Healthy Nonpatients Research Articles

Repeatability of a cold stress test to assess cold sensitization.

Non-freezing cold injury (NFCI) is a syndrome in which damage to peripheral tissues occurs without the tissues freezing following exposure to low ambient temperatures. To assess the test-retest reliability of a cold stress test (CST) used to assess cold sensitization. Volunteers with no self-reported history of NFCI undertook the CST on three occasions. Thermal images were taken of the foot and hand before, immediately after and 5min after immersion of the limb in cold water for 2min. Cold sensitization was graded by the two clinicians and the lead author. Spot temperatures from the toe and finger pads were recorded. There were 30 white and 19 black male participants. The ratings indicated substantial agreement [a Cohen's kappa (κ) value of 0.61-0.8] to within ± one grading category for the hands and feet of the white volunteers and the hands of the black volunteers. Limits of agreement (LoA) analysis for toe and finger pad temperatures indicated high agreement (absolute 95% LoA < 5.5°C). Test-retest reliability for the feet of the black volunteers was not supported by the gradings (κ = 0.38) and toe pad temperatures (absolute 95% LoA = 9.5°C and coefficient of variation = 11%). The test-retest reliability of the CST is considered adequate for the assessment of the cold sensitization of the hands and feet of white and the hands of black healthy non-patients. The study should be repeated with patients who have suffered a NFCI.

Addressing Issues in the Development and Use of the Composite International Reference Values as Rorschach Norms for Adults

This article describes 3 studies evaluating normative reference data for the Rorschach Comprehensive System (CS; Exner, 2003, 2007), with a particular focus on the viability of the Composite International Reference Values (CIRVs) that were compiled from 21 adult studies by Meyer, Erdberg, and Shaffer (2007). Study 1 documented how the CIRV norms are virtually identical when organized into 3 groups differentiated by the quality of their data collection effort, including an optimal group of 4 samples that relied on multiple experienced examiners and provided ongoing quality control over administration and coding. Analyses also showed that relative to the group of more optimal samples, the group of less optimal samples did not produce more variability in summary scores within or across samples or lower interrater reliability for coding. Study 2 used the existing CS reference norms to generate T scores for the CIRV means and documented how the CS norms make other samples of healthy nonpatients look psychologically impaired in multiple domains. Study 3 documented with examples from 4 different countries how 2 sets of within-country local norms produced notably different results on some variables, which compromises the ability of local norms to be used instead of the CIRVs. Taken together, the 3 studies provide support for the use of CIRVs in clinical practice as norms that are generalizable across samples, settings, languages, and cultures and that account for the natural variability that is present when clinicians and researchers contend with the ambiguity contained in the standard CS reference materials concerning the proper ways to administer and code. We conclude by urging CS users to rely on the CIRVs when making clinical inferences and to adopt alternative methods of ensuring they are following cohesively standardized administration and coding guidelines.

Using Crisis Theory to Explain the Quality of Life of Organ Transplant Patients

To evaluate the literature on the stress, coping, and quality of life of organ transplant candidates and recipients, and to place previous research within a theoretical context. CINAHL database, Proquest database, Google Scholar; references from articles were also reviewed to identify additional data. Qualitative and quantitative research studies and meta-analyses pertinent to the stress, coping, and quality of life of transplant candidates and recipients were selected. Stressors associated with the transplantation process, coping strategies of transplant patients, and quality of life or transplant patients have been well researched for many years. Patients typically use problem-focused coping strategies in response to various stressors. Transplant recipients typically report a higher quality of life than do transplant candidates; however, posttransplant quality of life does not typically equal the quality of life of healthy nonpatients. The relationship between stress, coping, and quality of life of transplant patients has not yet been systematically investigated from a theoretical perspective. Recommendations for further research are provided.

Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts

Previous findings suggested that hypochondriacal attitudes could originate from a pessimistic trait independent of illness-related thoughts. We hypothesised that hypochondriacal attitudes correlated with a general cognitive tendency towards negative interpretations and reduced familiarisation. Healthy non-patients were invited to participate. The sum score from the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales assessed hypochondriacal attitudes. Participants without any knowledge of the Chinese language were asked to guess whether or not each of eight Chinese characters had a positive meaning and whether the characters appeared familiar. Stimuli without semantic content avoided a reference to illness in order to assess a general cognitive bias. Participants with high hypochondriasis scores rated apparently familiar stimuli as being less positive in comparison to low hypochondriacal participants, F(1,78) = 9.2, p = 0.003, η 2 = 0.10; correlation of hypochondriasis scores to the differences between ratings of familiar and unfamiliar characters: ρ = 0.345, p = 0.002. Positivity and familiarity ratings did not correlate with hypochondriacal attitudes independent of each other. A less positive appraisal of familiar experiences, which is unrelated to illness-related thoughts, may maintain hypochondriacal concerns. A general distrustful attitude towards familiar procedures should be considered in hypochondriasis.

Anger Management Style Moderates Effects of Attention Strategy During Acute Pain Induction on Physiological Responses to Subsequent Mental Stress and Recovery: A Comparison of Chronic Pain Patients and Healthy Nonpatients

To examine whether high trait anger-out chronic low back (CLBP) patients would show exceptionally large symptom-specific lower paraspinal (LP) responses, compared with healthy nonpatients, during pain induction, a subsequent mental stressor, and recovery when they were urged to suppress awareness of pain and suffering. CLBP patients (n = 93) and nonpatients (n = 105) were assigned randomly to one of four attention strategy conditions for use during pain induction: sensory-focus, distraction, suppression, or control. All participants underwent a cold pressor, and then performed mental arithmetic. They completed the anger-out (AOS) and anger-in (AIS) subscales of the Anger Expression Inventory. General Linear Model procedures were used to test Attention Strategy Condition x Patient/Nonpatient Status x AOS (or AIS) x Period interactions for physiological indices. Significant interactions were found such that: a) high trait anger-out patients in the Suppression condition seemed to show the greatest LP reactivity during the mental arithmetic followed by the slowest recovery compared with other conditions; b) high trait anger-out patients and nonpatients in the Suppression condition seemed to show the slowest systolic blood pressure recoveries compared with other conditions. Results extend previous work by suggesting that an anger-out style moderates effects of how attention is allocated during pain on responses to and recovery from a subsequent mental stressor. Results provide further evidence that trait anger-out and trait anger-in among CLBP patients are associated with increased LP muscle tension during and after pain and mental stress.

It must be awful for them: Perspective and task context affects ratings for health conditions

AbstractWhen survey respondents rate the quality of life (QoL) associated with a health condition, they must not only evaluate the health condition itself, but must also interpret the meaning of the rating scale in order to assign a specific value. The way that respondents approach this task depends on subjective interpretations, resulting in inconsistent results across populations and tasks. In particular, patients and non-patients often give very different ratings to health conditions, a discrepancy that raises questions about the objectivity of either groups’ evaluations. In this study, we found that the perspective of the raters (i.e., their own current health relative to the health conditions they rated) influences the way they distinguish between different health states that vary in severity. Consistent with prospect theory, a mild and a severe lung disease scenario were rated quite differently by lung disease patients whose own health falls between the two scenarios, whereas healthy non-patients, whose own health was better than both scenarios, rated the two scenarios as much more similar. In addition, we found that the context of the rating task influences the way participants distinguish between mild and severe scenarios. Both patients and non-patients gave less distinct ratings to the two scenarios when each were presented in isolation than when they were presented alongside other scenarios that provided contextual information about the possible range of severity for lung disease. These results raise continuing concerns about the reliability and validity of subjective QoL ratings, as these ratings are highly sensitive to differences between respondent groups and the particulars of the rating task.

Attentional network task performance in patients with schizophrenia–spectrum disorders: Evidence of a specific deficit

Although attentional deficits are frequently displayed by schizophrenia and spectrum patients, the precise nature of the impairment is unclear. The present study investigates attentional performance in 26 schizophrenia–spectrum outpatients and 24 healthy controls using the Attentional Network Task (ANT). We assessed the efficiency of the segregated alerting, orienting, and executive control networks by measuring how response latencies were influenced by alerting cues, spatial cues, and flanking stimuli. In overall ANOVAs we found main effects of cue condition and flanker congruency. The data also revealed a significant interaction of group and flanker type, with schizophrenia–spectrum patients taking longer on average to resolve conflict. These results suggest that compared to the healthy nonpatients, schizophrenia–spectrum patients show a deficit in their executive control network. Considered together, these findings support the notion that schizophrenia–spectrum patients have a specific attentional deficit, rather than a global one. The significance of these findings is considered from both experimental and clinical perspectives.

