Sources of conflict in the medical marriage

The authors surveyed a sample of 134 physicians and 125 physicians' spouses regarding marital satisfaction, sources of marital conflict, and complaints about their spouses. Contrary to conventional wisdom, the number of hours at work did not relate to the degree of marital satisfaction. The chief sources of conflict in the medical marriage appear to revolve around differences in the partners' needs for intimacy, perceptions of the problems in the marital relationship and in each other, and communication styles. Lack of time due to the demands of practice seems to be a complaint that serves the function of externalizing the conflicts in the marriage onto factors outside the marriage.

Reliability of data taken from medical charts

While it is desirable to conduct clinical research across different institutions using the richness and complexity of daily clinical data from the hospital chart, it is possible only if reliable information can be obtained. This report represents the efforts made by eight collaborating private psychiatric hospitals to devise two instruments to provide reliable rating and notation of clinical information found in the medical record. Such information will spawn future studies of applied clinical research.

Patient and hospital treatment clusters

Patient admission data and treatment data collected for 536 cases from 11 collaborating private psychiatric hospitals were subjected to cluster analysis. From the patient admission data, four large clusters and three small clusters emerged. Two very large and general clusters and four very small clusters were obtained from the treatment data. Both sets of clusters were cross-classified against diagnosis, length of hospital stay, and attainment of therapeutic goals. There were several significant but small relationships between clusters and these criteria. There was little overlap between diagnosis and the patient data or treatment data clusters. Length of stay related only to the treatment clusters which included a number of variables measuring different treatment amounts. The method seems potentially useful because it groups individuals along dimensions of interest, but further effort must be spent on more specific treatment descriptions and better outcome variables.

Problems to anticipate in treating difficult patients in a long-term psychiatric hospital

In a previous report, the authors identified four dimensions of patient pathology associated with treatment difficulty: withdrawn psychoticism, character pathology, violence-agitation and suicidal-depressed behavior. In a subsequent study, they linked these dimensions to patterns of countertransference. The present research extends the two prior reports by examining the relations of the patient pathology dimensions to staff members' dissatisfaction with four areas of treatment: interpersonal approaches, structure and control, quality of teamwork, and medication. The major findings are: withdrawn psychoticism primarily relates to dissatisfaction with interpersonal treatment approaches; character pathology entails dissatisfaction with the level of structure and control; violence-agitation poses particular problems for teamwork; and suicidal-depressed behavior is unrelated to dissatisfaction with any dimension of treatment. The authors propose that these various problems in treatment are, in part, mediated by patterns of countertransference which they described in the prior paper. These findings should help staff members to focus their attention on areas of treatment in which problems are bound to arise in work with different types of difficult patients.

An anatomy of countertransference: staff reactions to difficult psychiatric hospital patients

Countertransference among hospital staff was investigated as part of ongoing research on difficult-to-treat psychiatric hospital patients. Staff's ratings of their emotional reactions to 127 patients on long-term units were analyzed by factor analysis, and the resulting factors were correlated by discipline with patient problem behaviors. Among the conclusions were that different forms of psychopathology elicit characteristic patterns of emotional reaction from staff; that some dimensions of psychopathology, particularly suicidal-depressed behavior and violence-agitation, elicit different emotional reactions among different disciplines, thus laying the groundwork for division among staff; and that the more difficult the process of hospital treatment, the more likely staff will experience a variety of emotions.

Profiles of difficult psychiatric hospital patients

In a study of 127 long-term psychiatric hospital patients perceived as difficult to treat, investigators used hierarchical grouping analysis to differentiate ten profile groups of patients. The groups are based on four dimensions or clusters of characteristics previously derived by factor analysis: withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The ten profile groups are described and are related to staff ratings of overall treatment difficulty, prognosis, sex, diagnosis, and other variables. The main conclusion is that treatment difficulty stems in large part from the compounding of different dimensions of severe psychopathology. Thus a pan-symptomatic group, with high scores on all four dimensions, ranks highest in overall treatment difficulty.

Relation of intelligence to ego functioning in an adult psychiatric population

Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQs and clinical ratings of 10 ego functions in a diagnostically heterogeneous sample of 60 adult psychiatric inpatients were correlated. With severity of pathology statistically controlled, higher intelligence was associated with more adequate ego functioning in several spheres: primary autonomous functions, thought processes, object relations, and mastery-competence. There were also some clinically meaningful differences between the Verbal and Performance IQs in the pattern of correlations. Extending Hartmann's original views, the authors employ an ethological framework to conceptualize intelligence in relation to the ego's role in adaptation, emphasizing that intelligence is an important-albeit neglected-aspect of ego functioning.

Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches

Headache variables were examined for 136 subjects who participated for 36 weeks in one of four groups--No Treatment, Autogenic Phrases, Electromyographic (EMG) Biofeedback, and Thermal Biofeedback. All subjects kept daily records of headache activity and medication usage and participated in 22 laboratory sessions during which frontalis electromyographic and hand-temperature measurements were taken; those in the three treatment groups practiced at home. There was a substantial reduction in headache variables in all groups. The No-Treatment Group differed significantly from the treatment groups combined, with the least reduction in headache variables. The Thermal Biofeedback Group vs. EMG Biofeedback and Autogenic Phrases Groups showed a suggestive trend toward improvement in the frequency and intensity of total headache.

