Effect of feedback signal and psychological characteristics on blood pressure self-manipulation capability.

Blood pressure presentation mode and personality are likely to influence biofeedback outcome. Thirty-six normotensive subjects were randomly assigned to visual or auditory continuous systolic feedback. "Distracting speech" and "broad band noise" were also superimposed and the effect on the biofeedback response was investigated. Psychological influence was also investigated. Systolic pressure reduction of 4 +/- 4.3 mmHg (visual, p = .04) and 5 +/- 5.5 mmHg (visual + auditory, p = .03) were achieved compared with auditory feedback (2 +/- 4.7 mmHg), which was less effective. The addition of noise or speech had no effect on the systolic response, but speech adversely affected diastolic reduction (p = .04). Mood (p = .003) was associated with systolic lowering, whereas increased trait anxiety (p = .06) and expectation (p = .03) had trends for opposite effects. Increased anger-hostility, state-anxiety, and expectation (p = .06) had links with systolic raising capability. We conclude that feedback modality and psychological characteristics have implications for studies investigating blood pressure manipulation capability.

Life event stress and myocardial reinfarction: a prospective study.

Earlier studies of life event stress in coronary heart disease (CHD) have been flawed by cross-sectional design and inadequate methods for assessing life-event stress. This 3-year prospective study of acute myocardial infarct (AMI) patients reveals significant independent associations between acute and chronic stressors at first admission, and risk of recurrent AMI and death, occurring in the 3 years of follow-up. Relative risks of reinfarction (or death from reinfarction) in the entire sample, for acute events and chronic difficulties were, 2.5 and 2.3 respectively and were statistically significant. When subjects admitted with first AMI were considered alone, relative risks were 3.1 and 4.1 respectively. The clinical significance of these findings is discussed.

Suppression of anger and gastric emptying in patients with functional dyspepsia.

Psychologic distress and gastric motor dysfunction have both been implicated in the pathogenesis of functional (non-ulcer) dyspepsia (FD). This study assesses the association between psychologic factors and gastric emptying in 28 FD patients. Subjects completed an extensive range of psychologic questionnaires and underwent dual-isotope scintigraphic assessment of solid and liquid gastric emptying. Attempts to resist, control, suppress, and hold in anger, to adopt a fighting spirit whilst dealing with chronic stressors, and manifest unhappiness were predictors of prolonged gastric emptying. These findings suggest that psychologic factors may be important in the aetiology of gastric stasis and subsequent upper gastrointestinal symptoms in patients with functional dyspepsia.

Effects of acute psychologic stress on small-intestinal motility in health and the irritable bowel syndrome.

Psychologic stress may be a provoking factor in the alterations in phase-2 motor activity of the migrating motor complex (MMC) which have been recorded in patients with the irritable bowel syndrome (IBS). To test this, changes in phase-2 duodenojejunal motor activity during 20 min of psychologic stress in 10 patients with IBS were compared with those shown by 10 healthy subjects. Autonomic arousal in response to the stressor was assessed by cardiovascular responses and self-reported levels of anxiety and tension. IBS and controls showed a significant cardiovascular and subjective response to stress which was comparable in the two groups. In general, duodenal phase-2 motor activity was suppressed during stress in both IBS and controls. Jejunal motor activity showed a similar inhibitory response in both groups, but the change in motility index was significant for controls only. Qualitatively, stress did not cause clustered contractions in either the IBS or the control group. However, in IBS patients with clustered contractions in the basal period there was inhibition of this pattern during stress. These findings suggest that acute psychologic stress profoundly suppresses, rather than enhances, duodenojejunal MMC phase-2 motility in healthy subjects. IBS patients, irrespective of their underlying phase-2 motor pattern show similar, although less marked, changes in motility.

Life stress and non-ulcer dyspepsia: a case-control study.

Sixty-two patients with persistent NUD symptoms were compared with healthy persons of comparable age, sex and social status on a variety of life stress, personality, mood state and coping measures. Highly threatening chronic difficulties were significantly more evident in the NUD group than controls (98 and 2% respectively), as were acute life events which remained highly threatening one week after their onset. Other psychological variables significantly related to NUD were high levels of anxiety and depressive symptoms, personality traits indicating neurotic or anxious tendencies, a tendency to use less mature stress-coping mechanisms and to have less high-quality emotional support. Multivariate analysis revealed the presence of highly threatening stressors to be by far the most important predictor of NUD status. The implications of these findings in relation to the significance of stress and other psychological variables in the aetiology and treatment of NUD are discussed.

Rectal bleeding. Patient delay in presentation.

