a strong and sometimes desperate hedonistic and extrovert element that will often not be denied so long as body weight does not get too low, and individuals nevertheless feel desperately ‘out of control’ and insecure beneath their bravura.
Abstract: Disgust with "fatness" and a consequent preoccupation with body weight, coupled with an inability to reduce it to or sustain it at the desired low level, characterizes the abnormal normal weight control syndrome. Individuals remain sexually active in a biological sense and often also socially. Indeed their sexual behaviour may be as impulse ridden as is their eating behaviour, which often comprises phases of massive bingeing coupled with vomiting and/or purgation. The syndrome is unlike frank anorexia nervosa in that the latter involves a regression to a position of phobic avoidance of normal body weight and consequent low body weight control with inhibition of both biological and social sexual activity. In abnormal normal weight control there is a strong and sometimes desperate hedonistic and extrovert element that will often not be denied so long as body weight does not get too low. Individuals nevertheless feel desperately "out of control" and insecure beneath their bravura. The syndrome is much more common in females than in males. There is a clinical overlap with anorexia nervosa and obesity in many cases as the disorder evolves. Depression, stealing, drug dependence (including alcohol) and acute self-poisoning and self-mutilation are common complications. Clinic cases probably only represent the tip of the iceberg of the much more widespread morbidity within the general population. Like anorexia nervosa and for the same reasons the disorder is probably more common than it used to be.
62 citations
TL;DR: Results from the Treatment Support Index indicate that a significantly greater percentage of Lodge residents than non-residents were satisfied with the quantity, quality, and/or diversity of support available to them.
Abstract: Sixty-four women undergoing radiotherapy for breast cancer in a residential setting which offered structured cognitive and emotional support, are compared for level of psychological distress and satisfaction with staff support with 104 women living at home during treatment. The outcome measures were the 30-item Goldberg General Health Questionnaire (GHQ) and a 5-item author-constructed Treatment Support Index. A surprisingly large percentage of the sample did not, at any time, manifest appreciable psychological distress. For those women whose level of distress changed by a GHQ score of 3 or more over the three week course of treatment, residence in the Lodge was associated with decreased risk of change for the worse, and increased probability of change for the better. Results from the Treatment Support Index indicate that a significantly greater percentage of Lodge residents than non-residents were satisfied with the quantity, quality, and/or diversity of support available to them.
52 citations
TL;DR: The general approach to the concept of adjustment is critically reviewed and its implications for research considered and a number of important selected factors are reviewed and conclusions in each of the areas are presented.
Abstract: The manner in which dialysis patients respond to the stress of chronic renal failure has been focused on in an active body of research. The general approach to the concept of adjustment is critically reviewed and its implications for research considered. A number of important selected factors are reviewed and conclusions in each of the areas are presented. Specific problems are defined and alternative approaches proposed.
46 citations
TL;DR: The salivary gland enlargement in patients with anorexia nervosa appears to be related to both the nutritional deficiencies and the bizarre eating habits characteristic of these patients.
Abstract: Enlargement of the salivary glands can occur in patients with anorexia nervosa (AN). This enlargement appears to be related to both the nutritional deficiencies and the bizarre eating habits (particularly the bulimia and vomiting) characteristic of these patients. In some patients, the salivary gland enlargement persists despite return to normal weight. Three patients illustrating this finding are described and the implications of this association between AN and salivary gland enlargement are discussed.
41 citations
TL;DR: It is concluded that psychological factors can influence the physiology of the disease and the synthesis of recent advances in basic metabolic, endocrinologic, and stress research, relevant to juvenile diabetes, into a psychophysiologic model is discussed.
Abstract: Diabetes Mellitus is the most common endocrine disease found in children, and its reported incidence is increasing. Most investigators now agree that improved diabetic control is effective in decreasing both long and short term complications. The delineation of factors which affect control are, therefore, of importance. Classically, the physician has emphasized insulin dose, presence of infection, diet, and exercise. Emotional factors have long been thought to play a role in diabetes mellitus. The exact nature of this role, however, has been rather elusive and controversial. The authors review this literature, summarize the major viewpoints, and conclude that psychological factors can influence the physiology of the disease.The focus of this paper is the synthesis of recent advances in basic metabolic, endocrinologic, and stress research, relevant to juvenile diabetes, into a psychophysiologic model. The authors discuss future research directions necessary for clarification of the model, as well as its ps...
