Howard P. Iker

The Affect of Hopelessness and the Development of Cancer: I. Identification of Uterine Cervical Cancer in Women with Atypical Cytology

&NA; Forty women were studied who were discovered on repeated routine examination to have cervical cytology suspicious for cancer. Although all subjects were asymptomatic for cervical disease all had cytological evidence of dysplasia. Biopsy revealed 14 subjects with carcinoma, in 13 of whom the disease was in situ in extent. The presence or absence of cancer was significantly predicted on the basis of presence or absence of interview criteria defined as a high hopelessness potential and/or recently experienced feelings of hopelessness. The so‐called predisposition as well as psychological factors found by other investigators to differentiate women with cervical cancer from women with other forms of cancer or “no cancer” did not differentiate between the subjects in the present study.

The psychological setting of uterine cervical cancer.

In a series of studies of medically sick patients, unselected for diagnosis, we found a high frequency of significant life events which were reported to have led to feelings of “giving up” prior to the “apparent” onset of the disease. The “giving up” expressed by the subgroup of patients with cancer was more specifically categorized as a hopelessness type of “giving up.” Such a feeling was portrayed by a complete sense of frustration for which the individual felt there was no solution. In addition, the individual blamed himself for the frustration having occurred in the first place.’ It was with this background then that we undertook the present study. We wanted to test whether our psychological criteria, which we considered triggering for the clinical appearance of disease, could be used to identify disease before it was diagnosed. In order to make this test, we selected a group of women who were admitted to the Gynecology Service of the University of Rochester Medical Center for a cone biopsy because they had had repeated cervical smears that were reported to contain Class 111 Papanicolaou cells, (cells called suspicious but not diagnostic for cancer). Only those women who were essentially healthy, had no gross evidence of cervical disease and were under the age of 50 were studied. Our study of these women included an open-ended, tape-recorded interview and several psychological tests. The study of all subjects was made the day following the biopsy procedure. The data were collected, and the interpretations were made before the subject, her physician, the pathologist, or the investigator knew the biopsy results. We predicted cancer would be present in those women who reported they had responded to a life event, in the 6 months prior to the first positive smear, with feelings of hopelessness. Similarly, we predicted cancer would not be found in those who did not report such experiences. We made only three predictions about the psychological tests we employed. These involved three subscales of the MMPI -the Depression, Ego Strength and Masculine-Feminine scales. (We predicted higher depression, lower ego strength, and lower femininity scores for those with cancer.) A prediction was made and recorded at the end of each interview, the iderviews were transcribed and the interviews were reviewed as three separate groups at yearly intervals. All the interview ratings were made by one investigator. There were 28 subjects in the first group, 12 in the second, and 11 in the third. Thus, fifty-one subjects have been studied to date.

Plasma ACTH levels in depression before and after recovery: Relationship to the dexamethasone suppresion test

Sixteen patients with major depressive disorder who were nonsuppressors on the dexamethasone suppression test (DST) on hospital admission were studied for plasma levels of adrenocorticotropic hormone (ACTH). Eight patients reverted to normal suppression with clinical recovery, while eight remained nonsuppressors. There was a significant reduction of ACTH levels in those who normalized on their DST, while ACTH levels remained high in the group that continued to be nonsuppressors. The results favored the hypothesis that dexamethasone nonsuppression in depression is mediated by high ACTH levels.

Emotional complications of adolescent grand mal epilepsy

Adolescents who have grand mal epilepsy and their parents were interviewed, and the adolescents were evaluated neurologically. Better seizure control and less neurologic disability were unexpectedly associated with less open communication between the adolescents and their families and friends, and with a poorer self-image and poorer expectations for the future. These findings were unrelated to IQ or school performance. This outcome is consistent with other studies of invisible defects and stigmatization, and suggests that youngsters who have relatively mild defects involving social disability may be more troubled than those with more apparent defects, for which denial may be operative. An incidental finding in the study was that a question more predictive of overall family, social, and academic function than the neurologic findings was simply whether or not the youngster was attending the appropriate grade in school for his or her age.

Use and quality of bitewing films in private dental offices

Patient records (387) were obtained from twenty-five dentists in private practice in Rochester, New York. The number and types of radiographs taken at each recall examination in the most recent 10-year period were recorded. Bitewing radiographs were taken at 50.5% of the recalls with size 2 film used most frequently (83.7%). The average recall interval was 8.4 months overall and 18.0 months for bitewing recalls. Of all proximal surfaces available on the bitewing films, 68.2% were judged adequately separated for diagnostic purposes. For individual surfaces, the highest percentages were recorded for the mesial surface of the maxillary second premolar (89.9%) in the permanent dentition and for the distal surface of the mandibular second molar (83.7%) in the deciduous dentition. Taking four bitewing films instead of two improved the percentage of adequately separated proximal surfaces at a given recall by 2% to 25%. The percentage of unreadable proximal surfaces caused by overlapping or distortion on the bitewing radiographs, when excluding the canines, ranged from 6.3% to 39.5% in the permanent dentition and from 12.5% to 24.9% in the deciduous dentition.

The influence of weight loss on the dexamethasone suppression test

To evaluate the influence of weight loss on the dexamethasone suppression test (DST), we studied 61 patients with major depressive disorder as defined by the Research Diagnostic Criteria, 59 healthy normal volunteers, and 16 volunteers who lost weight by dieting. Nonsuppression on the DST was not correlated to weight loss in the depressed patients. Of the healthy volunteers, 12.5% converted to nonsuppression status. This conversion rate is not significantly different from nonsuppression rates in the normal population. Implications of these findings are discussed.

SELECT: A Computer Program to Identify Associationally Rich Words for Content Analysis. II. Substantive Results.

An overview of these results indicates that SELECT is, in general, producing results in which elicited themes parallel those produced by frequency-based word selection. More importantly —and consonant with the impetus for development of the method — SELECT is delivering factors which are larger, more easily interpretable, and more discriminable than these available from frequency data and is doing so within the constraint of basic thematic identities.

Words: A computer system for the analysis of content

WORDS is a computer-oriented system for content analysis designed to elicit major content themes without recourse to a priori categorization systems. The system consists of a number of modular and independent programs that the user can configure in any fashion to process the data to be analyzed. This paper presents current information on WORDS, WORDS programs, WORDS systems logic, and on the availability of the system.

Computer Analysis of Content in Psychotherapy

The authors describe a proposal for and methods of studying the content of psychotherapeutic interviews. Utilizing a factor-analytic approach, the associations in time among words emitted by the patient and/or therapist are analyzed by computer.

Bitewing radiographs and dentists' treatment decisions

A study involving twenty-one general dentists in private practice in Rochester, New York, was performed to assess the relationship between radiographic evidence of caries and restorative intervention in permanent teeth. Seven thousand three hundred thirty-eight bitewing radiographs taken of 387 patients over the most recent 10-year period were obtained and independently examined by six Eastman Dental Center faculty members as to presence of restorations and caries status of nonrestored proximal surfaces. Patients 20 years of age and younger had significantly lower mean maximum caries penetration scores before restorative treatment when compared to older patients. For all age groups, the mean maximum caries penetration scores indicated that, on the average, restorative treatment was initiated before there were radiographic changes in dentin. There were no differences among the dentists in the study regarding the mean elapsed time between radiographic caries diagnosis and restorative treatment. The random distribution and low number of apparent caries reversals, and the subsequent restoration of 25% of these teeth, suggested that the dentists in this study did not employ systematic remineralization strategies for their patients.