摘要:

Scant attention has been paid to psychotherapy with patients who have acquired neurological conditions. In this paper the authors describe the common psychological problems and repetitive themes that emerge in the therapeutic process with these patients, as well as the salient attitudes toward therapy and the therapist that these patients manifest. Case vignettes illustrate the theoretical and technical considerations.

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The use of nocturnal penile tumescence (NPT) monitoring for the differential diagnosis of erectile dysfunction has burgeoned during the last decade. This article reviews the history, development, and attempts at validation of NPT for diagnostic purposes. Problems associated with NPT are discussed, including the potential effects of unrecorded concomitant sleep parameters and variability in data scoring and diagnostic criteria. In addition, less expensive and more convenient methods of NPT monitoring are reviewed, and their strengths and weaknesses are discussed. Finally, theoretical problems related to the use of NPT for differential diagnosis of organic and psychogenic erectile dysfunctions are presented. In light of the problems associated with NPT monitoring, exclusive reliance on this technique for diagnostic purposes is discouraged. Instead, a biopsychosocial approach to the understanding and assessment of erectile dysfunction is advocated

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Diabetic impotence is generally presumed to be secondary to peripheral abnormalities of the vascular or autonomic nervous system, although central nervous control of the autonomic nervous system has not previously been studied. Measures of rapid eye movement (REM) sleep as potential indicators of central autonomic dysfunction were studied along with sleep-related tumescence for 10 impotent diabetics, nine psychogenically impotent men, and 10 men whose impotence was secondary to pelvic trauma. Low REM density was found in the diabetics with REM density correlating with measures of tumescence. These results suggest that central autonomic dysfunction may be a contributing factor in the impotence of diabetic men. A metabolic disturbance in the central nervous system of diabetics which might alter both sleep and autonomic nervous system activity is proposed to explain these results and may help in the understanding of other observed abnormalities in both the sleep and autonomic dysfunction of diabetics.

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Scophrenic patients are frequently orienting nonresponders to innocuous stimuli, become responsive to significant target signals, and become hyporesponsive again on prolonged repetition. We wish to a) determine whether schizophrenic patients can display orienting response (OR) flexibility, responding to newly designated targets and ceasing to respond to newly designated nontargets; b) determine whether renewed hyporesponding can be averted with reminders of target relevance and repeated introduction of new targets; and c) compare schizophrenics with depressives and normal controls. Fifty schizophrenics (14 drug free), 50 depressives (20 drug free), and 50 normal controls receive four trial blocks involving the same sequence of 16 1000− or 2000-Hz tones delivered to either the right or left ear. A subsample of each group (N= 14) receives all blocks as a simple habituation series; others (N= 36) have to press a pedal for designated target signals (left ear or right ear, 1000 Hz or 2000 Hz), ignoring all nontarget tones. On each trial block, a new target signal is defined, and previous targets are discarded. Skin conductance and finger pulse amplitude analyses are presented. Both patient groups show enhanced ORs to newly relevant targets and ceased ORs to newly irrelevant former targets as well as normals. Both show OR decline with target repetition despite reminders and new targets.

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This paper examines the influence of life context factors and the amount of treatment on treatment outcome after 1 year among 265 unipolar depressed outpatients. Preintake medical conditions, family conflict, and lack of family support predicted poorer treatment outcome. Moreover, patients' family conflict and confidant support at intake interacted with the amount of treatment to influence outcome. Patients who had a close confidant and less family conflict showed better outcome with brief therapy; patients who lacked a confidant and had more family conflict experienced better outcome with longer treatment. Posttreat-ment stressors and lack of social resources were associated with poorer treatment outcome. The findings imply that treatment can provide temporary support to compensate for a lack of social resources. More intensive treatment may be needed for patients who experience more family conflict and who have a poor relationship or no relationship with a confidant

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A total of 247 consecutively evaluated geriatric medical patients was administered a battery of neuropsychological and psychological tests as part of their diagnostic workup for unexplained deterioration in their functioning. Depression was assessed with a short form of the MMPI, the Brief Symptom Inventory, and the Geriatric Depression Scale. By Research Diagnostic Criteria, most suffered from major (59%) or minor (21%) depressions; some degree of cognitive impairment was seen in 80% of the patients, defining a population of “vulnerable” geriatric patients typical of referrals to a general medical hospital setting. Using both conventional score cutoff criteria and discriminant analyses, false-negative rates up to 53% for major depression and 100% for minor depression were found. Psychometric misrecognition of depression was not related to degree of dementia or education but on some measures was positively associated with verbal intelligence level and patient age. Contrary to previous suggestions that psychometric measures overestimate depression in the elderly, these findings suggest that there may be a subgroup of elderly in which treatable affective distress is not appreciated.

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The Social Rhythm Metric (SRM) is an instrument designed to quantify an individual's daily social rhythms. Social rhythms are important both as a way of structuring the day cognitively and as time cues (or zeitgebers) that drive the biological clock (circadian system). The development of the SRM and its pilot testing in 50 healthy control subjects is described, along with measurements of reliability and validity. The potential of the SRM for integrating psychosocial and biological research and its clinical applicability are discussed

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Several psychosocial variables were investigated as predictors of 4-year survival in a sample of 97 end-stage renal disease (ESRD) patients undergoing treatment by hemodialysis, continuous ambulatory peritoneal dialysis, or renal transplantation. Hypothesized psychosocial predictors included depression, mood disturbance, life happiness, affect, pessimism, self-esteem, knowledge of renal disease and its treatment, perceived control over important life domains, perceived intrusiveness of ESRD into important life domains, illness-related concerns, difficulties in daily activities, number of regular leisure activities, somatic symptoms of distress, social networks, recent negative life events, and defensive response styles. Methodological controls were incorporated to test the prognostic significance of these variables and included a) exclusion of deaths attributable to “unnatural” causes; b) multivariate statistical controls for physical and demographic determinants of survival; c) widely used standardized psychosocial instruments; and d) temporally aggregated psychosocial measurements to enhance reliability. Hierarchical multiple regression analyses identified four variables as significant and independent predictors of increased survival times in ESRD: a) comparatively fewer serious nonrenal comorbid illnesses; b) younger age; c) regular involvement in an increased number of leisure activities; and d) overall life happiness described as “an even mixture of unhappiness and happiness” (as compared with “very happy”). However, no evidence was obtained to support the hypothesis that increased depressive symptoms and/or moods contribute to compromised survival in ESRD

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Lycanthropy, an unusual psychiatric syndrome involving the delusion of being an animal, usually occurs as a transient symptom of severe psychosis. A review of the historical and modern medical literature, as well as of contemporary anthropological reports, suggests multiple etiologies for lycanthropy, including seizure disorders and use of psychotomimetic drugs. A clinical illustration is presented in which the delusion of being an animal in human form has persisted for over 15 years and has been refractory to treatment. The authors speculate that disturbances of self-identity may combine with neurological abnormalities to produce some cases of this syndrome

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

There is considerable evidence that the tendency to be hot tempered is familial (Lefkowitz et al., 1977; Mattes and Fink, 1987; Stewart and deBlois, 1983) and may be transmitted as a personality trait rather than as part of an associated diagnosis (Mattes and Fink, 1987). While conducting a family study of patients with temper outbursts, seven adopted patients were identified; this provided an opportunity to evaluate whether the familial transmission of temper outbursts is genetic or environmental.

ISSN:0022-3018    

出版商:OVID    

年代:1990

数据来源: OVID