28 citations
TL;DR: Self-reported health, symptoms, sexual activity, and psychosocial changes were found to form an inter-related cluster of outcome measures and poor recovery was predicted by self-reports of high trait anxiety while in hospital, and by manual occupation.
Abstract: Psychological tests were completed by myocardial infarct (MI) patients during their initial hospitalization, and further tests and a structured home interview occurred seven months later (N = 28). Self-reported health, symptoms, sexual activity, and psychosocial changes were found to form an inter-related cluster of outcome measures. Poor recovery was predicted by self-reports of high trait anxiety while in hospital, and by manual occupation. Poor recovery was also associated with in-hospital reports of dissatisfaction with work and few confiding relationships. The development of a brief pencil and paper screening instrument for MI patients in need of special rehabilitation support is discussed.
22 citations
TL;DR: The psychotherapeutic model proposed is useful in promoting more adaptive coping in the COPD patient and recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed.
Abstract: An etiology of maladaptive coping in Chronic Obstructive Pulmonary Disease is proposed and a model for psychotherapeutic intervention with poorly coping COPD patients is presented. Failure in mourning, manifested by a lack of shift in patient's expectations and goals leads to: 1) difficulty in accepting illness related feelings of loss; 2) chronic anxiety; 3) attribution of responsibility for feelings and behavior to external factors; and 4) poor compliance with medical regime. Recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed. Psychotherapeutic intervention aims at: 1) facilitating acceptance of losses and restructuring of life goals; 2) interrupting the cycle of alienation and social withdrawal; and 3) increasing patient's control over affective arousal and respiratory functioning. Utilization of supportive individual psychotherapy, family or marital therapy, and specific behavioral techniques is discussed. Family or marital therapy is seen as the treat...
TL;DR: Studies are reviewed that address the question of whether anorexia nervosa is associated with abnormalities in central nervous system catecholamine metabolism and the hypothesis that norepinephrine and dopamine metabolism are altered in this disorder.
Abstract: Studies are reviewed that address the question of whether anorexia nervosa is associated with abnormalities in central nervous system catecholamine metabolism. There is some support for the hypothesis that norepinephrine and dopamine metabolism are altered in this disorder.
TL;DR: Emphasis on the process and content of the emotional aspects of rehabilitation are presented as a process interwoven with a patient's physical rehabilitation.
Abstract: Emphasis on the process and content of the emotional aspects of rehabilitation are presented as a process interwoven with a patient's physical rehabilitation. The impact of trauma and subsequent re...
TL;DR: Two cases from an adolescent dialysis group are presented to illustrate the limitations of the generally used models of patient compliance and noncompliance with medical treatment.
Abstract: Two cases from an adolescent dialysis group are presented to illustrate the limitations of the generally used models of patient compliance and noncompliance with medical treatment. Understanding the noncompliance of these two young men required awareness of their psychological development and of the interpersonal matrix in which they lived. Their noncompliance was the result of a failure to master a transition from dependence to autonomy which probably could not have been predicted in advance, but which might have been detected as it developed and might have been avoided through appropriate interventions with the patients and their families.
TL;DR: The dysfunctional characteristics of anorexic families are described and two approaches to the treatment of these families, one developed by Minuchin and the other by Selvini Palazzoli are described.
Abstract: Family systems theory views anorexia nervosa not only as a product of dysfunctional transactional patterns within a family, but also as a crucial stabilizing element within the family. This paper describes the dysfunctional characteristics of anorexic families as well as the relevance of these characteristics to the anorexic symptoms. Two approaches to the treatment of these families, one developed by Minuchin and the other by Selvini Palazzoli, are described and the compatability of family therapy with individual therapy is briefly discussed.
TL;DR: An 80-item scale for measuring attitudes toward psychiatry in medicine was developed and tested, with consultation-liaison psychiatrists exhibiting the most favorable attitudes and highly specialized physicians showing the least.
Abstract: An 80-item scale for measuring attitudes toward psychiatry in medicine was developed and tested. Item selection from the initial 160 items was based on factor analysis and internal consistency of the eight resulting subscales, six subscales exhibiting Cronbach Alpha coefficients ranging from .79 to .95, with two showing coefficients of .57 and .59.The subscales were sensitive to differences in medical specialty, with consultation-liaison psychiatrists exhibiting the most favorable attitudes and highly specialized physicians showing the least. The subscales correlated significantly with subscales of the Zimny Medical Specialties Preference Inventory related to preference for psychosocial and non-specialized medical activities.
