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OBJECTIVE: The relationship between characteristics of self-soothing ability, the capacity for evocative memory, and aloneness was investigated in a clinical sample of 50 bulimia nervosa (BN) patients. METHOD: Individuals meeting DSM-III-R criteria for BN who participated in a randomized trial of guided imagery completed measures of Soothing Receptivity and a modified version of the UCLA-Loneliness scale, resulting in the Aloneness/Evocative Memory Scale. RESULTS: A lower level of soothing receptivity (indicating a decreased capacity for self-soothing) was correlated with a decreased capacity for evocative memory. A lower level of soothing receptivity and decreased capacity for evocative memory were associated with a greater experience of aloneness. DISCUSSION: Results suggest the need for a more comprehensive understanding of the role of affect regulation and the experience of aloneness in BN and the need to develop treatments to specifically address these features of the illness. Copyright 2000 by John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Eight trainees in psychiatry taking their final oral fellowship examinations were compared with 16 controls to determine the effect of stress on their immune system. Two measures of stress were utilized to distinguish the highly stressed subjects from those minimally stressed. T cell subpopulations. B cell numbers, mitogen reactivity, natural killer cell activity, plaque forming cell responsiveness, antigen specific T suppressor cell activity, and hormone levels were studied 2 weeks before and 2 weeks after the exam. The results demonstrated transiently elevated numbers of T and B lymphocytes but impaired plaque forming cell and mitogen responsiveness in the highly stressed group prior to their exam which normalized later. The results support the concept that stress may significantly alter the immune response in man. [ABSTRACT FROM AUTHOR]

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received. [ABSTRACT FROM AUTHOR]

The field of psychiatry is experiencing great excitement at this time, much as it was 100 years ago. Current excitement is rooted in the greatly strengthened therapeutics, new models for understanding, and an exponential increase in knowledge of brain function as well as in the opportunity to revise health care delivery. While public expectations of professionals have generally fallen, the role of the healer, which is at the heart of psychiatric practice, has remained high in public regard. Psychiatry has also had to develop new relationships with an active consumer movement. Consumers now appropriately expect to be part of the planning, governance, and evaluation of care. Patients are questioning the research agenda and demand a role in determining the conduct of investigations. This active consumer movement is playing an important role in destigmatizing mental illnesses. Newer, nonmoralistic theories about mental illness and the profession's emphasis on the public trust have also played an important role. The increasing closeness of psychiatry to the rest of medicine has had a greatly beneficial impact, not only on stigma but also on diagnosis and treatment. Care must be taken, however, to see that diagnosis does not become a means to avoiding understanding of people. A welcome recent change has been the reunion between psychiatry and the addictions. This reunion has been facilitated by the development of multifactorial models of care in the mental health field and harm-reduction strategies in the addictions. This bodes well for more integrated treatment in the coming years. The strong psychiatric treatments that are now available and those on the horizon also auger well for an exciting period in our field. The excitement is enhanced by recognizing the multiple approaches to care that have been demonstrated to be effective and the need for great investment in research in this country and by developing new partnerships between the profession and public. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years.Methods: A total of 29 psychiatrists, all of whom had participated in a study during their residency 21 to 24 years earlier, completed a self-report questionnaire. The first set of questions addressed the type and characteristics of their professional practice; the second set assessed aspects of their nonprofessional practice; and the third set assessed aspects of their nonprofessional, personal lifestyles. The personality traits of neuroticism and extraversion were assessed during the residency years and were used as predictors. Composite measures of self-perceived external success and personal satisfaction were computed. Regression models were constructed to determine the best predictors of these composite measures.Results: Neuroticism proved to be a significant predictor of external success but not of personal satisfaction, with higher scores predicting a lower rating of perceived external success. There were 2 practice characteristics--involvement with research and practising from an orientation other than psychoanalytic--that predicted perception of success. One personal lifestyle characteristic--the perception that one's nonprofessional life sustained professional life--also predicted perception of success. The best predictor of personal satisfaction was overall satisfaction with nonprofessional aspects of life.Conclusions: Personality, nonprofessional social support, and engaging in research are associated with greater perceived success and personal satisfaction with a career in psychiatry. [ABSTRACT FROM AUTHOR]

Objective: Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment.Method: The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions.Results: Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsychosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers.Conclusions: Improving understanding of the reasons for treatment refractoriness in patients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process. [ABSTRACT FROM AUTHOR]