Patients' anxiety as a function of expectation and degree of initial interview ambiguity.

Each of 9 psychiatric residents administered 5 structured and 5 unstructured initial interviews to patients of an adult outpatient clinic. Patients' expectations about psychotherapy were obtained before the interviews. As predicted, when patients experienced interviews compatible with their expectations, they tended to rate their anxiety significantly lower than did patients experiencing interviews incompatible with their expectations. The kind of interview alone did not make a significant difference. Residents rated those interviews incompatible with the patients' expectations as most difficult. The implications for psychotherapy of these and related findings are discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Different ways of moving ahead after analysis: Changes in experiential dimensions.

Within research on psychoanalysis, the common model of analytic change conceptualizes it as structural reorganization and development of self-analytic function. The present article takes as its point of departure analytic patients who, in follow-up interviews, do not present their experience of change according to this common model. Instead of categorizing analysands as being either successful or unsuccessful cases, the article aims to develop concepts of change that pertain to the experiential domain. Themes in the self experience of three former patients are explored. The data is gathered through follow-up interviews. The interviews were conducted with an analytic approach, which provides data on transference themes. Data from the interviews is not intended to provide empirical support for outcomes, but provides material from which concepts of change can be explored and discussed. The three cases illustrate three distinct psychic dimensions: safety, meaningfulness and sameness. All the cases have in common that they show, as described by Modell (1990), a containing transference in the follow-up interviews. Based on the postulated dimensions of self-experience, and with the view that containing transference is a common theme, it is further argued that, despite showing object-dependency, these informants have undergone an experiential change that is of existential significance. This is a kind of change that, it may be argued, is beyond a structural one; one that may be conceptualized as a precondition for the kind of change assumed by the main analytic model. To develop a self-analytic function, the patient may first need to develop a containing one. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Child Anxiety Treatment: Outcomes in Adolescence and Impact on Substance Use and Depression at 7.4-Year Follow-Up.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2–4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Danger ideation reduction therapy (DIRT): preliminary findings with three obsessive-compulsive washers

Three obsessive-compulsive patients received Danger Ideation Reduction Therapy (DIRT) in an initial treatment trial. All three subjects presented with contamination/washing concerns but refused to participate in exposure and response prevention. DIRT is solely directed at decreasing danger-related expectancies concerning contamination. DIRT procedures do not attempt to address inflated personal responsibility. In addition, DIRT does not involve direct or filmed exposure to contamination-related stimuli, or behavioural experiments. Components of DIRT include corrective information cognitive restructuring, filmed interviews, microbiological experiments, attentional focusing and Hoekstra's (1989) probability of catastrophe estimation task. Treatment consisted of between six and ten 1-hr weekly sessions. At post-treatment, substantial reductions in scores on the Padua Inventory, Maudsley Obsessional-Compulsive Inventory and two global rating scales were apparent for all subjects. These improvements were maintained at a 3-month follow-up. The theoretical and clinical implications of these preliminary findings are discussed.     

Unexpected results in long-term medically treated ruptured intracranial aneurysm including data on 14 patients followed more than 30 years each

This is the longest reported follow-up of patients with ruptured intracranial aneurysms treated entirely medically with hypotension. Patients with ruptured brain aneurysms, untreated except for plain bedrest, are at a well-recognized risk of recurrent hemorrhage. Some surgically treated patients also remain at risk of recurrent hemorrhage in follow-up. This is a review of results in patients whose active but entirely medical (hypotensive) treatment was started in the first 10 years of a 40-year study. It suggests a way of reducing risks in both of the above 2 groups. 53 consecutive patients with proven ruptured brain aneurysm(s) were treated as early as possible with medical-hypotensive therapy alone by the author and followed, personally, until death or, if they survived, for at least 30 years each (or until lost to follow-up). The patients included many considered to have been poor operative risks with some having been designated inoperable by the referring neurosurgeons. As part of the long-term follow-up, magnetic resonance angiography (MRA) has been begun. Long-term follow-up was defined as the time beginning after 9 weeks from (admission) hemorrhage. 9 patients had died during the earlier stages of hemorrhage (and treatment) i.e., before the 9 weeks period had elapsed; their data was presented previously. This yielded 44 patients for long-term follow-up. Only 2 patients (both had multiple aneurysms) on this regimen have died of either proven hemorrhage (1 patient) or presumed hemorrhage (1 patient). Most patients survived and maintained an excellent condition. Medical-hypotensive therapy of ruptured intracranial aneurysms has produced much better long-term results than expected. This is significant for (1) patients requiring medical treatment alone and (2) surgically treated patients who may benefit from additional long-term protection.     

Efficacy of an outpatient treatment program for insomnia: A preliminary report.

