Psychoanalytic observations on the effect of lithium on manic attacks

This paper describes a predictable relation between our manic-depressive patients' blood lithium levels and particular changes in their conscious and unconscious mental processes (i.e., their thoughts, wishes, fantasies, inclinations, and feelings). These changes were, in turn, predictively related to specific changes in these patients' overt manic symptomatology. Because each of our patients' manic episodes was heralded by a marked increase in unconscious or conscious phallic sexual thoughts, feelings, and behaviors, and because this increase preceded any observed deterioration in ego or superego functioning, we hypothesize that a primary increase in our patients' phallic instinctual drives secondarily overwhelmed the capacity of their egos to defend against these drives, and that this, in turn, resulted in the development of our patients' overt manic symptoms. Psychoanalysis (or psychoanalytically oriented psychotherapy) made our patients consciously aware both of their previously unconscious phallic sexual thoughts and impulses, and of their defenses against them. This new awareness enabled our patients to recognize when their, now conscious, phallic sexual impulses and thoughts became inappropriately intensified; and this, in turn, permitted them to avoid overt manic episodes by counteracting these inappropriate inclinations with increased doses of lithium.     

The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Self- and social perception of physical appearance in chest wall deformity

This study analyzes self- and social perception of physical appearance in patients with chest wall deformity (CWD), including both pectus carinatum and pectus excavatum. Self-perception of appearance in 76 patients with CWD and social perception of patients' appearance by 20 adult and 20 adolescent raters was assessed using the Appearance Rating Scale (Stangier et al., 2000) and evaluated for agreement and multivariate correlates. Results indicate no agreement between self- and social rating. Based on mean scores patients rated their appearance significantly more negatively than adult raters but only slightly different than adolescent raters. Adolescent raters' judgment of the patients' appearance was related to CWD characteristics, while self-rating rather seems to be related to psychosocial factors. Because adolescents are a relevant peer group for adolescent patients with CWD their evaluation of the appearance might influence patients' self-image and might affect their psychological functioning. Effective interventions focusing on social interactions are needed.     

Discrepancies between patients' and partners' perceptions of unsupportive behavior in chronic obstructive pulmonary disease

The literature on chronic diseases indicates that partner support, as perceived by patients, contributes to well-being of patients in either a positive or a negative way. Previous studies indicated that patients' and partners' perceptions of unsupportive partner behavior are only moderately related. Our aim was (1) to investigate whether discrepancies between patients' and partners' perceptions of two types of unsupportive partner behavior-overprotection and protective buffering-were associated with the level of distress reported by patients with chronic obstructive pulmonary disease (COPD) and (2) to evaluate whether the direction of the differences between patients' and partners' perceptions was associated with distress (i.e., whether patient distress was associated with greater patient or greater partner reports of unsupportive partner behavior). A cross-sectional study was performed using the data of a sample of 68 COPD patients and their spouses. Distress was assessed using the Hopkins Symptom Checklist-25. Patients' and partners' perceptions of unsupportive partner behavior were assessed with a questionnaire measuring overprotection and protective buffering. Distress was independently associated with patients' perceptions of protective buffering and discrepancies in spouses' perceptions of overprotection. Regarding the direction of the discrepancy, we found that greater partner reports of overprotection as compared with patient reports were related to more distress in COPD patients. Our study showed that patients' distress was associated not only with patients' perceptions, but also with discrepancies between patients' and partners' perceptions of unsupportive partner behavior.     

Aphasia, dyslexia and the phonological coding of written words

A possible account of the reading difficulty of certain aphasic-dyslexic patients includes the notion that they are impaired in translating the written word into a phonological code via grapheme-phoneme conversion rules. This notion was tested in two experiments, both utilizing orthographically regular non-words (like dake) as stimuli. The first experiment provides an analysis of two patients' (largely successful) attempts to repeat non-words, and their (almost totally unsuccessful) attempts to read them. Second, in a lexical decision task (is this written letter-string a word or not?), the finding that normals are slowed by non-words homophonic with real words (like flore) was replicated using a modified technique. This effect, attributable to phonological coding, was not shown by the patients. At the same time, their ability to discriminate between words and non-words was essentially intact. Consideration was given to mechanisms which might underlie such patients' correct and erroneous readings of words and non-words.     

