David K. Wellisch

Psychosocial Aspects of Mastectomy: II. The Man's Perspective

In order to assess factors related to mens adjustment to mastectomy and its aftermath the authors administered a questionnaire to 31 men whose wives or partners had had mastectomies. Most men reported a good overall adjustment, but a subgroup remained distressed and reported adverse effects on their relationships with wives or lovers. The data indicate that the nodal points in the process are the involvement of partners in the decision-making process, the frequency of hospital visits, resumption of the sexual relationship, and the man looking at his partners body after surgery. These findings have implications for counseling couples who face this emotionally stressful procedure.

Psychosocial Correlates of Immediate versus Delayed Reconstruction of the Breast

Two groups of consecutive patients from two different plastic surgical practice populations were evaluated to determine psychosocial differences between those who underwent immediate (n = 25) versus delayed (n = 38) breast reconstruction. Psychological assessment consisted of a standardized symptom inventory (BSI) and a specially designed self-report questionnaire investigating reactions unique to mastectomy and reconstruction. Both groups were extremely equivalent with regard to sociodemo-graphic data, with the typical subject being a well-educated and employed Caucasian wife. Verbal reports of physical complaints revealed no significant differences between the two groups except for difficulty with arm movement, which was statistically higher for the immediate group (p = 0.006.). This difference most likely was due to the axillary dissection being performed simultaneously at the time of reconstruction. The relationship between timing of reconstruction and self-reported distress over the mastectomy experience revealed that only 25 percent of the women who underwent immediate repair reported “high distress” in recalling their mastectomy surgery compared with 60 percent of the delayed reconstruction group (p = 0.02). In reference to the two scales measuring psychological symptoms, a general trend was present, with the delayed group scoring higher (although not statistically significantly) on 9 of our 12 scales. Ninty-six percent of the immediate group and 89 percent of the delayed group reported satisfaction with results. These findings challenge previously held assumptions about the timing of breast reconstruction, including a sociodemographic stereotype for the women requesting immediate repair, a presumed benefit from “living with the deformity,” and a diminished level of satisfaction for those who elect immediate reconstruction.

Psychological Functioning of Daughters of Breast Cancer Patients: Part I: Daughters and Comparison Subjects

Sixty daughters of mothers with breast cancer were matched for age, educational level, and race with 60 comparison subjects without a maternal history of breast cancer to assess the impact on psychological adjustment, coping, body image, sexual functioning, and health knowledge and practices of having had a mother with breast cancer. Daughters of breast cancer patients showed significantly less frequent sexual intercourse, lower sexual satisfaction, and greater feelings of vulnerability to breast cancer, and they could identify a greater number of symptoms of breast cancer. No differences between groups were found in psychological symptoms, coping styles, breast self-examination practices, mammography practices, health knowledge, or body-image ratings. Contrary to clinical studies, women at risk for breast cancer showed good overall coping with few signs of significant dysfunctions in relation to comparison subjects.

Craving love? Enduring grief activates brain's reward center

Complicated Grief (CG) occurs when an individual experiences prolonged, unabated grief. The neural mechanisms distinguishing CG from Noncomplicated Grief (NCG) are unclear, but hypothesized mechanisms include both pain-related activity (related to the social pain of loss) and reward-related activity (related to attachment behavior). Bereaved women (11 CG, 12 NCG) participated in an event-related functional magnetic resonance imaging scan, during grief elicitation with idiographic stimuli. Analyses revealed that whereas both CG and NCG participants showed pain-related neural activity in response to reminders of the deceased, only those with CG showed reward-related activity in the nucleus accumbens (NA). This NA cluster was positively correlated with self-reported yearning, but not with time since death, participant age, or positive/negative affect. This study supports the hypothesis that attachment activates reward pathways. For those with CG, reminders of the deceased still activate neural reward activity, which may interfere with adapting to the loss in the present.

Impact of Breast Cancer on Asian American and Anglo American Women

This pilot study constitutes the first exploration ofthe impact of breast cancer on Asian American women.Three hypotheses guided this study: (1) Asian Americanwomen would choose breast conserving therapy andbreast reconstruction at a lower rate than the AngloAmerican women due to cultural differences in bodyimage, (2) Asian American women with breast cancerwould express psychological distress somatically andAnglo American women would express distress emotionally, and acculturation levels of the AsianAmerican women would modify the expressions ofdistress such that women with high acculturation willexpress distress more emotionally and lessacculturated women would express distress moresomatically, and (3) Asian American women would seekassistance for psychosocial problems at asignificantly lower rate than Anglo women. Ethnicity,age, and levels of acculturation were found to besignificant variables that had to be consideredsimultaneously. The three hypotheses were onlypartially supported: (1) Asian American women chosebreast conserving therapy and adjuvant therapy at asignificantly lower rate than the Anglo Americanwomen, (2) Contrary to the hypothesis, somatization didnot appear to be a dominant form of symptompresentation for Asian American women regardless oflevel of acculturation, and (3) Asian American womensought professional assistance for psychosocialproblems at a significantly lower rate than Anglowomen. Asian American women reported using differentmodes of help-seeking behavior for emotional concernsand receiving different sources of social support thanthe Anglo American women. Cultural interpretations ofthe findings are offered to explain the differences inthe physical, emotional, and social responses to thebreast cancer experience of Asian American womencompared with the Anglo Americans, and notably betweenthe Chinese- and Japanese Americans as well. Thefindings of this study warrant more refinedexploration in order to improve the medical,psychological and social outcomes for Asian Americanwomen with breast cancer.

