Personality Disorders and Spinal Cord Injury: A Pilot Study

A substantial body of research has found that spinal cord injury (SCI) patients have relatively high degrees of energy, impulsivity, and risk-taking (W. Fordyce, 1964; G. P. Taylor, 1970; B. Woodbury, 1978). The present study endeavors to extend our knowledge to the personality disorder (PD) domain. Forty SCI participants and 40 matched controls were given a semistructured diagnostic interview and a self-report personality disorder instrument. Findings indicated that 27.5% of SCI patients, and a similar number of controls, have PDs. Unexpectedly, impulsive/externalizing disorders (histrionic, narcissistic, antisocial, and borderline) were not unusually high in SCI patients, and were not higher than controls. Avoidant and depressive disorders were unexpectedly high.     

特殊类型的无骨折脱位型颈髓损伤治疗分析

为了探讨多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤的治疗,回顾了本院收治的4例多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤患者的临床资料,并结合相关文献报道进行分析。结果显示,4例患者均早期行前后路联合手术椎管减压,3例患者行预防性气管切开,4例患者术后随访时间6个月～48个月,平均随访24个月。固定节段均获骨性融合,内固定物无松动、断裂;后路手术无再关门现象。术后神经功能评价按Frankel分级,均有1个～2个级别恢复,术前A级2例,B级2例;术后B级2例,C级1例,D级1例。提示对于多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤早期行前后路联合手术减压;预防性气管切开可获得良好的治疗结果。     

Quality of Life and Bladder Management post Spinal Cord Injury: A Systematic Review

To explore the relationship between neurogenic bladder management techniques and quality of life (QoL) among individuals with spinal cord injury (SCI). A key terms literature search was conducted in multiple electronic databases (i.e., MEDLINE, CINAHL, EMBASE, and PsycINFO). Studies published up to and including May 2013 were reviewed and evaluated based on the following criteria: (1) full-length journal article published in the English language; (ii) human subjects ≥18 years; (iii) ≥?50 % of subjects had a SCI; (iv) results on QoL, as it related to bladder management method, were reported for at least three subjects. A total of 422 articles were extracted and upon review of titles and abstracts, 7 studies met the inclusion criteria. There were two level 2 cohort studies and five level 5 observational studies. Sample sizes ranged from 37 to 282 with an average of 117.1 individuals per study. All participants were at least six months post injury. Bladder management methods used included intermittent (patient/attendant), indwelling (suprapubic/transurethral), and condom catheterization, micturition assistive maneuvers, and electrical stimulation. Normal voiders scored better in all QoL measure domains compared to other management methods. Those using attendant intermittent and indwelling catheterization scored the poorest on the domains Personal Relationships, Emotions, and Mental Health. There is insufficient evidence to provide a definite conclusion as to the relationship between bladder management methods and QoL post SCI. However, individuals relying on others to aid in voiding may experience lower QoL compared to those who are independent.     

Coping in Caregivers of Youth with Spinal Cord Injury

This study examined coping among caregivers of youth with spinal cord injuries (SCI). Using a cross-sectional survey study design, 164 caregivers completed a demographics questionnaire and the Brief COPE. Their children, youth with SCI ages 7–18, completed the Kidcope. T-tests were conducted to examine differences in caregiver coping by demographic and injury-related factors. Further, logistic regression models were evaluated to examine predictive relationships between caregiver coping and youth coping. Several demographic and injury-related factors were related to caregiver coping, including caregiver gender, race, and education, as well as youth gender, age at injury, and time since injury. In the logistic regressions, two caregiver coping strategies were related to youth coping: caregiver self-blame coping was related to youth self-criticism, and caregiver behavioral disengagement coping (giving up attempts to cope) was related to youth blaming others coping. The findings suggest that caregiver coping may play a role in the coping of their children, and should be considered when addressing coping among youth with SCI.     

Early Versus Late Onset of Spinal Cord Injury Among the Elderly

The objective of this study is to compare elderly individuals with late (60 years old) versus early (<60 years old) onset spinal cord injury (SCI) across quality of life (QOL) domains for which cross-sectional design was used. The outcome measures selected were secondary medical complications (e.g., pneumonia, autonomic dysreflexia, number of days hospitalized), Functional Independence Measure (FIM), Satisfaction With Life Scale (SWLS), and the Craig Handicap Assessment and Reporting Technique (CHART). Analyses between groups showed that individuals with SCI onset 60 years of age or older were significantly older, had a greater proportion of incomplete lesions, were more likely to have SCI resulting from medical complication, and were less likely to be working. After controlling for differences in demographic and lesion characteristics, the majority of QOL domains were similar between groups. However, overall self-reported handicap (CHART-total score) was significantly greater among elderly with late onset SCI, particularly in the areas of physical independence and social integration. Differences in QOL between elderly with late versus early onset SCI were most prominent in the area of physical independence and social integration. The importance of appropriate statistical control, theoretical implications, and future directions are discussed.     