Older spouses' perceptions of partners' chronic arthritis pain: implications for spousal responses, support provision, and caregiving experiences

This study of older patients with osteoarthritis and their spouses examined concordance between patients' and spouses' reports of patients' pain severity and the association of concordance with support and caregiving outcomes. Patients and spouses independently viewed videotapes of the patient performing simulated household tasks and provided ratings of patients' pain. Spousal overestimation of patients' pain was the most common type of nonconcordance. Spouses who were accurate in their perceptions of their partner's level of pain during a log-carrying task responded less negatively and provided emotional support that was more satisfying to patients. In addition, spouses who were accurate in their perceptions of their partner's pain during the log-carrying task reported less stress from providing support and assistance. Future research that uses such observational methods may be highly useful for understanding the effects of chronic illness on older couples.     

Understanding Patients' Reactions to Services: The Role of Personal Service Values in Heart Patient Satisfaction and Wellness

This study proposed an individual-difference perspective on heart patients' customer-service satisfaction. We hypothesized that heart patients' satisfaction with service is positively related to wellness and that instrumental care, expressive care, and communication effectiveness are positively related to satisfaction and wellness. We also hypothesized that patients' values for services would moderate the relationship between service provision and outcomes. A survey of 217 heart patients provided support for these hypotheses. Of particular interest were findings that: (a) the service provision-service outcomes relationship was moderated by service values for some patient groups but not for others; and (b) the service provision-outcomes relationship differed across patient subgroups. We discuss the implications for patient satisfaction research and for planning individualized treatment strategies.     

The psychosocial effects of rheumatoid arthritis on the patient and the well partner

Rheumatoid arthritis (RA) is a chronic disorder that can have a severe impact on patient's lives. This present study investigated four questions regarding the psychosocial effects on patients and their well partners. First we found that depression for both patients and partners were slightly elevated and 35.7% of patients and 23.3% of well partners had scores above the cut-off for possible clinical depression on the Center for Epidemiological Studies Depression Scale. Second, there was no significant difference between the patients' level of distress and that of the partners. Third, there were moderate positive correlations between patients' and partners' scores on measure of psychological functioning. Fourth, there were no differences in either the patients' or partners' well-being based on the gender of the patient. Finally, an exploratory analysis was conducted to examine the factors which influence the patients' and partners' depression and their view of the relationship.     

Patients' versus informants' reports of personality disorders in predicting 7 1/2-year outcome in outpatients with depressive disorders

Concordance between patients' and informants' reports of personality disorders (PDs) is low, raising the questions of which source provides more valid data and whether both contribute unique information. This study compared patients' and informants' reports of PDs in predicting outcome in a 7 1/2-year follow-up of 85 depressed outpatients. Patients and informants were independently evaluated using structured interviews; outcome was assessed using structured interviews with patients. Both patients' and informants' reports of PD diagnoses and dimensional scores independently predicted depression symptoms and global functioning at follow-up. However, only informants' reports made a unique contribution to predicting social adjustment. This finding indicates that both patients and informants provide unique information on Axis II psychopathology and argues for the use of both sources in the assessment of PDs.     

Autobiographical memory: influence of right hemisphere damage on emotionality and specificity

This study investigated the ability of right hemisphere damaged (RHD) patients to recall autobiographical material in response to emotional versus nonemotional cues. A modified Crovitz paradigm was used in which patients were asked to recall a specific episode from their own life that related to a cue word. These episodes were rated for emotionality and specificity by independent raters. Patients also rated the emotionality of their own episodes. Independent raters judged the reports of the RHD patients as less specific and less emotional than those of matched nonneurologic control subjects. This was true for episodes in response to emotional as well as nonemotional cue words. RHD patients' own ratings of these episodes, however, did not differ from those of controls. These findings are discussed in terms of RHD patients' overall difficulties in processing emotional material and in terms of the nature of autobiographical memory.     

Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

Suicide and internalised relationships: A study from the perspective of psychotherapists working with suicidal patients

A study was conducted into the personal meanings of suicide. It is recognised that early experiences of relationships can have a bearing upon a later tendency towards suicide. This project investigated the representations which these relationships take on within the person's inner world and their effect upon the person's behaviour. One hundred psychotherapists were surveyed, by means of a postal questionnaire, regarding their work with suicidal patients. Five follow-up interviews were conducted. The main themes that emerged in the patients' relationships were rejection, invasion and engulfment. These were experienced as forms of abandonment. Incidents involving loss or rejection in the patients' present life were found to re-activate these earlier relationships.     

