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This second paper on the reassociation of dreams confirms 1. the value of reassociating a key dream (The Beetle Bug Dream) and 2. the use of lysergic acid diethyl amide (LSD) as an adjunct to psychoanalytic therapy. The patient (Joyce) was a young mother whose very severe eczema and asthma were accompanied by an incapacitating depression. The following summary of the three interviews indicate briefly the psychodynamic materials developed which helped Joyce uncover her confused sexual identifications and fear of lesbianism. In Interview 96 the initial Beetle Bug Dream was studied cautiously. On analysis the tentacles of the Beetle Bugs symbolically represented the hands of a man mauling a girl's skin. A sexual approach by a man is considered an attack. "Bugs get under the skin. If Jack (my husband) touches my skin, that spot itches." A second Beetle Bug is described. The special aspect of this unique Bug is that it was not threatening. This Bug is discussed in terms of the transference: the silent analyst and a father who responded to her childhood travail by silence are compared. Reassociation of the Beetle Bug Dream without LSD took place one year later. The session (Interview 235) lasted about 45 minutes and the verbatim recording occupied 12 typewritten pages. Free association led to the realization that the patient was programmed in part to identify with her father--a silent, passive individual. It was apparent that a psychological struggle for femininity, induced by the confused identification led to a threat of penetration by the sting of the Beetle Bug and, where a man was involved, penetration by the penis. Interview 236 (three days later) was conducted under LSD 25. The Beetle Bug Dream again formed the basis of this interview, which lasted four hours and occupied 46 pages of typewritten, verbatim material. A new feeling of independence from maternal influence is felt. "It used to be if I just thought of her, I could start scratching." The relationship with her husband is complicated by "deep, dark secrets." She is afraid of her husband. Her mother emphasized she was "one" with her father. Contact with aggressive males during adolescence, as well as seductive episodes were disturbing. In camp she feared that she might be a lesbian. This fear persisted into adult life. The threat of the Beetle Bug sting is developed further. Hostile feelings toward the penis are revealed in detail, The part of the penis in the vagina could be chopped off--the penis was what the sting of the Beetle Bug would be if it penetrated the skin. The bridegroom attacks the bride. An unwanted pregnancy is equivalent to the broken sting remaining in the skin. These revelations led to insight regarding unusual violent anger toward her child during toilet training. The data support the view that publication of verbatim recordings are a necessary condition for establishing psychoanalytic procedures as a basic science of medicine and of the validity of psychodynamic theory...
J Asthma Res 1976 Jul
PMID:Reassociation of dreams. II. An LSD study of sexual conflicts in eczema and asthma. 101 Aug 10

Asthma is the most common chronic illness of childhood. An increased prevalence of psychopathology has been shown repeatedly to occur in severely asthmatic children, but little evidence exists to suggest that this is true for children with mild asthma. A major problem in interpreting the psychological literature addressing asthma has been the absence of studies of children with specified subtypes of the disease and the analysis of heterogeneous samples including children with a wide range of ages and poorly defined disease characteristics. Depression and anxiety disorders occur at a greater prevalence in severely asthmatic children and may be exacerbated by antiasthmatic medications. Vocal cord dysfunction may be misdiagnosed as asthma and is suggested to be associated with an increased risk of psychiatric disturbance. The presence of depressive illness in very severe asthmatic patients is associated with greater asthma mortality and requires intervention. Treatment considerations include the need for a high level of suspicion for noncompliance in patients who are nonresponsive to antiasthmatic medications, judicious use of antidepressant medication, referral of children with co-occurring psychiatric symptoms for psychiatric assessment and management, and consideration of early intervention strategies to minimize the initial expression of asthmatic symptoms.
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PMID:Psychiatric complications of pediatric asthma. 141 62

The purpose of this study was to compare psychologic and physiologic variables during intense dyspnea to those at times of no or low dyspnea in people with asthma. Thirty-six adults ranging from 19 to 76 years old were tested when they first came to the emergency department in acute dyspnea and again when they had no or low dyspnea just prior to discharge. Clinical signs found to be higher during high dyspnea than low dyspnea were respiratory rate, pulse, wheezing, and accessory muscle use. Peak expiratory flow rates and oxygen saturation were significantly lower, while anxiety, depression, somatization, and hostility were higher during times of high dyspnea. The panic/fear, fatigue, dyspnea, hyperventilation/hypocapnia, congestion, and rapid breathing subscales of the Asthma Symptom Checklist were also higher during high dyspnea compared to low dyspnea.
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PMID:Psychologic and physiologic aspects of acute dyspnea in asthmatics. 185 43

The outcome of 49 asthmatics (20 men and 29 women) who had suffered a severe exacerbation of asthma requiring mechanical ventilation was investigated in a follow-up study ranging from 23 weeks to 10 years. Over this time, there were 6 fatalities, all female chronic asthmatics requiring treatment with bronchodilators, beclomethasone, and short courses of oral steroids. Three died at home as a consequence of a sudden attack. Another patient developed a cardiorespiratory arrest immediately after having received a sedative. In the remaining two cases, death occurred within hours or days of progressive deterioration. Four of the six women had required psychiatric treatment for an anxiety-depression syndrome. These findings support previous studies suggesting that psychological disturbances may be predisposing factors to death in bronchial asthma.
J Asthma 1989
PMID:Predisposing factors to death after recovery from a life-threatening asthmatic attack. 270 30

