Keith W. Pettingale

Patterns of expression of anger and their psychological correlates in women with breast cancer

Abstract Previous work from the Faith Courtauld Unit described an association between the diagnosis of breast cancer and an apparent tendency to suppression of anger, particularly in younger patients. A detailed study of this phenomenon has been carried out in 71 patients prior to breast biopsy, using structured interviews, the Eysenck Personality Questionnaire (EPQ) and the Spielberger State—Trait Anxiety Inventory (STAI). Taped transcripts of interviews, independently rated, using a revised anger rating scale, again demonstrated a significant difference between patients with benign breast disease and those with breast cancer in expression of anger. Mean EPQ ‘N’ score was significantly lower for cancer patients. STAI A-State and A-Trait anxiety scores were significantly higher than standard scores for all patients other than young cancer patients. The pattern of correlation between variables differed for the two diagnostic groups suggesting (a) that cancer patients are more stressed by impending biopsy and (b) that young cancer patients are more likely than other patients to use denial in the face of stress.

Serum iga and emotional expression in breast cancer patients

Abstract As part of a multidisciplinary study of 160 women admitted consecutively for breast tumour biopsy, we measured expression of anger and serum immunoglobulins before operation, when we had no knowledge of the provisional diagnosis, and at 3, 12 and 24 months after operation. Expression of anger was not related to serum IgG, IgM or IgE levels, but IgA levels were found to be significantly higher in patients who habitually suppressed anger than in those who were able to express anger (p

Coping and cancer prognosis

Psychological responses to a diagnosis of breast cancer, assessed three months post operatively, are related to outcome 10 yr after operation. These results confirm the findings previously reported at 5 yr. The need for further study into the nature of the reported psychological response categories and the likely mediating mechanisms is emphasized.

Psychological response to cancer diagnosis— I. Correlations with prognostic variables

A prospective, multidisciplinary study of 168 newly diagnosed patients with early breast cancer and Hodgkins or non-Hodgkins lymphoma was conducted. Psychological assessments were conducted at 3 and 12 months following diagnosis and correlated with clinical and pathological variables. There was no statistical association between psychological response to breast cancer and any other prognostic variable measured. In lymphoma patients of both groups there was evidence of greater psychiatric morbidity in those with more advanced disease and those who failed to respond to treatment. However there was also no statistical association between any cognitive response category and known prognostic variables. There was no evidence that the patients gender or type of tumour affected their overall mental adjustment to cancer and the effect described in breast cancer may apply to all types of malignant disease.

A toxicity study of recombinant interferon-gamma given by intravenous infusion to patients with advanced cancer.

SummaryEighteen patients with solid tumours were treated with human recombinant interferon-gamma at escalating dose levels starting at 1×106 units/m2 per infusion and rising through 3×106, 6×106, 9×106 and 22×106 to a maximum of 110×106 units/m2 per infusion. The IV infusions were given three times a week over a 4-week period.Side effects were seen in all patients, but were mild except at the highest dose. Acute dose-related effects included pyrexia, tiredness, thirst, chills and rigors. Chronic dose-related effects included anorexia, lethargy, weakness, disorientation, a trace of proteinuria and minimal rises in liver enzymes. In addition, effects were observed which were not related to dose. These included headache, nausea and vomiting, backache, myalgia, flatulence and a mild, transient reduction in neutrophils and erythrocytes.At the highest dose level dose-limiting toxicity was observed, consisting in severe tiredness and anorexia, hypotension, disorientation and changes on the electrocardiograph.Overall, toxicity was similar to that seen with preparations of interferon-alpha, except that no tolerance to the effects of interferon-gamma was noted. We observed less hepatic and haematological toxicity, but also recorded flatulence, handcramps and electrocardiograph changes, which have not been reported with interferon-alpha.When given according to this regimen, doses of 22×106 units/m2 per infusion of recombinant interferon-gamma were generally well tolerated by the patients.

Referrals to psychiatrists in a general hospital--comparison of two methods of liaison psychiatry: preliminary communication.

Patients on a general medical ward were offered a liaison psychiatric service with ‘unlimited’ access, in which referrals were accepted from nurses, other paramedical staff and junior doctors in addition to senior medical staff. This new service (method II) was compared with the usual liaison service (method I, referrals initiated or approved by senior medical staff only) which was continued in parallel on a comparable general medical ward. Method II resulted in a threefold increase in referral rate and led to a significant alteration in the types of problem attracting referral. Despite the much higher rate of method II referrals, however, similar percentages of referrals by both methods were offered psychiatric follow up. The results do not support the commonly held belief that it is the failure of ward staff to recognize psychiatric morbidity which accounts for the low rate of referrals to many psychiatric liaison services.

