Nelson F. Jones

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...

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.

Psychomaintenance of Chronic Physical Illness

Psychomaintenance refers to the psychologic and behavioral perpetuation and exacerbation of physical illness (Dirks, 1978; Jones, Kinsman, Dirks, & Dahlem, 1979). In this regard, it should be noted that psychomaintenance does not address the etiology of illness as an area of interest but instead focuses on how psychologic and behavioral factors maintain and increase both perceived severity and medical intractability of the illness once it has already developed. How is it that the patient continues to be functionally incapacitated by illness, despite medical treatment that is effective in most other cases? How is it that the patient appears to require a disproportionately intense medication regimen? How is it that the patient continues to be hospitalized longer and more frequently than would be indicated by the objective medical parameters of the illness? What is the patient doing to contribute adversely to his or her medical response? What is the patient not doing in relation to the illness, and what negative effects does that have on medical management and treatment? These are questions whereby the specific mechanisms of psychomaintenance can be isolated. The mechanisms of psychomaintenance appear to be general across illness types and often so commonplace as to be overlooked.

Exploring schizophrenic thinking in older adolescents with the WAIS, Rorschach and WIST†

Literature that addresses the diagnosis of mental disorder in adolescents strongly suggests that it may not be possible to do so. Schizophrenic thinking, in particular, has been seen as generally characteristic of adolescents. Making judgments of specific responses from the Rorschach, the WAIS, and the WIST, 10 expert clinicians were able to make judgments with regard to 12 adolescents in the 16-19 age range that were surprisingly accurate in discriminating among schizophrenics, nonschizophrenic hospitalized adolescents, and a normal control group. Results indicate that schizophrenic thinking is not necessarily characteristic of adolescents and that information from the WIST may be helpful in identifying schizophrenic adolescents.

Bender-Gestalt Performance and Recall in an Asthmatic Sample?

In a sample of intractable adult asthmatics, the prevalence of Bender-Gestalt signs suggestive of neuropsychological problems was documented. Sixty-five per cent of the sample was found to have equivocal or definite Bender-Gestalt signs suggestive of cerebral dysfunction. A clear majority of the asthmatics manifested definite signs of memory impairment when they were asked to recall the Bender designs. The study provides the first documentation of the neuropsychological sequelae of asthma in adults.

Functionally determined invalidism in chronic asthma

Abstract Ninety asthmatic patients were divided into three groups according to MMPI Panic-Fear scores. The groups were well equated for the actual severity of their asthma as indexed by daily, longitudinal pulmonary function measures during treatment and rates of rehospitalization following discharge from treatment. All patients were surveyed at admission, discharge, 6 months post discharge and 12 months post discharge for their ratings of interference due to illness in their vocational, social and physical activities. As hypothesized, high Panic-Fear patients consistently reported that their asthma created more interference in their daily lives than did moderate and low Panic-Fear patients. Additional findings indicated that the asthma interfered most with physical activities, secondly with vocational activities and least with social activities. It was also found that reported interference decreased following intensive, long-term inpatient treatment.

Distribution of Alexithymic Characteristics within an Adult Outpatient Population

Utilizing the MMPI Alexithymia Scale (MMPI-AS), a retrospective study was undertaken to determine the distribution of alexithymia within an outpatient population. Approximately 7.64% of the outpatient population displayed the alexithymic trait. Analysis of alexithymia by sex revealed that 10.61% of males and 5.13% of females evidenced alexithymia. This does not correspond with other studies on the distribution of alexithymia within other nonpsychosomatic populations. Issues regarding the measurement instrument, distribution of alexithymia, as well as areas for further investigation are addressed.

Pediatric patient attitudes toward chronic asthma and hospitalization

Abstract Through key cluster analysis techniques, seven attitude clusters, Minimization of Severity, Passive Observance of Illness, Bravado, Expectation of Staff Rejection, Moralistic Authoritarianism, Stigma, and External Control, were delineated in a population of hospitalized pediatric asthmatics. The clusters showed adequate internal consistency, reliability, and generality. Comparison of the pediatric clusters with previously obtained adolescent-adult clusters suggested that basic attitudes toward illness or hospitalization develop in childhood but undergo connotative transformations in the adolescent-adult years. Furthermore, correlational analysis of attitude cluster scores with chronological age revealed that some clusters crystallize early in childhood while others are subject to change over the short run. The possible implications for treatment are discussed.

Patient attitudes and clinical judgment as related to patients' course in hospital

Abstract Twenty-seven patients were followed closely to determine their treatment and response in a psychiatric hospital. Attitudes toward hospitalization were sampled at admission. Only inconsistent support was gained for the socio-psychological theory that social class phenomena, including attitudes, are directly related to the patients course in the hospital. Only when symptomatology and clinical judgment are examined as intervening variables are the findings consonant with social class related findings. Caution is urged in interpreting either intrapsychic or social variables as responsible for a patients course until the relationships among them are clarified.

Alexithymia in Chronic Bronchitis/Emphysema: Personality Characteristics and Illness Attitudes

Personality characteristics and illness attitudes of alexithymic and nonalexithymic chronic bronchitis/emphysema patients were assessed using the Minnesota Multiphasic Personality Inventory (MMPI) along with supplementary scales and the Respiratory Illness Opinion Survey (RIOS). Two validity scales, three clinical scales and one supplementary scale from the MMPI along with one illness attitude category from the RIOS discriminated alexithymic and nonalexithymic patients. These findings are disparate from those observed in an asthmatic population and point to an interplay between illness type and alexithymia in terms of personality and illness attitudes.