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Background: A high level of pain catastrophizing has negative influences on outcomes in many surgical disciplines. Our purpose was to determine whether surgeons are able to accurately identify high catastrophizing in orthopedic patients after routine clinical consultation. Methods: In this prospective study, English-literate patients aged 18 years or older were assessed by 1 of 11 orthopedic surgeons. Patients completed the Pain Catastrophizing Scale (PCS), and the surgeon rated each patient as having a high or low level of catastrophizing after the clinical encounter. We calculated accuracy and agreement of surgeon assessment with the PCS at a cut-off score of 30 (score > 30 = high level of catastrophizing) and used multivariate testing to determine whether patient age or sex, surgeon experience or subscores of the PCS (rumination, magnification and helplessness) influenced surgeon accuracy. Results: Among 203 patients (109 women and 94 men), the mean PCS score was 18.4 (standard deviation 12.9), with no sex difference and no significant correlation to patient age. Of the 40 patients who scored 30 or more on the PCS, 22 (55%) were not identified as having high levels of catastrophizing by their surgeon. Accuracy was 0.72, and agreement was 0.2. Female patients were more likely than male patients to be identified as high catastrophizing regardless of PCS score (odds ratio 2.0, 95% confidence interval 1.04-4.0). Conclusion: Surgeons were not able to accurately identify patients with high levels of pain catastrophizing during routine initial consultation. In considering which patients may most benefit from interventions to improve coping and reduce catastrophizing, explicitly measuring pain catastrophizing will be required. Contexte : Un niveau élevé de dramatisation face à la douleur a une influence négative sur les résultats dans plusieurs disciplines chirurgicales. Notre objectif était de déterminer si les chirurgiens orthopédistes sont capables d'identifier avec précision un niveau élevé de dramatisation de la douleur chez les patients après une consultation clinique de routine. Méthodes : Au cours de cette étude prospective, des patients capables de communiquer en anglais âgés de 18 ans ou plus ont été évalués par un de 11 chirurgiens orthopédistes. Les patients ont répondu au questionnaire PCS (Pain Catastrophizing Scale), une échelle de mesure de la dramatisation face à la douleur, et après la consultation clinique, le chirurgien assignait à chaque patient un niveau faible ou élevé de dramatisation. Nous avons calculé la justesse et la concordance de l'évaluation du chirurgien avec le score PCS, avec un score seuil de 30 (score > 30 = niveau élevé de dramatisation) et utilisé un test multivarié pour déterminer si l'âge ou le sexe, l'expérience du chirurgien ou certaines sous-échelles de la PCS (rumination, amplification et sentiment d'impuissance) influaient sur le jugement du chirurgien. Résultats : Sur 203 patients (109 femmes et 94 hommes), le score PCS moyen a été de 18,4 (écart-type 12,9), sans différence liée au sexe ni corrélation significative avec l'âge des patients. Sur les 40 patients ayant obtenu un score de 30 ou plus à l'échelle PCS, 22 (55%) n'ont pas été identifiés comme présentant des niveaux élevés de dramatisation par les chirurgiens. La précision a été de 0,72, et la concordance de 0,2. Les patientes étaient plus susceptibles que les patients d'être identifiées comme présentant un niveau élevé de dramatisation, indépendamment du score à l'échelle PCS (rapport des cotes 2,0, intervalle de confiance à 95% 1,04-4,0). Conclusion : Les chirurgiens ont été incapables d'identifier avec précision les patients présentant des niveaux élevés de dramatisation face à la douleur durant la consultation initiale de routine. Pour savoir quels patients sont plus susceptibles de bénéficier d'interventions visant à améliorer leurs capacités d'adaptation et réduire la dramatisation, il faudra des mesures précises du niveau de dramatisation face à la douleur., Mounting evidence suggests that factors other than objective disease severity or technical success of a surgical intervention can influence surgical outcomes. Among these factors is a catastrophizing coping style. High [...]