Patient delay in presentation of rectal bleeding has been identified as a factor in delayed diagnosis among patients with colorectal cancer. The aim of this study was to identify demographic or psychological factors, or beliefs or behaviors related to delay in presentation of rectal bleeding. In 93 patients presenting with this symptom to their general practitioner, delay ranged from 0 to 249 days with a median of 7 days; 27 (29 percent) delayed more than 14 days. Delay was unrelated to age, sex, ethnic origin, competence in English, length of schooling, social status, availability of social support, measured psychologic traits, and to the belief that the cause might be cancer. The proportions delaying more than 14 days were statistically significantly elevated among those who were not worried by the bleeding (47 percent delayed); those who did not regularly look at their feces or the toilet paper after use (37 percent); and those who took some other action before presenting to their general practitioner (43 percent).

Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease.

Patients with dyspepsia of unknown origin (DUO) and those with similar upper abdominal symptoms but with an organic cause (peptic ulcer) were assessed on personality and psychological symptom measures. The DUO patients had significantly more symptoms of anxiety and tension and higher scores for trait tension and hostility than the organic group. The two groups did not differ significantly in terms of depressive symptoms, neuroticism, psychoticism, or suppression of negative affects. The implications of these findings for the aetiology and diagnosis of DUO are discussed.

Coronary artery bypass surgery--impact upon the patient's spouse.

The spouses of 65 coronary artery bypass graft surgery (CAGS) patients were assessed to determine levels of psychological symptoms and social impairment both before and 12 months after surgery. There was substantial psychological morbidity in spouses pre-operatively, with from one-third to one-half having clinically significant levels of depression and/or anxiety symptoms. Pre-operatively there was also significant global psychosocial impairment in the spouse. Of the specific domains of psychosocial adjustment, recreational and psychological adjustment was most severely affected, vocational/domestic adjustment and sexual adjustment being less impaired, and extended family relationships showing minimal impairment. There was significant improvement in spouses' psychological and global psychosocial adjustment at 12 months, with recreational adjustment showing the greatest improvement. Significant improvements also occurred in vocational adjustment but not in domestic or sexual adjustment. Neither physical, psychological nor social adjustment variables preoperatively in either the patient or spouse were predictive of psychological morbidity in the spouse (anxiety or depression) at 12 months. Similarly there were no significant patient or spouse preoperative predictors of social adjustment in the spouse at 12 months. However, the patients post-operative psychological morbidity and the spouses social and psychological morbidity were related.

A prospective evaluation of the psychosocial effects of coronary artery bypass surgery.

Eighty-nine patients were prospectively studied to determine psychological and psychosocial impairment prior to and after coronary artery graft surgery (CAGS). Psychological morbidity prior to surgery was high, with one-third having clinically significant levels of depression and/or anxiety symptoms. Scores on the Psychosocial Adjustment to Illness Scale indicated a generally high level of psychosocial impairment pre-operatively, with vocational and domestic functioning being most severely affected, social and sexual functioning being less impaired, and extended family relationships being largely unaffected. In general, there was a significant reduction in psychological morbidity and an improvement in psychosocial functioning at 6 months, which remained at 12 months. Vocational and domestic functioning showed the greatest improvement. Sexual and social functioning showed modest improvements overall, with significant numbers reporting residual impairment due to their heart disease. These findings add to a growing body of evidence demonstrating generally favourable psychological and social outcome following CAGS.

Psychological dysfunction in psychiatric and general nurse trainees.

The often held belief that psychiatric professionals are more psychologically disturbed than similar non-psychiatric professionals was not supported by the present study. Indeed in a comparison of two groups of nurse trainees, general nurse trainees showed a small but significantly greater degree of psychopathology than psychiatric nurses. When confounding variables and social desirability response set was taken into account, general nurse trainees had significantly higher scores on neuroticism, trait and state anxiety and depression. The groups did not differ on psychoticism (antisocial traits), extraversion, hypochondriasis or, work or social impairment. In terms of use of illicit drugs, the psychiatric nurses used only more cannabis than general nurses which was accounted for by females alone.

Acute and chronic life event stress in coronary atherosclerosis.

The relation between acute and chronic life events stress and atherosclerosis was assessed in 491 patients having coronary angiography for presumed coronary heart disease. There was no evidence that recent acute stressful events or chronic difficulties in adult life were independently related to coronary artery atherosclerosis once potentially confounding variables such as sex were controlled.

Type A behaviour and coronary atherosclerosis.

The relation of the Type A behaviour pattern to coronary atherosclerosis was assessed in a sample of 519 coronary angiography patients. Type A measures were the Structured Interview and the Framingham questionnaire. Angiographic indices included a composite coronary occlusion index and number of coronary vessels significantly diseased. Univariate analysis involving the entire sample showed no significant relation between Type A and severity of coronary vessel disease. Analyses for two subsamples, namely males currently employed in white collar occupations and persons found to have significant disease at angiography, also failed to indicate a relationship between Type A and coronary disease. Multivariate analysis revealed sex, cholesterol and age to be risk factors for atherosclerosis; Type A behaviour was not. The implications of these findings are discussed.