An innovative approach to assessing outcome of long-term psychiatric hospitalization

The failure of research on long-term hospital treatment to show consistent relationships between length of stay and treatment outcome may reflect a need for more refined measures to evaluate long-term treatment. The authors developed an individualized method of assessing improvement in patients' major areas of impairment over the course of treatment. Using the new approach and two more traditional methods, the authors evaluated the outcome of 37 discharged long-term patients of a private psychiatric hospital who had been rated at admission and discharge on 21 variables related to ego function; affective symptoms; risk of suicide, self-destructiveness, and violence; substance abuse; level of treatment alliance; and, at discharge only, on overall level of improvement. Although the traditional methods failed to show a correlation between length of stay and most of the variables, the individualized approach found that a longer hospital stay was related to greater improvement in areas of most impaired functioning.

Episodic and residual thought pathology in chronic schizophrenics: effect of neuroleptics

We sought to determine the effect of neuroleptic treatment on thought disorder in chronic schizophrenics, using the Thought Disorder Index (TDI). We were able to demonstrate that high levels of thought disorder are found in chronic schizophrenic and schizoaffective patients, while in both bipolar patients and normal controls thought pathology is minimal. Moreover, the TDI appears to be particularly well suited to the characterization of thought disorder in chronic schizophrenics. For total scores on the TDI, we were unable to demonstrate a significant reduction in thought pathology, although it was evident that thought disorder as reflected in the Conceptual Disorganization and Unusual Thought Content subscales of the Brief Psychiatric Rating Scale is significantly reduced by neuroleptics. In analyses of subscores of the TDI reflecting four levels of severity, we were able to show that more severe forms of thought pathology are normalized by neuroleptics, while less severe pathology is largely unaffected. Our results suggest that neuroleptic treatment reduces thought pathology associated with acute episodes, but that somewhat milder, though still disabling, residual thought pathology persists after clinical remission has been attained.

Relation of neuroleptic dose and tardive dyskinesia to attention, information-processing, and psychophysiology in medicated schizophrenics

Relationships of neuroleptic dosage and tardive dyskinesia with measures of attentional, information-processing, and psychophysiological dysfunctions in medicated chronic schizophrenics were explored by correlational and stepwise multiple-regression analysis. High neuroleptic dosage was found to be associated with increased reaction time, reduced span of apprehension, low basal skin conductance level, and reduced skin conductance reactivity. Severe abnormal involuntary movements were associated with increased eye-tracking dysfunction, increased scanning eye-movement rate, increased reaction time, and reduced skin conductance reactivity. These findings led to the hypothesis that neuroleptic dosage and tardive dyskinesia may be sources of error variance in the measurement of attentional, information-processing, and psychophysiological functions in schizophrenics.

A research design to predict required length of psychiatric hospital stay

It is often an important clinical task to predict how long a given patient will need to be hospitalized, but past research efforts to provide an empirical basis for such predictions have not been highly successful. The authors propose a conceptual model for predicting length of stay that goes beyond previous research; they not only include a range of traditionally employed patient characteristics but also take into account the nature of the treatment goals and the availability of post-hospital treatment resources. The model forms the basis for an objective prediction procedure which will be tested in a large-scale research project on long-term hospital treatment outcome.

Patterns of staff perception of difficult patients in a long-term psychiatric hospital

In a study to determine which psychiatric patients are perceived by staff as most difficult to treat, clinical staff from several disciplines rated problem behaviors of 127 long-term inpatients in a private psychiatric hospital; staff also rated overall treatment difficulty, progress, and prognosis. No single patient characteristic determined staff's perception of patients as difficult to treat. Instead, four clusters of patient characteristics contributed to this perception; in decreasing order of influence, they are withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The study also showed that the patients who are considered particularly difficult are perceived as improving less and as having a poor prognosis.

Characterization of dehydration-induced luminescence of kaolinite

Dehydration-induced luminescence (DIL), the emission of light from a clay paste upon dehydration, was characterized experimentally for a colloidal kaolinite. The relationship between total photon count of the emitted light and film thickness is linear up to a thickness of 30 micrometers. The photon emission was obtained over a critical range of water contents (25-60%) of the oven-dry clay, and the kinetics of photon emission was presumed to be closely associated with the kinetics of film dehydration. Whether drying proceeded throughout the bulk or via a moving front was undetermined, but in either mode it was preceded by the formation of a thin dry film at the interface with the atmosphere. Grinding of the kaolinite for several minutes by mortar and pestle before paste preparations resulted in an overall increase of photon emission compared to unground kaolinite and in the formation of more than one emission peak, as well as a prolongation of the light emission. This effect on the kinetics of light emittance was observed for about two months after the application of the mechanical stress and suggests a means of detecting the mechanical stress history of a clay. An estimate was made of the spectral characteristics of the emitted light using optical filters and by incorporating tryptophan and salicylic acid into the kaolinite paste where they acted as fluorescent probes. The latter technique shifted the frequency of the light emitted by the kaolinite from the ultraviolet to the visible range where it was less effectively reabsorbed. The first method showed that the wavelengths of 97% of the emitted light was <460 nm and that 75% of the light had wavelengths < 410 nm. The second method showed that the total intensity of DIL increased in the presence of fluorescence molecules, suggesting that the emittance was in the ultraviolet range.