This study assessed a range of benefits from participation in a brief existential intervention consisting of a semi-structured videotaped interview with cancer patients and their families designed to illuminate a life legacy for the family (the Life Tape Project [LTP]). Results indicated the majority reported intervention-specific benefits, especially in the areas of symbolic immortality (passing on personal values and philosophy), self-reflection and growth, and improved family cohesion and communication. Participants, particularly those who had perceived their cancer as a threat of death, serious injury, or threat to their physical integrity, and responded with intense lear or helplessness, also reported more general reductions m mood disturbance, improvements in aspects of well-being (including overall quality of life), satisfaction with the understanding they received, and enhanced cancer-related posttraumatic growth. In short, the LTP is a brief, inexpensive, existential intervention that can yield broad positive psychosocial changes for a majority of participants. doi: 10.2190/OM.62.3.c

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2010.01.009 Byline: Enid Montague Abstract: A patient's trusting attitude towards technology used in their medical care may be a predictor of acceptance or rejection of the technology and, by extension, the physician. The aim of this study was to rigorously determine the validity of an instrument for measuring patients' trust in medical technology. Instrument validity was established based on a framework, which included test and data evidence for validity assessment. The framework for validity assessment evaluates the instrument on content, substantive, structural, generalizability, external and consequential aspects of validity. The results of the current study show that the instrument is reliable and valid for assessing a patient's trust in obstetric medical technology. Author Affiliation: Industrial and Systems Engineering Department, University of Wisconsin-Madison, 3217 Mechanical Engineering, 1513 University Avenue, Madison, WI 53706, USA Article History: Received 12 January 2009; Accepted 23 January 2010

Aim: The study aimed to examine the perceptions of illness in self and among others in patients with bipolar disorder in remission. The effect of a structured educational programme on the perceptions of illness was also tested. Method: We examined the perceptions of illness in self and in others (using a vignette) among patients with bipolar disorder in remission attending the Department of Psychiatry, Christian Medical College, Vellore, India. We also examined the effect of a structured educational programme on explanatory models in a randomized controlled trial. Explanatory models were assessed using the Tamil version of the Short Explanatory Model Interview. Results: Eighty two subjects were recruited for the trial; half of them received structured education while the other half received treatment as usual. There was agreement between perceptions related to the individual's own illness and their opinion of illness in others as assessed using a vignette at baseline and at follow-up. There were no significant differences in explanatory models between patients who received education and those who did not. Conclusions: The results of this study show that during periods of remission, patients can clearly see the relationship between their own illness and that described in others, suggesting that insight is state dependent and may be related to psychopathology with good recovery of insight during periods of remission. These findings also argue for the fact that the current multi-dimensional models of insight which focus on biomedical explanations and treatments are not culturally sensitive. The assessment of insight demands universal conventions with comparison to the local cultural standards rather than universal defi nitions and yardsticks which employ Western and biomedical perspectives.

Nurses who care for dying patients are under pressure emotionally because of their beliefs and values about death as well as the emotions and reactions of the patients and their families. This study examines the emotional difficulties of nurses caring for oncology patients in Turkey. The study used a descriptive survey design. The participants were 157 nurses from three medical oncology units in Ankara. Results showed that nurses had difficulty in talking to oncology patients about end-of-life issues and found that caring for dying patients affected their personal lives. This study also showed that the length of nurses' work experience had no effect on their feelings and perceptions toward terminally ill patients. However, the nurses who had more work experience were more likely to report difficulty in talking to patients. Most of the nurses expressed feelings of inadequacy and hopelessness about pain management and treatments. DOI 10.2466/PR0.106.1.119-130

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD. Keywords: Alzheimer's; spirituality; coping; qualitative

The objective of this study was to assess the effect of a biopsychosocial intervention on patients' feelings of well-being, perceptions of health and health indicators before and after treatment in [...]

