Robert O. Pasnau

Psychosocial Aspects of Mastectomy: II. The Man's Perspective

In order to assess factors related to mens adjustment to mastectomy and its aftermath the authors administered a questionnaire to 31 men whose wives or partners had had mastectomies. Most men reported a good overall adjustment, but a subgroup remained distressed and reported adverse effects on their relationships with wives or lovers. The data indicate that the nodal points in the process are the involvement of partners in the decision-making process, the frequency of hospital visits, resumption of the sexual relationship, and the man looking at his partners body after surgery. These findings have implications for counseling couples who face this emotionally stressful procedure.

Preventing nursing burnout: A challenge for liaison psychiatry

The authors conducted a study to assess and compare the level of job satisfaction among five groups of registered nurses working at UCLA Hospital. Fifty-seven female nurses completed the MMPI, Locus of Control Test, Work Environment Scale, and a questionnaire designed to assess job satisfaction. Results showed that there were no significant personality differences among the five groups of nurses. Significant differences between some of the groups were found in demographic variables and in work-related variables such as involvement, task orientation, work pressure, sense of authority on the job, and perceived communication with peers or other groups in the work environment. Nurses on the Medicine unit tended to have lower overall job satisfaction than those in the other units. The involvement of the Psychiatric Liaison Service on the five nursing units is described and discussed as a possible method for providing psychosocial support to the nurses and reducing high turnover rates.

A Comprehensive Program of Psychosocial Care for Mastectomy Patients

The traumatic experience of the discovery of a lump in the breast, the diagnosis of cancer and eventual mastectomy have focused medical attention on the importance of providing adequate psychosocial care for mastectomy patients. This paper outlines a comprehensive program now underway. The program includes the premastectomy (preventive), postoperative (interventive) and recovery (postventive) periods. To secure more information for this program, an initial project examining the psychological effects of mastectomy on women and their spouses has been undertaken. It is anticipated that these findings will be helpful in identifying some of the problems encountered and aid in the success of the program in attaining the desired results.

Evaluation of psychosocial problems of the homebound cancer patient: I. Methodology and problem frequencies.

&NA; Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled “Psychosocial Problem Categories for Homebound Cancer Patients.” This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.

Professional Characteristics of Psychiatric Residents Trained at the Ucla Neuropsychiatric Institute, 1956–1975

Psychiatrists who trained at the UCLA Neuropsychiatric Institute Residency program from 1956–1975 were surveyed about their current professional activities. The large majority lead diversified careers. Less than half of responding graduates spend more than half of their professional time in office private practice and more than three-fourths have medical school appointments. Fewer recent graduates have engaged in psychoanalytic training and more have taken post-residency subspecialty fellowships. Recent graduates have been more involved with administrative, consultative, and hospital work than earlier graduates. Recent graduates also more frequently report marital/family problems, socio-economically disadvantaged patients, minority group patients, epilepsy, and group therapy methods to be very or moderately important in their work. Factors contributing to changing practice patterns are discussed.

Low dose desipramine treatment of cocaine-related panic attacks.

Thirteen patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia that started during or shortly after cocaine exposure were treated in the UCLA Anxiety Disorders Program (Los Angeles, CA). Low starting doses (ranging from 2.5 to 10 mg/day) of desipramine were used. Doses were then slowly increased to an average daily dose of 25 mg. Eleven patients who were able to tolerate an initial increase in panic anxiety responded to this treatment strategy with almost full resolution of panic attacks. The authors discuss the possible value and mechanisms of low dose treatment of cocaine-related panic attacks.

Psychology interns on a consultation-liaison service.

This paper develops a rationale for training psychology interns on a consultation-liaison service to deal with the psychologic problems of medically ill patients and to work with their health care providers. General and specific goals are delineated to summarize training objectives for these interns at the end of three and six months on the service. The overall objective of the service in offering such a program is to train psychologists to feel competent and comfortable in meeting the psychologic needs of the medically ill. The service seeks to train psychologists primarily as clinicians and secondarily as researchers in the health care area.

Consultation-Liaison Outpatient Clinics

This paper describes the history of the provision of psychiatric services to outpatients in general (medical) hospitals in the United States. It also reviews the rationale for the development of consultation-liaison psychiatric clinics that have been created to meet the psychiatric needs of these patients. Results of a random survey of current consultation-liaison psychiatry outpatient clinics are presented and recommendations are made for a model outpatient clinic.

Small activity groups in the school: Report of a twelve year research project in community psychiatry

The authors report on a long-term project in mental health in an urban school district utilizing a structured activity group program as a method of developing preventive mental health activities in the schools. Over a 12-year period, more than 350 children between the ages of 6 and 15 and 32 teacher-leaders participated in work with 64 groups. Evaluations show positive results in providing mental health services which bridge the gap between classroom and formal psychiatric assistance, inservice training of faculty in the diagnosis of emotionally based learning problems, and developing insights about schools as social institutions. The authors suggest that warnings sounded by earlier investigators about such programs need not discourage future development of this consultation modality.

Psychotherapy as an adjunct to supervised fasting for obesity

Abstract This study evaluated the effect of individual and group crisis-oriented psychotherapy as an adjunct to medically supervised fasting in 72 obese patients. Individual crisis-oriented psychotherapy related significantly to successful completion of the program, to a higher percentage of excess weight lost, and to a higher percentage of patients approaching the ideal weight. The authors discuss crisis points to be anticipated in a fasting program and offer suggestions for therapeutic strategies.