Emotional impact of diagnosis and early treatment of lymphomas

Psychiatric morbidity, relevant symptoms and satisfaction with communication were assessed in patients suffering from malignant lymphoma. Before treatment started 15 of 40 patients had clinically significant psychiatric morbidity. Treatment, in its early stages, was not associated with a significant change in mean psychiatric morbidity scores but there was a decrease in ratings of concern about illness and an increase in ratings of nausea. Eleven of 31 patients seen for a second interview reported dissatisfaction with some aspect of communication with the medical staff.The findings suggest that emotional distress can be contained with a policy of frank communication; nevertheless dissatisfaction is common, being associated with initial less concern, good general health and neurotic personality traits. Personality assessment should be incorporated in future studies of doctor-patient communication.     

Emotional control and autonomic arousal in breast cancer patients

Thirty breast cancer patients and 27 “healthy” controls were compared for differences in personality, reported emotional state and autonomic responses occurring under conditions of acute experimental stress. The data indicated that breast cancer patients were more likely than a control group to report a tendency to control emotional reactions, particularly anger, and to respond to stress using a repressive coping style. Emotional state reported at different points throughout the procedure suggested that the breast cancer group experienced more anxiety and disturbance but were more inclined to inhibit their reaction. There were no differences between the groups on autonomic measures but within the breast cancer group increased electrodermal activity was significantly associated with a tendency to respond to stress using a repressive coping style. The results are discussed in relation to psychobiological models of cancer.     

Thyroid function and urine-concentrating ability during lithium treatment

It has been suggested that adenylate cyclase inhibition may be important in the development of both nephrogenic diabetes insipidus and hypothyroidism during lithium treatment. We measured serum thyroxine and urine-concentrating ability (U_max) in response to desmopressin (DDAVP) in 85 patients receiving lithium.

Hypothyroidism developed in eight patients while they were taking lithium. Impaired U_max was found in both euthyroid and hypothyroid patients while some hypothyroid patients concentrated their urine well. It is concluded that the dominant mechanisms by which lithium exerts these two effects are different.     

Some further studies on the prediction of experimental colds in volunteers by psychological factors

An analysis of the incidence of colds in volunteers, exposed experimentally to various rhinovirus and influenza virus challenges, confirmed an earlier report that assessments of virus shedding show a higher degree of infection by rhinovirus in Introverts than they do in Extroverts. The influenza trials however did not show such an effect. In addition, people with higher scores on a widely used self-report inventory of mild psychoneurotic symptoms tended to show more evidence of increased nasal secretion after infection by either type of virus. The specific scale showing the latter effect most clearly was that of Obsessional Symptoms. Taking account of these psychological factors greatly increased the sensitivity of a study of the beneficial effects of interferon.     

Psychosocial morbidity in the first three months following stoma surgery

One hundred and six consecutive subjects were seen in hospital a few days after undergoing surgery for bowel disease that necessitated the formation of a stoma. They consisted of patients with cancer (74), colitis (17) and diverticular disease (15). At this initial assessment details of psychological and social functioning were obtained for the proceeding three months before operation. At 3 months post-operatively the subjects were interviewed in their own homes, 87 subjects were available (12 died, 7 refused) and again psychological and social assessments were made. Seventeen per cent of males and 19% of females had moderate or severe psychiatric disturbance and there was also a significant number of patients with various social disturbances. Physical diagnosis did not significantly affect psychiatric outcome. There was, however, high pre-operative psychiatric disturbance and the relevance of this in assessing post-operative symptoms is discussed.     

Psychological interventions in cardiovascular disease

The literature on the behavioural treatment of primary hypertension, reduction of Type A behaviour, and psychological interventions during acute coronary care and rehabilitation after a myocardial infarction are selectively reviewed. There is growing evidence that relaxation and stress management can lower blood pressure by useful amounts in mild primary hypertension although the mechanisms underlying these reductions are unclear. Type A behaviour has been reduced in patients following a myocardial infarction and this led to reduced morbidity. Other interventions following myocardial infarction, both when the patient is in hospital and after discharge have produced at best only modest benefits and are, therefore, not widely applicable. Future research in rehabilitation should be directed at reducing the disabilities of patients with clearly identifiable problems that stem from their response to cardiovascular disease.     