To validate the Japanese version of the Patient Health Questionnaire against the Mini-International Neuropsychiatric Interview-Plus in Japan 131 patients in 4 primary care settings and 2 general hospital settings participated. These patients completed the Patient Health Questionnaire and returned it to their physician within 48 hr. Subsequently, the subjects underwent a diagnostic evaluation interview based on the Mini-International Neuropsychiatric Interview-Plus by an interviewer blind to the results of the Patient Health Questionnaire screening. The Patient Health Questionnaire diagnosis was characterized using kappa values between 0.70 and 1.0 for Somatoform Disorder, Major Depressive Disorder, Panic Disorder, Bulimia Nervosa, Alcohol Abuse/Dependence, and Premenstrual Disorder. Sensitivities, specificities, and negative predictive values were very good (between 0.84 and 1.0) for the first 4 diagnoses but not Alcohol Abuse/Dependence or Premenstrual Disorder, as were the Positive predictive values (between 0.78 and 1.0). Findings show very good concordance of the Japanese version of the Patient Health Questionnaire with the Japanese version of the Mini-International Neuropsychiatric Interview-Plus.

Although several efficacious treatments for posttraumatic stress disorder (PTSD) exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment given a wide range of treatment options in an analog sample. One hundred and sixty individuals, with varying degrees of trauma history, were asked to imagine themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated seven different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive-behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors. Keywords: PTSD, Exposure; Empirically supported treatment; Patient preference

Murray and Lopez (1997) predict that by the year 2020 the top two contributors to the burden of disease worldwide will be ischemic heart diseases and depression. More than five [...]

The link between deprivation and trauma during earliest childhood and psychosocial functioning and health in later life was investigated in a group of child Holocaust survivors. In a nonconvenience sample 203 survivors, born between 1935 and 1944, completed questionnaires on Holocaust survival experience and several inventories on current health, depression, posttraumatic stress, loneliness, and attachment style. Quality of postwar care arrangements and current physical health independently predicted lack of well-being in old age. Loss of parents during the persecution, year of birth of the survivors (being born before or during the war), and memories of the Holocaust did not significantly affect present well-being. Lack of adequate care after the end of Wodd War II is associated with lower well-being of the youngest Holocaust child survivors, even afteran intervening period of 60 years. Our study validates Keilson's (1992) concept of 'sequential traumatization,' and points to the importance of aftertrauma care in decreasing the impact of early childhood trauma. Keywords: Holocaust survivors, child survivors, trauma, after trauma care, sequential traumatization

Byline: Ami Rokach (1) Keywords: cancer; illness; loneliness; multiple sclerosis; terminal illness Abstract: Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the strategies used by patients with Multiple sclerosis (MS), by individuals diagnosed with cancer, and by the general population to cope with loneliness. Three hundred and twenty nine MS patients, 315 cancer patients, and 391 participants from the general population answered a 34-item questionnaire. Results indicated that with the exception of Reflection and acceptance, Distancing and denial, and Increased activity, the three groups cope with loneliness significantly differently. Author Affiliation: (1) The Institute for the Study and Treatment of Psychosocial Stress, 104 Combe Ave., Toronto, ON, Canada, M3H 4J9 Article History: Registration Date: 11/08/2006 Received Date: 19/05/2006 Accepted Date: 09/08/2006 Online Date: 27/09/2006

Objective: Patterns of successive saccades and fixations (scan paths) that are made while viewing images are often spatially restricted in schizophrenia, but the relation with cannabis-induced psychosis has not been [...]

Objective: To evaluate a Better Outcomes of Mental Health Care Access to Allied Psychological Services Program for general practice patients referred for high-prevalence mental disorders. Methods: Participants were South Australian general practitioners (GPs; n=26) and their patients referred for treatment of high-prevalence psychological disorders, of whom 229 provided baseline measures, 106 provided post-treatment measures, and 85 provided follow-up data three months after termination of treatment. Interventions were Focused Psychological Strategies supplied by mental health specialists; outcome variables included GP satisfaction, patient satisfaction, psychological distress, life impairment, and health service usage. Results: Satisfaction with the treatment program was high for both the GPs and the referred patients. Patients who attended three or more treatment sessions showed reduced distress and disability, and gains were maintained three months later. Health service usage declined with acceptance of referral regardless of treatment experience. Conclusions: Lack of controls and missing data were methodological weaknesses. Results support the effectiveness of integrated primary mental health care to reduce psychological distress and disability, while impact on service usage warrants further investigation. Implications: Reduction of suffering and increased economic productivity may both result from this public health initiative to increase access to effective treatments for common chronic mental conditions. Key words: Mental disorders, depression, program evaluation, primary health care, delivery of health care.