Asthma is a complex and multifactorial illness. Early theories focused on the psychosomatic aspects of this disease and more work has been done through the years to explore these theories and to further elucidate the variety of psychiatric conflicts, personality traits, and stressors, and the role they play in asthma. More recently, mechanisms have been postulated whereby these conflicts can influence the pathologic process in the lungs causing symptoms of asthma. These seem to act at the level of the limbic system and hypothalamus, the autonomic nervous system, and the immunologic system. Many psychiatric factors play a strong role in maintenance of the asthma. Family interactions, anxiety, depression, panic-fear, and many others can facilitate or impede compliance with an appropriate medical regimen. Although all these variables have yet to be sorted out definitively, asthma is certainly an area where psychiatrists can have a major therapeutic impact.
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PMID:Psychiatric aspects of asthma in adults. 407 8

This study examined the psychosocial adjustment of children with asthma compared to children with diabetes, with cancer, and healthy children and the role of functional status in psychosocial adjustment. The total sample included 100 children, aged 8-16 years, (mean = 11.5 years), consisting of 48 boys and 52 girls. Children with asthma scored significantly higher on measures of affective adjustment (depression and internalizing behavior), significantly lower on self-esteem, and evidenced significantly greater functional impairment. Children with cancer missed significantly more school days. After controlling for functional status, no significant differences remained in affective adjustment but absences remained significantly higher for the children with cancer.
J Asthma 1995
PMID:Psychosocial adjustment and the role of functional status for children with asthma. 755 75

The comorbidity of severe asthma and depression is frequent and complicates the patient's comprehensive medical management. Asthma and depression are thought to interact to worsen both conditions, especially at the severe end of the spectrum of disease. This article reviews the current thinking regarding the synergistic effect of the two disorders, highlighting the importance of considering both disorders in the comprehensive management of severe asthma. Outpatient management and treatment issues addressed include the use of screening/case-finding tools, medication management, physician counseling, and referral.
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PMID:Severe asthma and depression. 813 Sep 24

Personality dimensions seem to play an important role in chronic diseases by maintaining or increasing the patient's physical complaints. This study examines in bronchial asthma: (a) the relationships among clinical data, baseline lung function, and personality traits; and (b) the patient's characteristics related to the physician's judgement about his or her asthma severity. Five questionnaires measuring anxiety, depression, self-consciousness, and subjective symptoms were completed by 51 asthmatic patients. Responses to questionnaires and clinical and demographic data were factor-analyzed. Factor analysis revealed that the physician's severity judgement is based on elderly age, high scores on depression, and longer duration of asthma.
J Asthma 1994
PMID:Bronchial asthma and personality dimensions: a multifaceted association. 819 58

Although asthma is not an emotional or psychological disease, strong emotions can sometimes make asthma worse. Asthmatic attacks and reductions in FEV1 have been intentionally induced in asthmatic patients through exposure to emotional stimuli. People of lower socioeconomic status have been associated with higher prevalences of both anxiety and depression. Therefore, a group of indigent (IP) and nonindigent privately insured asthmatic patients (non-IP) were surveyed to determine their perceptions of asthma triggers. The patients responded to several possible triggers by the following descriptors: never, rarely, sometimes, frequently, always. There were no significant differences at the 0.05 level between the groups in age, gender, or length of history of asthma. In response to the question pertaining to asthma triggered when upset or anxious, 51% of 57 patients responded to the "frequently" or "always" category in the IP compared to 19% of 52 in the non-IP. Further research is warranted to explain these differences. If these differences are real, optimal therapies for psychogenic asthma (e.g., addition of anticholinergic aerosols) or the treatment of anxiety itself in the IP need to be evaluated.
J Asthma 1993
PMID:Perception of anxiety as a contributing factor of asthma: indigent versus nonindigent. 832 25

The Dutch Asthma Centre Davos in Switzerland is a clinic where patients with chronic nonspecific lung disease (CNSLD) are given multidisciplinary treatment. In a prospective study in the clinic, data on quality of life (functional, psychological and social characteristics) and medical consumption (use of oral corticosteroids and use of health services) were collected in a group of 147 patients with CNSLD. 18 patients were lost due to non-medical reasons. Quality of life and the use of oral corticosteroids were registered on admission, at discharge and 4 weeks, 6 and 12 months after discharge. Data on use of health services were gathered over the period between one year before admission and one year after discharge from the asthma centre. The results of this study show a decrease in the use of oral corticosteroids, in the number of visits to the family physician and outpatient department and the number and duration of hospital admissions. Favourable changes occurred in psychological functioning, (including anxiety and depression) and positive changes were observed in the degree of limitation the patients experienced in their activities of daily living. No convincing changes were found in social functioning, including social support. It can be concluded, on the basis of these results, that a stay in the Dutch Asthma Centre Davos has favourable effects on medical consumption and on some aspects of quality of life.
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PMID:[Favorable effects of a stay in the Dutch Asthma Center Davos on medical consumption and quality of life in COPD patients]. 842 71


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