Treatment of patients with chronic somatic symptoms by means of art psychotherapy: a process description.

BACKGROUND: Inability to express emotions is common in patients with long-lasting somatic symptoms associated with incapacitation and impaired quality of life. One method for treating this inability is art psychotherapy. In this study the typical course in such treatments is described. Patients were followed longitudinally before therapy and every 4th to 6th month during the treatment. METHODS: Patients with long-lasting psychosomatic conditions resulting in partial or total loss of working capacity for at least 1 year have been treated in the programme. All of them had chronic pain. The majority of the patients that were referred to us were offered treatment. Three-fourths of those who started treatment stayed in treatment as long as the therapist considered it optimal. Twenty-four patients (22 women and 2 men) in the present study had their treatment started on average 2 years (range 13-42 months) before the end of the treatment period. In addition these 24 patients were contacted 6-48 months after the end of the therapy (average 23 months) and a short post-evaluation was made by telephone. RESULTS: The first year of treatment was characterized by emotional turmoil paralleled by increased energy level reflected in temporary elevation of serum uric acid. Significant improvement was observed with regard to anxiety-depression after one year of treatment. A tendency towards decreased levels of psychosomatic symptoms in general was observed after two years of treatment. One-fourth of the 20 non-working or part-time working patients increased their working activity. CONCLUSIONS: A slow partial recovery was observed. Art psychotherapy may have contributed to this.

'Person under train' incidents from the subway driver's point of view--a prospective 1-year follow-up study: the design, and medical and psychiatric data.

UNLABELLED: From the subway driver's point of view, a 'person under train' (PUT) incident is a serious life event. This study focuses on the 1-yr consequences of such events. Follow-up was made 3 wk, 3 months and 1 yr after the event. 40 consecutive PUT subway drivers were followed. For each PUT driver, a control driver matched with regard to gender, age and country of birth was followed at identical intervals. MAIN RESULTS: the PUT group had significantly more sick days during the interval from the event to 3 wk later. During the period 3 wk to 3 months after the event no difference between the groups was observed. From 3 months to 1 yr after the PUT significantly more days were again reported by the PUT group. 38% in the PUT groups vs 14% in the control group had at least 1 month of sickness absence during this period. A mild acute psychophysiological reaction was observed 3 wk after the event, with elevated prolactin and increased sleep disturbance in the PUT group. Such acute reactions were transitory and not correlated with long-term sick leave, which was predicted independently, however, by a high plasma cortisol level (analysed in men) and a high depression score. Drivers in the group with seriously injured victims were absent from work for longer periods than drivers in the groups with mildly injured or dead victims. PUT victims described a successively worsened psychosocial work situation during the 12 months of follow-up whereas the drivers in the control group described an unchanged situation.

The psychological and social condition of hypertensives resistant to pharmacological treatment.

To characterize patients with therapy-resistant essential hypertension (TR) from a psychosocial point of view, 29 hypertensives, filling specified criteria for TR in a hypertension clinic were selected out of 800 patients screened. A control group of patients with established, but well controlled hypertension, pair-wise matching study patients for age and gender was also selected. TR patients were predominantly of working-class origin (68 vs 19% P less than 0.001). They tended to be more obese (BMI 28.7 +/- 5.5 vs 26.9 +/- 3.9 ns). TR tended to report fewer important life events, and reported significantly fewer positive events from the last 10 year period P less than 0.05. According to the EAI, their ability to channel emotions, especially anger, was impaired (P less than 0.01). So was their instrumental handling of emotions such as anger and sorrow (P less than 0.05). They experienced less of joy, and even had a more negative attitude towards that emotion (P less than 0.05). When adjusted for social class this latter difference was not statistically significant. Their degree of global emotional differentiation was lower (P less than 0.05). In the ISSI interview they had low scores for availability of emotional attachment (P less than 0.01), and friendship (P less than 0.05), but not for social integration. To conclude, when compared to well controlled hypertensives, TR exhibited the pattern, which has been shown to characterize young, asymptomatic, hypertensives in comparison to healthy subjects. These results must not be overinterpreted due to the limited sample.(ABSTRACT TRUNCATED AT 250 WORDS)

"Person under train" incidents: medical consequences for subway drivers.

UNLABELLED: From the subway driver's point of view, a "person under train" (PUT) incident is a serious life event. This study focuses on the 1-year consequences of such events. Follow-up was made 3 weeks, 3 months, and 1 year after the event. Forty consecutive PUT subway drivers were followed. For each PUT driver, a control driver matched with regard to gender, age, and country of birth was followed at identical intervals. MAIN RESULTS: The PUT group had significantly more sick days during the interval from the event to 3 weeks later. During the period 3 weeks to 3 months after the event no difference between the groups was observed. From 3 months to 1 year after the PUT significantly more days were again reported by the PUT group. Thirty-eight percent in the PUT group versus 14% in the control group had at least 1 month of sickness absence during this period. A mild acute psychophysiological reaction was observed 3 weeks after the event, with elevated prolactin and increased sleep disturbance in the PUT group. Such acute reactions were transitory and not correlated with long-term sick leave, which was predicted independently, however, by a high plasma cortisol level (analyzed in men) and a high depression score. Drivers in the group with seriously injured victims were absent from work for longer periods than drivers in the groups with mildly injured or dead victims.