What's in a case formulation? Development and use of a content coding manual.

A case formulation content coding method is described and applied to the formulation section of 56 intake evaluations randomly selected from an outpatient psychiatric clinic. The coding manual showed good reliability (mean kappa = 0.86) across content and quality categories. Although 95% of the formulations included descriptive information, only 37% addressed hypothesized predisposing life events accounting for the individual's presenting problems, and 16% included a precipitating stressor. Only 43% inferred a psychological mechanism, 2% inferred a biological mechanism, and 2% mentioned sociocultural factors. Formulations were more descriptive than inferential, more simple than complex, and moderately precise in use of language. In sum, clinicians used the formulation primarily to summarize descriptive information rather than to integrate it into a hypothesis about the causes, precipitants, and maintaining influences of an individual's problems.

The ideal and the feared self as predictors of psychological symptoms among geriatric care nurses.

Following the 1987 work of Higgins and of Ogilvie, we investigated whether discrepancies between one's actual self and ideal self predict psychological symptoms better than discrepancies between the actual and feared self. We also examined Ogilvie's 1987 finding that the feared self is a more concrete cognitive representation than is the ideal self. 51 geriatric nurses completed the SCL-90-R and a questionnaire designed to measure actual self, ideal self, and feared self. Discrepancies between scores for actual and ideal self predicted severity of reported depressive and global symptoms and discrepancies between the actual and feared self were correlated negatively only with scores on Hostility. Further, clinical judges rated the nurses' memories representing their feared self as more concrete than memories depicting their ideal self. Results are discussed in terms of self-discrepancy theory and how the ideal and feared selves might be studied further.

A two-year follow-up on the effects of a smoking ban in an inpatient psychiatric service.

The effects of prohibiting cigarette smoking on the behavior of patients on a 25-bed psychiatric inpatient unit were assessed immediately after implementation of a smoking ban and two years later. No major behavioral disruptions were observed after the ban. The number of calls for security assistance, physical assaults, instances of leather restraints and of seclusions, and discharges against medical advice did not increase significantly immediately after the restriction on smoking or two years later. Significantly more verbal assaults and prescribing of p.r.n. medications for anxiety occurred immediately after the ban but not two years later.

Role-relationship models for case formulation.

BACKGROUND: Personality disorders are important because they occur frequently and often complicate psychiatric symptom disorders. They are difficult to diagnose and formulate because unitary core traits and themes are hard to define for individual patients. A multiple-selves approach helps clinicians define core contradictions in belief that are frequently present. METHOD: A configurational system for case formulation was used with an approach of states and person schemas. Transactions and stories involving self and others were observed for recurrent elements of identity, attribution, and action. These elements were systematically arranged as role relationship models for each important state of behavior. Cyclic repetitions of maladaptive interpersonal behavior patterns were then explained in terms of motivations and social events that activate enduring, but erroneous, beliefs. RESULTS: Reliable and valid individualized formulations were derived by means of configurations of role relationship models. Inferring several levels of diverse self and other beliefs clarified the complexity usually found in disorders of personality. CONCLUSIONS: The role relationship models method of formulation is compatible with integrative approaches to treatment planning.

Symptom correlates and factor structure of the Health Professions Stress Inventory.

Generalizability, psychological symptom correlates, and the factor structure of the Health Professions Stress Inventory were assessed with a sample of 92 geriatric nurses. The inventory was designed to measure the sources and frequency of stress among nurses, physicians, and pharmacists; little is known, however, of the extent to which scores correlate with psychological symptoms or of the underlying dimensions of stress measured. Analyses showed high correspondence between responses of the geriatric nurses and the normative nurses as measured by mean values and Cronbach alpha. Factor analysis of the intercorrelations among items yielded 4 factors contributing to work-related stress, i.e., Lack of Perceived Enrichment Potential, Patient Care, Interpersonal Conflict, and Family Responsibility Conflict. Scores on the inventory correlated significantly with those of all SCL-90--R scales.

Work-related stress in American trial judges.

This study examines work-related stress among American trial judges using a relational model of stress, which emphasizes an individual's appraisals in a person-situation relationship. A representative sample of 88 judges completed three questionnaires addressing type and magnitude of specific work-related stressors, psychological stress symptoms, and psychosocial moderators of stress. Factor analysis revealed five types of stressors: case, litigating party, purposes and consequences of decisions, conflicts between professional and personal values, and seriousness of a criminal offense. The most stressful aspects of work relate to poorly prepared or disrespectful counsel, exercising judicial management and discretion, and highly emotional cases under public scrutiny. Correlational analyses show that stress is associated with cognitive, emotional, and behavioral symptoms, including a possible adverse impact on decision-making capacity. Results are discussed in terms of the relational model of stress.

The effect of tamoxifen on cervical squamous maturation in Papanicolaou stained cervical smears of post-menopausal women.

Using cervical smears obtained as part of routine gynaecological examinations, a retrospective study of the effects of the drug tamoxifen on squamous epithelial maturation of the cervix of post-menopausal women being treated for advanced breast cancer was made. The degree of squamous epithelial maturation was quantitated by using the Maturation Index and the Maturation Value. Although tamoxifen is a synthetic, non-steroidal compound classified as anti-oestrogenic, the findings indicate that this drug commonly produces a level of squamous maturation indicative of oestrogenic stimulation in Papanicolaou stained cervical smears from post-menopausal patients receiving this drug. Knowledge of the oestrogenic effect of tamoxifen in the cervix can obviate clinical concern about endometrial carcinoma.

An improved method of cell recovery following bronchial brushing.

Cytologic examination of bronchial brush specimens is effective in diagnosing bronchogenic carcinoma. A major problem is loss of cells and cellular detail associated with the direct smear technique (DST). A more recent method, the Saccomanno brush wash (SBW), uses a narrow-mouthed vial to scrape cells off the brush directly into fixative. We sampled 12 directly visualized airway tumors using standard brush technique. The same brush was then agitated in a SBW vial, which was centrifuged, the cell pellet being smeared over a predetermined area of a slide. Designated areas of each slide were counted and total malignant cells per slide extrapolated. DST slides had significantly fewer cells than SBW slides, and cellular detail was better with SBW in seven cases, DST in one case, and equal in four cases. SBW appears preferable for handling of bronchial brush specimens.