Quality of Social Support Predicts Hopelessness and Depression Post Spinal Cord Injury

Research has documented elevated levels of depression and suicide in the spinal cord injured (SCI) population, with the majority of suicide attempts occurring within 12 months of injury onset. Social support has been linked with depression and suicidal intent, and this study aimed to determine the impact of the quality and quantity of social support on levels of depression and hopelessness, an indirect indicator of suicide risk in the SCI population. Fifty-three individuals with traumatic SCI at Week 6 of their rehabilitation, and 42 at Week 18, with an approximate male to female ratio of 4:1, completed the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Social Support Questionnaire. Stepwise multiple regression analyses revealed that high quality of social support was associated with low hopelessness and depression scores, being more pronounced at Week 18 postinjury. The impact of social support on psychological well-being demonstrates the importance of fostering and integrating social support in rehabilitation following spinal cord injury.     

Spinal Cord Circuits

Over the past decade, research at three different levels of sensorimotor control has revealed a degree of complexity that challenges traditional hypotheses regarding servocontrol of individual muscles: (a) The connectivity of spinal circuits is much more divergent and convergent than expected. (b) The normal and reflex-induced recruitment of individual muscles and compartments of muscles is more finely controlled than was noted previously. (c) The mechanical interactions among linked skeletal segments and their often multiarticular muscles are neither simple nor intuitively obvious. We have developed a mathematical model of the cat hind limb that permits us to examine the influence of individual muscles on posture and gait. We have used linear quadratic control theory to predict the optimal distribution of feedback from a hypothetical set of proprioceptors, given different assumptions about the behavioral goals of the animal. The changes in these predictions that result from changes in the structure and control objectives of the model may provide insights into the functions actually performed by the various circuits in the spinal cord.     

Sexual Desire and Depression Following Spinal Cord Injury: Masculine Sexual Prowess as a Moderator

Men’s adherence to masculine norms stressing sexual prowess may contribute to their adjustment to changes in sexual functioning following spinal cord injury. The authors test this hypothesis by examining the moderating role of men’s conformity to gender norms for sexual prowess on the relationship between sexual desire and depression. One hundred and sixteen male citizens of the United States with spinal cord injuries were recruited for participation in the internet-based survey. Results indicated that participants with strong sexual desire evinced higher rates of depression when they conformed to masculine norms emphasizing sexual prowess. Men with little reported sexual desire, by contrast, demonstrated lower rates of depression when they endorsed norms for prowess. Directions for future research and treatment interventions are offered.     

Social Problem-Solving Abilities and Health Behaviors Among Persons with Recent-Onset Spinal Cord Injury

Although many persons with spinal cord injuries (SCI) are at risk for preventable complications, very little research has examined the health behaviors of these individuals. In this study, we examined self-reported health behaviors of persons with recent-onset SCI. We also studied the association between health behaviors and social problem-solving abilities. The results indicated that positive problem-solving characteristics were associated with more adaptive wellness and accident prevention behaviors. A negative orientation toward problem solving and avoidant and impulsive/careless styles was associated with increased traffic and substance risk taking. Implications are discussed in terms of health education, research, and prevention programs.     

Family Caregivers of Persons With Spinal Cord Injury: Predicting Caregivers at Risk for Probable Depression

OBJECTIVE: To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health. DESIGN: Correlational and logistic regression analyses of data collected in a cross-sectional design. PARTICIPANTS: Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. MAIN OUTCOME MEASURE: The Inventory to Diagnose Depression. RESULTS: Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables. CONCLUSIONS: The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may have probable depression.     

Psychological Variables Associated with Pain Perceptions Among Individuals with Chronic Spinal Cord Injury Pain

Structural equation modeling was used to examine the relationships between selected psychological variables and pain perceptions in 103 individuals experiencing chronic pain following traumatic spinal cord injury (SCI). Previous studies have suggested strong relationships between psychological variables and chronic SCI pain, but further delineation of such relationships is needed in order ultimately to develop more effective pain management strategies for individuals afflicted with such pain. Anger was found to be significantly related to perceptions of pain (p < .05), but neither guilt nor anger suppression was significantly associated with perceived pain. Internal health locus of control was associated with decreased pain perceptions (p < .05), but there was no significant relationship between internal health locus of control and anger. Punishing responses from significant others to pain complaints were related to feelings of guilt (p < .05) and perceived pain (p < .05), but this relationship was not mediated by guilt.     

Communal Behaviors and Psychological Adjustment of Family Caregivers and Persons With Spinal Cord Injury

OBJECTIVE: Examined the influence of mutual communal behaviors on the adjustment reported by persons with spinal cord injury (SCI) and their family caregivers. Previous research has found that persons who have a history of mutually communal behaviors in relationships may react differently to relationship changes after an acquired physical disability than dyads with few communal behaviors. METHOD: Family caregivers and persons with SCI were administered measures of mutual communal behaviors, depression, and life satisfaction. Structural equation modeling was used to test the relations among caregivers' communal behaviors and care recipients' communal behaviors, depression, and life satisfaction. RESULTS: Caregiver and care recipient reports of communal behaviors were not significantly correlated. Significant paths indicated that care recipients' communal behavior scores were positively associated with their life satisfaction, and care recipients' depression was inversely associated with their life satisfaction. Caregivers' communal behavior scores were unrelated to their self-reported adjustment. CONCLUSIONS: Caregiver-care recipient dyads may differ in their perceptions of communal behaviors in their relationships. Although care recipient reports of communal behavior may be related to their life satisfaction, communal behaviors may not serve a similar function among caregivers of persons with SCI.     