Anger and other psychological factors in coronary atherosclerosis.

This study of 519 coronary angiography patients failed to replicate our earlier findings in 90 angiography patients (Tennant & Langeluddecke, 1985) which showed that trait tension, trait anxiety and suppression of anger were correlates of atherosclerosis. In the present study a variety of psychological measures, including state and trait anxiety, tension, anger, locus of control and suppression of anger, depression and anxiety, showed no significant association with coronary atherosclerosis as assessed by coronary angiography.

Type A behaviour and other psychological factors in peptic ulcer disease.

A variety of personality traits and psychological symptom states have been reported to be associated with peptic ulcer disease. In the present study, male patients with confirmed duodenal or gastric ulcer(s) are compared with patient and non-patient control groups in terms of Type A behaviour, the Eysenck personality dimensions, hostility, state and trait anxiety, and depression. By comparison with cardiac patients, the peptic ulcer groups obtained lower Type A scores but were similar on the other variables. By comparison with age and sex matched community controls. GU patients obtained higher trait anxiety and psychoticism scores while the DU group had higher state anxiety levels. The implications of these findings in terms of the role of psychological factors in the aetiology of peptic ulcer disease are discussed.

Changing coronary heart disease risk-factor status: the effects of three behavioral programs.

Seventy-five persons (57 male and 18 female) with a high risk of coronary heart disease (CHD) were randomly assigned in equal numbers to three 8-week behavioral treatment programs. All three treatments were designed to alter simultaneously a number of risk-elevating behavior patterns, in the expectation that change in any one behavior pattern would reinforce change in others. Weight, blood pressure, and aerobic fitness were regularly assessed in all subjects. Serum lipids were also measured, but less frequently. All three interventions produced significant beneficial changes in the major objective measures, and the changes were well maintained after 12 months. The most improved group exhibited the following mean changes: weight loss of 9.2 kg, reductions in blood pressure of 12.9/8.8 mm Hg, improvement in aerobic capacity of 33%, reduction in serum cholesterol of 0.45 mmol/liter, and reduction in current overall CHD risk of 41%. The effectiveness of the interventions was positively related to the degree to which the programs emphasized training in, and detailed application of, behavioral change principles.

Psychological and physical morbidity in the aftermath of a cyclone.

A Fijian community affected by a cyclone was compared with an unaffected but similar community. Two months after the cyclone both psychological and physical morbidity was 2-3 times greater in the affected community than in controls. By the third month morbidity had resolved to levels similar to those in the unaffected population. Brief, catastrophic stress without loss of life appears to provoke psychological and physical morbidity of relatively brief duration.

Threatening life events in the onset of schizophrenia, schizophreniform psychosis and hypomania.

In a study of cases of recent onset of schizophrenia, schizophreniform psychosis and hypomania (DSM-III criteria), threatening life events were significantly related to the onset of schizophreniform psychosis but not schizophrenia. The results also suggest that threatening events may precipitate hypomanic episodes.

Psychological correlates of the type A behaviour pattern in coronary angiography patients.

The convergent validity of two popular self-report Type A questionnaires (the Jenkins Activity Survey and Framingham Scale), and their association with personality traits related to Type A, affective states and traits, and history of nervous illness, were assessed in a sample of 92 coronary angiography patients. The correlation between the two Type A measures, although significant, was modest. Both Type A measures had strong associations with standard personality traits (neuroticism and trait tension). The Framingham Scale was strongly correlated with distressing psychological states (tension, anxiety and depression) while the JAS showed a lesser association with these measures. The implications of these findings in terms of the convergent validity of the two Type A measures, and the independence of the Type A concept from other personality and emotional variables, are discussed.

Psychological correlates of gastric and duodenal ulcer disease.

Psychological correlates of gastric and duodenal ulcer disease were assessed in a group of somewhat older patients with ulcer disease identified by endoscopy. Associations between both ulcer types and symptom measures (anxiety and depression) seemed only to reflect severity or chronicity of gastrointestinal symptoms or the impending endoscopy procedure. Associations with 'trait' psychological indices may be of causal significance. Duodenal ulcer patients had higher 'introversion' and 'psychoticism' scores (on the EPQ) than controls, while gastric ulcer patients had higher psychoticism scores and 'trait anxiety' scores. These findings could not be attributed to confounding variables. When the two ulcer groups were compared, the gastric ulcer group had significantly higher neuroticism, psychoticism and hostility scores which were not attributable to confounding variables. The higher depression scores in gastric ulcer patients, however, simply reflected the greater chronicity of their physical symptoms. The groups did not differ significantly on measures of trait anxiety, tension, introversion or Type A behaviour.