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The authors have calculated the mathematic relationship between measured elements of illness behavior in chronic low-back pain. Objective physical impairment accounts for about one-half the total disability that also is affected by psychologic reactions. The most important psychologic disturbance in low-back pain is emotional distress, measured on questionnaires as increased bodily awareness and depression and presenting clinically as inappropriate descriptions of symptoms and inappropriate responses to physical examination. Simple methods for the assessment of distress and illness behavior in chronic low-back pain are developed and described.
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PMID:Chronic low-back pain, psychologic distress, and illness behavior. 623 14

When it is discovered that cancer has recurred, patients experience a period of acute emotional distress, with increased anxiety, fear, helplessness, and depression. Well-meaning colleagues, friends, and relatives feel compelled to tell them about unorthodox cancer "cures." These unproven remedies tend to fit holistic health concepts purporting to enhance the body's own defenses; most involve the use of chemicals or drugs, nutritional supports, vitamins, vaccines, and mind-body techniques. In the past decade, laetrile has been the most popular unorthodox remedy. The distraught patient and family are deluged with information and have trouble evaluating what is valid. Physicians who treat patients with cancer should make sure that they themselves understand the emotional basis for a patient's need to pursue unorthodox remedies. The risk is heightened when the patient senses the doctor has "given up" and has "nothing more to offer." Patients should feel able to ask questions about unproven remedies without fear that the physician will be judgmental or punitive. Participation in a clinical trial of a new and promising treatment under investigation, within the full protection of ethical guidelines, should be suggested as an alternative to unproven treatments outside the medical system that are not subject to the same constraints.
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PMID:Why patients seek unproven cancer remedies: a psychological perspective. 627 65

In this paper, the author emphasizes the practical importance for the internist of determining the underlying content of the patient's fantasies about his illness and its treatment. These fantasies are often the cause of the anxiety and depression that accompanies physical illness and may be quite divorced from the reality of the situation. When the particular fantasies are elicited, the physician will be in a position often to directly reassure the patient about unrealistic concerns. By communicating his understanding, the physician increases the power of the patient's bond to him and is in a position to substantially alleviate emotional distress that stems from physical illness.
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PMID:Meaning as an intervening variable. 637 73

The coping styles 55 women who underwent abortion at the Fleming Center in North Carolina were assessed in reference to their use of avoidance and approach mechanisms. A 15-point denial subscale from the Impact of Even Scale was used to determine their dependence on avoidance mechanisms. The scale contained items such as "I tried to remove it from memory." The intrusion subscale of the Impact of Event Scale was also used. A 6-point scale, designed for the study, was used to assess their reliance on approach mechanisms and contained items such as "I tried to deal with my feelings." Anxiety and depression levels were measured by the self-rating Symptom Checklist-90, which is often used to assess depression and anxiety levels in psychiatric outpatients. The 55 women were asked to rate themselves in reference to these scales a few hours before they were scheduled for abortion and then again about 1 hour following abortion. The mean age of the women was 23.2 years, the majority were single, and 39% had 1 or more previous abortions. All the pregnancies were aborted during or before the 181th gestation week. Prior to abortion the patients showed fairly high levels of denial, anxiety, and depression. Levels of denial and intrusion were similar to those observed for bereaved individuals in other studies. Their anxiety levels were slightly higher and their depression levels slightly lower than those observed for populations of psychiatric outpatients. The reduction may have been due to relief or to the coping mechanisms used by the women. The women could not be neatly divided into avoiders and approachers; however those who tended to be high deniers were more distressed initially than low deniers. High approachers were initially more distressed than low approachers. Distress was significantly decreased after the abortion for high approachers, but not for low approachers. Following abortion, both high approachers and low approachers had similar levels of distress, ie., anxiety and depression. Perhaps the type of counseling provided for the patients immediately before abortion helped high approachers reduce their anxiety and depression level. The counselors provided the patients with abortion and birth control information and gave patients an opportunity to discuss their discision to have an abortion. This counseling approach was consistent with an approach coping style, and probably was more helpful for high approachers than for low approachers. Counseling strategies should be adapted to the coping styles of individual patients.
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PMID:Coping with abortion. 652 Mar 95

In this descriptive study of 30 men with chronic genitourinary cancer, subjects were found to have minimal emotional distress in response to a periodic diagnostic procedure (cystoscopy). State anxiety levels and critical thinking ability measured preprocedure were not significantly different from levels obtained six to eight weeks postprocedure in subjects with negative biopsy results. Routine hospitalization for diagnostic monitoring was found, during COPE interview (Weisman & Worden, 1976), to be less stressful than regular work or financial and family concerns. Subjects with higher concurrent life stress had higher state anxiety and achieved less resolution of problems. Although anxiety levels for the group were within normal limits, 33% of the sample were categorized as having high anxiety on at least one testing occasion. This high-anxiety group had more severe behavioral responses, including feelings of depression, helplessness, and inability to set priorities.
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PMID:Stress-coping response to genitourinary carcinoma in men. 656 63