The role of attentional strategies in moderating links between acute pain induction and subsequent psychological stress: Evidence for symptom-specific reactivity among patients with chronic pain versus healthy nonpatients.

Vulnerability to stressors after pain may depend on the degree to which the strategy used to process information about pain perpetuates thoughts of suffering and distress. Patients with chronic low back pain (CLBP) may show susceptibility to stress after pain through symptom-specific (lower paraspinal [LP]) muscle reactivity. Patients with CLBP (n = 100) and healthy nonpatients (n = 105) underwent a cold pressor, under sensory focus, distraction, suppression, or control conditions, and then performed mental arithmetic. Only patients under the suppression condition revealed increased LP tension during pain that was sustained during mental arithmetic and sustained systolic blood pressure after mental arithmetic. Patients with CLBP who suppress pain may detrimentally affect responses to the next noxious event, particularly through prolonged LP muscle tension, that may contribute to a cycle of pain-stress-pain.

Ignorance of Hedonic Adaptation to Hemodialysis: A Study Using Ecological Momentary Assessment.

Healthy people generally underestimate the self-reported well-being of people with disabilities and serious illnesses. The cause of this discrepancy is in dispute, and the present study provides evidence for 2 causes. First, healthy people fail to anticipate hedonic adaptation to poor health. Using an ecological momentary assessment measure of mood, the authors failed to find evidence that hemodialysis patients are less happy than healthy nonpatients are, suggesting that they have largely, if not completely, adapted to their condition. In a forecasting task, healthy people failed to anticipate this adaptation. Second, although controls understated their own mood in both an estimation task and a recall task, patients were quite accurate in both tasks. This relative negativity in controls' estimates of their own moods could also contribute to their underestimation of the moods and overall well-being of patients.

Psychological Defense Strategies According to the Defense Mechanism Test Among Patients with Severe Conversion Disorder

