Psychological factors in cosmetic plastic surgery: recent developments in patient care.

The goal of cosmetic surgery is to facilitate improvement in the patient's psychological functioning primarily by modifying the patient's body image. This article updates the professional literature on recent developments in the study of the psychology of cosmetic plastic surgery.

Social and psychological effects of major craniofacial deformity.

This paper discusses the social and psychological experiences of patients with the most severe forms of craniofacial deformity. The paper concludes that individuals with the most severe forms of craniofacial deformities are at risk for experiencing social and psychological stress and for having their quality of life negatively impacted by the experience of having a facial deformity. Much of the stress experienced by these individuals is the result of the negative social response to their facial deformity. It is emphasized that many patients will not develop psychopathology, because of intervening personality and family factors that may ameliorate these negative social stressors. The excellent progress made in assessing, preventing, and treating the negative psychosocial impact of facial deformity is noted. Finally, in attempting to understand the impact of facial deformity on quality of life, emphasis is placed on the subjective evaluation of these factors by each individual patient and family.

Psychometric assessment of psychologic factors influencing adult burn rehabilitation.

This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patient's treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. The hope is that the early and accurate identification of those patients who are in need of psychosocial services can lead to the implementation of services that will ameliorate psychosocial problems and facilitate total patient rehabilitation. Although many excellent measures exist, the most important assessment tool for the screening of psychosocial problems in patients with burns, which has emerged from this review, is the Psychological Adjustment to Illness Scale (PAIS). The PAIS integrates many of the relevant characteristics of psychologic screening and provides normative values that are specific to patients with burns. Ideally, this scale should be supplemented by an assessment of post-traumatic stress disorder, substance abuse, and personality and coping styles, because these critical factors are not adequately covered by the PAIS. Finally, the Burn Specific Health Scale shows promise for the assessment of health status and quality of life in patients with burns. Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patient's total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.

Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients.

This paper reviews the senior author's long-term experience with the surgical-psychiatric treatment of 100 aesthetic surgery patients with significant psychological disturbances. Patients with psychological disturbances of a magnitude generally considered an "absolute contraindication" for surgery were operated on and later assessed to determine the psychological impact of surgery. Patient follow-up averaged 6.2 years (maximum follow-up 25.7 years). Of the 87 patients who underwent operation (7 patients were refused surgery and 6 voluntarily deferred surgery), 82.8 percent had a positive psychological outcome, 13.8 percent experienced "minimal" improvement from surgery, and 3.4 percent were negatively affected by surgery. There were no lawsuits, suicides, or psychotic decompensations. Patients with severe psychological disturbances frequently benefited from combined surgical-psychiatric treatment designed to address the patient's profound sense of deformity. This study suggests that plastic surgeons are "passing up" a significant number of patients who may be helped by combined surgical-psychological intervention.

Special considerations in the management of a patient with multiple sclerosis and a burn injury.

The purposes of this report were to describe a successful treatment of a burn injury in a patient with multiple sclerosis as well as to outline specific aspects of therapy that contributed to minimizing the risk of complications in this challenging patient. Multiple sclerosis is the leading cause of neurologic morbidity and death among young adults. It is an inflammatory disease of the central nervous system that involves the autonomic and somatic components and is characterized by a primary destruction of myelin. The demyelinated nerves exhibit an increased temperature sensitivity that accounts for the adverse effects of elevated core temperature on the neurologic signs and symptoms of this disease. Because burn injury, infection, and vigorous exercise elicit an elevation of core temperature with an accompanying deterioration in neurologic function, lowering the elevated core body temperature is mandatory. The dysautonomias of multiple sclerosis may be as devastating as their somatic counterparts and may have life-threatening implications. In recent years, advances in our understanding of the pathophysiology of central nervous system dysfunction have enabled physicians to improve dramatically the management of symptoms in multiple sclerosis without significantly altering the progressive long-term course of the disease.

Patients seeking symmetrical recontouring for "perceived" deformities in the width of the face and skull.

This article describes plastic surgery patients who sought symmetrical recontouring of the width of the face and skull. The basic demographic and personality characteristics of these facial width deformity (FWD) patients and the surgical procedures performed on them are discussed. Details of the surgical and psychological management of three representative cases are given. Speculative conclusions regarding the general characteristics of the FWD population are offered. Suggestions are proposed for a combined surgical-medical psychotherapeutic collaboration in managing these patients.

Cognitive and personality characteristics of worriers.

