The introduction of a choice to learn pre-symptomatic DNA test results for BRCA or Lynch syndrome either face-to-face or by letter.

In predictive DNA testing for hereditary cancer, test results should traditionally be disclosed face-to-face. Increasingly, however, counselees ask to receive their test result at home by letter. To compare the quality of genetic counselling in the traditional way to a procedure in which counselees are offered a choice on how to get their test result. Counselees from families with a known BRCA1/2 or Lynch syndrome mutation were randomised into two groups. The control group was given the DNA test result in a face-to-face consultation. In the intervention group people could choose to learn their test result face-to-face or by letter. The quality of genetic counselling was assessed through questionnaires at three different moments. Data of 198 counselees were analysed. The quality of genetic counselling and psychological functioning were equally good in both groups. The majority of cases chose for disclosure by letter. The counselees with a good test result in the intervention group were the most satisfied. Our results indicate that in predictive DNA testing for BRCA1/2 and Lynch syndrome, a choice protocol is equally safe and more satisfying. Moreover, it is more efficient for both counsellor and counselee.

Catastrophizing and causal beliefs in whiplash.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: This study investigates the role of pain catastrophizing and causal beliefs with regard to severity and persistence of neck complaints after motor vehicle accidents. SUMMARY OF BACKGROUND DATA.: In previous research on low back pain, somatoform disorders and chronic fatigue syndrome, pain catastrophizing and causal beliefs were found to be related to perceived disability and prognosis. Furthermore, it has been argued with respect to whiplash that culturally dependent symptom expectations are responsible for a chronic course. METHODS: Individuals involved in traffic accidents who initiated compensation claim procedures with a Dutch insurance company were sent questionnaires (Q1) containing the Neck Disability Index, the Pain Catastrophizing Scale, and the Causal Beliefs Questionnaire-Whiplash. Of 1252 questionnaires dispatched, 747 (59.7%) were returned. Only car occupants with neck complaints were included in this study (n = 140). Complaints were monitored using additional questionnaires administered 6 (Q2) and 12 months (Q3) after the accident. RESULTS: Pain catastrophizing and causal beliefs were related to the severity of concurrent whiplash disability. The severity of initial complaints was related to the severity and persistence of whiplash complaints. Attributing initial neck complaints to whiplash was found to predict the persistence of disability at 6 and 12 months follow-up, over and above the severity of the initial complaints. CONCLUSION: The results suggest that causal beliefs may play a major role in the perceived disability and course of neck complaints after motor vehicle accidents, whereas pain catastrophizing is predominantly related to concurrent disability.The current findings are consistent with the view that an early conviction that neck complaints are caused by the medico-cultural entity whiplash has a detrimental effect on the course of symptoms.

Psychological assessment of patients with Menière's disease.

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menière's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease.

[Dental treatment anxiety. A review of useful anxiety-measuring instruments]. / Angst voor tandheelkundige behandelingen. Een overzicht van de bruikbare meetinstrumenten.

Dental anxiety is a common problem. Different tests have been developed to measure the nature and the severity of dental anxiety or phobia. These tests can help to identify highly anxious patients who need special dental care. In this article, the dental anxiety tests useful in The Netherlands are reviewed.

Sprain of the neck: quality of life and psychological functioning. A 4-year retrospective study.

Aim of the study was to analyse quality of life and psychological functioning in patients with sprain of the neck, to analyse the relationship between complaints, quality of life, psychological functioning and personality factors, and to analyse the profile of patients with whiplash associated disorders (WAD), 4 years after trauma. From the University Hospital Groningen 193 patients with the diagnose sprain of the neck filled out a questionnaire. Of this group 100 subjects did not have complaints before the accident and were therefore at risk for the development of complaints as a result of sprain of the neck. Quality of life and psychological functioning were assessed using the RAND-36 and the SCL-90, respectively. Personality was assessed by means of the Dutch Personality Questionnaire. Of the group at risk (56% women and 44% men, mean age: 33.9, SD: 14.6) quality of life was significantly worse in subjects with complaints (mean: 78.4, SD: 15.5) compared to subjects without complaints (mean: 87.5, SD: 8.7). Psychological functioning did not differ significantly between the group with complaints compared to group without complaints. Personality did not differ between the groups. Personality and complaints together were significantly related to quality of life (r: 0.77) and psychological functioning (r: 0.85). No specific profile of WAD patients was found. In conclusion, personality and complaints influence quality of life and psychological functioning to a considerable extent.

[Intensive patient education and treatment program for young adults with atopic eczema]. / Intensives Patientenschulungs- und Behandlungsprogramm für junge Erwachsene mit atopischem Ekzem.

