摘要:

Objectives. Motor neurone disease (MND) has been regarded primarily as a disorder of the motor system. The current review sets out toprovide a summary of what is known about the cognitive and psychological consequences of this neurodegenerative disorder, and how this disease impacts on those caring for a person with MND. Method. A Medline and PsycLit search was undertaken, for the years 1983‐1997 supplemented by a manual search, to extract literature on the cognitive and emotional changes described in MND, as well as on styles of coping by MND patients. In addition, articles relating to the reactions of carers of MND patients were reviewed. Results. A consistent body of data is reported indicating the presence of subtle cognitive deficits (of a predominantly fronto‐temporal type) in MND patients who do not demonstrate clinical dementia. Emotional disorders (e. g. anxiety and depression), as well as emotional lability, have been documented in patients in cross‐sectional studies despite the limited availability of systematic research. Although reactions to the disease and coping skills of carers have been poorly studied, some carers demonstrate difficulty in dealing with physical and emotional stress posed by the disease. Conclusions. The atheoretical nature of much of the research into emotional disorder and coping skills in MND patients and their carers means that as yet it is difficult to predict who will be at particular risk of developing psychopathology during the course of the illness. Research to date also fails to elucidate the role of the patients' possible cognitive dysfunction in determining their coping behaviour. Future research, preferably longitudinal in design, should seek to determine whether aspects of the emotional response to MND by patients and their carers are specific to the disorder or characteristic of chronic, terminal neurological disease in ge

ISSN:1359-107X    

DOI:10.1348/135910799168579

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Objectives. To evaluate the immediate effectiveness of a cognitive‐behavioural group therapy intervention for the management of sickle cell disease SCD pain. Design. This study is taken from an ongoing longitudinal, multi‐centred, randomized controlled trial. Method. Ninety‐seven patients with SCD recruited from seven London hospitals were randomly allocated to one of three treatment conditions after giving written consent: a CBT pain management group, an attention placebo group and a nointervention control. All participants completed a number of measures at baseline and post‐intervention to assess psychological well‐being, pain and coping. Results. Results are presented for the 59 participants who met the study entrance criteria, attended treatment group sessions above the cut‐off point selected for treatment completion, and completed sessions both baseline and post‐intervention assessments. Significant post‐intervention treatment group differences in favour of the CBT intervention were identified for nearly all of the psychological measures using the Kruskal‐Wallis test. Within‐group significant differences over time were also found for the CBT condition for the majority of the measures. Following the identification of centre differences in baseline measures, two‐way ANCOVAs were conducted with centre and condition for the ranked data of each psychological measure using ranked baseline scores as covariates. Observation of the adjusted means indicated that most of the post‐intervention effect was accounted for by centres 1 and 2, with centre 4 having a minimal effect and, for centre 3, some of the measures showing a reverse effect to that predicted. Conclusions. Overall, the cognitive‐behavioural approach employed appears to be immediately effective for the management of SCD pain in terms of reducing psychological distress and pain, and improving coping. Further analysis of longitudinal and cost‐effectiveness data currently being collated will indicate whether long‐term and financ

ISSN:1359-107X    

DOI:10.1348/135910799168588

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Objectives. The study describes cardiovascular reactivity to challenge 18 months post‐episode in primary myocardial infarct patients. Reactivity during laboratory tests was compared to changes induced by self‐reported stressful events and related to measures of anxiety and depression. Design. Prospective changes of mood states were documented between the postepisode period and an 18‐month follow‐up. Cross‐sectional bivariate correlations and regression analyses were used to relate mood states to cardiovascular responses. Method. Questionnaires were used to document anxiety, depression, more general negative and positive mood status, and patients'general appraisal of stressorsin 30 postmyocardial infarct patients. Responses were collated 4 weeks following their episode and again 18 months post‐episode at psychophysiological assessment. Systolic and diastolic blood pressure and heart rate were measured under four conditions: baseline rest in the laboratory, laboratory challenge tests, ambulation over a 12‐hour period, and self‐reported stressors during this period. A time domain assessment of heart rate variability was also collected over the ambulatory period. Results. Heightened reactivity was significantly greater to self‐reported stressors compared with laboratory challenge. Depression assessed in the immediate post‐episode period proved the best predictor of heightened reactivity to stressors of relevance to patients, and of heart rate variability. Mood status was not a strong predictor of responses to arbitrary laboratory challenge. Conclusions. The data are consistent with the hypothesis that an increased probability of subsequent episodes in post‐myocardial infarct patients suffering depression may be related to reactive vascular responses to self‐perceived stressors and chang

