Investigating risk for grief severity: Attachment to the deceased and relationship quality

Abstract

Previous research examining the interrelationship between attachment, relationship quality, and bereavement outcomes suffers from a lack of precision and sophistication in the measurement of the core constructs of interest. The present study adapted an existing measure of attachment and employed a novel instrument of relationship quality to examine specific attachment to and relationship quality with the deceased as contributors to grief symptom severity. A sample of 385 bereaved college students completed measures retrospectively assessing relationship quality, attachment to the deceased, and grief symptomatology. Findings indicate that specific attachment to the deceased differs significantly from global attachment style and that relationship quality and attachment anxiety and avoidance interact in significant ways to predict the risk of grief severity. Specifically, individuals with a Preoccupied attachment style (high anxiety, low avoidance) are most at risk for adverse grief reactions in the context of high relationship closeness and conflict. This study is limited by an over-representation of extended family loss, which may have unique implications for attachment and relationship quality. Grief therapists should consider the implications of attachment and relationship quality with the deceased in the selection of relationship-enhancing or relational problem-solving interventions.     

Validation of hourly pain intensity profiles with chronic pain patients

This study examines how empirically derived pain intensity profiles relate to psychological adjustment in chronic pain patients. Hourly pain intensity ratings over the course of a day of 189 chronic pain patients were categorized into 6 groups using a hierarchical regression analysis technique. The profiles reflected linear, curvilinear, multilinear or "no profile" effects. Judges' ratings of pain intensity profiles were found to be less reliable than ratings based on empirical analysis. The majority of patients showed linear profiles while 26% of the patients showed no consistent relationship between hourly pain intensity and time of day. Patients who showed no consistent trend in their pain ratings reported having significantly higher ratings of emotional distress. They tended to have conflicts at home and showed more pain behavior than patients who had a distinct pain profile. Support is given for the potential clinical utility of pain rating profiles.     

A micropuncture study of collecting tubule function in rats with hereditary diabetes insipidus

The reabsorption of water and solute by the papillary collecting duct was studied during water diuresis and vasopressin-induced antidiuresis in young rats with hereditary hypothalamic diabetes insipidus. The tip of the left renal papilla was exposed and fluid was obtained by micropuncture from loops of Henle and from collecting ducts at the papillary tip, and at an average of 1 mm proximal to the tip. In water diuresis the ratio of tubule fluid to plasma (TF/P) osmolality (osm) of loop fluid was 1.73 ±0.058 (SE); of fluid from the proximal collecting duct, 0.63 ±0.027; and from the tip, 0.55 ±0.024; indicating a substantial osmotic pressure difference across the collecting duct epithelium. The fraction of filtered water reabsorbed (× 100) by the terminal collecting duct was 1.58% ±0.32. In antidiuresis the TF/P osm of loop fluid was 2.65 ±0.109; of fluid from the proximal collecting duct, 2.20 ±0.093; and from the tip, 2.71 ±0.111; indicating a marked decrease in the driving force for water reabsorption. The fraction of filtered water reabsorbed (× 100) by the terminal collecting duct was reduced to 0.58% ±0.08, while the delivery of solute to the same segment was unchanged from that in water diuresis. The glomerular filtration rate (GFR) of the right kidney declined from 327 ±24.4 μl/min in water diuresis to 274 ±24.4 μl/min in antidiuresis (P < 0.005); similar results were obtained in a study comparing right and left GFRs in five additional rats. Thus, fractional reabsorption (and very likely the absolute volume) of water reabsorbed by the terminal collecting duct was less in antidiuresis than in water diuresis (mean difference, 1.01% ±0.29, P < 0.005).     

Disorders of urinary concentration and dilution

A new approach to the classification of disorders of urinary concentration and dilution is recommended based on recent studies of how the kidney elaborates a urine of widely varying osmolality. The capacity to concentrate urine depends on f_T, the fractional reabsorption of solute delivered to the loop of Henle; f_U, the excretion of solute relative to the sum of solute excretion and solute delivery to Henle's loop; f_W, the fraction of solute loss by vascular outflow from the medulla relative to that reabsorbed by the loop; and finally, collecting duct response to antidiuretic hormone (ADH). A decrease in f_T or an increased f_U or f_W will diminish urinary concentrating ability, as will resistance of the tubule to ADH. Conversely, urinary dilution depends on the delivery of sodium and water to the ascending limb; NaCl reabsorption by the ascending limb; and the absence of ADH. A decrease in sodium and water delivery to the ascending limb or in NaCl reabsorption by the ascending limb will impair urinary diluting ability, as will the presence of ADH. The consequences of disorders in urinary concentrating and diluting ability vary widely. In an alert patient with an intact thirst center, there may be no consequence; in a patient unable to communicate thirst or whose thirst center is deranged, the results may be catastrophic. Keeping in mind the kidney's few basic requirements for formation of concentrated or dilute urine may help the physician avoid these potentially serious dislocations of water balance.     

The prevalence of seizure types among individuals referred for phase I neuropsychological assessment: demographic and neuropsychological characteristics

The prevalence of seizure types among the subpopulation of patients referred for phase I neuropsychological assessment likely differs from the prevalence of specific seizure types within the general seizure population. Understanding the prevalence of clinical diagnoses is critical to maximizing the predictive value of any assessment or diagnostic technique, clinical neuropsychological assessment of patients with seizures being no exception. Data from a series of 835 patients referred for phase I neuropsychological evaluation are used to report the prevalence of specific seizure types, as well as neuropsychological and demographic characteristics. Considerations for clinical neuropsychological research and practice are briefly discussed.