Fibrositis and psychologic disturbance

Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms.

Life events before the onset of rheumatoid arthritis

All female patients seen at a rheumatological clinic within 1 year of the onset of rheumatoid arthritis were referred for psychiatric assessment. There was 1 refusal and 22 patients were seen by the author, a psychiatrist working in the Department of Rheumatology. Psychiatric assessment, combined with a brief survey of important life events in the year before the onset of symptoms, was compared with a similar assessment made on randomly selected age-matched well women, among whom there was also 1 refusal. 12 of the patients and 5 controls (p = 0.03) reported a bad relationship in childhood with their mothers. 15 patients reported life events in the year before the onset of the arthritis, compared to 8 controls in the matching year (p = 0.03). In 12 of these 15 patients and 3 of the controls the events were assessed as carrying moderate or considerable long-term emotional threat (p = 0.005). In 11 of these 12 patients the interval between the event and the onset was less than 3 months.

Explicit incestuous motifs in psychosomatic patients

In this study, which is the first ever to deal with the issue of incestuous motifs in psychosomatic patients, the author reviewed the charts of all his psychosomatic patients, seen in at least 40 interviews between 1975 and 1980, and the charts of all his non-psychosomatic patients, seen in at least 40 interviews between 1970 and 1975, in order to determine the frequency of explicit incestuous motifs in each group. It was found that the motifs had been reported by more psychosomatic patients than non-psychosomatic patients. Also, it was found that the explicit incestuous motifs which had been reported by the psychosomatic patients were more intense and pervasive than those which had been reported by the non-psychosomatic patients. These findings are discussed with reference to the issue of failure of the ego's defense mechanisms in psychosomatic patients.

How are women sicker than men? An overview of psychosomatic problems in women

An overview is presented of psychosomatic problems in women - the epidemiology, physiology and psychology. Surveys of sickness rates in women and psychological studies are used as a basis of speculation about higher female morbidity rates. Theories of psychosomatic illness, the somatic concomitants of hysteria and alexithymia are reviewed as they pertain to observations of gender differences in disease phenomena. A clinical case is presented of thyrotoxicosis, one of the illnesses predominantly found in women.

A test of delayed recovery following stressful stimulation in four psychosomatic disorders

Sternbach proposed a three component model to account for the emergence of psychosomatic symptoms. He hypothesized that if an individual exhibited (1) marked response stereotypy, and (2) inadequate homeostatic restraints, then (3) exposure to activating situations would result in psychosomatic episodes. The main purpose of the present study was to examine the second component of the Sternbach model, homeostatic inadequacy, as indicated by impaired rate of recovery from stressful stimulation. In addition, the presence of response stereotypy was investigated in this study. Ten subjects from each of 5 diagnostic groups (rheumatoid arthritis, essential hypertension, migraine headache, tension headache, and healthy controls) were observed under conditions of unstructured relaxation, easement (exposure to stimuli intended to enhance relaxation), mild stress, and recovery from stress. Forearm and forehead muscle potential, peripheral temperature, electrodermal response, heart rate and systolic and diastolic blood pressure were monitored during these sessions. Although evidence of symptom specific response stereotypy was regularly observed, slowness of recovery did not emerge as a robust phenomenon in the four psychosomatic disorders investigated. The phenomenon was consistently observed in the arthritic subjects, absent in hypertensives and tension headache subjects, and ambiguous for migraine subjects.

Medical care and the arthritis sufferer: a survey in outer Melbourne

Chronic rheumatic diseases affect more than 750,000 Australians, who consume medical services at least in proportion to their numbers. A survey in Ringwood, Victoria found consistent accounts by sufferers of unmet expectations and shortcomings in medical care.

The Sickness Impact Profile: development and final revision of a health status measure

The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.

