Social science & medicine. Part E, Medical psychology最新文献

It is believed in primitive society that physical health depends on harmonious social relations and that sickness follows social disruption. The mortality patterns of adults in modern society support this view, but its biological basis is not widely appreciated. This essay reviews the mechanisms by which chronic psychological arousal produces chronic physiological arousal and, in turn, specific biological pathology.

The brain sets for the body a broad pattern of physiological and metabolic activity and enforces it by control over the autonomic and endocrine systems. Under conditions of arousal the brain sets a pattern of catabolism, mobilizing all the mechanisms that produce energy for “coping” and suppressing the mechanisms that store energy or use it for growth, repair, and surveillance against pathogens. As part of this adaptive response the brain mobilizes cardiac, vascular, and renal mechanisms to raise blood pressure. When arousal is chronic, the high pressure causes damage which, in interaction with a variety of arousal-induced chemical changes, leads to endstage diseases such as coronary heart disease, stroke, and kidney disease. The biological causes of cancer and diabetes are not fully known but seem to be powerfully influenced by arousal-induced endocrine patterns.

Treatment of arousal pathology at the end stages has been highly technological, of limited success, and very expensive. The leading alternative has been an attempt to prevent endstage disease by treating mild hypertension on a mass scale (23–60 million patients in U.S.) with potent drugs. As drugs block peripheral pressor mechanisms, the brain drives them to compensate and to require blocking by additional drugs. Over the decades of prophylaxis for which drugs are intended, their cumulative iatrogenic effects are likely to be serious. Psychosocial treatments for mild hypertension (including placebo, relaxation techniques, and social support) appear to be quite effective. These treatments appear to work by reducing chronic arousal, and tend not to evoke compensatory or iatrogenic responses. The extraordinary sensitivity of the brain and the neuro-endocrine system to psychosocial intervention suggests that in modern, as in primitive society, these are the treatments that will prove safest and most effective.

Requirements of analgesics following appendectomy was used as a model to assess the impact of the civil war situation in Lebanon on patient reaction to pain. The records of 246 patients who had undergone appendectomy for acute appendicitis under general anesthesia with no complications or concurrent diagnoses were reviewed. Sixty seven of these patients were operated in the prewar years, 67 during the war and 112 in the postwar period. The total dose of analgesics in pethidine equivalents and the number of injections were calculated for each patient. In addition, socioeconomic, demographic and clinical data were collected on all these patients. Patients operated during and after the war required significantly less postoperative analgesics compared to prewar patients. Following stepwise multiple regression analyses, it was shown that males, ward patients and residents of Beirut required significantly lower amounts of postoperative analgesics compared to females, private patients and those living outside Beirut. The major difference between the requirements of prewar patients and war time and postwar patients may be explained on the basis of a combination of patient and system related factors. System related factors may include a change in attitude and assessment of patient pain by nurses in war time that has continued after the war. Patient related factors may be secondary to changes in the perception of pain due to the stressful war situation.

A description of cystic fibrosis (CF) symptoms, complications, and their diagnosis is followed by an overview of medical and nonmedical treatment. Particular attention is given to the fact that medical treatment is purely palliative and mostly restricted to the physical complications. Prognosis, methods for prevention, and early detection are also discussed. The psychological effects of the disease are examined in light of the anecdotal literature and research concerning the impact of the disease on the patient and family. It is noted that much of this research has been subjective and methodologically weak and suggestions for improvements are offered. Issues of growing concern for psychology and medicine in treating the fibrocystic patient are discussed, and on the basis of evidence that the life expectancy of CF patients is progressively increasing, it is concluded that psychologists will play an ever increasing role in the lives of both patients and families. Suggestions from the area of health care psychology are presented for both psychological treatment and research.

This is a longitudinal study of the antecedents of entry into psychotherapy. The population studied consisted of 123 adults, aged 40–50, who had been subjects of long-term growth studies since childhood or early adolescence. These subjects were grouped according to whether or not they had sought psychotherapy within the period 1958–1970. Discriminant analysis was used to form composites of antecedent personality and life-course indicators that best distinguished those who sought psychotherapy in the study period from those who did not. Indicators of personality included a Q-sorted evaluation of psychological health and a series of assessment scales derived from the California Psychological Inventory; these variables were measured at the beginning of the study period. Indicators of life-events were obtained by systematically coding retrospective open-ended interviews that were conducted with each subject at the end of the study period. The two composites, along with indicators of demographic background, were entered into a path modelling procedure, to predict entry into psychotherapy.

The analysis uncovered differences between men and women in the pattern of “therapy-prone” personality and life-course. Men who entered therapy exhibited acting-out and impulsive personality traits, coupled with a life-events profile indicative of role-failure. Women exhibited a general psychological distress profile, with few distinct life-course characteristics. The independent variables accounted for between 57 and 79% of the variance in therapy-seeking; personality and life-course accounted for the bulk of the variation.