Psychological factors contributing to disproportionate disability in chronic bronchitis

Disability in fifty chronic bronchitis patients was measured by the twelve-minute walking test. The degree of disability was examined in relation to lung function and a measure of disproportion of disability was derived. This measure was significantly related to a number of attitude measures, in particular the patients' beliefs about treatment and treatment outcome, but was not strongly related to psychiatric disturbance on the GHQ. However, high levels of psychiatric disturbance were found within the overall sample.     

Age changes at cerebral artery bifurcations and the pathogenesis of berry aneurysms

Cerebral artery bifurcations with and without aneurysms were studied in postmortem brains by histology (1-μm resin sections) and by scanning electron microscopy. Specimens were taken from 20 patients without aneurysms with an age range of 1 month-80 years. Gaps in the tunica media at the carina and the lateral wall of the bifurcations were observed in 60% of specimens from arteries at all ages, but they were larger in older patients. A more striking change with age was the development of inelastic pads of intimal thickening in relation to bifurcations. Intimal pads were observed at and distal to the carina of bifurcations, but scanning electron microscopy also revealed intimal pads proximal to bifurcations in 60% of patients over the age of 30 years and in 2 out of 9 (22%) patients under 10 years. Similar pads covered a much wider area of vessel wall proximal to the necks of berry aneurysms in the 15 patients studied. Contralateral bifurcations in these patients showed no difference from non-aneurysm patients. It is suggested that the inelastic intimal pads form as a result of haemodynamic stress and that the presence of such pads may alter the stresses and strains at vessel bifurcations. Together with the presence of a gap in the tunica media, the pattern of inelastic intimal pad formation may be a major predisposing factor in the formation of cerebral artery aneurysms.     

Blood pressure changes during acute mental stress in hypertensive subjects using the Oxford intra-arterial system

The Oxford intra-arterial system was used to measure blood pressure changes during mental stress testing in 20 hypertensive subjects. All subjects underwent a Stroop test, and in nine subjects, a cine film test was also performed. The Oxford system is particularly suited to measuring blood pressure accurately during mental stress testing because (i) it measures blood pressure directly and continuously, and (ii) it causes relatively little subjective awareness of experimental apparatus. The method was found to be safe and acceptable to the patients. Blood pressure increased by a mean of 26% during the Stroop test, but the range of responses was wide (9–59%). The mean increase during the cine film test was only 12%. Subjective stress scores were higher for the cine test. These results are discussed in terms of personal control over the stressor, and it is argued that accurate means of blood pressure measurement will be needed before the possible links between stressor blood pressure responses and essential hypertension can be further explored.     

Immune responses to myelin antigens in Guillain-Barré syndrome

Antibodies to nerve antigens were sought in the sera of 17 patients with acute Guillain-Barré syndrome (GBS), 11 with chronic relapsing demyelinating poly-radiculoneuropathy (CRP), 20 with other neuropathies (ON), 15 with other neurological diseases (OND) and 19 normal subjects. Complement-fixing antibodies to a suspension of human peripheral nerve tissue were identified in only 2 patients with GBS and 1 with chronic progressive neuropathy. Five GBS sera gave complement fixation reactions with rabbit sciatic nerve. The sera were also tested for galactocerebroside (Gal-C) binding activity using a solid phase assay. The range of values in all groups was the same, although the mean values for patients with GBS, ON and OND were higher than those of normal subjects. In a radioimmunoassay for antibodies to bovine P2 slightly more radiolabelled antigen was precipitated by the GBS group of sera than by sera from the other groups, but only one serum from the GBS and another from the CRP patients precipitated more than 10% of the label. Addition of bovine P2 to cultures of peripheral blood mononuclear cells from 11 patients with GBS did not cause significant stimulation. Immunoassay for antibody to myelin basic protein (MBP) showed an increased proportion of sera with low binding activity in the GBS and CRP groups. The results suggest that humoral immune responses to potentially neuritogenic antigens are found with marginally increased frequency in patients with GBS and CRP.     

Sensorimotor cortical projections to the marginal zone of the trigeminal subnucleus caudalis

An ultrastructural investigation of the marginal zone (lamina I) of the spinal trigeminal subnucleus caudalis was carried out in 7 adult cats at 30 h through 7 days after ablations of face area of the contralateral sensorimotor cortex. Corticofugal boutons were observed to undergo electron-dense degeneration in the marginal zone beginning 4 days after the cortical lesion. These boutons were small (1--2 micrometers), widely dispersed and made synaptic contacts onto small dendrites or dendritic spines. These new observations indicate that cortical inhibition and facilitation of ascending orofacial sensation may be mediated in part by a direct pathway to the marginal zone.     

