Psychological issues in cancer and non-cancer conditions.

The mechanism whereby incoming noxious stimuli result in emotional and behavioural changes is centred within cognitive processes. The mechanism is activated for all forms of pain but variations in the emotions generated and coping styles and strategies adopted occur. They are related to each individual's appraisal of their pain and the condition giving rise to it--major differences in appraisal relate to the presence or absence of malignancy with its potential threat to life. The psychological treatments of cognitive behavioural therapy have a role in the management of all chronic pain but historically have been employed more in non-cancer pain conditions than in patients with cancer pain. In the United Kingdom, the facilities for the treatment of pain by cognitive behavioural therapy are very limited and for that reason counselling, long used in aiding cancer patients, is likely to remain the main form of psychological treatment in that group.

Essential hypertension: the relationship of psychological factors to the severity of hypertension.

165 hypertensive patients attending one general practice in Portugal were found to report significantly higher scores on measures of neuroticism, anxiety, depression and general psychological distress than 152 normotensive patients at the same practice. Hypertensive patients with evidence of organ damage exhibited significantly higher depression scores than those without such damage. These differences between normotensives and hypertensives, and between hypertensive with and without organ damage are discussed and previous research in this area is reviewed.

Psychogenic pain: a study of marital adjustment.

The marital adjustment of patients with psychogenic pain disorder was evaluated and compared with a matched group of patients with other neurotic disorders. Pain patients spouses were found to have better marital adjustment and less psychiatric morbidity than the spouses of neurotic patients. These findings are discussed in terms of the concepts of "sick role homeostasis" and "tertiary gain".

Psychological aspects of chronic pain.

This paper summarizes psychological factors which can influence a patient's experience of chronic pain--namely personality and social variables, mood disturbance, hysteria and others. Psychological treatments which are available for pain management, including behavioural-cognitive therapies and relaxation, and the functions of multidisciplinary pain units are described.

Cognitive sequelae of severe head injury in relation to the Glasgow Outcome Scale.

Aspects of reliability and validity of the Glasgow Outcome Scale were studied by examining outcome scale categories and cognitive test scores in 57 patients with severe closed head injury seen within 2 years of injury. Inter-rater reliability of a three and six point scale was high. The three point scale, unlike the six point, showed a significant statistical association with cognitive test scores. The relationship between test score and outcome category was accurate within the first 3 months of injury, but considerably less so thereafter.

Three months after severe head injury: psychiatric and social impact on relatives.

Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury.

Patient outcome in the year following severe head injury and relatives' psychiatric and social functioning.

Fifty-seven consecutive severe male head injury patients together with a defined female relative were assessed at home 3, 6 and 12 months after injury in order to measure the psychiatric and social impact of the injury on the relative. Relatives were found to have significant and persistent psychiatric and social dysfunction and they considered themselves to have a high burden in caring for the relative throughout the year. No particular relationship was found to be the more vulnerable. The most frequent predictor of the relatives' psychiatric and social status was the level of symptomatic complaints voiced by the patients. The findings suggest the need for comprehensive rehabilitation of head injury patients and their relatives.

Post-concussional symptoms, financial compensation and outcome of severe blunt head injury.

Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group were pursuing claims for financial compensation while patients in the other were not. Patients were assessed on cognitive tests, and both patients and relatives were interviewed at 3, 6 and 12 months after injury. There were few differences between claimants and non-claimants: post-concussional symptoms were common in both, cognitive performance was equal, and the reports given by relatives of changes in the patients were very similar. However, the reports given by patients themselves differed with claimants reporting slightly more symptoms than non-claimants.

The short-term outcome of severe blunt head injury as reported by relatives of the injured persons.

A close relative of 55 severely head injured adults (post-traumatic amnesia greater than or equal to 2 days) was interviewed 3, 6 and 12 months after injury to obtain information about psychosocial changes in the patient. The problems most frequently reported were emotional disturbances, poor memory, and subjective symptoms, with physical disability much less common. The amount of stress experienced by relatives did not diminish between 3 and 12 months, and was related to the incidence of mental and behavioural changes in the patient. The question of whether or not compensation was being claimed did not appear to influence the outcome.

Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.

The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality of life in disabled survivors.

Cognitive sequelae in relationship to early indices of severity of brain damage after severe blunt head injury.

A group of 89 severely head injured patients was tested psychologically within two years of injury, and test performance was related to indices of brain damage. Duration of coma (Glasgow Coma Scale) bore little relationship to later cognitive outcome but duration of post-traumatic amnesia significantly predicted cognitive performance. Patients with an operated haematoma performed better than non-operated cases, reflecting a selection bias. The side of haematoma was not significant, nor were the presence, or type, or side of skull fracture.

The stages of recovery from severe head injury with special reference to late outcome.

Ten years research into the physical and psychosocial consequences of severe brain damage in adults has revealed substantial information about the process of recovery. The main features are evidence that the greater part of physical and mental recovery occurs within six months of injury and that in most cases the mental consequences of injury outweigh the physical ones and place the greater burden upon the injured person's relatives. Impairment of memory is the most common cognitive disorder and alterations in personality often occur also and are the most taxing of the mental deficits for all concerned. The process of recovery has three stages, in the first the patient is unconscious, in the second he or she regains full consciousness signified by the end of the period of post traumatic amnesia and continues to show evidence of rapid improvement in basic physical and mental functions. The rate of recovery shows within six months of injury in most cases and this represents the end of the second stage. In the third stage, which may last for many months, both the patient and his or her relatives adapt to the residual disabilities of the former. Methods of managing the three stages should include physical, psychological and social techniques and the way in which they may be linked to the patients' differing physical and psychosocial needs during the three stages of recovery are briefly discussed.

Psychological and psychiatric aspects of pain.

The relationship of pain to personality and the significance have been discussed. Pain may first be evidence of tissue damage, secondly it may be used as a means of communicating emotional distress to others and thirdly, it may be a means of manipulating others, expressing hostility or relieving guilt. The evidence is clear that an understanding of mental life and its relation to pain is important if this symptoms is to be dealt with effectively, irrespective of whether it is physical or psychogenic in origin.