Symptom perception: psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

Detection of psychiatric morbidity in gynecology patients by two brief screening methods

Psychiatric morbidity was studied in 100 women attending gynecological outpatient and inpatient set-ups using two brief screening instruments: the General Health Questionnaire, 12 items, and the Present State Examination, ten short questions. Psychiatric morbidity was detected in 36% and was found to be higher in women with uterine prolapse and infections but not in those with menstrual irregularities (p < 0.001). The commonest psychiatric symptoms detected in this population were worrying (50%), aches and pains (51%), depression (50%) and disturbances of biological function (51%). The commonest diagnoses were neurotic depression (70%) and adjustment disorders (23%). The screening instruments used were found to be simple, sensitive, specific, with high identification indices and easy to administer.

Patients with chronic pelvic pain and/or infertility: psychological differences pre- and post-treatment

This study investigated the psychological differences between gynecological clinic attenders with either pelvic pain or infertility, or with both pelvic pain and infertility both before and after laparoscopic investigation with concurrent treatment. Given the differing meaning attached to the procedure by these groups, it was hypothesized that infertility patients would be more anxious but with less evidence of psychopathology in comparison with the pain group prior to laparoscopic surgery. Postsurgery and in the short term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypotheses, pain patients obtained higher anxiety scores in comparison with the infertility group both pretreatment as well as post-treatment. The latter group's scores were comparable to normative data. Other results were generally in line with the hypotheses, pain reduction for both pain groups being associated with a reduction in psychopathology. Patients with pain plus infertility resembled pain patients at pretreatment, while at post-treatment, they bore a closer resemblance to infertility patients in their psychological profile. This was despite the fact that for both pain groups, pain relief was similar. This reinforces the notion that in the patient groups studied anxiety is associated with pain rather than with infertility.

The psychiatrist in an obstetric/gynaecology hospital: establishing a consultation-liaison service

The establishment and first six months of a psychiatric consultation-liaison service to an Australian obstetric and gynaecology hospital is described. Referrals, diagnoses and follow-up of patients are discussed, with case reports used to illustrate the types of patients seen. Evaluation of the findings and possible future directions for the service are discussed.

[Detection of psychosocial dysfunction in ob-gyn patients]

The human behavior and its social determinants are critical variables for understanding the etiology, treatment, and prevention of many disorders previously attributed to biological substrates. Among the many categories of human behavior to receive special attention from health researchers and practitioners are life events, coping responses and emotional state. The relation between these categories constituted a particular field of investigation. This relationship rather than forcing to focus on disease, distress, disability, and other failures in human functioning, permits to address health, abilities, resources, and other positive aspects of human functioning. On the other hand, the re-organization of health services considers interdisciplinary work as an objective, as it is necessary to care for the patient in an integral manner, with the consequent benefit of a more efficient service. In addition it is known that patients with psychosocial dysfunctions who use general practice care facilities overutilize these services in an unnecessary manner. With this in mind it is clear that is necessary to balance the service's cost-benefit for a more efficient clinical attention. In this paper we present the results of the categories mentioned above: life events, coping responses and its relationship with emotional state in a representative sample of 399 female patients who in 1986 received services at the National Institute of Perinatology-INPer-. Of these patients, 297 were obstetrical patients -OBS- and 102 gynaecological ones -GINE-. All patients answered these instruments: General Health Questionnaire -GHQ-7 of 30 items, a subscale of Health and Daily Living for Coping Responses and Life Events Scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychomimetic reactions after neurolept and propofol anaesthesia

The purpose of this study was to compare the frequency of psychomimetic reactions after 24 h and 3 months following total intravenous anaesthesia with propofol and neurolept anaesthesia. Forty otherwise healthy female patients were randomly divided into two groups. All were undergoing elective gynaecological laparotomy for non-malignant disease. Nineteen patients were anaesthetized with droperidol, fentanyl, pancuronium, N2O/O2. Twenty patients received total intravenous anaesthesia with propofol, fentanyl and pancuronium. Twenty-four hours after the anaesthesia the patients were interviewed about their subjective experiences of anaesthesia and recovery. Three months after the operation the patients were sent a questionnaire concerning ability to work, sleep and memory disorders. After 24 h the anaesthesia was judged as good by 18 patients receiving propofol and 13 patients receiving NLA (n.s.). The recovery was judged as good by 16 patients in the propofol group and six patients in the NLA group (P < 0.05). Locked-in feelings were reported by one patient in the propofol group and ten patients in the NLA group (P < 0.01). Impairment of memory was reported by one patient in the propofol group and seven patients in the NLA group (P < 0.01). A questionnaire used after 3 months was answered by 18 patients in the propofol group and 17 patients in the NLA group. There were few complaints, and no differences were found between the two groups. In conclusion, total intravenous anaesthesia with propofol seems more acceptable than anaesthesia with neurolept as judged by the patients 24 h after anaesthesia. There were no differences between the two groups concerning psychomimetic reactions 3 months after anaesthesia.