ISSN:1359-107X    

DOI:10.1348/135910799168597

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Objectives. To assess the utility of measures of affect and social‐cognitive variables in predicting risk behaviours for coronary heart disease in post‐myocardial infarction (MI) patients. Design. A longitudinal design was adopted with predictor variables measured while participants were in hospital and dependent variables (exercise, alcohol consumption, diet and smoking) measured 3 months following discharge. Method. A random sample of 43 patients with a first MI were identified on the wards and given a questionnaire measuring anxiety and depression, and measures of outcome and self‐efficacy expectancies and intentions relevant to each risk behaviour. Thirtyseven participants completed further behavioural measures at 3‐month follow‐up (excluding those who died in the follow‐up period), a 90% completion rate. Results. Social cognition measures were predictive of later behaviour, and in particular light exercise. Here, intentions accounted for 51% of the variance in behaviour explained after partialling out pre‐MI levels of exercise. Affect was less predictive, explaining only 7% of the variance in light exercise. Conclusions. Beliefs and intentions about future risk behaviour are formulated in the immediate post‐infarction period. Future rehabilitation programmes would benefit from some intervention, probably educational, at t

ISSN:1359-107X    

DOI:10.1348/135910799168605

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Objectives. The aim of this paper is to describe the development and refinement of nine measures of perceived work characteristics for use in studies of the psychological wellbeing of health services employees. The constructs measured are: autonomy/control, feedback, influence, leader support, professional compromise, role clarity, role conflict, peer support and work demands. Design. The study was a large scale cross‐sectional survey. Methods. National Health Service Trust staff were selected from seven major occupational groups (nurses, doctors, administrative staff, managers, professions allied to medicine, professional and technical staff, and ancillary staff) within a sample of Trusts chosen to be representative of those in England. Questionnaires incorporating the scale items were completed by over 9,000 staff. The fit with the a priori nine‐dimensional measurement model was tested using confirmatory factor analysis. Scale internal reliabilities and norms were calculated, and aspects of construct validity were examined. Results. The findings show a good fit to the measurement model for the sample as a whole and across occupational groups. All the scales exhibit acceptable internal reliabilities; and normative data is provided for all seven occupations (with norms for more specific job categories available on request). Analyses suggest good construct validity, showing the scales discriminate as anticipated across occupational groups and job categories, and they have the expected relationships with job satisfaction and psychological strain. Conclusions. The measures developed are usable for research purposes across the major occupational groups, with the possible exception of ancillary staff. Further work is desirable to confirm the measurement properties and extend the normative datab

ISSN:1359-107X    

DOI:10.1348/135910799168614

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Objectives. To examine the inter‐rater reliability of a newly developed measure of the communication process in dental settings. To assess the relationship between the measure of communication process and patient satisfaction with the consultation. Design. An observation‐based assessment scale for dentist‐patient consultations was developed, based upon a theoretical model of dentist‐patient communication. Behavioural definitions for each item were developed on the basis of observations of five video‐recorded consultations. Inter‐rater reliability for the scale was then assessed by observation of 34 student dentist‐patient consultations. Validity of the scale was assessed by examining the correlation between the scale and other measures of the dentist‐patient consultation and with patient satisfaction. Results. All items on the scale showed acceptable levels of inter‐rater reliability. The scale correlates well with other measures of communication and with patient satisfaction with the interview. Conclusions. The CDSS proved to be a reliable and valid measure for the assessment of communication processes in the limited sample studied. Further research is required to assess its applicability in a broader

ISSN:1359-107X    

DOI:10.1348/135910799168623

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY

摘要:

Book reviewed in this article:Smoking in adolescence: Images and identities. By Barbara Lloyd, Kevin Lucas, Janet Holland, Sheena McGrellis&Sean Arnold.Coping with catastrophe, 2nd ed. By Peter Hodgkinson&Michael Stewart.Cambridge Handbook of Psychology, Health and Medicine. Edited by Andrew Baum, Stanton Newman, John Weinman, Robert West&Chris McManus.

ISSN:1359-107X    

DOI:10.1348/135910799168632

出版商:Blackwell Publishing Ltd    

年代:1999

数据来源: WILEY