Sherman Eisenthal

Fatigue syndrome due to localized radiation

For cancer patients, fatigue is a disturbing symptom caused by many factors. Since fatigue is the most common side effect of localized radiation to the breast, this treatment provides a unique opportunity to follow patients prospectively as they develop one type of fatigue. We evaluated the effect of radiation treatment in 15 women with Stage I or II node-negative breast cancer who were otherwise healthy. Fatigue, contrary to our hypothesis, did not increase linearly with cumulative radiation dose over time. It dropped from the first to second week and rose in the third week. The cumulative effects reached a plateau in the fourth week (after an average of 17 fractions), which was maintained during the remaining weeks of treatment. Within 3 wk after treatment, fatigue had diminished. No patient had sustained depressive symptoms. Cardiopulmonary exercise capacity in 5 patients at 6 and 12 wk did not change from just before radiation. Other markers, including reverse triiodothyronine and pulse change with orthostatic stress, did not correlate with subjective fatigue nor cumulative radiation in 15 patients. The curve of the fatigue syndrome during treatment conforms to the adaptation of the organism to a continuing stress and begins to describe a mild fatigue syndrome associated with radiation.

Treatment-related fatigue and serum interleukin-1 levels in patients during external beam irradiation for prostate cancer

To define changes in sleep and subjective fatigue associated with localized radiation treatment, and to determine their relationship to interleukin-1B (IL-1), we prospectively followed 15 men, none of whom were depressed during 8 wk of radiation treatment for localized prostate cancer. Each patient rated fatigue daily on a visual analogue scale, recorded hours slept, and completed the Beck Depression Inventory weekly. Serum IL-1, taken at baseline and Fridays, was measured by quantitative enzyme immunoassay. Ranked weekly mean fatigue scores for each subject increased at week 4 (mean, 17 fractions, 1.8 Gy) then plateaued and rose in weeks 6 and 7. In week 6, the last week of full volume radiation, subjects slept most compared to all other weeks including week 7 when treatment was coned down. Ranked serum IL-1 tended to rise between weeks 1 and 4, as fatigue scores rose. These data suggest that localized radiation treatment is associated with increased fatigue and sleep requirement independent of depressive symptoms. Relative serum IL-1 changes may be one signal for the systemic reaction and subjective fatigue associated with the acute effects of radiation.

Evaluation of the initial interview in a walk-in clinic. The patient's perspective on a "customer approach".

There have been different models on how to conduct the initial psychiatric interview in a walk-in clinic. A “customer approach” has been developed which stresses: a) eliciting and understanding the requests that patients have regarding how they hope to be helped; and b) negotiating a treatment plan with the patients. We evaluated this customer approach from the perspective of the patient. The first hypothesis was supported. The patients perception of the clinicians utilization of the customer approach correlated positively and substantially with measures of outcome, especially feeling satisfied and helped. The second hypothesis was also supported. Utilization of the customer approach continued to correlate positively and substantially with outcome even when patients did not get the disposition originally wanted. We discussed the clinical significance of the customer approach especially in regard to patient objectives in the initial interview—a treatment plan vs. symptom relief.

Patient requests in a walk-in clinic. Replication of factor analysis in an independent sample.

This study attempts to test the hypothesis that 14 categories of patient requests are relatively independent mathematically. The request categories were identified in the conduct of initial interviews in a walk-in clinic. To test the independence of the 14 request categories, we administered an 84-item Patient Request Form (PRF) to 296 patients coming to the walk-in clinic of a general hospital. In a previous study using a 75-item version of the PRF on a sample of 201 patients, only nine of the request categories were confirmed according to the criterion that three of the five items in the request category appear on the same factor with a loading of 0.4 or greater. The 84-item PRF is a revised form which contains 40 new items designed to capture more accurately the clinical meaning of the requests. Thirteen of the 14 request categories were confirmed in the present factor study using the same confirmation criterion as the earlier study. Three higher order request dimensions were identified by a factor analysis of each patients 14 request category scores. The request dimensions were for affective-dependence, cognitive understanding, and active intervention. Preferences among the requests are described. The results of this study are relevant in the following ways; 1) knowledge of the range and definition of patient requests enhances the clinicians ability to hear and respond to the patients request; 2) facilitating the patients expression of his request enhances the flow of the interview; 3) describing the distinct requests gives clinicians the opportunity to explore the efficacy of various treatment responses to each request; 4) knowing the request facilitates the negotiation process when clinician and patient are in conflict; 5) the PRF serves both as a clinical and a research tool; and 6) the methods used in this study are applicable to other settings, particularly in medical clinics.