TL;DR: A literature review and clinical case presentation approach are employed to highlight unresolved diagnostic issues in Primary Anorexia Nervosa.
Abstract: A literature review and clinical case presentation approach are employed to highlight unresolved diagnostic issues in Primary Anorexia Nervosa. The material is examined and discussed along a multidimensional list of variables considered important for the diagnosis, including definitions of weight loss, associated biological symptoms, eating patterns and body image disturbances.
TL;DR: A taxonomy of the hidden agenda contained in consultation issues identified during the authors' two years experience with the Oncology Unit of a large Veterans Administration Medical Center is described.
Abstract: This article describes a taxonomy of the hidden agenda contained in consultation issues identified during the authors' two years experience with the Oncology Unit of a large Veterans Administration Medical Center. The authors found that in an overwhelming majority of cases the motivation for referral was overdetermined. Not infrequently it was found that the staff was in need of support, while patients worked out their own destiny. A framework for understanding the conceptual themes of the taxonomy is formulated in terms of general systems theory.
TL;DR: The psycho-physiological states that present clinically as psychiatric emergencies are discussed, and medical model differential diagnosis is discussed.
Abstract: Nowhere else in the discipline of Psychiatry is the use of medical model differential diagnosis more relevant than in the evaluation of the psychiatric emergency. This article discusses the psycho-physiological states that present clinically as psychiatric emergencies.
TL;DR: The number of life changes in the previous two years and the amount of adjustment required to cope with these changes, together with the social support available to help cope withThese events were the most powerful predictors of accident/error rate.
Abstract: A prospective study of accident/error rates was carried out on thirty-one nursing students. Recent life changes and stresses, social support available to cope with this stress, depression, illness rate, and coping skills were measured at baseline. Five weeks later students recorded accidents suffered and errors made over a week long period. The number of life changes in the previous two years and the amount of adjustment required to cope with these changes, together with the social support available to help cope with these events were the most powerful predictors of accident/error rate. Together they accounted for 70 per cent of the variance. Multiple regression equations for the outcome variables were calculated to study the best linear predictor combination. Depression and coping skills had poor predictor power. The implications of the findings for health care personnel are discussed. Steps to lower the accident/error rate in those at risk are outlined.
TL;DR: Philosophical and theological notions regarding food and eating are briefly reviewed, as is the history of anorexia nervosa.
Abstract: Philosophical and theological notions regarding food and eating are briefly reviewed, as is the history of anorexia nervosa. Modern studies of social, psychological, and biological aspects of anorexia nervosa have failed, as yet, to provide an organized, coherent understanding of the etiology of this disorder.
TL;DR: Studies of patterns of lutenizing hormone (LH) secretion in anorexia nervosa are reviewed and it is found that Restoration of ideal weight is not always associated with return to adult circadian LH secretion patterns.
Abstract: Studies of patterns of lutenizing hormone (LH) secretion in anorexia nervosa are reviewed. Restoration of ideal weight is not always associated with return to adult circadian LH secretion patterns. Abnormalities in LH secretion (immature patterns) may represent a biological “marker” of active anorexia nervosa.
TL;DR: A case of tranylcypromine (Parnate) overdose is presented in which the main toxic effects were headache, obtundation, hypertension, and diffusely peaked T-waves on ECG.
Abstract: A case of tranylcypromine (Parnate) overdose is presented in which the main toxic effects were headache, obtundation, hypertension, and diffusely peaked T-waves on ECG. The latter effect, which occurred in the absence of hyperkalemia, has not been previously associated with monoamine oxidase inhibitors (MAOI). Recent case reports of tranylcypromine toxicity are briefly reviewed, confirming the potential for hypertension, hypotension, shock, hyperpyrexia, intracranial hemorrhage, agitation, hyperkinesis, coma and death in association with overdosage, or concommitant ingestion of sympathomimetic substances or other drugs. These ECG changes add to the worrisome list of potential toxicities in an era in which MAOI are finding increased clinical use.
TL;DR: This study examined perceptions of ward atmosphere and ideal ward atmosphere by twenty patients, twenty-four staff, and fifteen family members on an oncology unit at a major cancer research institute to assess the compatibility of patient, family member, and staff needs along relationship, treatment program, and systems maintenance dimensions.