The implications of using information about patients' behavioral styles as a patient-motivation method by dentists for effectively communicating their therapy procedures to them are discussed. The DISC systems is a method where patients are categorized as dominant, influencing, steady or cautious and accordingly the treatment is planned.

* BACKGROUND Music is considered an ideal therapy for reducing stress in patients receiving mechanical ventilation. Previous studies of the effect of music on stress in such patients have focused [...]

Using the data of 96 patients with temporomandibular disorders the economic feasibility of using a biopsychosocial intervention when compared to a normal treatment is studied.

Using data collected from 108 adult patients in a periodontology clinic, the efficacy of using self reports of patients in managing dental anxiety of patients is studied.

We examined stigma in persons with hepatitis C and its relationship with mood and adjustment to illness. We studied 87 persons awaiting interferon treatment for hepatitis C at St James's Hospital, Dublin. Stigma was assessed using Fife's Experience of Illness scale. A structured clinical interview was used to establish DSM-IV diagnosis. The Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI) were also used as measures of mood. Factor analysis and clustering around latent variables analysis were used to assess scale structure and reliability. The stigma scale had an overall reliability of 0.94. A strong dimension of fear of disclosure emerged, from item analysis, together with dimensions of social isolation and social rejection. Stigma was higher in those in manual occupations and the unemployed than in those in non-manual occupation. There were high levels in those with disease associated with injecting drug use and iatrogenic disease caused by transfusion or anti-D blood products, and low levels in those who had been treated for haemophilia with contaminated products or whose hepatitis was of unknown origin. Adjusted for confounders, a 1-decile increase in stigma score had an odds ratio of 1.4 for DSM-IV depression and similar associations with depression on the HADS and BDI. Stigma was also associated with poorer work and social adjustment, lower acceptance of illness, higher subjective levels of symptoms and greater subjective impairment of memory and concentration. These associations were replicated in the non-depressed subsample. The results underline the strong link between stigma and well-being in hepatitis C. However, they also suggest that stigma is a complex construct that will require further research to elucidate. Keywords: Ireland; Hepatitis C; Depression; Stigma; Injecting drug use

Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of imminent violence. This intensive study of patients (N = 132) at high risk for community violence is the first to evaluate prospectively the temporal relation between symptoms and violence. Symptoms were assessed with the Brief Symptom Inventory and threat/control override (TCO) scales. Results indicate that a high-risk patient with increased anger in 1 week is significantly more likely to be involved in serious violence in the following week. This was not true of other symptom constellations (anxiety, depression, TCO) or general psychological distress. The authors found no evidence that increases in the latter symptoms during 1 week provide an independent foundation for expecting violence during the following week. Keywords: mental illness, symptoms, violence, risk, anger

Irritable bowel syndrome (IBS) is a functional gastrointestinal illness, characterized by potentially debilitating symptoms without pathologic findings, often associated with psychological conditions. Little is known about the psychosocial aspects of this condition on an international scale. A total of 239 patients in eight countries were given a series of psychological and medical questionnaires, including IBS activity, relationships with significant others, beliefs regarding the etiology of symptoms, and assessment of quality of life. There were highly significant associations between IBS severity and all other measures. Symptoms were worse if relationship conflict was high and if attributions about illness were physiological rather than psychological. Symptoms were less severe if relationship depth and support were high, and illness was viewed as psychological. Implications for treatment are discussed. Keywords: Irritable bowel syndrome; Family dynamics; Cross-cultural; Mind-body

