William Van Gordon

Observations on Wind Exposure and Phthisis.

I am strongly of opinion that the facts which Dr. Havilaiid lias placed before the profession are still imperfectly appreciated, and that something still remains to be said, not perhaps on the score of local shelters, but on the choice qf su,fficiently wind-pr otected localities, where the patients whole t2me can be spent in a tranquil atmosphere. I have, therefore, ventured to bring before the Society some facts which made a strong impression on my mind when studying thle distribution of the phthisis death-rate in Devonshire. When the erection of a sanatorium near Exeter was discussed recently, I set to work to acquaint myself with the distribution of the phthisis death-rate in the Exeter neighbourhood and in Devonshire generally. From the annual returns made to the County Council since I89I, I took tile annual death-rates from phthisis in the rural sanitary districts, and from these I calculated the average annual phthisis death-rate in each district. Table I illustrates the differences. The rural districts were chosen partly because many urban (listricts have long been phthisis health resorts, and some imnported cases have naturally been included in the returns, partly because I thought that the conditions of life in the rural districts would be more uniform than in the urban. The map was by no means what I expected to find it, and it seemed desirable to seek an explanation of its peculiarities. Relation to general death-rate seemed the first point to determine, taking general death-rate as a guide to general conditions of sanitation, conditions which have done so much in recent years to modify phthisis mortality. The second map illustrated the differences in the general death-rates of the rural sanitary districts. From a comparison of of these maps it was seen that phthisis death-rate and general death-rate have a different distribution. But the inclusion of phithisis in the general death-rate tends to mask the actual difference. So atlhird map was constructed to show the distribution of the general death-rates when phthisis had been excluded from them (see Table II). Plithisis death-rate and general death-rate thus illustrated evidently have a distilnctly different distribution. Further, the variations in phtliisis mortality from district to district are relatively much greater than those of general inortality. Tavistock has a phthisis death-rate more than twice that of Axminster, whilst the extremes of general death-rate are only about 14 and i6. Lastly, the year-to-year curve of phthisis death-rate is by lno means necessarily the same as the year-to-year curve of general death-rate in the same district. In some districts one curve is actually rising when the other curve is falling. These considerations leave no room for doubt that, so far as we can judge from consideration of general death-rate, the distribution of phthisis death-rate in the rural sanitarv districts of Devon is due to some other cause that that of general

Mindfulness-based interventions: towards mindful clinical integration

During 2012, over 500 scientific articles on mindfulness were published. This was more than the total number of mindfulness articles published between 1980 and 2000. A recent survey by the Mental Health Foundation (MHF) found that 75% of general practitioners in the UK believe that mindfulness is beneficial for patients with mental health problems (MHF, 2010). Indeed, recent findings indicate that Mindfulness-based interventions (MBIs) may be effective treatments for a broad range of psychological disorders and somatic illnesses (e.g., Chiesa and Serretti, 2011; Fjorback et al., 2011). Given the recent growth of interest into the clinical utility of mindfulness, an appraisal of the empirical evidence and discussion of issues that impact upon the ethical standing and credibility of MBIs is timely.

Towards a second generation of mindfulness-based interventions

Australian & New Zealand Journal of Psychiatry, 49(7) In addition to featuring in the practice guidelines of the American Psychiatric Association and the United Kingdom’s National Institute for Health and Care Excellence for the treatment of recurrent depression in adults, emerging evidence suggests that mindfulnessbased interventions (MBIs) have applications for treating diverse psychopathologies and disorders including addictive behaviours (e.g. pathological gambling, workaholism), post-traumatic stress disorder (PTSD), anger dysregulation, attention deficit hyperactivity disorder, pain disorders (e.g. fibromyalgia), sexual dysfunction and psychotic disorders (Shonin et al., 2014). Mindfulness is also recommended by the Royal Australian and New Zealand College of Psychiatrists as a non-first-line treatment for binge eating disorder in adults. However, commensurate with growing interest into the clinical (and non-clinical) applications of MBIs, there are growing concerns over the rapidity at which mindfulness has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains (Van Gordon et al., 2015). Specifically, these concerns centre on the alleged absence within the first-generation MBIs (FG-MBIs) of the factors that, according to the 2500-year-old system of Buddhist meditative practice, are deemed to maximise the efficacy of mindfulness. Simply put, some researchers, clinicians and Buddhist scholars have suggested that mindfulness in MBIs has been altered from its traditional Buddhist construction to such an extent that it is inaccurate and/or misleading to refer the resultant technique as ‘mindfulness’. To address these concerns, a number of second-generation MBIs (SG-MBIs) have recently been formulated and empirically investigated. Thus, we explicate the key differences between FG-MBIs and SG-MBIs, appraise key empirical findings and issues relating to SG-MBIs and discuss the implications of the trend towards a second generation of MBIs for psychiatrists and service users.

