Personality In Patients Research Articles

The ethics of deep brain stimulation (DBS).

Deep brain stimulation (DBS) is an invasive technique designed to stimulate certain deep brain regions for therapeutic purposes and is currently used mainly in patients with neurodegenerative disorders, such as Parkinson's disease. However, DBS is also used increasingly for other experimental applications, such as the treatment of psychiatric disorders (e.g. severe depression), weight reduction. Apart from its therapeutic potential, DBS can cause severe adverse effects, some that might also have a significant impact on the patient's personality and autonomy by the external stimulation of DBS which effects lie beyond the individual's control and free will. The article's purpose is to outline the procedures of DBS currently used in therapeutic and experimental applications and to discuss the ethical concerns regarding this procedure. It will address the clinical benefit-risk-ratio, the particular ethics of research in this field, and the ethical issues raised by affecting a patient's or an individual's personality and autonomous behaviour. Moreover, a potential ethical guideline, the Ulysses contract is discussed for the field of clinical application as well as the question of responsibility.

Correlation of psychoemotional status and adaptation to complete dentures

Patients with full adentia are characterized by the formation of specific psycho-emotional status. Rational psychotherapeutic support of these patients largely determines the efficiency of dental prosthetic treatment. At the same time, the definition of mental and emotional status is not included in the diagnostic examination protocol. Considering the above the purpose of the study was to evaluate mental and emotional status of patients receiving complete dentures. Prosthetic rehabilitation of 30 patients with complete teeth loss was performed and clinical evaluation and evaluation of mental and emotional status were carried out before and after treatment. Patients with negative experiences of prosthetics showed a higher level of personal and situational anxiety. There was correlation of adaptation to removable dentures and the patient's personality traits. It is determined that emotional instability during treatment tends to decrease affecting the timing of adaptation to complete dentures. It is noted that patients with repeated prosthetics have earlier recovery of coordination ability of the masticatory muscles.

Patient personality and therapist countertransference.

The purpose of this review is to provide a comprehensive and critical examination of the empirical literature about the relation between patient personality and therapist countertransference. The therapist's countertransference can play a crucial role in psychotherapy outcomes, especially in the treatment of personality disorders. The therapist's emotional responses to patients can accomplish the following: inform the clinician about the patient's personality, impact therapy outcome, influence patient resistance and elaboration, mediate the influence of the therapist's interventions and influence therapeutic alliance. In the last years, several studies have empirically demonstrated the presence of a specific pattern of therapist responses that are related to different patient personality disorders. Other works showed how the effects of the therapist's technique depend on the emotional context in which they are delivered and in particular countertransference experiences. Moreover, researchers suggest that the therapist's emotional responses occur across all kinds of therapy and are independent of the therapist's theoretical preferences.

Core clinical competencies for dental graduates in Taiwan: Considering local and cultural issues

Background/purposeDepending on the educational institute to which they are associated, professors of dentistry differ in their objectives and ideals. Thus, reaching a common consensus regarding the requirements that are essential in this field has proven exceedingly difficult. This study sought to provide a reference for the design of clinical courses and the assessment of educational outcomes in the field of dentistry. Materials and methodsThis study used the nominal group technique with 12 volunteers recruited from the School of Dentistry, National Taiwan University (Taipei, Taiwan) to identify the essential core competencies required by dental students before graduation. ResultsThe participants classified the core competencies into two categories, namely, operational and nonoperational, and then prioritized them according to importance. The three most important of nonoperational capabilities were patient–dentist discourse (querying patients and responding to questions), treatment planning, and the ability to deal with medically compromised dental patients. The three most important operational capabilities were cavity filling, infection control, and proper handling of needles. ConclusionPatient–dentist discourse was identified as the most important duty in dealing with patients on their first visit. Suitable discourse can help to identify the purpose of the current visit and obtain information related to a patient's dental and medical history. It also gives the dental staff an indication of the patient's personality traits and helps in the formulation of an initial treatment plan following the examination.