Nineteen patients with a diagnosis of conversion disorder (according to DSM-IV criteria), and 32 healthy nonpatients, were assessed using the Defense Mechanism Test (DMT), which is a projective perception test that examines psychodynamic defense operations according to psychoanalytical theory. The conversion group was significantly separated from the non-patient group. The nonpatients showed better reality testing and the ability to perceive the negative affective element of the stimulus picture when compared to the patient group. The conversion group was characterized by a lateness of perception, specific constellations of defensive maneuvers, and a much more nonemotionally adapted pattern compared to the control group. This supports the notion that conversion symptoms are non-verbal communications inhibiting more articulated verbal expressions of emotions. The results lend support to the theories of psychodynamic self psychology, where the organization of affect experience is believed to constitute an essential structural aspect of the self, determining to what degree affects will have (or not have) a disrupting effect on the individual's capacity to relate to self and to others. It is suggested that the combination of the DMT and the soft multivariate modeling of data may have clinical implications in the assessment of patients with conversion symptoms. 19 Patienten mit einer nach DSM-IV-Kriterien gestellten Diagnose einer Konversionsstörung und 32 gesunde Vergleichspersonen wurdn mit dem Defense Mechanism Test (DMT) untersucht. Dieser ist ein projektiver Test zur Erfassung psychodynaischer Abwehroperationen und basiert auf dr psychoanalytischen Theorie. Die Patienten unterschieden sich signífikant von der Vergeichspopulation. Letztere zeigte eie bessere Realitätsprüfung und bessere Fähigkeiten, negative Affekte in einer Vorlage wahrzunehmen als die Patienten. Die Patienten wren charakterisiert durch eine verzögerte Wahrnehmung, spezifische Konstellationen von Abwehrmanövern und ein deutlich weniger emotionales Reaktionsmuster. Dieses Ergebnis stützt die Auffassung, wonach Konversionssymptome nonverbale Kommunikationen darstellen, die wiederum artikulierte verbale Äßerungen hemmen. Die Ergebnisse stützen auch die Auffassung der Selbstpsychologie, wonach die Organisation von affektiven Erfahrungen einen wesentlichen strukturellen Aspekt des Selbst konstitutieren und festlegen, in welchem Ausmaß Affekte sich negativ auf die Fähigkeit eines Individuums auswirken, zu anderen oder zu sich selbst in Beziehung zu treten. Es wird diskutiert, daß eine Kombination des DMT und einer multivariaten Modellierung darauf basierender Daten klinische Implikationen für die Diagnostik von Patienten mit Konversionsstörungen haben könnte. 19 patients avec le diagnostic DSM-IV d'un trouble de convewrsion et 32 sujets en bonne santé ont été évalués par le DMT (Defense Mechanism Test), un test de perception projective qui examine les opérations de défense selon la théorie psychanalytique. Le groupe de conversion s'est distingué de manière significative du groupe des non-patients. Ce dernier s'est montré supérierur en ‘reality testing’ et dans sa capacité à percevoir l'élément affectif néfgatif dans l'image présenté. Le groupe de conversion s'est caractérisé par une perception tardive, des constellations spécifiques des manoeuvres défensives, et un pattern adapté de façon beaucoup plus non émotionnelle. Ceci soutient la notion que les symptômes de conversion sont des communications non vrbales inhibant une expression verbale plus articulées des émotions. Les résultats apportent un renfort aux théories psychodynamiques de la psychologie du Soi pour laquelle l'organisation de l'expérience affective est supposée constituer un aspect structural essentiel du Soi en déterminant dans quelle mesure les affects auront un effect perturbant ou pas sur la capacité de l'individu d'étre en relation avec soi-même et les autres. Il est suggéré que la combinaison ente DMT et un modelage multivarié modéré des données pourrait avoir des implications cliniques sur l'évaluation des patients présentant des symptômes de conversion. Se evlauaron diecinueve pacientes con diagnóstico de trastorno de conversión según los criterios del DSM IV, y 32 personas sanas con el Test de Mecanismos de Defensa (DMT), un test proyectivo que examina las operaciones psicodinámicas de defensa según la teoría psicoanalítica. El grupo de conversión difirió significativamente del grupo d no-pacientes. Estos últimos mostraron pruebas de realidad y habilidad para percibir los elementos negativos del afecto en los caudros-estímulo mejores que las de los pacientes. El grupo de conversión se caracterizó por una morosidad en la percepción, por constelaciones específicas de maniobras defensivas y por una pauta adaptativa mucho más no-emocional que el grupo control. Este hallazgo apoya la noción d que los síntomas de conversión son comunicaciones no verbales que inhiben expresiones verbales más articuladas de las emociones. Los resultados dan apoyo a las teorías psicodinámicas de la psicología del self, en las que se considera que la organización de la experiencia afectiva constituye un aspecto estructural esencial del self que determina el grado en que los afectos tendrán (o no) un efecto disruptivo sobre la capacidad del sujeto de relacionarse consigo mismo y con otos. Se sugiere que la combinación del DMT y el modelamiento multivariado blando de los datos tiene implicaciones clínicas en la evaluación de pacientes con síntomas de conversión.

A Review of the Neuropsychological Effects of Commonly Used Prescription Medications

The practice of clinical neuropsychology has traditionally accorded limited attention to the impact of prescription medications on cognitive functioning. Though neuropsychologists see a wide array of patients with cerebropathologic and other organ system disease that are under pharmacotherapy, systematic attention to how these compounds potentially affect neuropsychological functioning has lagged. Psychomotor functioning, concentration, and memory are the most common cognitive domains negatively affected by such medications. In general sedative, psychomotor, and, to a lesser extent, attention/concentration effects covary and typically show tolerance with sustained drug administration. Memory effects are more resistant probably due to ongoing anticholinergic effects and the established link between the cholinergic system and memory functioning. This review covers the basic science and clinical literature addressing neuropsychological functioning both in healthy nonpatients and in patients treated with antidepressants, anxiolytics, stimulants, antihypertensives, antiepileptics and antihistamines. Critical to the understanding of the effects of these agents is the integration of multiple factors that modulate medication-induced neurocognitive effects, such as chronicity of treatment, tolerance, age, ethnicity, metabolic capacity, psychological, and neurological disorders in the patient, and the benefits of successful treatment of these disorders.