Evaluated 20 patients who suffered from chronic insomnia and who completed all phases of a 1-yr treatment program. The treatment, which consisted of 5 weekly, 1-hr group sessions and a follow-up 1 mo later, provided education about sleep, instruction in relaxation techniques, stimulus control instructions, and training in sleep hygiene. Self-monitoring data collected by the Ss showed general improvement across a variety of sleep parameters. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vivo quantification of brain volumes in subcortical vascular dementia and Alzheimer''s disease. An MRI-based study

Ibuprofen is one of the most effective and widely used non-steroidal analgesic and anti-inflammatory agent. It is marketed as a racemic mixture though it is known that the pharmacological activity resides in the (S)-(+)-enantiomer only. Several direct/indirect liquid chromatographic methods involving a variety of chiral/achiral phases along with their possible role in resolution, chiral and achiral agents used for derivatisation have been discussed with special reference to ibuprofen, and mentioning their application to the resolution of other 2-aryl-propionic acids/profens.     

Women''s experiences of non-invasive breast cancer: literature review and study report

A review of the post-1990 literature on breast cancer has identified a large body of psychosocial research focusing on coping styles, quality of life and women's participation in choice of treatment. However, numerous methodological problems were found, including a variety of different diagnoses included in samples both within studies and between studies, making comparisons difficult. In particular, no article was traced which focused on non-invasive breast cancer, or ductal carcinoma in situ (DCIS). Therefore a small exploratory study was conducted using qualitative methods to explore women's experience of DCIS, in an attempt to begin exploration of possible similarities or differences in the way women experience invasive and non-invasive breast cancer. A convenience sample of 10 women treated at two hospitals in an Australian state capital city was interviewed, and three themes which emerged from these interviews are discussed in this article. These are discovering the problem, reaction to the diagnosis, and information. Most women unexpectedly reacted in a calm and accepting way to receiving the diagnosis of DCIS, and this may be because they had had no signs of disease but been recalled for further tests after routine screening. They felt well and had no cause to assume a poor prognosis. It is possible also that their reactions were affected by a television health education campaign at the time, which gave a very optimistic picture of the benefits of early detection of breast cancer. Information-giving, as reported by the women, seemed deficient. None of them knew that they had had a non-invasive condition, one thought her disease had been benign, and another that hers was "evasive'. Findings are discussed in relation to the literature on information-giving and on the role of the nurse in this area, and suggestions are made for further research to systematically compare women's reactions to having invasive and non-invasive breast cancer in order that nurses may be aware of their possibly different needs and respond to them appropriately.     

Emerging and re-emerging infectious diseases: a biological evolutionary drama

Cervical intraepithelial neoplasia grade 3 (CIN 3) is treated surgically. Follow-up of these patients is important to ensure successful treatment. The present study was undertaken to determine whether human papillomavirus (HPV) testing can be used to discriminate patients who will have recurrences from those who will not. It is composed of 26 patients who presented with recurrences of CIN and 22 patients who remained disease-free after treatment. DNA was extracted from paraffin-embedded cone biopsies of incident CIN 3, their corresponding follow-up Pap smears taken 3 months postoperatively, and their secondary cone biopsies of the recurrent lesions. The extracted DNA were then analyzed by PCR for the presence of HPV. The posttreatment cervical smears in the recurrent group had a (25/26) 96% HPV prevalence, while HPV DNA was not detectable in any of the 22 patients in the control group. The HPV types in both the initial and recurrent lesions correlated very well. This suggest that most recurrences are likely to be due to persisting lesions or subclinical HPV infections that had not been completely removed. Cytology alone was not sufficiently sensitive to discriminate the patients at risk for recurrences. It appears that HPV testing can be useful to monitor the therapeutic result.     

Clinical dilemmas in contemporary psychotherapy: The search for clinical wisdom.

Examines the concept of the clinical dilemma in the contemporary practice of psychotherapy. The notion of "dilemma management" by the psychotherapist is viewed as a ubiquitous phenomenon in the psychotherapeutic process. Dilemmas in a range of areas of clinical practice are discussed. These include (1) differing treatment modalities, such as insight-oriented psychotherapy, behavior therapy, marital and family therapy, and group therapy; (2) systemic issues such as spousal codependency and family homeostasis; (3) transference and countertransference; (4) therapeutic neutrality and management of the therapeutic boundary; and (5) psychological assessment and psychiatric diagnosis. Finally, observations are made about the interpersonal process of dilemma management in psychotherapy that models for patients an effective way of approaching the pervasive conflicts and dilemmas in their own lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Five–six-year follow-up of broad-spectrum behavioral treatment for alcoholism: Effects of training controlled drinking skills.

The long-term outcome of broad-spectrum behavioral treatment for alcoholism and the relative effects of training controlled drinking skills were examined in a 5–6-year follow-up of the subjects studied in Foy, Nunn, & Rychtarik (1984). Data were collected from subjects and collaterals through structured interviews conducted by individuals blind to initial group treatment assignment. Systematic review was made of death certificates, driving records, and alcohol-related hospitalizations. Results showed no significant difference between groups on any dependent measure at the 5–6 year follow-up point. The stability of drinking patterns is analyzed, and predictors of outcome at 5–6 years are presented. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elderly people's use of services: a survey

This article describes some of the findings of a longitudinal survey of three samples of older people living at home in East London and Mid Essex. It describes the service use and need for community services of the three samples at their baseline interviews, and then looks at how their patterns of use and need changed by the time of their follow-up interviews. It shows that older people are generally using services appropriately, but that there are still unmet needs. Service use was found to increase with age as health and functional ability declined. Further findings will be published shortly.     