The treatment of workaholism with Meditation Awareness Training: A Case Study

INTRODUCTION The prevalence of workaholism in Western populations is approximately 10%, although estimates vary considerably according to how “workaholism” is defined. There is growing consensus that workaholism is a bona fide behavioral addiction that exists at the extreme end of the work-engagement continuum and causes similar negative consequences to other behavioral addictions such as salience, conflict, tolerance, withdrawal symptoms, and mood modification. Other more specific consequences include burnout, work compulsion, work–family conflict, impaired productivity, asociality, and psychological/somatic illness. Recent decades have witnessed a marked increase in research investigating the etiology, typology, symptoms, prevalence, and correlates of workaholism. However, despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies. Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice. Thus, there is a need to establish dedicated and effective treatments for workaholism. A novel broad-application interventional approach receiving increasing attention by occupational and healthcare stakeholders is that of third-wave cognitive behavioral therapies (CBTs). Third-wave CBTs integrate aspects of Eastern philosophy and typically employ a meditation-based recovery model. A primary treatment mechanism of these techniques involves the regulation of psychological and autonomic arousal by increasing perceptual distance from faulty thoughts and mental urges. A “meditative anchor,” such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present-moment sensory and cognitive–

Does mindfulness work

Reasonably convincing evidence in depression and anxiety

Perforate Septum Ventriculorum, with Infective Endocarditis of the Pulmonary Valves

is supplied in the report of the Committee of Collective Investigation of the Anatomical Society published in the Journal of Anatomy and Physiology in 1894. Out of eight snbjects which I examined a complete bony pterygo-spinous foramen was present in one. In this case it was present on both sides. I have also met with it once in operating. Thus I have met with this variation in two out of nine cases. The question of the possible existence of the pterygo-spinous foramen deserves consideration in consequence of the impeJiment it is liable to prove to the successful performance of certain operations. In the operation of excision of the inferior maxillary nerve at the foramen ovale, if a pterygospinous foramen is present, that portion of the nerve which passes through it will be protected and probably preserved from division, and thus the object for which the operation was undertaken, namely, the complete removal of the nerve below the foramen ovale, will be defeated. In the case of partial ossification of the pterygo-spinous ligament, the efficiency of the protection afforded to the above-mentioned pcrtion of the inferior maxillary nerve, and the chance of its escaping division in this operation, will of course vary with the amount of ossification present. In Roses operation for the removal of the Gasserian ganglion, should there be a pterygo-spinous foramen, this will be the foramen first arrived at in exposing the edge of the foramen ovale by scraping off the pterygoid muscle from its attachment to the sphenoid. When operating it is extremely difficult to distinguish the pterygo-spinous foramen from the foramen ovale. The operator will probably conclude that he has reached the foramen ovale, and will apply his trephine to the edge of the pterygo-spinous foramen. This mistake will much increase the difficulties of the operation, and may give rise to complications which will prevent its successful completion. The following case illustrates the points to which attention has been called above:Mr. P. A. first came to me at the beginning of 1890, at which date he was 54 yeara of age. He. had been a sufferer from trigeminal neuralgia for ten years. The case was a typically severe one. It was confined to the right side. Two diagnostic points localising the disease to the third branch of the fifth nerve deserve notice. The patient stated that when his complaint first began thbe pain was always brought on by movements of the jaw, and was felt just behind the articulation of the lower j,w from whence it spread over the side of the head and face. It would appear from this that the auriculo-temporal branch was first affected, and that pain was set up by traction on the fibrous sheath derived from the dura mater, in which the inferior maxillary nerve is enveloped, and whose tubular prolongations over the auriculo-temporal and masseteric branches are blended with the capsule of the temporomaxillary articulation, and are exposed to a certain degree of traction during the movements of the lower jaw. Secondly, I noticed that during very severe and prolonged attacks of pain the right side of the tongue became thickly furred, while the left side appeared natural, or only slightly affected in this way. This appearance seemed to suggest trophic changes resulting from nervous disturbance. As the patient stated that he had derived benefit from an operation on the auriculo-temporal nerve performed ty Dr. Greathead, of Grahamstown, in i886, I decided to remove the terminal ends of the inferior dental and-lingual nerves. This was done in March, 1890. I divided the inferior dental nerve in the dental canal immediatfly in front of the masseter muscle after exposing the canal by means of a small trephine and dragged out the terminal end ofthe nerve through the mental foramen. About two inches of the lingual nerve was removed by dissecting it out at the base and side of the tongue. This operation gave perfect rest for one year. During the next six months the patient had occasional twinges. During the following six months the pain increased and began to resume its old character. In June, I892, I excised the inferior maxillary nerve at the foramen ovale, reaching the nerve by deepening the sigmoid notch. I removed all that left of the inferior dental nerve by dragging up-the part that was left in the inferior dental eunal through the dental foramen. This operation gave rest for about two years and a half, after which time the pain began to return. I then tried the effect of the percuteur. During the first six months of 1895 I gave the patient IOO sittings, each lasting half an hour. During this period the attacks of pain gradually increased in severity. I was not able to satisfy myself that this treatment affected the course of the disease. In November, I895, I operated on the Gasserian ganglion by Roses method. At the time of the operation the possible existence of a pterygo-spinous foramen was present to my mind in consequence of my having met with this variation only a few days previously in the course of a dissection. Nevertheless I decided (wrongly, as it turned out) against this condition. I mention this in order to show how difficult it is to recognise the pterygo-spinous foramenwhen operating. It was not until the plate of bone cut out by the trephine had been removed that I became aware that what I had taken to be the foramen ovale was really a pterygo-spinous foramen. The trephine hole was therefore wrongly situated, the trephine having been placed against the edge of the pterygo-spinous foramen instead of against that of the foramen ovale. The distance between the outer edge of the foramen ovale and the nearest point of the trephine hole was about -er inch. There was, therefore, a considerable thickness of bone to be removed before the ganglion could be reached, and in doing this with the chisel the cavernous sinus was unfortunately opened. This accident was, of course, a most formidable obstacle to the successful completion of the operation. The end of the nerve which had been divided at the foramen ovale at the previous operation was fixed to the bone and neighbouring tissues by firm adhesions, while that part of the nerve issuing from the pterygo-spinous foramen appeared to have escaped division altogether. The adhesions were broken down and the superior maxillary nerve divided behind the foramen rotundum, but at this stage I found I must abandon my original intention of dissecting out the ganglion in consequence of the profuseness of the haemorrhage, and was forced to content myself with cutting through the ganglion and removing the remains of the inferior maxillary nerve together with that part of the ganglion in immediate connection with it. When I last heard from my patient, eighteen months after this operation, he had been absolutely free from pain since its performance. The practical conclusions to be drawn from the above case may be summed up as follows:I. The possible existence of a pterygo-spinous foramen is a point against the performance of excision of the inferior maxillary nerve at the foramen ovale. 2. It is a point in favour of the Hartley-Krause operation on the Gasserian ganglion as compared with Roses operation.