An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients.

This paper investigated the nature of social support for Asian‐ and Anglo‐American women post breast cancer treatment. Forty‐six Anglo‐ and Asian‐American (13 Anglo‐American, 18 Chinese‐American and 15 Japanese‐American women) women were assessed 6 months to 3 years post‐treatment. Assessments consisted of a semi‐structured interview plus standardized psychological tests. Three major hypotheses were developed and tested in the study. Results showed: (1) Anglo‐American women indicated a greater need for social support than either of the two Asian‐American groups in 66% of the categories; (2) no differences were found between the three ethnic groups in receipt of emotional or tangible social support; and (3) the network size and composition differed significantly in 83% of the categories between the Anglo group and at least one of the Asian groups. These differences were in size, mode, and perceived adequacy of social support. Implications for culturally‐based clinical practice which emerge from these findings are discussed. Copyright

Psychosocial outcomes of breast cancer therapies: lumpectomy versus mastectomy.

The psychological status of 50 patients who had been treated for breast cancer was assessed an average of 21 months after treatment. The patients were grouped according to major treatment modalities: mastectomy with breast reconstruction, mastectomy without breast reconstruction, or lumpectomy. Lumpectomy patients had a significantly more intact body image (p less than .008) and a greater sense of sexual desirability (p less than .009) than patients in the other groups. The patients did not differ on frequency of sexual relations or on emotional symptomatology. The results of this study generally validate those found in comparable studies showing that lumpectomy promotes a more intact body image but that no surgical procedure either produces or inhibits psychological symptomatology.

Relationship of Dialysis Modality and Other Factors to Cognitive Function in Chronic Dialysis Patients

To determine if dialysis modality may be an independent factor in the level of cognitive function in chronic dialysis patients, cognitive function was studied in 17 pairs of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) subjects matched for sex, age, diabetic status, and interval since dialysis onset. Data on current metabolic, medical, psychological, and vocational function status were obtained. Neuropsychological (NP) measures included the Number Cancellation Protocol (NCP), Trailmaking test forms A and B (TMT A, TMT B), Symbol Digit Modalities (SDM), and the Rey Auditory Verbal Learning Test (RAVLT). The CAPD subject group had consistently more efficient cognitive function than the CHD subject group. Regardless of modality, the groups of subjects under age 51 and those who were vocationally active had significantly better NP performance. No cognitive function differences were found in groups categorized by sex or duration of dialysis. Creatinine levels were more highly correlated with NP scores than were BUN levels, with higher creatinine levels associated with better cognitive function. Serum calcium, CO2, total protein, albumin, and SGOT levels also were correlated with NP scores. CAPD may be more effective than HD in reversing uremic encephalopathy by mechanisms mostly unrelated to serum creatinine and BUN levels. Longitudinal studies will be needed to determine if dialysis modality is an independent factor in the degree of reversal of uremic encephalopathy.

Long-Term Effects of Testicular Cancer on Marital Relationships

Thirty-four long-term survivors of testicular cancer and their wives were interviewed individually almost four years past the end of treatment to measure psychological and relationship functioning. Factors identified as important for couple adjustment to cancer--good communication, spousal support, and marital satisfaction--all acted positively to facilitate functioning in this sample. Good psychological adjustment was reflected in scores on the POMS, CES-D, Sense of Coherence, and Relationship Dimension of the Family Environment Scales. Several couples demonstrated lasting impairment, but, overall, the great majority of relationships were strengthened and couples emerged more tightly bonded.

When grief heats up: Pro-inflammatory cytokines predict regional brain activation.

BACKGROUND Pro-inflammatory cytokines are associated with sickness behaviors, a set of behaviors including low mood, which are orchestrated by the brain and described as shift in motivational state. The present study investigated the hypothesis that local inflammation is associated with greater subgenual anterior cingulate cortex (sACC) activation in persons undergoing chronic stress. METHODS Women undergoing the emotional stress of bereavement had fMRI scans during a grief elicitation task. Local inflammation was measured by salivary concentrations of two markers of pro-inflammatory cytokine activity (e.g., interleukin-1beta and soluble tumor necrosis factor receptor II). RESULTS Analyses revealed that both inflammatory markers were positively associated with ventral prefrontal activation (e.g., sACC and orbitofrontal cortex) as well as other regions important in the emotional task such as noun retrieval (e.g., temporal cortex), and visual processing (e.g., cuneus and fusiform gyrus). In separate analyses, the ventral prefrontal activations correlated with free recall of grief-related word stimuli, but not neutral word stimuli. CONCLUSIONS This is the first study to demonstrate the relationship between emotional processing, regional brain activation and localized inflammation in a chronically stressed population of adults.