Worriers and nonworriers from a college population were compared on the Imaginal Processing Inventory, the Self-Consciousness scale, and the Sandler-Hazari Obsessionality Inventory. Subjects from both groups also engaged in either brief relaxing or stressful imagery. Before the imagery task, measures of cognitive activity were obtained from periods of relaxed wakefulness, focused attention and anagram performance. After the imagery task, focused attention and anagrams measures were repeated. Worriers reported a more negative daydreaming style, greater difficulty with attentional control, and greater obsessional symptoms, public self-consciousness and social anxiety. On thought sampling measures obtained during relaxed wakefulness periods and rated by objective judges, and on self-report measures obtained during the focused attention task, worriers evidenced significantly more negatively affect-laden cognitive intrusions. No differences were found on anagram performance, and imagery condition did not influence any measure, suggesting that instructed fear images are insufficient to initiate worrisome episodes.

The syndrome of psychosis, intermittent hyponatremia, and polydipsia: evidence for diurnal volume expansion.

Seven patients (6 men and 1 woman, mean age 39.1 +/- SD 6.9 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent serial determinations of serum sodium (SOD), plasma atrial natriuretic peptide (ANP), and urinary osmolality (UOSM) at 7 AM and 4 PM. There was a diurnal increase in ANP (7 AM 17.9 +/- 5.1 pg/ml and 4 PM 27.7 +/- 9.0 pg/ml, p = 0.02), a diurnal decrease in serum sodium (7 AM 141.1 +/- 1.7 mEq/l, 4 PM 129.9 +/- 3.2 mEq/l, p less than 0.0001) and no diurnal change in UOSM. The diurnal increase in ANP in the the PIP syndrome contrasts to the diurnal decrease in ANP reported in normal subjects. Our data, while preliminary, suggest that patients with the PIP syndrome have increased intravascular volume leading to ANP secretion, natriuresis, and hyponatremia.

Diurnal weight gain as a predictor of serum sodium concentration in patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Ten male patients (mean age 37.3 +/- 6.4 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent measurement of weight, sitting and standing blood pressure, and serum sodium concentration at 7 a.m. and 4 p.m. weekly for 8 consecutive weeks. Blood pressure was higher in the afternoon than in the morning. The diurnal decrease in serum sodium (141.4 +/- 2.8 to 134.2 +/- 4.8 mEq/l) was associated with a diurnal increase in weight (78.4 +/- 9.7 to 80.0 +/- 10.3 kg). When the weight increase was normalized by dividing by 7 a.m. weight (NDWG), the following relationship evolved: diurnal serum sodium decrease = 3.060 + [201.728 x NDWG]. Therefore, NDWG accounted for 63.1% of the variability of serum sodium. Using the known relationship of plasma water, total body water, and total body weight, we calculated that antidiuresis (afternoon weight gain) accounted for 62.5% of afternoon hyponatremia. Thus, two separate methods of calculating the relationship between antidiuresis and hyponatremia provided remarkably similar findings. We derived a table to predict 4 p.m. serum sodium values based on 7 a.m. weight, 7 a.m. serum sodium, and 4 p.m. weight.

Similarity of patterns of urine excretion among nonpolyuric and polyuric patients with thought disorders.

From a study population of 29 institutionalized chronically psychotic patients, 70% of whom had schizophrenic or schizoaffective disorders, nonpolyuric and polyuric patients had similar diurnal patterns of urine excretion. Patients excreted a larger portion of daily urine volume after noon (55%) than before noon (45%).

Assessing child-rearing behaviors: a comparison of ratings made by mother, father, child, and sibling on the CRPBI.

This study of the reliability and validity of scales from the Child's Report of Parental Behavior (CRPBI) presents data on the utility of aggregating the ratings of multiple observers. Subjects were 680 individuals from 170 families. The participants in each family were a college freshman student, the mother, the father, and 1 sibling. The results revealed moderate internal consistency (M = .71) for all rater types on the 18 subscales of the CRPBI, but low interrater agreement (M = .30). The same factor structure was observed across the 4 rater types; however, aggregation within raters across salient scales to form estimated factor scores did not improve rater convergence appreciably (M = .36). Aggregation of factor scores across 2 raters yields much higher convergence (M = .51), and the 4-rater aggregates yielded impressive generalizability coefficients (M = .69). These and other analyses suggested that the responses of each family member contained a small proportion of true variance and a substantial proportion of factor-specific systematic error. The latter can be greatly reduced by aggregating scores across multiple raters.