Patients benefi ts from physicians empathy and results of including of empathy development into medical training.

BACKGROUND:  The extent of empathy is an individual human property, not completely dependent on cognitive intelligence. People arise with certain genetic fundament for empathy but the ability to perceive empathically develops further during the life. There has been much discussion in the medical literature about the importance of empathy and physician communication style in medical practice. Empathy has been shown to have a very real positive eff ect on patients outcomes. The literature suggests that empathy training is warranted and should be incorporated into surgical residencies through didactics, role-playing and simulations, and apprenticeship to empathic attending role models. PURPOSE: This paper reviews empathy and its importance as it pertains to the physician-patient relationship and improving patients outcomes, and the need for increased education in empathy during medical training.

Basic information for identifying psychological disorders caused by malignant disease.

BACKGROUND: Improvements in cancer dia-gnosis and treatment explain a substantial increase in the number of patients chronically affected by or recovering from cancer. This is a fragile population, physically, psychologically and socially affected by the consequences of the disease and the associated treatment. The National Comprehensive Cancer Network (NCCN) reacted to this fact, creating the NCCN guidelines for survivorship. They provide screening, evaluation and treatment recommendations for the consequences of cancer and cancer treatment. PURPOSE: Inspired by this NCCN recommendation, we drew up this article pointing out the psychological issues like anxiety, depression and fatigue in order to help the physicians refer their patients timely to psychologic or psychiatric care.

Prevalence of psychopathology in patients suffering from breast and gastrointestinal cancer.

Prevalence of psychopathology in 107 in- and outpatients suffering from cancer was assessed by means of self-rating inventory (Symptom Check List (SCL-90)) and an interview. There were 86 women with breast cancer and 21 patients with gastrointestinal cancer (9 women and 12 men). Inventory was administered once after surgery. Psychopathology exceeding so called mean borderline values derived from control samples ranged from 2% to 33% of the patients in particular dimensions of the inventory. Maximal mean values of the psychopathology were found in the dimensions of somatisation, depression, anxiety, phobic anxiety, hostility and of items not included, reflecting mostly sleep and eating distortions. Mean values of the psychopathology were insignificantly lower in patients after mastectomy, compared with gastrointestinal cancer patients. No significant differences between initial (I and II) and advanced (III and IV) stages of the illness were achieved in the patients from both investigated samples. Screened patients are suitable for psychiatric or psychologic therapeutic intervention.

Psychosomatic medicine in Czechoslovakia: history, present state and perspectives.

The history and present state of psychosomatic medicine in Czechoslovakia are described in detail. At the present time, a concept of Z.J. Lipowski is spreading. Since the formation of the Section for Study of Psychosomatic Medicine, a part of the Czech Psychiatric Association in 1975, several teams of physicians and clinical psychologists have started work in various fields of psychosomatic medicine. Some inpatient and outpatient psychosomatic wards and units were opened. Pre- and postgraduate training in psychosomatics and behavioral medicine have started. Future developments of psychosomatic health care in Czechoslovakia will require the integration of the psychosomatic approach and the bio-psychosocial model of disease into primary health care and other bio-medical disciplines. Psychosocial theory must be incorporated into prevention, diagnosis, treatment and rehabilitation of all diseases using the method of liaison psychiatry, along with the further institutionalization of psychosomatic care.

[Sulpiride (Eglonyl Alkaloid) in the treatment of functional disorders of the digestive tract]. / Sulpirid (Eglonyl Alkaloid) v lécení funkcních poruch zazívacího ústrojí.

Sulpirid was administered in an open clinical trial--150 mg/day for 4 weeks--to 31 patients (15 man and 16 women, mean age 31.5 years, mean duration of complaints 1 month to 6 years) suffering from functional disorders of the digestive system. Their health status was evaluated by a specialist in internal medicine, by a psychiatrist and a self-administered SCL-90 questionnaire before the onset of treatment and after four weeks. In 29 patients the complaints disappeared or improved markedly and this improvement persisted also after discontinuation of the drugs. In the entire group a significant drop of the mean initial intensity of psychopathological feature in all dimensions of the questionnaire occurred; the improvement was more marked in men where the mean baseline values of psychopathology were higher. There was also a significant decline of the mean numbers of positively evaluated items in 9 of 10 dimensions of the questionnaire. The drug was well tolerated by the patients with the exception of one transient allergic skin reaction. So far the exact ratio of improvement of psychopathology as a therapeutic response to sulpirid administration and the placebo effect on the patient's complaints cannot be exactly evaluated. Sulpirid has some advantages, as compared with other psychopharmaceutic preparations used in this indication (e.g. amitriptyline, dosulepine).

[Aspects of the 10th decennial revision of the international statistical classification of diseases (ICD-10)]. / O nekterých aspektech projektu 10. decenální revize mezinárodní statistické klasifikace chorob (ICD-10).

The author gives a critical account of some general principles of the project of classification ICD-10, changes in the classification of items in the area of endogenous psychoses, neuroses psychogenic conditions and personality disorder respectively. Changes in the mentioned groups may at first cause some embarassment, in advocates of defined schools even indignation. The author evaluates positively the shift of schizoaffective psychoses to affective disorders; omission of neurotic depression is probably premature. Simple schizophrenia could be classified as it was so far. The problem of latent schizophrenia is more complicated. The classification will enrich clinical thinking by progressive elements of operational diagnosis and partly also by multiaxial diagnosis by introduction of the code which records the importance of psychosocial stress ("Z"). It may stimulate the declining interest in phenomenology and nosology. In general the ICD-10 project is considered a necessary and in some instances useful compromise with principles of DSM-III classification. Its introduction will cause transient difficulties. Only after some experience with the new classification and validating studies it will be possible to express a more responsible opinion on the project.

[Psychological symptoms in patients with hearing and equilibrium disorders and possibilities of treatment with psychopharmacologic agents]. / Psychická symptomatika u nemocných poruchami sluchu a rovnováhy a moznosti jejího psychofarmakologického ovlivnení.

The aim of the investigation was to find out in a group of 130 hospitalized men and women, suffering from impaired hearing and equilibrium, the prevalence of psychic symptoms and psychopathological syndromes and symptoms suitable for psychopharmacological intervention. The method of interview and questionnaire SCL-90 was used which makes it possible to extract from quantifiable answers to 90 questions 10 symptoms constructions (dimensions) which roughly correspond with psychopathological syndromes. Psychopathological syndromes which are associated with the basic disease and are suitable for psychopharmacological intervention are in both sexes the following: somatization, depression, anxiety, phobic anxiety, impaired sleep and appetite. The assessed symptoms corresponding to a varying extent to the items of the questionnaire in both sexes are within the mentioned dimensions. In the subsequent stage the authors differentiate psychopathological syndromes and symptoms in acute and chronic ENT disease of the investigated groups. The authors maintain that psychopharmacological drugs influence in a favourable way not only the present mental symptoms in the framework of secondary psychopathology but also the psychosomatic component of the basic disease and thus have a favourable effect on its course. The author recommend some antidepressants, anxiolytics and neuroleptics to be used in small doses.