Robert A. Kinsman

Panic-fear in asthma: requests for as-needed medications in relation to pulmonary function measurements.

Requests for as-needed medications and treatments (PRNs) by asthmatic patients scoring high, moderate, or low on the Asthma Symptom Checklist panic-fear category were studied for days when patients were matched at normal, intermediate, and subnormal levels of pulmonary function. Low panic-fear patients were the least likely to request PRNs regardless of the pulmonary function level. In contrast, high panic-fear patients often requested PRNs each level of pulmonary function. Only moderate panic-fear patients made progressively more PRN requests on days when pulmonary functions were lower. These observations and others concerning the adverse influence of extreme panic-feat coping styles upon the treatment of asthma were discussed.

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...

Baseline levels in muscle relaxation training.

Variations in the baseline levels of physiological measures, a familiar problem in psychophysiological research, can affect the results of clinical applications and research in the self-control of bodily processes. In this presentation, the problem is illustrated within the context of skeletal muscle relaxation training using continuous biofeedback(BF) based on surface electromyographic(EMG) activity. In terms of the Law of Initial Values(LIV), higher EMG levels are expected to be associated with greater decreases during training. The combined results of two studies documented an LIV-like effect for pretraining baseline levels with greater EMG decreases after training for subjects with the higher pretraining baselines. Left uncorrected, such baseline differences were shown to lead to discrepant results between two identical studies, and therefore to conflicting conclusions about the effectiveness of these procedures. The available methods suggested to correct for the biasing effect of baseline differences in research are described, with particular emphasis on the analysis of covariance.

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.

Relationship between airways response to allergens and nonspecific bronchial reactivity.

Bronchial inhalation challenges to histamine, methacholine, and at least one antigen were performed on 183 asthmatic patients who previously had received skin tests to at least 16 different antigens. Individuals with a positive skin test and a positive antigen inhalation challenge to the same antigen had lower thresholds of response to both histamine and methacholine. This pattern was statistically significant for mixed trees, mixed grasses, mixed molds, and house dust but not for mixed ragweed. For those individuals who had a negative antigen inhalation challenge, skin test reactivity (positive or negative) alone was not associated with a different threshold of response to histamine or methacholine. Also, a higher percentage of positive antigen inhalation challenges were seen in the group of individuals with a low threshold of response to both histamine and methacholine than in groups with either a moderate or high threshold of response to these chemical agents. The results imply that at least two factors are associated with a positive bronchial inhalation challenge to a specific antigen: nonspecific airways hyperreactivity, as indexed by a methacholine or histamine inhalation challenge, and a positive skin test.

Death in Asthma: A Psychosomatic Autopsy

In most, if not all, chronic illnesses, the patient is a participant in medical management. Attitudes and behaviors during treatment can influence medical outcome in important ways that are becoming increasingly understood. This case history illustrates how a personal style may have contributed to the worst possible outcome, death, in an illness that is usually not fatal. There is a need to unravel the complex interplay between the psychological and medical factors contributing to such extremes in medical treatment failure in order to permit timely and appropriate intervention.

Requests for as-needed medications by asthmatic patients: Relationships to prescribed oral corticosteroid regimens and length of hospitalization

In a previous study, patient-coping styles, indexed by panic-fear symptomatology, were found to be associated with specific patterns of requesting as-needed (PRN) medications and treatments: Patients who tend to emphasize their symptoms (high panic-fear) requested PRNs frequently, even on days when their pulmonary function levels were essentially normal, while those who tend to minimize their symptoms (low panic-fear) requested PRNs infrequently, even on days when their pulmonary function levels were subnormal. In the present study, we found that patients who requested PRNs frequently spent more days in the hospital than those who requested PRNs only rarely. Intensive medication regimens (i.e., daily corticosteroids or alternate-day corticosteroids supplemented with TAO, cromolyn, or aerosolized steroids) were more often prescribed for patients requesting PRNs frequently than for those requesting PRNs rarely. These differences in patient management were attributable neither to differences in pulmonary function nor directly to differences in panic-fear rating. Thus, patient-coping styles can influence the treatment prescribed, and optimal management requires that individual patient-coping styles be considered in planning a regimen.

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.