Familial context of genetic testing for cancer susceptibility: moderating effect of siblings' test results on psychological distress one to two weeks after BRCA1 mutation testing.
(1/113)
OBJECTIVES: To determine whether psychological distress differs among individuals tested for a BRCA1 mutation and is moderated by the pattern of their siblings' test results. MATERIALS AND METHODS: Participants in this study are members of a large kindred identified with a BRCA1 mutation. Subjects included 87 males and 125 females who completed a baseline interview, were tested for a BRCA1 gene mutation, received their results in person from a genetic counselor, completed a follow-up interview 1-2 weeks after the receipt of their test results, and had complete data on all variables used in the analysis. The main outcome of the study was psychological distress as measured by the Impact of Event Scale during the 1-2 week follow-up interview. Data were analyzed based on multiple regression. RESULTS: Male carriers, relative to noncarriers, experienced significantly more distress if they were the first tested than when all of their tested siblings were already known to be negative. Noncarrier males whose siblings all tested positive also encountered significant test-related distress. The largest adverse psychological consequences for female carriers, relative to noncarriers, were for those who were tested first and those whose tested siblings were noncarriers. CONCLUSIONS: The familial context in which genetic testing is conducted may be important for understanding how individuals react to their own test results. (+info)
Ethnographic interviews to elicit patients' reactions to an intelligent interactive telephone health behavior advisor system.
(2/113)
Information technology is being used to collect data directly from patients and to provide educational information to them. Concern over patient reactions to this use of information technology is especially important in light of the debate over whether computers dehumanize patients. This study reports reactions that patient users expressed in ethnographic interviews about using a computer-based telecommunications system. The interviews were conducted as part of a larger evaluation of Telephone-Linked Care (TLC)-HealthCall, an intelligent interactive telephone advisor, that advised individuals about how to improve their health through changes in diet or exercise. Interview findings suggest that people formed personal relationships with the TLC system. These relationships ranged from feeling guilty about their diet or exercise behavior to feeling love for the voice. The findings raise system design and user interface issues as well as research and ethical questions. (+info)
Psychological sequelae of elective abortion.
(3/113)
A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy. (+info)
Psychological therapies for post-traumatic stress disorder.
(4/113)
BACKGROUND: After exposure to traumatic stressors, a subgroup of survivors (20-30%) will develop post-traumatic stress disorder (PTSD). AIMS: Since the incidence and prevalence rates for PTSD in the community are significant, it is important that general practitioners and psychiatrists be familiar with possible therapeutic options. In this review we shall look at the published evidence about the effectiveness of psychological treatments for PTSD. METHOD: The psychopathological mechanisms involved in PTSD are discussed. Studies of the effectiveness of different psychological therapies are reviewed. RESULTS: The review suggests that persistent fear or shame reactions are key aspects of PTSD. Evidence from systematic reviews suggests that psychotherapeutic treatments are effective in the therapy of reactions based on fear, and may increase the effectiveness of pharmacological therapy. There is less systematic evidence for the efficacy of interventions for symptoms based on shame. CONCLUSIONS: Although a proportion of patients with complex or chronic PTSD may require specialist interventions, most patients can be treated effectively by a general psychiatric service which can offer both pharmacological and psychological interventions. (+info)
Letter: Wilful exposure to unwanted pregnancy.(5/113)
Putting suffering into perspective: implications of the patient's world view.
(6/113)
The need for suffering patients to reexamine their assumptions about life presents therapists with unique challenges and opportunities. Patients with a religious world view often struggle with whether God cares about, or has sent, their pain. Atheistic patients also search for the meaning in their lives but reject the answers offered by traditional authorities. Patients who are uncertain or ambivalent about their world view may challenge a therapist to provide an audience, insight, or direction. Using case examples, the author explores the therapist's role in helping patients with differing world views to integrate their suffering. (+info)
Quality of life and emotional responses in cadaver and living related renal transplant recipients.
(8/113)
BACKGROUND: The specific impact of transplantation on living related donor (LRD) and cadaver (CAD) kidney transplant recipients and their health-related quality of life (HQoL) has received little attention. This study examined the role of sociodemographic, medical and psychological factors in these two groups. METHODS: A total of 347 transplant recipients (76 LRD and 271 CAD patients) completed the Short Form 36 Health Survey and Transplant Effects Questionnaire. RESULTS: Overall, transplant patients showed satisfactory HQoL particularly with respect to emotional well being. HQoL levels were found to be equivalent in both transplant groups. ANCOVAs showed that LRD recipients expressed more guilt in relation to the donor (P<0.001). Multivariate analysis revealed that worry about the viability and functioning of the transplant alone predicted 15.1% of the variance in the SF-36 mental composite score (MCS) whereas age, income, comorbidities and time on dialysis explained 37.8% of the variance in the SF-36 physical composite score (PCS). Multiple regression analyses performed separately for LRD and CAD patients showed that predictors of MCS and PCS between the two groups were similar. CONCLUSIONS: Our results indicate that different forms of transplantation (LRD vs CAD) may lead to different emotional responses albeit with no apparent quality of life differences. In particular, feelings of guilt appear to be prominent in LRD transplantation. (+info)