Motivation types and mental health of UK hospitality workers.

The primary purposes of this study were to (i) assess levels of different types of work motivation in a sample of UK hospitality workers and make a cross-cultural comparison with Chinese counterparts and (ii) identify how work motivation and shame-based attitudes towards mental health explain the variance in mental health problems in UK hospitality workers. One hundred three UK hospitality workers completed self-report measures, and correlation and multiple regression analyses were conducted to identify significant relationships. Findings demonstrate that internal and external motivation levels were higher in UK versus Chinese hospitality workers. Furthermore, external motivation was more significantly associated with shame and mental health problems compared to internal motivation. Motivation accounted for 34–50% of mental health problems. This is the first study to explore the relationship between motivation, shame, and mental health in UK hospitality workers. Findings suggest that augmenting internal motivation may be a novel means of addressing mental health problems in this worker population.

Efficacy of “attachment-based compassion therapy” in the treatment of fibromyalgia: A randomized controlled trial.

Objective There is a growing interest in evaluating the effectiveness of compassion interventions for treating psychological disorders. The present study evaluated the effectiveness of “attachment-based compassion therapy” (ABCT) in the treatment of fibromyalgia (FM), and the role of psychological flexibility as a mediator of improvements. Methods A total of 42 patients with FM were randomly assigned to ABCT or relaxation (active control group). Both the intervention and control condition were combined with treatment as usual (TAU). The primary outcome was functional status (FIQ), and the secondary outcomes were clinical severity (CGI-S), pain catastrophizing (PCS), anxiety (HADS-A), depression (HADS-D), quality of life (EQ-5D), and psychological flexibility (AAQ-II). Differences between the groups were estimated using mixed-effects models, and mediation assessments were conducted using path analyses. Results The ABCT group demonstrated superior outcomes compared to the relaxation group, including better FIQ values after treatment (Bu2009=u2009−3.01; pu2009=u20090.003). Differences in FIQ were maintained at 3-month follow-up (Bu2009=u2009−3.33; pu2009=u20090.001). The absolute risk reduction in ABCT compared to relaxation increased by 40.0%, with an NNTu2009=u20093 based on criteria of ≥50% FIQ reduction after treatment. Psychological flexibility had a significant mediating effect on improvements. Conclusion These results suggest that ABCT combined with TAU appears to be effective in the treatment of FM symptoms. Clinical Trial Registration http://ClinicalTrials.gov, identifier NCT02454244.

