Wanting to work: managing the sick role in high-stake sickness insurance meetings.

This article respecifies and develops Parsons's sick role theory, focusing on the postulate that the sick person must 'want' to get well. Using conversation analysis and discursive psychology to study how the psychological term 'want' is used in high-stake, multi-professional meetings with sickness benefit claimants in Sweden, the article shows how establishing that one 'wants' to get well requires extensive interactional work. In the examined meetings, the sick person's 'want' formulations make explicit the relationship between 'wants' and illness or inabilities, thus allowing for motivational character to be established without committing to its implications, and without appearing strategic or biased. By contrast, professional parties in the meetings invoke the sick person's 'wants' either to hold them accountable, or for establishing a desired course of recovery, confirming the centrality of such 'wants' in this setting as well as the risks associated with expressing them. The article suggests that analysing psychological matters as they are oriented to by participants renders sick role theory relevant for a wide range of settings and respecifies criticism of the model.

Diagnostic criteria for psychosomatic research and somatic symptom disorders.

The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.

Actitudes de las mujeres diagnosticadas de cáncer de mama frente a la toma de decisiones compartida / Shared decision making in breast cancer. Womens' attitudes

Fundamentos: La mayor autonomía y el protagonismo de las mujeres con cáncer de mama en las decisiones sobre su salud son aspectos recientes en su asistencia sanitaria. El objetivo del trabajo es identificar y caracterizar los elementos que influyen en la toma de decisiones terapéuticas de las mujeres. Métodos: Metodología cualitativa de tipo fenomenológico. Muestreo teórico intencionado que incluyó a 70 mujeres diagnosticadas de cáncer de mama. Se realizaron 45 entrevistas y 3 grupos focales entre octubre de 2009 y julio de 2010 en 15 Comunidades Autónomas españolas. Análisis basado en los principios de la grounded theory con el apoyo del programa Atlas.ti v6.1. Resultados: Las pacientes se muestran proclives a tomar un papel activo o pasivo en la toma de decisiones dependiendo de la edad, la información disponible, su autovaloración como agente capaz de decidir y la importancia relativa al aspecto estético.Amedida que avanza la enfermedad se puede producir un cambio en la posición de las mujeres, desde una postura inicial pasiva a una posición más activa. La actitud de los profesionales sanitarios frente a la toma de decisiones compartida y la información que ofrecen influye en la participación de las pacientes mientras que la familia juega un papel fundamental como apoyo o refuerzo en sus decisiones. Conclusiones: La postura ante la toma de decisiones de las mujeres con cáncer de mama es muy variable, cobrando especial importancia la situación emocional, nivel de información disponible y la influencia del entorno(AU)

Background: The patient autonomy and the greater role for women with breast cancer in the decisions about their health are recent issues in healthcare. The objective of this work is to identify and characterize the elements that influence them in treatment decisions. Methods: A phenomenological type qualitative study. Theoretical Sampling included 70 women diagnosed with breast cancer. 45 semi structured interviews and 3 focus groups were performed between October 2009 and July 2010 in 15 regions of Spain. The analysis was based on the principles of grounded theory with the support ofAtlas.ti v6.1. Results: Patients are likely to take an active or passive role regarding decision-making depending on different variables such as their age, the information available, their self-assessment as capable agents to make decisions and the relative importance given to physical appearance. As the disease progresses, it can cause a change in women attitude, from an initially passive attitude to a more active role. The attitude of health professionals concerning shared decision-making and the information they offer determines patient participation while the family plays an essential role as a support or reinforcement of decisions made by patients. Conclusions: The patients’ attitude regarding the decision-making of patients is very variable, becoming increasingly important the emotional status, the level of information available and the influence of the context(AU)

Bounded autonomy in deciding to seek medical help: carer role, the sick role and the case of dementia.

Social psychological theories of illness and health decision making place the individual with the symptoms at the centre. In the case of dementia it is often a relative who is first to contact health care professionals. The article illustrates how the autonomy of both the individual with symptoms and their carers is bounded by the actions of others. An over arching theme of 'bounded autonomy in decision making', and four subthemes emerged. Bounded autonomy is where a person's actions are constrained or contested by another person. There are implications for interventions to bring forward the point at which diagnosis occurs.

Estudio cualitativo sobre la autopercepción del estigma social en personas con esquizofrenia / Qualitative study about the self perception of social stigma in people with schizophrenia

Introducción y objetivos: Pocos son los estudios que evaluan la autopercepción del estigma social en las personas que padecen esquizofrenia. El objetivo del presente estudio consiste en analizar la percepción sobre la esquizofrenia que tienen las personas que la padecen. Material y métodos: Se realizaron dos sesiones en cuatro grupos focales de personas con esquizofrenia que estaban siendo atendidas en servicios de rehabilitación psicosocial del Parc Sanitari de Sant Joan de Déu. A partir de un guión establecido se valoraron un total de 11 áreas abordadas en los grupos. Resultados: Las áreas de peligrosidad, culpa, pérdida de roles sociales y miedo al rechazo fueron aquellas que más mencionaron y más preocupaban a las personas que participaron en los grupos focales. Conclusión: Intervenciones para reducir el estigma social en la comunidad y en los propios usuarios/as deberían ser tenidas en cuenta, especialmente en estas área (AU)

Introduction and Objetives: Few studies evaluated the perception of social stigma in people with schizophrenia. The aim of this study was to analyze the perception of people who suffers schizophrenia. Material and methods: Two sessions in four focus groups of people with schizophrenia who were being treated in psychosocial rehabilitation services Sanitari Parc de Sant Joan de Déu were done. A total of 11 areas (guided by a screenplay) were assessed in the groups. Results: The areas of danger, guilt, lost of social roles and fear of rejection were those most concerned and most mencioned by the people who took part in focus groups. Conclusion: Interventions to reduce social stigma in the community and in the self- users should be taken into account, especially in these areas (AU)

Do patients with psychogenic nonepileptic seizures have positive covert attitudes toward sickness?