A phenomenological study was conducted with 20 spinal cord injured persons and their family members to examine the meaning of living with spinal cord injury 5 to 10 years after the initial injury. Seven themes emerged from the data. The themes are looking for understanding to a life that is unknown, stumbling along an unlit path, viewing self through a stained glass window, challenging the bonds of love, being chained to the injury, moving forward in a new way of life, and reaching normalcy. The uncovered meanings enhance our understanding and appreciation that living with spinal cord injury is a continuous learning experience. The study findings may be useful in the development of self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for both spinal cord injured persons and their family members throughout the course of living with the disability. Keywords: spinal cord injury; phenomenology; meaning; experience; family

This research examined the experience of Amyotrophic Lateral Sclerosis (ALS) patients who depend on an invasive mechanical ventilator in Japan. We investigated their difficulties in expressing their needs, their desires and wishes, and their sources of support and happiness. We examined the relationship between these factors and patient demographics, and hope as an indicator of successful adaptation to the illness experience (assessed by the Herth Hope Index). Interview results guided the formation of an anonymous questionnaire distributed to patients by mail. We interviewed 27 patients and their families and surveyed 157 respondents with a questionnaire. Most patients experienced multiple categories of difficulties, which correlated with reduced hope. More severe physical symptoms correlated with more emotional and social difficulties. Notable findings included a high prevalence of unalleviated pain, fear or experience of ventilator difficulties, and fear of burdening others. Having more sources of psychosocial support and happiness was associated with greater hope. Living at home was associated with fewer social difficulties. No patients claimed additional sources of support without claiming family or professional caregiver support, suggesting their mediation may be crucial in maintaining other social connections. Users of computer communication reported more sources of support and happiness and less frustration from difficulty expressing themselves. The most common reported desires, following a cure for ALS, related to the happiness of the patients' families, and a desire not to burden them. We also found that invasive mechanical ventilation (IMV) had been initiated emergently in 30.1% of patients without patient or family consent. Our results provide an insight into the world of this challenged population, elucidating the difficulties they face, and clarifying the role of support and other factors in maintaining hope. We identify concrete areas to which increased attention should be directed in patient care. Keywords: Amyotrophic lateral sclerosis; Hope; Invasive mechanical ventilator; Expression; Psychosocial support; Difficulties; Japan

Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had multiple health problems and, with one exception, all were functionally impaired. Descriptive comparison suggests that suicide decedents were more likely than their counterparts to suffer from depressed mood, suicidal ideation, prior suicide attempt(s), alcohol dependence, chronic pain, strained family relationships, lack of social support, and financial difficulties. Identifying suicide risk factors that place older adult home health care utilizers at particularly high risk for suicidal behaviors within this population will further help target suicide preventive interventions by home care providers.

Many patients with complicated grief suffer severe symptoms for several years after the loss, interfering with daily life. We sought to determine which elements of a patient's daily routine were likely to be missed or added. Sixty-four patients completed a diary each evening for 2 weeks. The diary asked whether each of 13 daily life activities were done or missed on that day. Comparisons were made with 64 matched healthy control participants. Patients were significantly more likely than controls to miss contact with another person, breakfast, lunch, dinner, starting work, and going outside, and to add a nap and evening snack.

You ask me: what is life? That is like asking: what is a carrot? A carrot is a carrot and that's all there is to it. --Anton Chekhov He wakes [...]

Abstract An objective measure of psychological well-being (a previously understudied outcome for persons with dementia) was developed and tested as part of a longitudinal study (n = 96 participant pairs; [...]

The author's reflections on Becky's legacy (see Werth, this issue) revolve around the idea that she can serve as a role model and that Becky's and Jim's experiences provide guidance to others who will inevitably go through the dying process. She also highlights several themes she saw in Werth's article: a cultural revolution around dying, the individuality of the dying experience, the need to expand the framework of care for the dying, and access to care and limits on access. She concludes by focusing on the need for communication between the dying person and loved ones.

This study investigates the associations between clients' emotional and behavioral responses to treatment termination and eight sets of indepentent variables, covering the source of termination (client, therapist, external source); the termination process (speed, centrality, control, choice, and desire), and the perceived outcome (failure, goal achievement) of the therapy. Subjects were 92 student therapists and 40 professional therapists, who reported on their clients' perceptions, experiences, and responses. All the variables examined were associated with one or another client response. The findings support the view of treatment termination not only as a loss experience but also as a transition. They highlight the need for therapists to pay careful attention to both the source and the process of treatment termination. KEY WORDS: treatment termination; clients' responses to treatment termination.