Facing the diagnosis of myocardial infarction: A qualitative study

Background: Patient experience is increasingly recognized as one of the three pillars of quality in health care, alongside clinical effectiveness and patient safety. However, little attention has been paid to the patients’ experience from the point of view of health care delivery.Objective: To explore the initial experience of patients facing a new diagnosis of myocardial infarction (MI).Methods: Thirty semi-structured, individual interviews were performed. The Grounded Theory method was used. Atlas.ti qualitative data analysis software facilitated the analysis.Results: Three patterns of MI diagnosis experience were found: a close encounter with death, severe pain, and ‘silent’ MI. Newly-diagnosed MI patients who experienced a close encounter with death expected that, after necessary life-saving measures, their physician would not force immediate conversation, but leave them alone, simply to take pleasure in being alive. Newly-diagnosed MI patients who did not experience a close encounter with death expected that their physician would provide not only medical care but also immediate emotional support and opportunities to discuss in their own words their ideas, thoughts, concerns and fears. Six factors facilitated patients coping with a new diagnosis of MI: stay in hospital, completion of diagnostic tests, trust in physicians, the patient's previous expectation that he/she could have a heart attack, the patient's personality, and the need for solitude.Conclusion: Physicians should be aware that different patterns of patient experience when facing MI could indicate patients’ differing needs for immediate emotional support and communication.

Supervision and the art of baseball.

AbstractSupervision of psychotherapy consists of a three-person matrix: supervisor, student, and patient. My approach to supervision is to work within a student's natural personality and not to attempt to change it. A comparison is made to baseball wherein a player's natural approach may be modified but not significantly altered. In both cases uncertainty is normative. Supervision requires a learning which may develop into a facsimile of therapy in order for the student to reinforce positive aspects.Keywords: psychodynamic, psychotherapy, supervision, trainingResumeLa supervision en psychotherapie repose sur une matrice de trois personnes : le superviseur, l'etudiant et le patient. Mon approche en matiere de supervision est de travailler avec la personnalite naturelle de l'etudiant et de ne pas chercher a la changer. On pourrait comparer cette notion avec le baseball : on ne peut que modifier legerement l'approche naturelle d'un joueur. Dans les deux domaines, l'incertitude est normative. La supervision requiert une « alliance d'apprentissage » qui peut evoluer en un genre de therapie afin que l'etudiant puisse renforcer ses aspects positifs.Mots-cles : psychodynamique, psychotherapie, supervision, formation.When I entered graduate school in the middle of the last century, I was told in no uncertain terms that research in psychology was extremely difficult and required a rather lengthy apprenticeship leading to a PhD and then a career requiring continuing dedication and effort. Clinical work, on the other hand was considered to be somewhat easier and mastered in practicum placements and in- ternships. Reality, in the form of years in both the clinical and academic realm has convinced me of the complexity and difficulty of clinical work. The research paradigm conforms to a set of well-established rules both in terms of design, analysis of data, conclusions and so on. This applies to both clinical experimental research (randomized controlled trials, etc.) and grounded theory research. On the other hand, clinical work can be viewed as a unique experiment with each patient as an N of 1. It becomes even more complex in that the clinician must be part of that experiment with each patient and cannot be a constant fixed variable. Clinical work in diagnosis and psychotherapy includes, indeed depends, on personality variables of the psychologist interacting with the unique- ness of the patient's personality and presenting problems. The unique- ness of the psychologist interacts with the patient's personality and presenting problems. Supervision of clinical work is even more com- plex, as I will try to explicate in the article because it involves a three person interaction: supervisor, student, and patient.1My approach to supervision starts with my assessment of the student's natural clinical tendencies. In this regard, I will use professional baseball, especially hitting (batting) as an analogy. It is said and is received wisdom in the sports world that the most difficult act is that of hitting a baseball. It requires enormous skill to hit a hard round ball with a wooden cylindrical bat travelling at upward of 100 mph from a distance of 60 feet, 6 in. The most proficient players may do this successfully three out of 10 at- tempts. I have probably witnessed about 2,000 major league base- ball games and countless games on TV and what has always struck me apart from the complexity of the game are the various ap- proaches to hitting, and the stance each player has. As Yogi Berra, the baseball philosopher said, You can see a lot by observing. Some players have an open stance (more facing the pitcher), some have a more closed stance, some hold the bat low, some high, some close to the home plate, some more distant, some crouch, some stand upright. They use individual trigger mechanisms. Batters vary in terms of how they hold the bat and so on. Professional players have natural tendencies which they have adopted as youngsters. …

EPA-0153 – First psycohotic decompensation in a patient with extremely complex comorbidity - an integrative and individualized approach