Theory of Planned Behaviour, Skin Care and Pressure Sores Following Spinal Cord Injury

Objectives: To use the Theory of Planned Behaviour to explore factors associated with performing skin care behaviors and the occurrence of pressure sores in people with spinal cord injury. Design: A within-group cross-sectional design was used to assess 59 people with spinal cord injury living in the community. Of these, 17 participants returned a repeat assessment allowing a longitudinal examination of the relationship between intention and actual behaviour. Methods: A measure was developed in accordance with the Theory of Planned Behaviour guidelines through interviews with people with spinal cord injury. Measures of mood and knowledge of skin care behaviour were also included. Results: The Theory of Planned Behaviour components, mood and knowledge of skin behaviours predicted intention, skin care behaviour and occurrence of pressure sores. Knowledge of skin care was negatively correlated with occurrence of pressure sores (r=−.38, p < .01). Indirect perceived control was a particularly important predictor of pressure relief, accounting for 24% of the variance. Conclusions: Psychosocial factors, including the Theory of Planned Behaviour components, predicted skin care behaviours and the occurrence of pressure sores. These findings provide empirical support for the Theory of Planned Behaviour. The study also carries clinical implications for skin care education for people with SCI and their families.     

Resilient,Undercontrolled, and Overcontrolled Personality Prototypes Among Persons With Spinal Cord Injury

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Active Recreation and Well-Being: The Reconstruction of the Self Identity of Women With Spinal Cord Injury

This qualitative study obtained the viewpoints of four women with spinal cord injury about the meaning of active recreation in their lives. Using the constant comparison method, common points of view were revealed within the narratives, leading to the finding that active recreation contributed to a positive self-concept. This facilitated the reconstruction of participants' identities as fit, confident, and social women actively engaged in their communities. Since participation in active recreation was found to be important to the self-identity of women who value physical activity, integrating this role into occupational therapy can facilitate the recovery of a desired self.     

Disruptive Individual Experiences Create Lifetime Periods: a Study of Autobiographical Memory in Persons with Spinal Cord Injury

Previous research showed that transitional events causing catastrophic and long‐lasting changes in group of people's lives (e.g., wars) create autobiographical periods. We investigated whether spinal cord injury (SCI), an involuntary and externally driven disruptive event at the individual level, would also act as a temporal landmark and spawn personal periods and whether these periods have comparable functions and temporal characteristics as those generated at the group level. Thirteen volunteers with SCI recalled a cue‐related autobiographical event for each of 22 cue words. Later, participants thought aloud when dating each event. We used the prevalence of injury‐related references as an index of the degree to which spinal cord injury affects people's lives. We found frequent references to injury for the period neighboring injury event. Unexpectedly, we also found that SCI resulted in post‐injury decrease in event memory. Results imply that SCI provides a temporal landmark and creates an autobiographical period.Copyright © 2015 John Wiley & Sons, Ltd.     

Loss Of Trust: Correlates Of The Comorbidity Of Ptsd and Severe Mental Illness

Abstract

The prevalence of post-traumatic stress disorder (PTSD) in the general population of the United States is a topic of speculation, with estimates ranging from 0.4% to 9% (Breslau, Davis, Andreski, & Peterson, 1991; Helzer, Robins, & McEvoy, 1987; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Likewise, estimates of the prevalence of PTSD within the population of persons with serious mental illness have varied widely, depending on how PTSD has been measured. While record verification of PTSD within mental health outpatient samples has routinely been very low (0%-3%), research assessments of PTSD have resulted in estimated rates of co-occurrence of 29% to 43% (Cascardi, Mueser, DeGirolomo, & Murrin, 1996; Craine, Henson, Colliver, & MacLean, 1998; Mueser et al., 1998). A lack of documentation of PTSD in clinical records and inattention to PTSD in clinical diagnoses are thought to greatly underestimate the extent of PTSD within mental health treatment populations. The general consensus among researchers has been that the occurrence of PTSD is much higher within the population of persons with diagnoses of mental illness than in the general population, particularly among those who have major depression (Friedman & Rosenheck, 1996).     

Lessons In The Psychology Of Loss: Accounts Of Middle-Aged Romanian Women

Abstract

In studying loss, it is important to develop a cross-cultural, interdisciplinary approach that is concerned with the historical, cultural, and social contexts in which loss occurs. However, the Western field of psychology is less well informed about the experiences and perspectives of loss across various cultures. Many countries in the contemporary world are seeking greater participation in the international community and control over their destinies. The related cultural, political, and social developments are commanding a need for heightened awareness and understanding of ethnic variations in dealing with the social change phenomenon and the psychology of loss.