Jerald F. Dirks

Panic-Fear: A Personality Dimension Related to Intractability in Asthma

&NA; A 15‐item MMPI scale has been developed that relates to the reported frequency of panic‐fear symptoms on the Asthma Symptom Checklist (ASC). High scale scores describe fearful, emotionally labile individuals who profess to be more sensitive than others and unable or disinclined to persist in the face of difficulty. The relationship between the MMPI panic‐fear scale and the ASC panic‐fear symptoms is highly replicable and related to a crucial aspect of chronicity in asthma. High scoring asthmatic patients were prescribed more intensive discharge steroid regimens upon completion of residential treatment. This relationship was not mediated by available objective pulmonary function measurements used to index medical condition. Development of the MMPI panic‐fear scale should enable further investigation of personality and behavioral aspects related to the perceived severity and intractability of other medical conditions and disabilities.

Panic-Fear: A personality dimension related to length of hospitalization in respiratory Illness

In a prior study,1 development of a 15-item Minnesota Multiphasic Personality Inventory (MMPI) Panic-Fear scale was described which relates to the reported frequency of Panic-Fear symptoms (e.g., feeling scared, panicky, worried, and frightened) on the Asthma Symptom Checklist (ASC). High MMPI Panic-Fear scale scores describe fearful, highly emotional individuals who profess to have their feelings hurt more easily than others, to feel helpless and to give up easily in the face of difficulty. High-scoring asthmatic patients were found to have been prescribed more intensive oral corticosteroid regimens at the time of discharge from a residential treatment facility months after testing. This relationship was not attributable to differences in pulmonary function.In the present study, the results of the earlier research were expanded in several ways. First, the MMPI Panic-Fear scale was found to be related to an aspect of medical intractability, i.e., length of hospitalization, in two chronic respiratory illne...

Psychological contributions to chronicity in asthma: patient response styles influencing medical treatment and its outcome.

Research is reviewed relating to two aspects of response styles among asthmatic patients, neither of which is a mere derivative of the patients medical condition. One aspect, indexed by panic-fear symptomatology, appears to be associated with the level of attention directed at breathing difficulties, ranging from symptom disregard (low panic-fear symptomatology) to symptom vigilance (high panic-fear symptomatology). A second aspect, indexed by a derived personality dimension, appears to be associated with the quality of the patients reactions to acknowledged breathing difficulties, ranging from extreme independence (low panic-fear personality) to helpless and ineffective dependency (high panic-fear personality). Simply, these aspects of patient response styles refer both to the attention directed toward breathing difficulties and to the quality of the patients reactions in response to acknowledged breathing difficulties. Their importance derives from 1) their interaction with the severity of asthma to influence medical decisions about the intensity of prescribed medications and length of hospitalization during medical treatment and 2) their effect on long-term medical outcome. Awareness of these two aspects of patient response styles should enable differential approaches to be adopted by physicians seeking to counteract psychological contributions to chronicity in asthma.

anxiety Reduction in Asthma: Four Catches to General Application1

&NA; Anxiety reduction procedures as adjuncts to medical treatment have almost invariably been reported to benefit asthmatic patients in individual case studies. However, the results of more systematically controlled studied are clearly inconsistent. This discrepancy is understandable in view of what is now known about anxiety in asthma. Four catches, each based on what has been reported about the roles and forms of anxiety in asthma, are presented. Each catch argues against general, across‐the‐board application of anxiety reduction procedures in asthma. Careful evaluation leading to more problem‐oriented treatment is needed in view of the different roles of anxiety in asthma.

medical Outcome in Asthmatic Patients: Effects of Airways Hyperreactivity and Symptom-focused Anxiety

&NA; Hypotheses about medical outcome in asthma, indexed by rates of rehospitalization within 6 months after discharge from long‐term intensive care, were evaluated. Predictions for rehospitalization were based on the levels of airways hyperreactivity, indexed by inhalation challenges with histamine or methacholine, and levels of anxiety focused upon and concurrent with periods of asthmatic distress, indexed by Panic‐Fear symptomatology. Results indicated that, although some prediction could be made on the basis of levels of anxiety and airways hyperreactivity alone, the best predictions resulted from the combined effects of these factors. Almost half of the patients who had highly hyperreactive airways and a tendency to disregard symptoms of breathing difficulty were rehospitalized. By comparison, none of the patients who had less hyperreactive airways and a tendency to be vigilant about their symptoms were rehospitalized. The hypotheses and results are discussed with respect to symptom‐focused and general, illness‐dependent types of anxiety which have different effects upon medical outcome in chronic asthma. The results have implications for the application of anxiety‐reducing forms of intervention in asthma.