Acute psychotic disorder is a relatively common clinical diagnosis, sometimes isolated, transient and non-returnable, but quite often representing the beginning of a more serious illness, such as schizophrenia, schizoaffective disorder or bipolar affective disorder. Psychotic decompensation within the personality disorder spectrum is often met in clinical practice as well. Standardized therapeutic protocols emphasize decisive application of psychofarmacotherapy, but for the complete treatment it is vital to understand the psychological characteristics of the patient's personality, his specific social and family relations, ensuring the achievement of a strong supportive therapeutic alliance. In this paper we present a female in-patient, aged 41, who has been treated for her first psychotic decompensation. Florid psychotic symptoms have been relatively quickly mitigated by the combined use of typical and atypical antipsychotics, with the adjuvant supportive anxiolytic therapy. During the treatment some crucial emotional and psychological moments in the patient's life have been identified, and only with their complete understanding have we been able to achieve full treatment. Especially important have been severe traumatic experiences since the patient's earliest childhood, with consequent inhibiting panic equivalents. The patient has established immature defence mechanisms, with the general functioning organized by passive-dependent patterns. She has been repeating those early adopted patterns in all forms of her social and family interactions. Occasional non-specific prepsychotic symptoms over the years she has been reducing through the alcohol abuse. This intriguing case report has once again confirmed that only a multidisciplinary personalized holistic approach may lead to a positive therapeutic progress and a better long-term prognosis.

Effect of Patient's Personality on Satisfaction with Their Present Complete Denture and after Increasing the Occlusal Vertical Dimension: A Study of Edentulous Egyptian Patients.

Complete denture wearers often find it difficult to accept a new denture. Personality traits are among the factors that possibly affect patient satisfaction with a complete denture. Our aim was to investigate the influence of patients' personality on satisfaction with their present denture and after an increase in the occlusal vertical dimension (OVD). Sixty edentulous patients with complete dentures (22 men and 38 women, mean age 66 years, and range 50–75 years) participated in the study. The age of their complete dentures ranged from 5 to 16 years. Patients' personalities were evaluated using the Arabic version of the Eysenck Personality Questionnaire. Their satisfaction with their dentures before and after restoration of the OVD and relining of the mandibular denture was evaluated using two questionnaires (I and II), Patients with a high score of neuroticism were less satisfied with their original dentures and after relining and an increase of OVD compared with patients with an average score in that trait. The personality trait of psychoticism was significant to patients' acceptance of an increase in OVD; that is, patients with a high score were less satisfied with their dentures after increase of OVD than patients with an average score. It is concluded that personality traits affect patients' acceptance of their complete dentures.

Psychological and Social Consequences after Reconstruction of Upper Extremity Trauma: Methods of Detection and Management

Upper extremity trauma and resulting disability is a stressful event and can affect a patient's personality. Several studies have shown that this injury type has serious psychological and/or social consequences. We systematically reviewed the evidence on the consequences of disability after a complex trauma (combination of soft tissue, osseous, vascular, and nerve involvement) of the upper extremity. We tried to find out the potential crucial factors that could determine the final hand function. In addition, we considered the challenges that need to be addressed to eliminate the adverse or negative effects that arise from upper limb trauma. In the literature, there is a growing interest to study changes in patients' quality of life and return to work. Psychological morbidity is an important part of patients' perceived general health. These issues could play an important role in the final functional outcome of the therapy. An early identification and treatment of trauma-related distress in patients may prevent progression of psychological pathology and mitigate negative effects on general health status. It may be important to evaluate the amount of psychological distress when caring for patients with hand injuries.

Seating

Patients with neuromuscular disorders are not able to adapt their sitting posture continuously. Seating devices, like seating orthoses, braces, seating shells, and custom-made cushions for wheelchairs, however may improve their quality of life by stabilizing their pelvis and trunk. Sitting should be regarded as a dynamic process regulated by motor reactions of trunk and pelvic muscles due to endogenic and exogenic influences. Prerequisites for the indication of high-quality and cost effective seating devices are guidelines for planning and fitting which consider both pathomorphologic mechanisms and the patient's personality. In order to avoid functional problems and pain caused by an insufficient seating device it is necessary to pay attention to the exact indication, time, and combination of technical options. Planning within a seating clinic needs teamwork. Primarily the goal of treatment is defined; it depends on the functional deficit, on the daily living activities of the patient, and on the social environmental factors. Secondly, fitting of the devices follows defined treatment guidelines. By examination of the sensor and musculoskeletal system, it is possible to classify the patient's sitting or seating ability for simplifying indication: three groups of ACTIVE sitters who are able to change position of trunk and pelvis actively are differentiated from three groups of PASSIVE sitters who have to be seated.