Rheumatoid arthritis: a study of relaxation and temperature biofeedback training as an adjunctive therapy

Rheumatoid arthritis (RA) is a painful systemic disease and is believed to be exacerbated by stress. Relaxation and biofeedback strategies have demonstrated utility in alleviating both pain and stress-related symptomatology, and therefore were tested for efficacy with this disease in a two-phase study. First, 24 patients were taught a relaxation technique and then trained in either temperature elevation or reduction. Second, a group of 15 patients thus trained was compared with 8 others who received traditional physiotherapy modalities. Psychological tests, functional/physical evaluations, as well as measurements related to pain, sleep, and other activities were carried out. Results of the first study revealed significant and positive changes following treatment that were primarily related to pain, tension, and sleep patterns for both groups, but no differential effects were noted between temperature elevation or reduction conditions. This was attributed to both groups having maintained temperature above baseline during biofeedback training. The results of the second study consistently favored the relaxation and biofeedback over the physiotherapy group on the physical/functional indices. The psychological measures tended to remain constant throughout both studies, leading to the conclusion that the effectiveness of treatment was specific to physical functioning rather than to a psychological enhancement of well-being.

A method to increase compliance to exercise regimens in rheumatoid arthritis patients

A hand exerciser with an electronic counter and a visual display was used to measure compliance objectively, to investigate the effects of visual feedback on compliance, and to assess the impact of exercise on seven mild and five moderate rheumatoid arthritis patients. A multiple time-series design varying the onset of the visual display was utilized. Compliance was assessed weekly over the 7 weeks of the study. Pretest and posttest measures of various indicators of hand functioning were taken by an occupational therapist. Visual display of the number of exercises completed decreased the number of noncompliant patients from six to two, with the maximum degree of noncompliance reduced from 44 to 5%. Thus the use of visual display is effective in producing compliance to exercise regimens. In light of the small sample size, however, no definitive conclusions can be drawn regarding the effects of exercise on hand functioning.

The impact of chronic disease: a sociomedical profile of rheumatoid arthritis

A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty-five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty-three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.

Sexual problems of women with rheumatoid arthritis

A questionnaire concerning sexual problems was given to 112 female rheumatoid arthritic (RA) patients. Replies were collected from 91 (81%). The results indicated that 1) recently married patients were concerned about pregnancy; 2) the sexual desire of most patients diminished, and intercourse became less frequent and less satisfying; 3) affected hip and knee joints made it difficult to assume sexual intercourse positions; and 4) patients who had unsatisfying sexual relationship reported a decreased demand for intercourse by their spouses and diminished frequency of their own orgasms. To lead a fulfilling married life, patients with RA should be counselled to adopt a positive attitude toward sexual relationship with their husbands.

Patterns of hostility revealed in the fantasies and dreams of women with rheumatoid arthritis

Data relevant to the feelings of hostility harbored by 25 women with rheumatoid arthritis is reported. Noteworthy points include: (1) a high incidence of early loss by death, often by suicide, of one of the parents; (2) a high incidence of involvement in incestuous relationships; (3) the occurrence in the period of onset of illness of severe provocation by an ambivalently loved person whom the patient cannot relinquish; (4) the presence of conscious fantasies of revenge toward this person which tend not to be carried over into action; (5) the presence of vicious dreams, often containing frankly oral-sadistic motifs in many of which the patient herself is portrayed in the role of victim.

Outpatient educational program for rheumatoid arthritis patients

A patient-education program was designed to meet the expressed needs of clinic rheumatoid arthritis patients. This program consisted of six educational seminars involving various health professionals. A quasi-experimental control group design was employed to evaluate the patients' cognitive and behavioral responses to this program. Responses were assessed through the administration of pretests, posttests, and three-month follow-up tests to treatment and control groups. The treatment group increased its cognitive score 22.5% from initial pretest to long-term follow-up, whereas the control group improved only 5.1% on these questions. The treatment group improved its behavioral score between the administration of the pretest and the posttest and maintained this improvement on the long-term follow-up. Although the control group initially scored somewhat higher on the behavioral measures, it reported a decrease in the performance of self-care activities on the posttest and follow-up.