Medication compliance in chronic asthmatic patients

In an attempt to assess patient and physician behavior patterns which interfere with effective medical treatment, 100 chronic adult and adolescent asthmatics were asked about the frequency and the nature of their medication non-compliance. The nature of the patients medication abuse was also related to underlying personality characteristics, as measured by the MMPI Panic-Fear scale. Finally eleven physicians were asked about the frequency with which they asked their patients about over abuse and under abuse of prescribed medications. The results are impressive, showing that 54.0% of the patients reported some type of medication abuse, and that the nature of the abuse may be predicted from the patients MMPI Panic-Fear score. Perhaps the most important finding was that while over 50% of the patients reported medication non-compliance (under abuse, over abuse, or cyclical abuse), only 27.3% of the physicians said that they routinely inquired about medication abuse. Such a discrepancy suggests one area in which patient and physician characteristics may have a bearing on the effective delivery of medical treatment. The findings underscore the need for physicians to include in their diagnostic procedure a routine inquiry into the patients patterns of medication non-compliance.

As-Needed Medication Use in Asthma Usage Patterns and Patient Characteristics

Daily inhaled bronchodilator medication usage was recorded using an electronic device and airway obstruction by daily peak flow measurement. The demographic, clinical, and psychological characteristics of the subjects were noted. Subjects were allocated to as-needed (prn) medication usage groups according to the mean number of inhaler activations on days with zero, moderate, and severe airway obstruction. Segregation into arbitrary and nonarbitrary use, and into overuse, appropriate use, and underuse resulted in six usage groups. Appropriate use was observed in only 10 of 39 subjects. The major psychological variable to differ among groups was the MMPI variable Pt, representing general anxiety. Arbitrary users had a significantly higher mean score than nonarbitrary users. The variable Specific Internal Awareness, representing a perceived difficulty in recognizing the premonitory symptoms of an asthma attack, also differed among the usage groups, with arbitrary users having the lowest scores. These findings raise the possibility that reliance on an objective measurement of airway obstruction rather than on subjective symptomatology might enhance compliance with prn medication in some patients.

Patient and physician characteristics influencing medical decisions in asthma.

The present study explores the complex interplay of objective indices of illness-severity and personal characteristics of patients and physicians as they influence judged illness-severity and medical decisions concerning length of hospitalization and intensity of prescribed oral corticosteroids in a chronic asthmatic population. The results indicate that, depending on the physicians personal characteristics, he may: a) confuse his patients psychological physical distress, resulting in medical judgment and decisions being influenced by patient personality; b) accurately distinguish between psychological physical distress but treat a psychological problem as though it were a medical problem; c) judge and treat the patients illness objectively, regardless of the patients personality. These findings stress the importance of expanding the present biomedical model of medicine to include a better appreciation of how social, psychological, and behavioral factors influence the medical decisions about treatment and the resulting outcome.

Panic-fear in asthma. Symptomatology as an index of signal anxiety and personality as an index of ego resources.

Clinical observations and studies of asthmatic patients have often concluded that there is a strong relationship between the degree of the patients anxiety and the medical intractability of his illness. However, psychotherapeutic interventions designed to alleviate patient anxiety have been noticeably inconsistent in achieving meaningful alleviation of the patients asthma. The present paper addresses this apparent paradox by positing the existence of two types of anxiety: a) asthma-specific anxiety, as indexed by Panic-Fear symptomatology scores of the Asthma Symptom Checklist; and b) characterological and pervasive anxiety, as indexed by Panic-Fear personality scores of the Minnesota Multiphasic Personality Inventory. In this study, long term medical outcome was found to be influenced by the combination of these types of anxiety. When high asthma-specific anxiety coexisted with high characterological anxiety, medical outcome following intensive long term medical treatment was exceptionally poor. In contrast, when high asthmaspecific anxiety coexisted with average levels of characterological anxiety, medical outcome was exceptionally good. These results are discussed relative to the theoretical distinctions between signal anxiety and anxiety concomitant with a lack of basic ego resources.

Alexithymia and the Psychomaintenance of Bronchial Asthma

A total of 579 adult and adolescent asthmatic patients were assessed for alexithymia while inpatients. Subsequent rehospitalization data was collected 6 months after discharge. Analyses revealed that