Fine needle tissue aspiration for accurate localization of histological specimens from complex structures

There is little information available regarding quality of life following critical illness. The consequences of a stay in an intensive care unit (ICU) can result in considerable psychological and physical morbidity. At the Homerton Hospital, London, UK an intensive care follow-up outpatient clinic was established to ascertain patients' experiences after discharge from the ICU. This exploratory study examines narrative data collected from 26 patients by means of unstructured client-led interviews. Themes are derived that have implications for staff, patients and relatives. The findings suggest that patients experience a variety of psychological and physical symptoms. Patients experienced vivid dreams, flashbacks, relocation and convalescent stress as well as profound tiredness and weakness. These are consistent with previous research findings. New themes were identified which suggest that mood changes, inability to cope, the need to talk about their ICU experience and indistinct memories of the ICU made recovery at home difficult for both the patients and their families. As a result of these findings, the role of a clinical nurse specialist has developed in order to improve liaison between and within departments, the hospital and the community. Future research will aim to focus on the role of the critical care/community liaison clinical nurse specialist and in improving outcomes through the use of action research.     

Performance appraisal and psychological distance.

This study investigated the rating attitudes of supervisors and subordinates and their reactions during public- and private-performance evaluations. 84 women nursing administrators were assigned roles as supervisors and subordinates and given instructions for subordinate-evaluation interviews. 24 interviews were conducted, 6 in private and 18 in public, with Os randomly selected from the nursing administrators. The results clearly indicated that supervisors were more negative in their initial subordinate-appraisal ratings than subordinates. In addition, Os were more negative in their ratings than participants. When evaluative interviews were conducted publicly, the subordinates experienced a number of negative reactions that were not evident in private interviews. The concepts of psychological distance and role stereotypes were discussed in explaining these results. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of randomization; responses of parents of critically ill babies to random allocation of treatment in a clinical trial

Randomized controlled trials (RCTs) are widely accepted by the scientific community as the most rigorous way of evaluating interventions in health care. Although their central feature, random allocation of treatment, is generally seen as methodologically appropriate, its application has caused much debate amongst health professionals and ethicists. This paper describes the views of parents who consented that their critically ill newborn baby should be enrolled in a neonatal trial. In-depth interviews were used to determine their response to the trial and randomization. The nature of the trial was often poorly understood. The random basis of the allocation of treatment and the rationale behind this approach were also problematic issues. Some parents did not perceive a random element in the process at all. These findings advance understanding of the perceptions of trial participants and raise important issues for those concerned with RCTs. Greater understanding of participants' views provides the potential to improve the management of future trials and so the experience of those agreeing to take part.     

Early cell response to radiation

The early steps of cellular radiation response have been investigated using a linear electron accelerator operated in a split-dose mode, in such a way that the time intervals between pulse exposures to relativistic electrons ranged from fractions of a second to a few minutes. The initial dose brought about large, synchronous changes in radiation sensitivity and generated a tetraphasic, W-shaped time-dependent profile of cell survival upon the second radiation exposure. While this time-related process was observed in most cell lines investigated, its kinetic parameters varied significantly from one cell line to the other. The number of DNA strand breaks (neutral and alkaline DNA filter elution) and the level of apoptosis (gel electrophoresis and flow cytometry) induced at the different phases of the time-dependent profile showed no relationship with the W-effect. It is presently hypothesized that mechanisms involved in molecular recognition of radio-induced lesions and initiation of genomic instability play a major role in this effect. Whatever the mechanism involved, the split-dose irradiation in the range of seconds enables dissecting the early steps of radiation response. The relevance of the W-effect to radiation therapy and technical drawbacks are discussed.     

Effects of growth mechanism on solution kinetics

The solution kinetics of second phases were studied as a function of various initial conditions resulting from either diffusion-controlled growth or interface-reaction-controlled growth prior to solution treatment. Calculations of solution kinetics based upon a planar, finite-geometry model were carried out using numerical methods and computer techniques. It was shown that second-phase particles formed by diffusion-controlled growth and existing in a matrix containing concentration gradients exhibit dissolution kinetics that differ markedly from those of particles formed by interface-reaction-controlled growth. An experimental analysis designed to use solution kinetics measurements to obtain the mechanism of growth of second phases is discussed. The effects of linear-gradient assumptions that have been used in an existing, closed-form, infinite-geometry model are evaluated. Formerly, Graduate Student in the Department of Metallurgical Engineering, Drexel University, Philadelphia, Pa.