The traditional model of medical ethics minimizes the particular, ever-changing, concrete realities of patients" lives in favor of general, invariable, abstract principles. Narrative ethics offers a powerful complement to that [...]

This paper analyzes 'empathy' and 'sympathy' as situated practices, sequential processes that are coconstructed by the participants in the situation. The data consists of 228 sequences of patients' descriptions of their problematic experiences and professionals' responses to them in videorecorded general practice and homeopathic consultations. One deviant case, in which the practitioner shows compassion to the patient in an exceptional way, is subjected to detailed analysis. It is argued that both professionals and patients orient to a degree of professional neutrality in these situations, but also that affiliative practices can be adjusted to the otherwise problem-governed course of the consultation. These orientations seem to address questions similar to those of theoretical distinctions made between the terms empathy and sympathy.

Patients with chronic health conditions often rate their quality of life (QoL) significantly higher than non-patients. One explanation for this discrepancy is that non-patients focus on the negative aspects of the onset of a condition, especially the early difficulties people face when they first experience a debilitating condition, without considering that patients can adapt to it over time. To test this hypothesis, we had 359 people perform person tradeoff (PTO) elicitations in an online survey, varying whether the treatment programs under consideration saved the lives of patients (a) with pre-existing paraplegia; or (b) who would experience new onset of paraplegia. Half of each group completed an 'adaptation exercise' which encouraged them to consider their own ability to emotionally adapt to negative events in general and specifically to having paraplegia. The adaptation manipulation increased the value participants placed on pre-existing paraplegia (p = 0.03) and on new onset paraplegia (p = 0.05), relative to saving healthy lives. Moreover, the adaptation exercise dramatically reduced the differences between evaluations of pre-existing and new onset paraplegia to values within 2% of each other. Our findings suggest that asking non-patients to do an adaptation exercise before giving QoL ratings may help close the gap in ratings between patients and citizen non-patients. Keywords: Adaptation; Person tradeoff; Health state valuation; Cost-effectiveness analysis; Utility measure; Internet survey

Recently, the Medical College of Ohio in Toledo received a $1.9 million gift, with the stipulation that it be used to teach medical professionals interpersonal skills. The gift came from [...]

The possible negative psychosocial effects associated with amelogenesis imperfecta (abnormal enamel formation characterized by poor esthetics and dental sensitivity) diseased patients is examined. Results indicate high levels of social avoidance, fear of negative evaluation, distress, low self esteem and mastery, and age related differences.

Patients' beliefs concerning the causes of their illnesses are core to a number of theoretical models of illness behaviour. The current study explored the themes that emerged from patients' accounts of the causes of their first myocardial infarctions (MIs). Semi-structured interviews were conducted with 12 patients within a week of their MI. at a UK district hospital. Transcripts were analysed using interpretative phenomenological analysis. Three researchers noted themes that emerged from each interview, then common themes were selected and refined on the basis of an aggregation of interviews. Three dominant themes emerged: (1) single versus multiple causation, (2) causes as triggers versus underlying dispositions, and (3) the potentially conflicting motives of avoiding blame whilst at the same time, seeking control. Whilst many participants had complex ideas concerning what caused their MI, and could often name several causes, they tended to emphasise the importance of a single cause, which often related to their symptoms. Further, several participants interpreted 'cause' in terms of an acute trigger of MI, rather than as a chronic causal factor. Participants were apparently attempting to answer the question about why they had an MI now, leading to talk about single causes that trigger MI. By contrast, much previous research has been concerned with patients' knowledge of 'risk factors', considering the production of only a few causes to reflect ignorance. A key process in participants attributing cause appeared to be attempting to avoid blaming themselves or others for their MI, whilst simultaneously seeking to assert control over future recurrence. Analysis of the functions and purposes of causal attribution suggests that patients' focus on blame and control may be both emotionally and behaviourally adaptive, if not necessarily epidemiologically precise. These findings suggest that interventions to change causal attributions may be misguided, and may even be harmful. Keywords: Causal attribution; Myocardial infarction; Interpretative phenomenological analysis; Stress; UK