Abstract: This study examined perceptions of ward atmosphere and ideal ward atmosphere by twenty patients, twenty-four staff, and fifteen family members on an oncology unit at a major cancer research institute. Specified preferences for an ideal ward atmosphere were assumed to reflect psychosocial needs of the three groups. Data were analyzed with multivariate statistics where it was found that perceptions of ward atmosphere differed for the three groups as did their perceptions of the amount of change needed to form an ideal ward atmosphere. This study was viewed as an initial and promising approach to assessing the compatibility of patient, family member, and staff needs along relationship, treatment program, and systems maintenance dimensions. It was believed that further studies of this type will increase the professional's understanding of the relationship between psychosocial needs and reponse to treatment.
TL;DR: A psychiatric liaison program on a medical intensive care unit is described, which facilitates an holistic approach to the patient and deals with intra-staff and patient-staff reactions in the critical care setting.
Abstract: A psychiatric liaison program on a medical intensive care unit is described. The principle elements of the program include the psychiatrist becoming a member of the MICU “team” via: 1) attendance at morning medical rounds; 2) conducting case conferences; 3) availability to the nursing staff as a separate entity; 4) consulting with the unit directors; and 5) supervising a resident in psychiatry in his consultative work on the unit. The liaison psychiatrist's presence on the team facilitates an holistic approach to the patient and deals with intra-staff and patient-staff reactions in the critical care setting.
TL;DR: The case of a mildly disfigured patient with Neurofibromatosis is discussed from the perspectives of his distorted body image, need to attribute problems in his social and work lives to unrealistic assessment of his disfigurement, changes in his self-concept following communication training, and the need for physicians and others working with these persons to treat their emotional, as well as physical, pain.
Abstract: The authors discuss the case of a mildly disfigured patient with Neurofibromatosis from the perspectives of his distorted body image, need to attribute problems in his social and work lives to unrealistic assessment of his disfigurement, changes in his self-concept following communication training, and the need for physicians and others working with these persons to treat their emotional, as well as physical, pain.
TL;DR: The vicissitudes of psychosocial research in a radiotherapy center evaluates the efficacy of counseling techniques in patients with early stage breast cancer receiving radiotherapy.
Abstract: This paper describes the vicissitudes of psychosocial research in a radiotherapy center. The project described evaluates the efficacy of counseling techniques in patients with early stage breast cancer receiving radiotherapy. The problems involved are discussed. They include the effects of: 1) introducing a psychosocial program into a medical setting; 2) research, specifically psychological, on staff and treatment in a nonresearch center; 3) asking patients to participate in a project the relevance of which is not immediately apparent; and 4) working under such conditions on the research itself. Conclusions and recommendations derived from this experience are made.
TL;DR: A program designed to provide medical consultation and teaching in a 107 bed psychiatric inpatient unit of a university medical center is described and bidirectional liaison units may prove to be a resource for psychiatry departments in the remedicalization process.
Abstract: The renewal of interest in the physician identity of the psychiatrist has exposed widespread deficits in skills such as physical examination. A program designed to provide medical consultation and teaching in a 107 bed psychiatric inpatient unit of a university medical center is described. The contributions of a psychosomatically-oriented internist to the development of this program of reverse liaison are considered. Bidirectional liaison units may prove to be a resource for psychiatry departments in the remedicalization process.
TL;DR: Three forms of psychiatry/psychology liaison are presented which demonstrate case-centered collaboration to address child and family concerns about death, team-centered activities which link family and staff roles in the course of terminal illness, and the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths.
Abstract: Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison program offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.
TL;DR: No significant differences were found between groups for self-report of experienced pleasure, however, a significant difference was found for observer ratings of positive affect, with the mildly depressed and “low normal” subjects showing a shorter duration and a lower degree ofpositive affect than the normals.
Abstract: Thirty male and thirty female adult subjects were divided equally into three groups on the basis of the Zung Self-Rating Depression Scale; mildly depressed (50-63), normal (40-49), and "low normal" (20-39) Observer ratings of positive affect were made during a one and one-half hour laboratory experiment, and self-ratings of pleasurable experience were collected at the end of the experiment Results showed no significant differences between groups for self-report of experienced pleasure However, a significant difference between groups was found for observer ratings of positive affect, with the mildly depressed and "low normal" subjects showing a shorter duration and a lower degree of positive affect than the normals These results partially replicate and extended previous work Implications for theory, research, and psychotherapy are discussed