How do cultural factors influence the teaching and practice of mindfulness and compassion in latin countries

Network for Prevention and Health Promotion in primary Care (RD12/0005/0006) grant from the Instituto de Salud Carlos III of the Ministry of Economy and Competitiveness (Spain), co-financed with European Union ERDF funds (FEDER “Una manera de hacer Europa”).

FURTHER EXPERIENCE OF THE CARDIAC SIGN IN CANCER.

SOME nine years ago I drew attention to a cardiac sign in cancer which seemed to possess some diagnostic value, and over four years ago 2 I published evidence that this value existed. I now desire to bring forward further evidence corroborating the former, and, from fuller experience, to define more closely the extent of the value and its limitations. May I remark that our means of diagnosing cancer, even in its later stages, are not always so perfect as to make any help superfluous? The cardiac sign in cancer consists of a remarkable diminution of the cardiac dullness in the recumbent posture as determined by digital percussion. In that postuire the dullness, in the normal adult, begins above about the third costal cartilage, reaches rightwards as nearly as possible to the mid-sternal line, and measures across about 3 to 3in. at the level of the fifth costal iartilage. On the other lhand, in the cancer patient who presents the sign the cardiac dullness in recumbency begins above about the fourth or fifth costal cartilage, has its riglht margin I in. or 1 in. to the left of the mid-sternal line, and measures across less than 2 in. at the level of tlhe fifth costal cartilage. Often it measures less than 1 in. across. Sometimes there is no cardiac dullness at all. Digital percussion is a good deal dependent on personal factors. The measurements I am here quoting refer to my own observations. Others may find somewhat different limits. The percussion I use is moderately light. The sign may be explained in three different ways: 1. In some cases of cancer the heart is small, and this reduction in size has been said to account for the reduction of the dullness. It may sometimes partly explain it; but by no means always; for often the dullness, though very small in the recumbent position, is normally or even abnormally broad in the erect. 2. If the loss of elasticity, so common in the skin in cases of cancer, affects the lung as well, it is conceivable tlhat ordinary respiration may induce a sort of spurious emplhysema and thus diminish the dullness. It is now known that a peculiar form of emphysema does often occur in cancer--Fenwick found it in 28 per cent. of his cases of gastric cancer 3-and no doubt in many cases this helps to produce the sign. 3. The cardiac sign is often associated with a remarkably soft and toneless pulse, and with very feeble heart sounds. If we suppose that the first is due to a deficiency of blood-such as the anaemia so often present suggestsand that the second shows a flabbiness of the heart muscle comparable to the flabbiness of the skeletal muscles so often recognizable in such patients, it is not difficult to imagine a flabby and imperfectly filled heart dropping back from the anterior chest wall on recumnbency more than a normal heart would do. And this is just what actuallyseems to occur. For the disparity between the heart dlullness in the erect and recumbent positions in cancer is usua.lly much greater than that observed either in health or in other diseases. I have found, for instance, a heart dullness in a case of cancer, measuring 5 in. across in the erect position, drop to 1i in. across when the recumbent posture was assumed. Indeed, in cases where an enlarged heart prevents the appearance of the cardiac sign as I have defined it, I have thought that such an exceptional disparity in the erect and recumbent dullnesses, or an exceptional withdrawal leftwards of the rightward edge of dullness on assuming the recumbent position, had almost the same tmeaning as the cardiac sigu itself. That, however, requires further investigation. But it is necessary to bear in mind certain obvious limitations of the signs significance. Thus, when any cause is present tending, like common emphysema, to reduce the hearts dullness, then a very small cardiac dullness has naturally no special meaning. Also where, in a case of suspected cancer, some well known cause of .enlarged cardiac dullness is present, such as albuminuria, valvular heart disease or retraction of lung from phthisis or former pleurisy, then tIe absenq of the cardiac sign is, of course, of no significance. I To these obvious limitations I would add two others, from experience, less obvious and yet easily understood. Where the heart is considerably displaced upwards by abdominal distension, I lhave found the sign unreliable Here clearly the organ is pushed from a wider into a narrower space, where it cannot so easily drop away on recumbency from the anterior chest wall. Again, where a large oesophageal cancer has lain just behind tlle heart the sign has been absent, and I have thouglit that tlhis might be explained by the growth pinning the organ forward against the sternum and rib cartilages.