Nephrotic syndrome during treatment with interferon.

1 Oliner H, Schwartz R, Rubio F, Dameshek W. Interstitial pulmonary fibrosis following busulfan therapy. Am J Med 1961;31:134. 2 Burke DA, Stoddart JC, Ward MK. Fatal pulmonary fibrosis occurring during treatment with cyclophosphamide. Br Med J 1982;285:696. 3 Akoun G, Mayaud C, Touboul JL. Diagnostic value of bronchoalveolar lavage in drug induced interstitial pneumonitis. Respiration 1984;46 (suppl 1): 71. 4 Costabel U, Schmitz-Schumann M, Matthys H. Bronchoalveolar T-cell subsets in gold lung. Evidence for a hypersensitivity reaction. Chest 1985;87:135. 5 Akoun GM, Herman DP, Milleron BJ, Mayaud CM, Perrot JY. Bronchoalveolar T-cell subsets in gold lung. Evidence for a hypersensitivity reaction. Chest 1985 ;87 :135-6. 6 Venet A, Caubarrere I, Bonan G. Five cases of immune-mediated amiodarone pneumnonitis. Lancet 1984;i :962-3. 7 Akoun GM, Gauthier-Rahman S, Milleron BJ, Perrot JY, Mayaud CM. Amiodarone-induced hypersensitivity pneumonitis. Evidence of an immunological cell-mediated mechanism. Chest 1984;85:133-5. 8 White DA, Gellene R, Rankin JA, Gupta S, Cunningham-Rundles C, Stover DA. Methotrexate pneumonitis: bronchoalveolar lavage findings suggest an immune mediated disorder. Am Rev Respir Dis 1984;129:A64. 9 Akoun GM, Mayaud CM, Milleron BJ, Perrot JY. Drug-related pneumonitis and drug-induced hypersensitivity pneumonitis. Lancet 1984;i:1362. 10 Guiselin M, Voisin C, Lafitte JJ, Gosselin B Aerts C, Tonnel AB. Contribution du lavage broncho-alveolaire au diagnostic et a la pathogenie du poumon radique. Rev Mal Resp 1984;l: 265.

Mycosis fungoides and Hodgkin's disease.

Three patients with the typical clinical course and pathology of Mycosis Fungoides (MF) were found also to have Hodgkin’s Disease (HD), nodular sclerosing type. In two cases, HD Was diagnosed 2 years after the diagnosis of MF; in the third case, both diseases were diagnosed simultaneously. Previous claims of MF transforming into second lymphomas are reviewed. The possible significance of our observed association of MF and HD is discussed. Cancer 44: 1408141 3, 1979.

Determinants of failure to prescribe target doses of angiotensin-converting enzyme inhibitors for heart failure

Angiotensin-converting enzyme (ACE) inhibitors reduce mortality, frequency of hospitalisation for heart failure and slow the progression of left ventricular systolic dysfunction w1,2x. These benefits are independent of baseline use of diuretics, aspirin and beta-blockers and of the type of ACE inhibitor prescribed. Since the original descriptions of outcome benefit from ACE inhibitors, attention has been focussed on examining the dose–response relationship. The ATLAS study demonstrated reduction in the combined endpoint of mortality and hospitalisation (hazard ratio 0.85, 95% CI 0.78–0.93) with lisinopril 32.5–35 mg daily vs. 2.5–5 mg daily but there is no significant benefit in all-cause mortality and cardiovascular mortality w3x. The NETWORK trial, conducted by general practitioners and hospital physicians in the UK, compared low dose enalapril (5 mg) with intermediate dose (10 mg) and high dose (20 mg) in patients aged 18–85 years with NYHA class II–IV w4x. The study did not demonstrate a relationship between dose of enalapril and clinical outcome (hospitalisation for heart failure, worsening heart failure, death). However, this study had limited power since it treated patients for only 6 months and reported few deaths and hospitalisations. An American study of elderly patients discharged from hospital on ACE inhibitors showed significantly lower mortality at 1 year in patients treated with high dose ACE inhibitors (enalapril 20 mg a day, lisinopril 20 mg a day and captopril 150 mg a day) w5x. The results of the ongoing ACHIEVE trial comparing quinapril 10 vs. 40 mg are