Changes over time in head and neck cancer patients’ and caregivers’ illness perceptions and relationships with quality of life

Objective: This study investigated changes in illness perceptions from diagnosis to six months later in patients with head and neck cancer (HNC) and their caregivers. The study also examined whether discrepancy in patient and caregiver perceptions at diagnosis predicted patient health-related quality of life (HRQL) at six months.

Design: Forty-two patient–caregiver dyads completed the Brief Illness Perception Questionnaire (Brief IPQ) at diagnosis and again six months later. Patients also completed a HRQL questionnaire at both time points. Analyses were performed using the Actor–Partner Interdependence Model.

Main Outcome Measure: Total patient HRQL assessed by the Functional Assessment of Cancer Therapy (FACT-H&N).

Results: Perceptions of emotional impact and illness concern reduced over time in patients and caregivers. Perceptions of treatment control and identity increased in caregivers only. After controlling for the effects of baseline HRQL, and the individual contribution of patient and caregiver illness perceptions, greater discrepancy in perceptions of timeline, personal control, and illness identity among dyads at diagnosis predicted lower patient HRQL at six-month follow-up.

Conclusion: Patients’ and their caregivers’ perceptions of HNC are dynamic over time. Greater discrepancy between patients’ and caregivers’ illness perceptions at diagnosis predict poorer subsequent patient HRQL.     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

中国古代辟疫思想的当代启示

通过对以未病先防为主导的中国古代主要辟疫思想及方法的回顾与思考,探讨了其对今天传染病预防的参考价值。认识到在当代传染病预防工作中,借鉴中国古代医学的思想与实践之精粹或许可为当代新发传染病的防治另辟新径,以期能对现代传染病的预治有所启示。     

Personality Dysfunction and the Management of Chronic Medical Illness: A Community Health Sample

The purpose of this study was to determine the influence of personality disorders on perceived health status, self-efficacy for management of the chronic illness, and physician perception of patient health. A total of 607 patients with self-identified chronicillness(es) volunteered to participate in the study. Out of this sample, 147 had collaborative physician data indicating a chronic illness. The final sample was 143 due to incomplete data. Results suggested that maladaptive personality characteristics, as measured by the Short-Form of the Coolidge Axis II Inventory (SCATI), were related to a number of important factors that influence self-management of chronic illnesses. When the personality constellations were broken into 3 groups (normal, subclinical, and clinical) significant differences were found on the 3 groups of dependent variables (Subjective Health, Self-Efficacy, Physician Appraisal) for the different personality disorders. These data provide useful information on several factors that influence effective disease management. Clinical implications and directions for future research are provided.     

相似和相同语言标签对幼儿归纳推理的影响

为进一步检验相似语言标签的效应,采用经典的三角属性归纳范式,通过两个实验研究了\"相似/相同\"的真实语言标签对4岁幼儿归纳推理的影响.在实验一中,三角范式中的三个刺激物属于同一类别,在实验二中,三个刺激物属于两种不同的类别.每个实验均有三种条件:在控制条件中,实验者用\"这个\"指代每个客体;在相似语言标签条件中,靶刺激与知觉不相似的比较刺激具有相同的、且暗示了类别成员关系的词素(例如,翠鸟—飞机—鸵鸟);在相同语言标签条件中,靶刺激和知觉不相似的比较刺激共享相同的语言标签(例如,鸟—飞机—鸟).结果一致显示,与控制条件相比,幼儿在相似语言标签条件下表现出了更多的基于概念的归纳,表明在真实语言标签条件下也存在相似语言标签效应.同时,研究结果也显示,幼儿在相似和相同语言标签条件下的归纳没有显著差异,说明语言标签在幼儿归纳中更可能传递了概念信息,从而挑战了Sloutsky等的理论.     

躯体化的心身交互机制及其中的文化因素

基于神经生物学的心身交互作用是当前躯体化病理机制的一个研究重点。在生理-心理的功能连续体中, 认知学习、感觉监控、注意、记忆过程等都会影响躯体症状的呈现。文化则会通过这些过程塑造个体对症状的归因和解释, 引发躯体症状的呈现和扩大, 最终通过不同文化特有的民族生理学模式形成具有文化特异性的疑病焦虑和医学无法解释症状。     

Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

Psychological Illness in Presidents: A Medical Advisory Commission and Disability Determinations

Although the 25th Amendment is intended to provide for instances of presidential disability, critics claim that it is impractical since it requires vice presidents and cabinet members to move overtly against the president—which they are unlikely to do. Also, they warn that medical information about the president is likely to be concealed. To overcome these problems, they recommend that a Medical Advisory Commission be established at the outset of every presidential administration to examine the president annually and then provide formal medical input so that the vice president and cabinet would be "compelled" to act in the presence of medically determined "inability," whether physiological or psychological. This paper argues, however, that such a proposal is badly flawed and quite unworkable, particularly in the case of psychological illness where accurate diagnosis typically depends on long-term, continuous doctor-patient interaction rather than through sporadic and superficial interchange. It concludes that less draconian measures in implementing the Amendment are far more sensible, such as those proposed by the Working Group on Presidential Disability which are discussed here.