BACKGROUND AND OBJECTIVE: By means of a 2-week intensive multidisciplinary training & treatment course in small groups (ISBP), young adults with atopic dermatitis may be able to achieve better self-management of their disease and reduce their number of doctor visits. METHODS: Patients aged 18-35 with moderate to severe atopic dermatitis (SCORAD > 20) were randomized in a treatment (ISBP) group of n = 31 and a control group of n = 20. Follow-up was 9 months. The outcome was assessed using validated primary and secondary parameters, both specific for atopic dermatitis and more general. RESULTS: Participants in the ISBP scored significantly better at follow-up in the Marburger atopic dermatitis-specific questionnaire and the self-care parameter, needed less time for medical consultations, and used more emollients without corticosteroids. Absence from work/sick leave was less at 10 weeks follow-up, but equal at 9 months. CONCLUSIONS: The ISBP program can be judged successful because both the patients and their doctors perceive their interactions as more efficient, less time time-consuming and more satisfying.

Psychological adaptation and social support of parents of pediatric cancer patients: a prospective longitudinal study.

OBJECTIVE: To investigate levels of support and the concurrent and prospective effects of support on the psychological functioning of parents of children with cancer in a prospective longitudinal study. METHODS: Parents' (n = 128) self-perceived level of psychological distress, quantity of support, and dissatisfaction with support were assessed, at diagnosis, at 6, and at 12 months. RESULTS: Parents received most support at diagnosis. Self-perceived quantity decreased with time, but parents indicated they remained equally satisfied. Support significantly predicted concurrent and prospective distress of fathers, but not of mothers. Dissatisfaction with support and negative interactions were consistent risk factors for fathers. Mothers who adjusted well psychologically received more support and were less dissatisfied than mothers who remained clinically distressed. Nevertheless, no persisting effect of support was found. CONCLUSIONS: Findings illustrate that social support varies with the stress situation and with gender. Identification of vulnerable parents at diagnosis on the basis of their perception of received quantity of and dissatisfaction with support seems difficult. Intervention efforts aimed at mobilization of needed support may be efficacious.

Risk factors for psychological maladjustment of parents of children with cancer.

OBJECTIVE: To examine risk variables for future, more immediate, and persistent psychological distress of parents of pediatric cancer patients. METHOD: Parents (n = 128) completed questionnaires at the time of diagnosis (T1) and 12 months later (T2). Multiple regression analyses were performed using the following as predictors: demographics, illness-related variables, other life events, personality, coping styles, and social support. RESULTS: Trait anxiety was the strongest predictor of both fathers' and mothers' future distress. Changes in trait anxiety during the year also accompanied changes in both parents' levels of distress. Additional prospective predictors for fathers were the coping style "social support-seeking" and dissatisfaction with support. Dissatisfaction with support also had short-term effects for fathers. An additional prospective predictor for mothers was the number of pleasant events they had experienced prior to diagnosis, while a short-term effect was found for performance in assertiveness. No predictors for the persistence of distress were found. CONCLUSIONS: These results underscore the importance of personality anxiety in predicting parents' risk for adjustment difficulties associated with the experience of cancer in one's child. An additional risk factor for fathers was social support. For mothers, previously experienced life events and the frequency of assertive behavior were additional risk factors.

Whiplash and post-traumatic stress disorder.

PURPOSE: This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed. METHOD: A review of the literature on psychological consequences of motor vehicle accidents and on risk factors associated with developing chronic whiplash complaints is given. A case report is presented to illustrate the treatment strategy. RESULTS: Traffic accidents lead to psychological complaints more often than is realized in clinical practice. It is estimated that PTSD occurs in at least 25% of traffic accident victims who sustain physical injuries. This number is probably higher in patients with chronic whiplash complaints. The case report shows that improvement in relation with the post-traumatic stress symptoms can have a beneficial effect on coping with the chronic whiplash complaints. CONCLUSIONS: The psychotherapeutic treatment of patients with chronic whiplash complaints and PTSD should be aimed primarily at coping with the trauma and not at the chronic pain complaints.

Cognitive-behavioral therapy for paruresis: a case report.

This article reviews directive interventions for paruresis, the inability to urinate in the proximity of others. As in treatments for other anxiety disorders, historical interventions have included the use of paradoxical intention and several different forms of exposure. The results of pharmacological treatment have not proven promising. Although a multidimensional treatment model has been recommended, little attention has been paid to treating cognitive components of the problem. In this paper, a single case is described in which cognitive components of the problem of paruresis were evident. A cognitive approach and exposure in vivo were applied. Measures of successful trials were obtained over 18 weeks. The combination of cognitive interventions and gradual exposure was effective in reducing paruresis. At follow-up 6 mo. later results had been maintained. The results of this case suggest more attention to the cognitive components is appropriate in the treatment of paruresis, as was stated previously for other specific social phobias.

Brief report: an intervention program for parents of pediatric cancer patients: a randomized controlled trial.

OBJECTIVE: To evaluate a psychoeducational intervention program for parents of pediatric cancer patients, using cognitive and behavioral techniques. METHODS: Parents were randomly assigned to an intervention (n = 39) and a control condition (n = 42). Baseline assessment took place at diagnosis. Short-term effects were measured immediately after the intervention, long-term effects six months later. Control parents received standard care. Intervention parents received, in addition, a manual-guided program during the first six months following the diagnosis. RESULTS: With time all parents became significantly less psychologically distressed. However, no between-group differences were noted in psychological functioning, satisfaction with support, and intensity of emotions immediately postintervention and six months later. CONCLUSIONS: Although the clinical evaluation of the intervention was positive, it appeared that a structured intervention program as described in this study was not any more effective than standard care.

