[Differences in the characteristics of hospital stress between medical and surgical patients]

This study explored differences in how medical and surgical patients compare on the degree of hospital stress and their subjective physical status. Subjects were 343 medical and surgical patients in five university hospitals in Seoul and Taegu. They responded to the Hospital Stress Rating Scale and a self-report on physical status. The controlled variables were age, education, number of previous hospitalizations and seriousness of the illness. Medical and surgical patient differences on nine factors of the hospital stress scale and nine areas of physical conditions were reported as follows explored: 1. 1) There was not a statistically significant difference at the .05 level in the total mean score for hospital stress between medical patients and surgical patients. 2) The mean score of the factor lack of information (M=2.308) for medical patients was higher than the mean score (M=2.064) of the surgical patients. 3) The mean scores of the factor of discomfort (M=2.130), loss of independence (M=1.889) for surgical patients were higher than for medical patients. 2. 1) There was a statistically significant difference at the .05 level in the total mean score for physical status between medical patients and surgical patients. 2) The mean scores were lower in subjective physical status for surgical patients (S) than for medical patients (M); stomach condition (S:M=2.8433, M:M=3.0000), self-assistance (S:M=3.0373, M:M=3.4498), movement (S:M=2.6716, M:M=3.2392), interest in your surroundings (S:M=3.0522, M:M=3.2632).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspects of personality of soldiers presenting to an endoscopy clinic

Eysenck Personality Questionnaires were completed by a consecutive series of 60 soldiers attending a military endoscopy clinic. Each individual was pair-matched with a non-endoscoped soldier from a medical ward and a soldier from the hospital alcohol treatment unit. Alcohol dependence and related disabilities were measured using the MAST, CAGE and SADQ questionnaires and liver function tests and MCV estimates were performed. Alcohol questionnaire scores and laboratory tests were analysed by discriminant function analysis and by applying 'cut-off' scores of the questionnaires. Analyses of the personality dimensions were carried out by analyses of variance and were examined in relation to sample, alcohol questionnaire scores and endoscopic findings. The soldiers from the alcohol treatment unit had the highest neuroticism score, followed by the soldiers attending the endoscopy clinic. Of the endoscoped soldiers, those diagnosed as non-ulcer dyspeptics had higher neuroticism scores than soldiers with ulcers. This finding was not associated with increased prevalence of alcohol dependence and related disabilities.

Anxiety and gastrointestinal illness

The substrate for modulation of the gastrointestinal tract by anxiety and other psychiatric disorders is provided by our knowledge of central nervous system control mechanisms of gastrointestinal functions. Recent experiments that examine the gastrointestinal response to acute stress amplify prior work and confirm that central stimuli, viz. emotional stress, can produce measurable gastrointestinal changes. These changes are not uniformly predictable on the basis of knowledge of the control mechanisms, alone. Acute stress experiments cannot be directly extrapolated to anxiety disorders and their relationship to gastrointestinal illness; careful physiologic studies in these more chronic disorders are sparse. Anxiety disorders and other psychiatric illnesses are particularly common in patients with the functional bowel diseases. This heterogeneous group of gastrointestinal diseases remains fertile territory for examining emotion-gut relationship on a biologic level.

Recollection of childhood events in adults with irritable bowel syndrome

We examined retrospectively premorbid factors that might relate to the development of irritable bowel syndrome (IBS). We administered a semistructural interview to adult IBS patients, adults with symptoms of IBS who had not visited a doctor (nonpatients), and asymptomatic normals. Patients with IBS differed from nonpatients by reporting more severe bowel problems, more frequent doctor visits in childhood, and more pain associated with current bowel symptoms. These factors may contribute to the tendency of people with bowel symptoms to seek medical care. More patients, and in most cases nonpatients with IBS, reported poorer general health and headaches, stomachaches, and bowel complaints during childhood. They also showed evidence for greater parental attention to illness with more frequent school absences and doctor visits than normal subjects. Loss and separation during childhood, and in the current family, and conflicted or dependent maternal relationships were also more frequently reported among patients and nonpatients. These factors may contribute to the development of IBS.

The relationship of psychiatric disorder to gastrointestinal illness

The definition of psychiatric illness by specific criteria has provided a new method for examining the relationship of certain gastrointestinal (GI) diseases to psychiatric disorder. Using this technique, researchers have found that rates of psychiatric diagnosis in patients with certain functional GI syndromes and Crohn's disease exceed those found in the general population and in comparably ill control groups. Timing of onset of both sets of symptoms (GI and psychiatric) suggests that the functional syndromes generally follow or coincide with the onset of psychiatric symptoms, whereas the onset of Crohn's disease is more independent. A relationship of psychiatric illness to other GI disease is suspected based on results of psychometric testing or on less structured attempts at psychiatric diagnosis employed in earlier studies. Psychiatric diagnosis by criteria definition may play an important role in more clearly understanding any relationship of psychiatric disorder to somatic GI disease as the applications of this scientific technique are expanded.

Depression in the hospitalized inpatient with various medical illnesses

The amount of depressive symptomatology in the medical population is high. Most of the symptomatology is, however, mild and probably represents an adjustment disorder with depression as a result of illness and hospitalization. Routine screening for depression in the hospitalized medically ill patient appears to be useful, given poor physician recognition of not only mild, but severe depressive symptomatology. Affective and cognitive symptoms of depression are the most discriminating for severe depression. Patients with bone and connective tissue disease, gastrointestinal disease, neurological disease, respiratory disease, and cancer appear to be the groups of diseases at greatest risk for serious depression in a tertiary care setting in the United States.

Stress-related disorders. Recent developments in hospital treatment

The stress treatment program at Ochsner, New Orleans, provides participants with knowledge of necessary skills and opportunities for rehearsal and practice within the setting. In addition, the modalities chosen reinforce what Lazarus and Opton described as "perceived control," which was found to be as instrumental as actual control in anxiety reduction. Upon return to day-to-day living, participants have the opportunity to use skills acquired and to receive reinforcement for doing so. The staff and patients found that traditional supportive and/or insight-oriented psychotherapy was as important as the vast array of behavioral training measures for inclusion in the patient's daily schedule. Individual therapy was provided to each patient up to 45 minutes daily, and one-hour group psychotherapy sessions were conducted three times a week. The belief that individual attention, social support, and insight into previous learning were critical ingredients to the appeal of individual psychotherapy was borne out in patient follow-up questionnaire data. Patients who were followed at the time of discharge and at six months in the Clark and Stiles study consistently ranked "individual session with their doctor" high within the ranking of some 14 treatment modalities or experiences. Collectively, the average of such rankings demonstrated "individual session" of equal benefit with the "stress management session," a purely behavioral/stress inoculation training experience. Such data therefore supported our initial belief that a marriage of the best of what traditional psychotherapy can offer with the best of behavioral medicine provides the optimal opportunity for growth and symptom improvement.