In this paper four different schools of dream analysis--classical, object relations, modern psychoanalytic, and self-psychological--are described, compared, and contrasted. Each approach is then applied to an analysis of the first dream reported by a patient. As each interpretations is accurate and useful in understanding this patient's psyche, it is concluded that an integrated framework should be used in dream analysis. KEY WORDS: dream; classical psychoanalysis; object relations theory; modern psychoanalysis; self-psychology.

This study examines the impact of 2 classes of psychological variables--expectancies for the future and self-efficacy--on recovery of function and reduction in symptomatology among individuals seeking total knee replacement surgery (TKR). The authors collected outcome measures (SF-36, WOMAC, Clinician assessments) prior to surgery, 4-6 weeks after surgery, and 6 months postsurgery for surgery patients and controls. Linear trend analyses by group gauged the impact of the surgical intervention on recovery, revealing significant improvements over time on physical health outcomes for the surgery patients not attained by controls. In addition, two classes of psychosocial variables-expectancies and efficacy beliefs--predicted the extent of gains in physical and mental health outcomes among those patients who elected to have surgery. When initial status was controlled, between 9 and 13 percent of the variance in TKR outcomes was due to expectations and efficacy. These results point to the importance of psychosocial variables in recovery of function and reduced symptoms after knee surgery. Index Terms: efficacy beliefs, expectancies, osteoarthritis, Total Knee Replacement (TKR), The National Health Survey of 1990-1992 indicated that 23% of adults aged 45 to 64 years and 45% of adults aged 65 to 74 years experience the debilitating effects of [...]

Byline: Chanita Hughes Halbert (1), Marc D. Schwartz (2), Lari Wenzel (3), Steven Narod (4), Beth N. Peshkin (2), David Cella (5), Caryn Lerman (6) Keywords: perceptions of stress and confidence; genetic testing; BRCA1 and BRCA2 Abstract: The objectives of this study were (1) to describe perceptions of stress and confidence following genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations and (2) to identify predictors of these processes. Participants were 130 high-risk women affected with cancer who received BRCA1/2 test results. Individual difference characteristics and interpersonal factors were measured by self-report before genetic counseling and perceptions of stress and confidence were evaluated by self-report 1 month following disclosure of test results. BRCA1/2 test results had a significant effect only on perceptions of stress ([beta] = 0.38, p = 0.0001), while trait anxiety had a significant effect on both perceptions of stress ([beta] = 0.44, p = 0.0001) and confidence ([beta] = -0.41, p = 0.001). These results suggest that interventions designed to address perceptions of stress related to medical decision-making and familial concerns may need to be targeted to BRCA1/2 mutation carriers and individuals who are highly anxious. Author Affiliation: (1) Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA (2) Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA (3) Department of Medicine, Epidemiology Division, University of California -- Irvine, Irvine, California, USA (4) The Centre for Research in Women's Health, Women's College Hospital, Toronto, Canada (5) Center on Outcomes, Research and Education, Northwestern University, Evanston, Illinois, USA (6) Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA Article History: Registration Date: 29/12/2004

Objectives. Complementary and alternative therapies have become popular with patients in Western countries. Studies have suggested motivations for patients' choosing a wide range of complementary therapies. Data on the expectations of patients who use complementary therapy are limited. We assessed the expectations of patients who use complementary therapy. Methods. Patients attending a British National Health Service (NHS) outpatient department that provided acupuncture, osteopathy, and homoeopathy were asked to complete a qualitative survey. Results. Patients expected symptom relief, information, a holistic approach, improved quality of rife, self-help advice, and wide availability of such therapies on the NHS. Conclusions. Physicians' understanding of patients' expectations of complementary therapies will help patients make appropriate and realistic treatment choices.