Overeaters anonymous: Impact on bulimia

Patterns of utilization and effects of participation in Overeaters Anonymous (OA) in 40 individuals meeting DSM-III criteria for bulimia are described. All were abstinent from compulsive overeating for a mean of 3 years, with 21 (52.5%) initiating sustained abstinence within the first month of membership. Most attended meetings 5 times per week and called their sponsors daily, and 25 (62.5%) were in psychotherapy concurrently. The authors describe the nature and philosophy of OA and discuss factors which might explain the symptomatic control achieved by this group.

Premorbid adjustment, paranoid-nonparanoid status, and chronicity in schizophrenic patients.

The independence of three descriptive dimensions, commonly used in the design of experimental research on schizophrenia, was investigated. The subjects were 258 male schizophrenic patients from three Boston area hospitals, two private and one public. Only paranoid status was found to be independent of the other two dimensions. Premorbid adjustment and chronicity of symptoms (defined by length of hospitalization) were significantly correlated, rt=.31. Data analysis and discussion focused specifically on the inconsistency between these data and those reported by Goldstein, Held, and Cromwell (1968) on the same problem. Differences in the populations sampled and in patient selection procedures were carefully examined but failed to resolve the inconsistency.

Evaluation of the initial interview in a walk-in clinic. The clinician's perspective on a "negotiated approach".

A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patients instrumental objective of participating in the treatment planning. The sharpest divergence between the clinicians and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of settings, and the implication for the delivery of services

Specificity of Patients' Requests in the Initial Interview

The concept of the patients request is described in detail in relation to a negotiated approach to conduct an initial interview in a walk-in clinic and in relation to other related concepts such as patients goals. The verbalization of specific requests of 363 patients to the psychiatric walk-in clinic of a general hospital was investigated, using a structured pre-intake interview. Although a majority of the patients (69.5%) verbalized a specific request, it was significantly less than the percentage (93%) who endorsed at least one request on the Patient Request Form. Specificity was related to socialization in the mental patient role, conditions of entry into the mental health system, and presenting complaint, but not related to demographic measures. The nonspecific patient is likely to come to the clinic at the suggestion of someone else, to be new to the clinic, having no past treatment history, and having general or situational complaints. The implications of these results for the conduct of an initial interview using the negotiated approach were discussed.

Psychiatrists and their prescribing practices

Abstract Of all the variables that influence the decision to treat psychiatric symptoms with medication, the characteristics of the physician have been studied the least. A survey questionnaire was sent to one-third of the Massachusetts Psychiatric Society membership; 48% responded. They were asked to note their prescribing practice for four common psychiatric symptoms (anxiety, depression, mood swing, and though disorder) at three levels of magnitude (mild, moderate, and severe). The results were evaluated with the respondents age, sex, type of practice and treatment orientation acting as independent variables. At the mild and severe symptom extremes, there was generally little disagreement about the use of medication. In the moderate range, however, differences in ideology influenced practice significantly. Age and gender differences were also found to exert a significant influence.

Attribution of Mental Illness in Relation to Sex of Respondent and Sex of Rated Stimulus Person

108 undergraduates rated the degree of mental illness of 10 case descriptions on a 5-point scale. Two forms were used, matched for the 10 case problems but varied for case sex. Analysis of variance yielded significant main effects for sex of the respondent and case sex. Male respondents attributed more mental illness than female respondents to the cases. The mean rating of case sex for male items was significantly higher than female items. However, 6 of the 7 items which varied sex between forms failed to differ significantly using t tests.