Gender differences in psychological adaptation and coping in parents of pediatric cancer patients.

This study investigated differences in psychological distress and coping styles between fathers and mothers of pediatric cancer patients, over a 1-year time period. Also examined were (dis)similarities in couples in distress and coping, and the relationship between (dis)similarities in coping and psychological functioning of both members of a couple. Parents (n = 124, 62 couples) were assessed at diagnosis, at 6 and 12 months. Fathers and mothers experienced higher levels of psychiatric symptomatology and psychological distress at diagnosis than men and women of a normgroup. Distress declined significantly with time. Although parents did not report more symptoms than the normgroup 12 months post-diagnosis, they still were psychologically out of balance. Contrary to findings in the general population, no differences were found between fathers and mothers in psychiatric symptoms or psychological distress on any of the measurements. Only a few gender differences in coping were found. Fathers used more active-problem focusing at diagnosis and a less palliative reaction pattern at 12 months than did mothers. Mothers used more social-support seeking on all measurements. A tendency for similarity in the use of the coping styles within couples was found. Discrepancies in coping in couples were positively related to distress in fathers at diagnosis. However, 12 months later, the more discrepant the couples were in their coping preferences the more distress the mothers indicated.

The diagnosis and psychopharmacological treatment of trichotillomania: a review.

Recently published literature has given rise to two questions: first, can trichotillomania be considered a variant of obsessive-compulsive disorder? and second, are psychopharmacological treatment strategies, in particular serotonin reuptake blockers, effective in the treatment of trichotillomania? The differences between trichotillomania and obsessive-compulsive disorder were too great to answer the former question affirmatively. To answer the latter question, an overview is given of clinical studies on the effects of psychopharmacological treatment of adolescents and adults with trichotillomania. A total of three studies with control groups and seven without were reviewed. The results varied widely and were inconsistent. The conclusion is that no psychopharmacological treatment strategies can be recommended so far.

Strategies for coping with pain and psychological distress associated with temporomandibular joint osteoarthrosis and internal derangement.

OBJECTIVE: To analyse the relationship among a variety of emotional, cognitive, and behavioral coping strategies and pain/suffering and psychological distress in patients with temporomandibular joint (TMJ) pain. DESIGN: Cross-sectional, correlational study. SETTING: Department of Oral and Maxillofacial Surgery, University Hospital Groningen. SUBJECTS: A consecutive sample of 53 patients with a mean age of 25 with TMJ osteoarthrosis and internal derangement or synovitis without internal derangement. There were seven men and 46 women. No patient was excluded. MAIN OUTCOME MEASURES: Pain/suffering was assessed using the West Haven-Yale Multidimensional Pain Inventory and visual analogue scales. Psychological distress was assessed by the General Health Questionnaire and the Symptom Checklist. Coping with pain was assessed by the Coping with Specific Symptoms Questionnaire. RESULTS: Psychological distress and pain severity were low, and there was little interference by pain with daily life. While none of the coping strategies were frequently used, these strategies did explain a significant proportion of the variance in pain and psychological distress measures (27-58% of the variance). Stepwise regression analysis showed that patients scoring high on expression of emotions and wishful thinking had significantly higher levels of pain/suffering and psychological distress. CONCLUSIONS: Previous studies of other subgroups of patients with temporomandibular disorders (TMDs) report higher degrees of psychological distress. The need to distinguish between specific subgroups of patients with TMD is emphasized by the results of this study. Cognitive-behaviorial interventions to improve ways of coping is not very useful for the subgroup in this study.

Nine rheumatoid factor assays compared.

In this study we have investigated five quantitative and three semi-quantitative rheumatoid factor assays and the Rose-Waaler assay in 120 patients suffering from rheumatoid arthritis and in 76 with other systemic diseases. All tests measure the IgM anti-IgG antibodies. The correlations between the quantitative tests were all higher than 0.86 and much better than between the quantitative and semi-quantitative tests and the semi-quantitative tests themselves (r between 0.22 and 0.85). The within run and between run precision studies for the quantitative tests showed CV values lower than 16%. In spite of the standardisation on the WHO and the Center of Disease Control Reference Preparation we found important differences in patient results. From an analytical point of view, the quantitative assays for rheumatoid factors show certain advantages over the traditional haemagglutination tests.

Urinary hydroxyproline as a measure in fracture healing.

The determination of any pattern in urinary total OH-proline following bone fractures has been the purpose of this investigation. This was carried out in a group of 11 patients with major fractures, a group of 8 patients with minor fractures and a control group of 10 healthy laboratory technicians. Indeed, some patterns could be detected. In patients with major fractures a considerable elevation of urinary total OH-proline was found which was correlated to the size and number of fractures and the healing tendency of the fracture. Normal to only slightly elevated urinary total OH-proline values during the course of the healing process of major fractures could perhaps indicate delayed union, or even malunion. Since fracture healing is usually assessed by X-ray examination and clinical experience, this study could provide a more accurate measure of the healing process of fractures.