The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

Message in a bottle: a comparative study of spiritual needs of children and young people in and out of hospital

Using the metaphor of a message in a bottle as a framework and sending an S.O.S. to adults, the question of what are the three biggest needs of children and young people was asked. Data consisting of 107 important needs of children and young people was collected from 36 children and young people both in and out of hospital: in hospital by chaplains and other health care professionals, and out of hospital by children and youth work undergraduate students. This was a convenience sample across the United Kingdom with the majority of respondents in the Midlands. The data were coded and then thematically analysed and separately compared to Maslow’s hierarchy of needs. Emotional needs was the largest theme for hospitalised children and young people and relationship needs for the non-hospitalised children and young people. For both groups Maslow’s level 3 need of belonging was the greatest averaging at just over half the needs shared. A discussion of the results of the analyses identifies some ways in which the needs of hospitalised children and young people may differ, identifying some implications for practice.     

Don’t tell me I’m normal: inpatient psychotherapy of a severely abused patient at the Cassel Hospital

This paper is a case study of a patient with severe personality disorder undergoing treatment at the Cassel Hospital. It looks at a phase of her individual psychoanalytic psychotherapy and how that sits within an institutional model of treatment that can be understood as applied psychoanalysis, in which Tom Main’s concept of a ‘culture of enquiry’ aims to observe and bring together splitting and projective processes operating at all levels of the organisation. The patient, who had been sexually abused and then suffered a prolonged suicidal breakdown, exerted intense pressure on the institution through her experience of herself as both a victim of abuse and a participant in it. A working through is described, in which different parts of the patient that had been projected into different parts of the institution are brought together, and her primitive demand for a two-person world gives way to an acceptance of triangulation. Themes from her individual sessions are enacted in the milieu-based treatment, and conversely struggles in the patient community appear in her sessions. It is from drawing these parts of the patient together as a whole institution that the treatment derives its power and effectiveness.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Was William James a Patient at McLean Hospital for the Mentally Ill?

Rumors that William James was a patient at McLean Asylum near Boston have persisted for several decades. I focus on the reasons why the question has been so difficult to answer in any definitive way; assess the evidence presented in support of the rumors; note that two different periods in James’s life (late twenties and early sixties) have been judged the most likely; and explore the diagnostic question as well: If he was in fact a patient, for what was he being treated? I also discuss evidence that his younger brother Robertson was a patient at McLean and consider the bearing of this evidence on the question of whether William James was a patient at McLean and on the diagnostic issue.     

The effect of context during word perception in schizophrenic patients

Hospitalized chronic and acute schizophrenics were compared with age- and social-status-matched controls on word perception tests to measure the effect of context on recognition thresholds. In Experiment 1 the method of J. Morton (1964, British Journal of Psychology, 55, 165-180) was adopted to see how related and unrelated contexts influenced word recognition thresholds when both context and stimulus word were presented visually. Experiment 2 was an auditory analog of Experiment 1 and in addition the chronic schizophrenics were selected on the basis of a presence or absence of auditory hallucinations. The influence of context on perceptual thresholds was quite normal in all schizophrenics. However, analysis of the incorrect responses elicited showed that some schizophrenic subjects do produce bizarre or irrelevant responses or perseveration to a greater extent than their controls. These results are explained in terms of automatic and strategic modes of information processing. The automatic processes responsible for the adjustment of perceptual thresholds operate normally in schizophrenics but response production which demands strategic selection and editing of responses is prone to malfunction which results in the observed deviations in the normal use of language.     

Classification of spelling errors and their relationship to reading ability, sex, grade placement, and intelligence

A simple scheme for the classification of spelling errors was applied to the errors of four groups of children, totaling 483 subjects, in grades 3 to 12. The subjects in two of the groups, Group I and Group IV, consisted of individuals who attended special schools for children with dyslexia or specific reading disability (SRD). Group II included school age siblings of subjects in Group I, and Group III included subjects drawn from regular school programs. It was shown that (a) type of spelling error is independent of sex, (b) there are no consistent effects of IQ or grade level on type of spelling error, and (c) disabled readers as a group are more likely to produce dysphonetic errors than are normal readers. Although the type of spelling error produced by children who had a spelling disability only was shown to be similar to that of normal readers and to differ from that of disabled readers as a group, disabled readers were shown to differ among themselves, lending strong support to the use of spelling error type as a characteristic for identifying subgroups.     

Variability in the initiation of articulatory movements in the speech of stutterers and normal speakers

This study was designed to investigate the differences between stutterers and normal speakers in phonatory and articulatory timing during the initiation of fluent utterances of monosyllabic words. Electromyographic recordings of four articulatory muscles and recordings of glottal vibrations were made of repetitive utterances of a series of monosyllabic words by 15 stutterers and 17 nonstutterers. These data were analyzed in terms of average interval times between voice onset and onset of EMG activity and between onset of EMG activity in each articulator and in terms of the intrasubject variability of these durational measures. Results showed that there were no significant differences between stutterers and nonstutterers in average interval times and that stutterers, in general, were significantly more variable in their speech onset timing. Findings are discussed in terms of recent hypotheses concerning the role of timing disturbances as the main source of speech disruption in stutterers.     

Comparison of metabolic rates, language, and memory in subcortical aphasias

Four patients with subcortical lesions and either aphasia or amnesia were compared to four patients with cortical lesions and aphasia. Each patient had [18F] fluorodeoxyglucose positron-emission computed tomography, language, and memory evaluations. Marked metabolic depression was found in the thalamus and caudate in all patients. The subcortical patients had only mild left-cortical changes, while the cortical patients showed marked cortical metabolic changes in the left hemisphere. Language changes were mild in the subcortical patients, while moderate to severe in the cortical patients. All patients showed severe verbal memory dysfunction. The only common abnormalities in the two groups were metabolic changes in the thalamus and severity of verbal memory dysfunction. These findings suggest a relationship between verbal memory and thalamic function.