Psychological distress in parents of children with acute lymphatic leukemia was evaluated by means of the Symptom Distress Checklist. This scale was administered twice: within a few days after the child's admission to hospital and 8 months later. Twenty-five consecutive, unselected subjects were compared with controls matched for age, sex, marital status and social class. At the first evaluation the sample presented higher mean scores than the controls for anxiety (P less than 0.005), depression (P less than 0.005), sleep disturbances (P less than 0.005) and obsessions (P less than 0.05). An 8 months' follow-up confirmed the persistence of anxiety (P less than 0.05), sleep disturbances (P less than 0.05) and above all depression (P less than 0.005).
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PMID:Psychological distress in parents of children with acute lymphatic leukemia. 657 23

Forty-four caregivers to spouses with a diagnosis of Alzheimer's disease provided a stressed subject population considered at high risk for depression. Unlike more typical unidirectional measures of perceived social support quality, subject ratings were elicited separately as to how helpful as well as how upsetting each network member was in five different support categories. Correlations between perceived network "upset" and depression (Beck Depression Inventory) were highly significant, while in no case did perceived "helpfulness" relate to depression. Using stepwise multiple regression, the set of five support category Upset ratings predicted depression better than did helpful/upset ratios, which in turn predicted depression better than the Helpfulness ratings as a group. The implications of these findings for the conceptualization of social support and its measurement are discussed.
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PMID:Social network interactions: a buffer or a stress. 663 3

The self-report Symptom Checklist-90 (SCL-90) was used to screen 105 consecutive first-visit patients in an outpatient neurology clinic. Neurologists diagnosed a primary psychiatric disorder in 35 patients (33%) and a secondary psychiatric disorder in 5. The SCL-90 uncovered previously unidentified emotional distress in 14 patients, for an overall incidence of psychiatric symptoms of 51%. Pain was the most common chief complaint (N = 49), and pain patients accounted for 86% of the primary psychiatric diagnoses. Tricyclic antidepressants were the most often prescribed medications; 81% of these prescriptions were given to pain patients, usually in low doses. Depression was the most common diagnosis (N = 15). Despite the high incidence of psychiatric symptoms, only 3 patients received a psychiatric referral. Neurologists and consulting psychiatrists should maintain a high index of suspicion for psychiatric symptoms when examining patients complaining of pain and, after assessing the presence and severity of depression, prescribe tricyclics judiciously.
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PMID:Psychiatric symptomatology in an outpatient neurology clinic. 685 58

The purpose of this study was to determine the prevalence of perimenstrual symptoms (PMS) in a free-living population of US women and to determine if prevalence estimates varied with parity, contraceptive status, characteristics of the menstrual cycle, and selected demographic variables. We identified all households from a census listing for five southeastern city neighborhoods that offered variation in racial composition and socioeconomic status. We ascertained all households in which there was one nonpregnant woman between the ages of 18 and 35 years per household. Of the 241 eligible women, 179 (74 per cent) participated in the study. Trained interviewers administered the Moos Menstrual Distress Questionnaire (MDQ) and other demographic measures to women between March and July 1979. Symptoms with a prevalence greater than 30 per cent included weight gain, headache, skin disorders, cramps, anxiety, backache, fatigue, painful breasts, irritability, mood swings, depression, or tension. Only 2 to 8 per cent of women found most of these severe or disabling. The exceptions were severe cramps reported by 17 per cent of women and severe premenstrual and menstrual irritability by 12 per cent. Cramps, backaches, fatigue, and tension were most prevalent during the menstruum; weight gain, skin disorders, painful breasts, swelling, irritability, mood swings, and depression were more prevalent in the premenstruum. Parity, oral contraceptive use, age, employment, education, and income were negatively associated with selected PMS. Use of an IUD, having long menstrual cycles, long menstrual flow, or heavy menstrual flow, and being able to predict the next period were positively associated with selected PMS. Race had both positive and negative effects on PMS.
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PMID:Prevalene of perimenstrual symptoms. 688 17

Recent research findings contradict the notion that premenstrual and menstrual symptoms constitute two mutually exclusive categories of perimenstrual distress. The purposes of this study were to describe the prevalence of distress associated with menstruation in a community population and to determine whether perimenstrual distress could be regarded as a single construct. Nonpregnant women (N = 193) between 18 and 35 were selected from five neighborhoods in a southeastern city in a way that allowed for variability in race and income. The women were interviewed in their homes and 179 were asked to complete the Moos Menstrual Distress Questionnaire (MDQ). At least 30% of the women reported weight gain, skin disorders, backache, painful or tender breasts, irritability, depression, headache, cramps, fatigue, swelling, mood swings or tension in the perimenstruum. Cycle phase differences were not found for 31 MDQ symptoms, but were found for: weight gain, crying, lowered school or work performance, taking naps, headache, skin disorders, cramps, anxiety, backache, fatigue, painful or tender breasts, swelling, irritability, mood swings, depression, and tension. Although there were significant differences between the premenstrual and menstrual phases for certain symptoms, the magnitudes of the mean differences were small (less than .3) except for cramps, weight gain, and fatigue. Furthermore, premenstrual and menstrual reports of the same symptoms were highly correlated. Thus, it appears reasonable to study perimenstrual distress as a single construct.
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PMID:Toward a construct of perimenstrual distress. 692 41


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