Social implications of blepharoptosis and dermatochalasis.

PURPOSE: To investigate the social implications of blepharoptosis and dermatochalasis. METHODS: Two hundred ten individuals rated whole-face photographs of a series of patients based on 11 different personal characteristics: intelligence, threat, friendliness, health, trustworthiness, hard work, mental illness, financial success, attractiveness, alcoholism, and happiness. Preoperative and postoperative photographs of both male and female patients with bilateral blepharoptosis and/or dematochalasis were used. The paired t test was used to compare preoperative versus postoperative ratings on the 11 characteristics. RESULTS: The preoperative photographs were rated more negatively than were the postoperative photographs (p < 0.01) on all 11 characteristics for both male and female patients by the 210 study subjects. CONCLUSIONS: Members of our society view individuals with blepharoptosis and dermatochalasis negatively. These social attitudes may lead to unjust bias toward affected patients, and surgical correction probably provides benefits beyond improved visual function.

Psychosocial implications of blepharoptosis and dermatochalasis.

PURPOSE: To investigate, for the first time, the psychosocial implications of blepharoptosis and dermatochalasis. METHODS: Two hundred ten individuals rated whole-face photographs of a series of patients on the basis of 11 different personal characteristics: intelligence, throat, friendliness, health, trustworthiness, hard work, mental illness, financial success, attractiveness, alcoholism, and happiness. Preoperative and postoperative photographs of both male and female patients with bilateral blepharoptosis and/or dermatochalasis were used. The paired t test was used to compare preoperative and postoperative ratings on the 11 characteristics. RESULTS: The preoperative photographs were rated more negatively than the postoperative photographs (P < .01-P < .001) on all 11 characteristics for both male and female patients by the 210 study subjects. CONCLUSIONS: Members of society seem to view individuals with blepharoptosis and dermatochalasis negatively. These psychosocial attitudes may lead to unjust bias toward affected patients, and surgical correction likely provides benefits beyond improved visual function.

Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model.

The understanding of adjustment to aging calls for models that illustrate the interaction of psychosocial and health factors. The authors surveyed a group of retired Catholic sisters, examining the contributions of psychosocial factors and religiousness to life satisfaction, psychological distress, and depression. Life satisfaction was best explained by a four-factor model that included mastery, social support, physical functioning, and religious commitment. General level of distress was best predicted by physical functioning, social support, and mastery, but not religiousness. Depression, on the other hand, was predicted by mastery, social support, and religious commitment. These data are consistent with a proposed model in which internal, external, and coping resources mediate the psychological impact of impaired functional status.

Incentives for teaching psychiatry.

A questionnaire was sent to chairs and faculty in 137 academic departments of psychiatry regarding the methods used to promote teaching and their perceived value. The incentives most often used included promotion and retention, nomination to committees, and peer recognition. Least often used were bonuses and a designated teachers' career track. Chairs and their faculty often disagreed as to whether some incentives were being used at all Recognition of teaching excellence was generally most highly valued as a useful incentive. Clarification of the nature and purpose of teaching incentives would likely improve their effectiveness.

Liabifity and accountability in psychotherapy supervision : a review, survey, and proposal.

The contemporary climate of medical-legal liability, and of increasing expectations of accountability from agencies that pay for psychiatric services and training stipends, has created an atmosphere within which issues of liability and accountability should be constructively addressed. The authors conducted a nationwide survey of psychiatry residency training directors and asked them to estimate the awareness of their supervisors of liability issues pertinent to the supervision of psychiatric residents learning psychotherapy. While the training directors assume that their faculty supervisors, including volunteer faculty, are familiar with issues of accountability, very few make tangible efforts to provide this information. The authors found that patients are not routinely informed of the identity of supervisors, although the patients are usually informed that a therapist is in training. The authors propose practical interventions whereby residency training programs could address the issues of faculty members' awareness of their accountability, the education and training of supervisors, the documentation of supervisory sessions, and the attitudes and practices of psychotherapy trainees.

Medical student abuse: perceptions and experience.

A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

A new scale for assessing behavioral agitation in dementia.

The primary purpose of the present study was to develop a reliable and valid rating instrument for assessing treatment efficacy for behavioral problems in the cognitively impaired elderly. The Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) Scale was developed for the operational assessment of troublesome and disruptive behaviors in dementia. Each behavioral category of the BEAM-D was clinically considered to be a significant deviation from normative behavior for the geriatric dementia patient. The reliability and validity of the BEAM-D was assessed in a group of 45 patients diagnosed with primary degenerative dementia. The mean interrater reliability of BEAM-D items was 0.90. Concurrent validity was established by comparison with currently used rating scales, the Brief Psychiatric Rating Scale (BPRS) and the Sandoz Clinical Assessment-Geriatric (SCAG). Stepwise regression analysis revealed that the items of the BEAM-D had a strong relationship with conceptually similar behavioral dimensions on the BPRS and SCAG.

Use of tricyclic antidepressants in recipients of heart transplants.

Cardiac transplantation has become an accepted treatment for certain endstage cardiac disease patients. Depression and significant psychosocial stress among heart transplant recipients are not uncommon, but published reports about the use of antidepressants in these persons are very rare. The authors of this study report on a group of nine heart transplant recipients treated with antidepressant medicines. Seven patients achieved clinical remissions of their depression, and only two were unable to tolerate the noncardiac side effects of the medication. Indicators of autonomic, electrocardiographic, and hemodynamic functions showed no adverse effects. Although the study is based on a small sample, it appears that tricyclic antidepressants are safe and effective in heart transplant recipients.

Capgras' syndrome following minor head trauma.

Capgras' syndrome, the delusion of substitution, has been reported in the setting of many different underlying functional and organic conditions. Only two cases of the syndrome following major head trauma have been reported. The authors present the first reported case of Capgras' syndrome following minor head trauma in an elderly woman.

Alcoholism in the elderly.

Common criteria for recognizing alcoholism are often not applicable to older patients. Because of physiologic changes associated with aging, a stable pattern of moderate alcohol consumption can begin to cause problems in late life. Frequent presentations include confusion, falls, emotional lability and adverse drug interactions. The physician can use the presenting complaint to focus on the alcohol problem. The patient can then proceed through detoxification to a comprehensive treatment program.

Growth hormone response to edrophonium in Alzheimer's disease.

Neuropathologic data from patients with Alzheimer's disease indicate the presence of neurofibrillary tangles in hypothalamic regions associated with regulation of pituitary hormone release. The authors explored the hypothesis that cholinergic projections to hypothalamic nuclei controlling pituitary growth hormone (GH) release degenerate in Alzheimer's disease. Integrity of cholinergic regulation was tested by assaying the GH response to a presynaptic cholinergic challenge. After administration of the choline esterase inhibitor edrophonium, the peak GH response was 14 ng/ml in healthy elderly control subjects and only 2 ng/ml in Alzheimer's patients. The magnitude of GH blunting was correlated with cognitive and functional deficits. Possible implications of these data for enhanced accuracy in the diagnosis of dementia are discussed.