Some individuals with psychogenic nonepileptic seizures (PNES) are seen as having adopted a "sick role" that relinquishes them of responsibility for meeting stressful life demands. Thus, patients with PNES may have positive, albeit unrecognized, attitudes toward seizures, or perhaps illness in general. Because such covert attitudes may not be amendable to self-report, the current study used the Implicit Association Test (IAT), a methodology by which attitudes toward illness and disability can be inferred from performance on an ostensibly neutral task. Individuals with PNES did not have a reduced interference effect when responding to sickness-related and pleasant words on the same response key. Exploratory analyses revealed that a pronounced somatic focus and higher extraversion were associated with more neutral attitudes toward illness among patients with PNES. This IAT methodology found little support for the notion that patients with PNES harbor positive attitudes toward illness. Limitations of the IAT methodology are reviewed and recommendations are provided.

Parenting-related childhood learning history and panic vulnerability: a test using a laboratory-based biological challenge procedure.

A small but growing literature highlights specific parenting behaviors in increasing panic vulnerability among offspring. The current study examined the association between parenting-related instrumental and observational learning of sick-role behavior during childhood and reactivity to a panic-relevant biological challenge procedure that has evidenced predictive validity in terms of panic onset. Participants were 93 physically and psychologically healthy young adults (39 females; M(age)=23.41 years). As expected, results indicated that instrumental learning experiences involving (panic-relevant) arousal-reactive symptoms predicted increased post-challenge anxiety, arousal, and negative affective valence, even after accounting for variability associated with other theoretically relevant variables (e.g., anxiety sensitivity). Consistent with prior work, this learning history effect was specific to arousal-reactive, as opposed to arousal non-reactive, symptoms. Unexpectedly, observational learning was not related to challenge responding. Findings are discussed in terms of the potential role of parenting in etiologic models of panic development.

Insight, cognitive dysfunction and symptomatology in schizophrenia.

Lack of insight is frequent in schizophrenia and usually influences negatively both patient's treatment and prognosis. This study aimed to investigate the relationship between insight, symptomatology and cognitive dysfunctions in schizophrenia using the PANSS five-factor model (modified from Gaag et al. in Schizophr Res 85:280-287, 2006). Forty patients diagnosed with chronic schizophrenia (DSM-IV) were evaluated with the scale to assess unawareness of mental disorder (SUMD), the PANSS and a neuropsychological battery. Spearman correlation and linear regression analyses were performed to investigate the relationship between clinical, neurocognitive and insight measures. The SUMD current and past awareness of symptoms score showed a correlation with WCST indices (correct answers and non-persevering errors). The negative and disorganization factor of the PANSS showed a positive correlation with current and past awareness of symptoms. However, when submitted to a linear regression model only the disorganization factor emerged as significant contributor for insight. Considering that the core items of the "disorganization factor" of the PANSS are related to cognition (e.g., poor attention, difficult in abstract thinking), insight is associated cognitive symptoms although no direct relationship between insight and neuropsychological tests was observed.

¿Puede curar la palabra? / Can words cure?

La autora trata a través de estas páginas de exponer la evolución de su pensamiento en psicosomática, lo que muestra en su forma de entender al enfermo somático desde el trabajo analítico y la repercusión en la clínica de dicha evolución, mediante la presentación de dos momentos especiales de dos casos clínicos (AU)

Through this paper, the author endeavours to expose the evolution of her thought on psychosomatics, wich is shown in her way of understanding the somatic patients through analytic work and the clinical repercussions of said evolution, through the presentation of two special moments in two clinical cases (AU)

The relationship of preoperative distress to endocrine and subjective responses to surgery: support for Janis' theory.

To test Janis' theory that preoperative worry can improve postoperative recovery, endocrine and subjective responses were measured in 27 patients undergoing major abdominal surgery which entailed threat to their health or longevity. Questionnaires to assess emotional and somatic state were completed preoperatively and for 7 days postoperatively. Plasma cortisol, noradrenaline, adrenaline, and glucose were measured pre-, per-, and postoperatively. Preoperatively, noradrenaline correlated positively with pain and distress, and adrenaline negatively. Postoperatively, endocrine levels and distress were not clearly related. Nevertheless, preoperative pain negatively correlated with postoperative adrenaline and cortisol levels. This, and the negative correlation between preoperative distress and postoperative pain are consistent with Janis' theory. In addition, we found that the longer patients waited on the day of surgery, the greater were the cortisol, noradrenaline, and glucose responses.

Prevalence vs. incidence of the mandibular pain dysfunction syndrome: implications for epidemiological research.

Conclusions about the aetiology and maintenance of the Mandibular Pain Dysfunction Syndrome (MPDS) are largely based on clinic populations, but there are indications that sufferers who seek help about their symptoms are not typical of the general population of sufferers. This raises important problems in extrapolating findings from the patient population to the general one. This paper argues that future epidemiological studies should take the various influences on the decision to seek advice into account so that conclusions about MPDS can be reached. Specific additions to research designs are noted.