[Results of psychosomatic research and their use in gynecology]

Several more recent research results in psychosomatic obstetrics and gynecology will be presented, and directions for the practice will be given. In conclusion, it will be discussed how, for the realization of psychosomatic concepts, 'old-fashioned thinking' with biased, monocausal, scientific approaches is unproductive. This concerns, in particular, university gynecological hospitals where psychosomatic thinking is only very hesitantly accepted. The goal is, therefore, to promote a new thinking process, which incorporates an increased consideration of reference points like sensibility, flexibility and creativity.

Raising awareness about reproductive morbidity

Lack of awareness of the extent and effect of reproductive morbidity on the health and quality of life of women in developing countries is evident at national, community and individual levels. Raising awareness at national level requires population-based, epidemiological information which must be validated. At community level, public opinion mediates women's actions when they are sick and fear of social consequences provides a barrier to treatment. Individually, women find it difficult to talk about sexual reproductive health and its management. Methodologies currently being developed for raising awareness at all levels are described.

Psychiatric morbidity in a gynaecology clinic in Nigeria

Psychological disorders among 233 women attending a gynaecology out-patient clinic was assessed by a two-stage screening procedure, using the GHQ-30 and the PSE. The prevalence of psychiatric disorders was found to be 35.2%. Psychiatric morbidity was significantly associated with a history of induced abortion, previous marriages, having no children, complaints of menstrual abnormalities, chronic pelvic pain and having unsupportive husbands. It is suggested that more attention needs to be paid to the psychological health of patients with gynaecological disorders (in line with the biopsychosocial model of health care). This will ensure an overall improvement in the quality of care.

Severity of premenstrual symptoms in relation to medical/psychiatric problems and life experiences

The Premenstrual Experience Assessment, a comprehensive questionnaire, was completed by 878 women who were currently having menstrual cycles. Their severity of premenstrual symptoms was studied in relation to demographic variables, gynecological problems, use of medications, psychiatric experience, life stressors, and duration of severity. 14 significant relationships were found. The findings are discussed both in terms of research and clinical practice.

Cognitive orientation and genital infections in young women

The purpose was to explore the psychological determinants of common genital infections in young women. The study was done in the framework of the cognitive orientation theory which assumes that cognition guides behavior and provides predictions of behaviors and psychophysiological phenomena. We expected that beliefs of four types (about self, norms, goals, and general) would predict the occurrence and/or frequency of 17 gynecological symptoms (e.g., itching, swelling, different vaginal discharges, abscesses). The subjects were 195 female volunteers, undergraduates, about 23 years old, without gross gynecological disorders, mostly (87.7%) unmarried, mostly (83.6%) having had intercourse. They were administered anonymously questionnaires about demographic variables, frequency and treatment of gynecological symptoms and 3 urological ones (for control), and about cognitive orientation that referred to pretested themes (e.g., assertiveness, hypochondriasis). Stepwise discriminant and regression analyses showed that the belief types enabled predicting the occurrence and frequency of all symptoms, with a mean 34.5% improvement over the 50% chance level, accounting for 45.7-67.2% of the variance. Also the urological symptoms were predicted although at a lower level. Discussion focuses on the specificity of cognitive-motivational determinants and their role in producing conditions favoring physical pathology.

[Senescent-hypochondriac disorders accompanied by subjective signs of involvement of the genitalia]

Examined were 65 patients complaining of unpleasant sensations in the zone of sex organs. It was established that neither the localization of hypochondriac feelings, the character of senestopathias nor their characteristic aspects of interpretation and emotional accompaniment are not of significance for differential diagnosis with neuroses and torpid schizophrenia. The diagnosis should be based on the presence or absence of characteristic for schizophrenia personality changes, thinking disorders.

A survey of women undergoing a pelvic examination

This study attempts to evaluate patients' satisfaction with certain aspects of a first visit antenatal or gynaecological consultation and the reaction to and preferences during a pelvic examination. Embarrassment and apprehension were emotions experienced by at least half those surveyed and the speculum examination was uncomfortable to more women than the bimanual examination. However, less than 10% found the pelvic examination worse than they had anticipated.

[Clinical characteristics of mental disorders observed in ambulatory-polyclinical gynecological practice]

Concomitant mental disorders were diagnosed in 97 of the 107 gynecologic patients aged 19 to 66. Twenty of these patients were previously consulted by psychiatrists. Five groups of mental conditions were distinguished, most frequently associated, in a certain mode, with gynecologic diseases. The results of our analysis necessitate that gynecologic outpatients be consulted by psychiatrists.

Fundamental and situational components in a strategy for attaining a positive patient experience of the pelvic examination: a conceptual approach

Since 1983, researchers in medicine, behavior, and health care have been involved in collaborative work concerning attitudes toward the pelvic examination (PE). Important components of the analysis are social actions and conduct, which are conceptualized from role theory. The outcome of the PE is determined by both fundamental and situational components. The purpose is to discover optimal environmental conditions under which the PE should be performed. The medical profession has a long history, primarily established within hospitals. Professional performance has been directed toward diagnosis and cure; consequently, a particularistic view dominates. Throughout history the midwifery profession has had the primary task of supporting the woman in confinement. The dominant view of the midwifery profession is universalistic. The strategy we present is an approach for conceptualizing the bases determining the PE situation. It is a distinct step toward finding gynecological practices that may create positive patient experience of the PE.