Interpersonal reactions to assertive and unassertive styles when handling social conflict situations

Determining how persons perceive and evaluate social assertiveness is a particularly important topic, since assertive training is primarily intended to alter the behavior of individuals in the context of social interactions. In the present study, college students observed videotapes which showed a model handling several social conflict situations in either an assertive or an unassertive manner. Because race of the individual may also influence the way assertiveness is viewed, both black and white models were used. Subjects then completed a 26-item adjective checklist to evaluate the personality of the model they observed. Results indicated that while assertive models were viewed as skilled and able in their handling of the portrayed social conflict situations, they were rated much less favorably than unassertive models on 14 adjectives assessing likeability. Race of model did not differentially affect this pattern. Implications of these findings are discussed.     

Heart rate, tonic cardiac variability and evaluation

Heart rate (HR) and various measures of heart rate variability (HRV) were measured while 29 male and 15 female student volunteers individually rated slide stimuli presented in one-minute intervals. Ratings were factor analyzed and factor scores analyzed as variables. Factor one: “evaluation” accounted for 52.5% of the variances. HR and HRV were not significantly related to the experimental conditions although factor one was related. HR was correlated to measures of HRV [such as the coefficient of variability (CV), coefficient of temporal variability (CVT), a cosine function (FREQ) and to a lesser degree the auto-correlation (RA)]. HR also correlated linearly to evaluation. CVT, CV and RA were also linearly correlated to evaluation. HRV (BURST) was independent of HR, other forms of HRV, and curvilinearly related to evaluation. A cyclic HRV function (FREQ) was found with a mode of 18.7 sec and accounted for 21.4% of the variance of the heart beat data. This cyclic function, not reported previously, should be further investigated.     

Patterns of confidence loss in the cued recall of normal people with attenuated recognition memory: their relevance to a similar amnesic phenomenon

Amnesics show relatively good cued recall (but very poor recognition memory) yet display little confidence in the accuracy of their cued recall responses. In the two studies reported here a similar pattern of results was found in normal subjects who were either tested after a long retention interval or after being given inadequate time to learn target words, i.e. cued recall was relatively unaffected whereas both yes/no recognition of words and confidence in cued recall were much impaired. The finding of equivalent impairment in recognition and confidence in cued recall suggests that these forms of memory are mediated by common memory mechanisms. These mechanisms must be impaired in amnesics and, in normal subjects, are very sensitive to delay and learning exposure manipulations. In contrast, cued recall depends largely on a different form of memory spared in amnesics, and which in normal subjects is less susceptible than recognition memory to delay and brief exposure manipulations.     

Persistent problems in the diagnosis of depression and their relationship to elitism in academic psychiatry

There has been and explosion of new concepts and new data in psychiatry. Such findings have raised new problems such as what constitutes an appropriate definition of depression, which criteria should be used for making such diagnoses, what relevance severity has to specific diagnoses, heterogeneity within the rubric of bipolar illnesses and the influence of drug treatments in precipitating the clinical syndrome of mania. Because these are complicated subjects, there may be a demand for a relatively elite group of researchers and teachers within the departments of psychiatry to adequately deal with these subjects and problems in programs for medical students and residents. The qualities of such faculty members are described in the paper. The need for teachers who engage in significant research is discussed.     

Biofeedback, self-control and tension headache

This research tested the belief that muscle contractions are a primary source of tension headache. EMG level was found to be associated with both headache-specific and more global symptoms following biofeedback training. However, the level of pretreatment relationship between EMG level and headache symptoms was weak, and the amount of reduction in EMG activity over the course of biofeedback did not explain improvement. In addition, although the voluntary control over muscle spasming evidence by lowered EMG readings appeared to enhance patients' post-treatment level of self-control, this cognitive process variable also could not account for outcome variance. The results offer limited support for the muscle-origins conception of tension headache and suggest the need for further research to clarify the contribution of physiological, cognitive and social factors to pain reduction.     

The relationship of cognitive styles and affective status to post-operative analgesic utilization

The relationship of post-operative analgesic utilization to field dependence, locus of control and psychologic status was studied in 37 post-cholecystectomy patients. The results show a positive correlation between psychological disturbance and increased medication. External locus and field dependence were also correlated with depression, but not more medication. The findings reject a linear relationship between these two personality variables and pain response, but suggest an interaction between cognitive styles and affective status that augments narcotic utilization.