Pilot study for assessing the behaviors of patients with schizophrenia towards a virtual avatar.

This study examined whether a virtual avatar could be perceived as a real human by patients with mental disease, especially schizophrenia, as well as whether a virtual avatar could be applied to acquiring patients' behavior characteristics in a short conversation situation. The virtual avatar has been used for various applications which need to communicate with other person or to train or educate by showing humanlike behavior. Recently, many researches have shown that the virtual avatar technology has been enhanced and the avatar could be perceived like real human. A virtual avatar, standing in a virtual room, was designed for this study. Tasks to approach, initiate a talk, and answer to avatar's questions was assigned to the 11 patients with schizophrenia. As behavioral parameters in the virtual environment, the interpersonal distance and the verbal response time were acquired. In addition, the Positive and Negative Syndrome Scale (PANSS) for patients was administered in order to investigate the relationship between patients' symptomatic characteristics and behavior parameters. The interpersonal distance was negatively correlated with the negative syndrome scale, a subscale of PANSS, which is consistent with previous research reporting the relationship between interpersonal distance and a real person's image. The verbal response time, however, was not correlated with any other subscale of PANSS. After analyzing subitems of the negative syndrome of PANSS, two positive correlations were found: one was with blunted affect and the other was with poor rapport. We concluded that the virtual avatar could be perceived as a real human by schizophrenic patients and the avatar could draw the schizophrenic patients' behavior characteristics.     

Is Expressed Emotion an Index of a Transactional Process? II. Patient's Coping Style

This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low-EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high-EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion (17) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.     

Personhood in a World of Forgetfulness: An Ethnography of the Self-Process Among Alzheimer's Patients

This article assesses the self-construct of Alzheimer's patients residing in a care facility, using qualitative research methods to determine whether a sense of personhood was retained despite the deteriorative consequences of the disease. Through systematic observations of patient actions and interviews with family members and staff, the study assessed the patients' experience of self. The self was conceptualized in social constructionist terms emphasizing how patients configure meaning in seemingly trivial everyday aspects of residential care. The research developed ways of understanding the patients' humanity, confirming that a self-process was sustained despite the effects of the disease. The article explores implications of a contemporary approach to treatment of patients as transformed, yet distinctive, human beings with valid relational and cultural lives.     

Two scales for measuring patients' perceptions for coercion during mental hospital admission

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.     

Changes in Cognitions, Emotions, and Behaviors in Depressed Patients and Their Spouses Following Marital Cognitive Therapy, Traditional Cognitive Therapy, Pharmacotherapy, and No Intervention

This study evaluated specific influences of a cognitive marital treatment (CMT) for depression based on an integration of cognitive theory of depression and systems theory. The effects of CMT on variables representing cognitions, emotions, and behaviors were compared with the effects of traditional cognitive therapy (CT), pharmacotherapy (PT), and no treatment (NT). Subjects were Major Depression Disorder and Dysthymic outpatients and their spouses. The changes considered were for pre–post treatment and pre-treatment–follow-up. CMT affected a wider range of variables than other treatments. In most instances it was also superior to the NT condition. Most of the gains were manifested at termination and lasted through follow-up. The variables affected by CMT were patients' and spouses' cognitions and emotions. PT had best effects on patients' emotions. CT affected patients' cognitions, but did not achieve superiority on any of the compared variables. None of the treatments produced significant changes in behaviors.     

"I Know Just How You Feel": The Validity of Healthy Women's Perceptions of Breast-Cancer Patients Receiving Treatment

The accuracy of healthy women's perceptions of how breast-cancer patients cope with treatment was assessed in this study. Standardized questionnaires measuring distress, coping, and illness perceptions were completed by 78 women undergoing postsurgical treatment for primary breast cancer. The patients' responses were then compared with assessments made by a matched community sample. The results showed a marked incongruity between healthy women's perceptions and actual patients' experiences of the disease and its treatment. Community women overestimated patients' distress, perceived the consequences of breast cancer to be more severe, and were more likely to believe that patients used denial and disengagement strategies. The discrepancy in findings has implications for the appropriateness of the support offered to patients by healthy women.     

Race, family interactions, and patient stabilization in schizophrenia

This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play in important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.