EHPS 2013 Abstracts

Up to 70% of hypertensive patients do not adhere to the medical recommendations. Among the factors influencing adherence, physician-patient relationship is important (the doctor and his practice characteristics, patient characteristics, and their interaction). For example, physician's interpersonal style and the way they are autonomy supportive can impact the subsequent patient's adherence. Indeed, supportive autonomy style can bring autonomous motivation and better self-regulation of health behaviours. However, physician's interpersonal style can also interact with patient's personality trait. Some people have a dependent personality and others more independent personality. These personalities would be associated with configuration of traits like agreeableness, conscientiousness, and neuroticism. So, interaction between physician's style and patient's personality is important to take into account. Moreover, in this interaction, patients' perceptions of the degree to which their physician is autonomy supportive can impact the need (motivational force which impels individuals) to regain or attempt to regain lost or threatened freedoms (the psychological reactance). Objective : The aim of this study is to explore relationship between health care climate (specifically, perceived autonomy support), hypertensive patient personality traits, psychological reactance (specifically, therapeutic reactance) and the therapeutic adherence. Method : To date (datas collection continues), 27 hypertensive patients (50% male/female - 55,23 y.o. [17.07]) completed : ✓ The Health Care Climate Questionnaire (Williams et al., 1996), ✓ The Big Five Inventory (John et al. 1991), ✓ The Therapeutic Reactance Scale (Dowd et al., 1991), ✓ and the Generic Adherence Scale (Tarquinio & Muller, 2013). Results : The first result to note is that factors influencing adherence differ depending on the target behavior. For example, the most surprising result concerns the role of extraversion in the observance behaviours. It is positively and strongly related to medication adherence but strongly and negatively associated with adherence to diet. Similarly, neuroticism and openness show no effect on drug adherence, but appear to be strongly involved in adherence to diet. In contrast, agreeableness and conscientiousness are only involved in drug compliance. On climate health, it seems to be a relevant variable in the case of drug compliance. And even in this case, its impact is greatly weakened when personality traits are taken into account. Given that the climate of health is correlated with personality traits (not shown here), the results of the stepwise regression show a partial mediating effect on the climate features of health / adherence relationship. Finally, only the verbal reactance seems to be important in adherence : less people are reactant and more they are compliant. Conclusion This study allows to conclude that adherence is a complex process which is associated with medical condition and medication, with physician-patient relationship, with patients' characteristics, and with the nature of target behaviour. The health care climate is important to consider, but patients' personality traits must be taken into account to understand the best way to interact with patients to reduce psychological reactance and promote self-regulation of health behaviours. These results are preliminary results and data collection should continue. Furthermore, it is possible that this study did not allow to identify the proper role of psychological reactance on adherence given the fact that reactant people are those : who likely stop making appointments, who are less likely to participate in such research. Reflection should be conducted to better understand the impact of psychological reactance in medical care. Finally, adherence to physical activity practice and to smoking cessation should also be studied.

Evidence Based Abreactive Ego State Therapy for PTSD

A single 5–6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.

Integration of psychoanalytic concepts in the formulation and management of hospitalized psychiatric patients

Although psychoanalysis and psychodynamic psychotherapy have flourished theoretically and in practice for an increasingly widespread population of patients, the mental health professions have in recent decades experienced a hegemony of managed care, a preoccupation with pharmacological approaches at the expense of psychological approaches, and a predilection for brief symptom-focused, more easily researchable manualized psychotherapies, in spite of literature demonstrating the effective contribution of psychoanalysis and psychodynamic thought to the practice of the mental health professions. In this article a psychiatric inpatient is considered from the point of view of what psychodynamic theory can offer practically to understanding and managing her. It is not suggested that this patient might necessarily benefit from formal psychodynamic psychotherapy, but rather that incorporation of a psychodynamic understanding of her can lead to a more effective management approach, especially regarding dealing with staff reactions to disturbing patients. Consideration of the patient's personality and recognition of the patient's having a comorbid personality disorder appeared important in her management, and have practical implications regarding staff members' understanding of the patient and the consequent identification and handling of transference and countertransference manifestations. Problems that are likely to occur as enactments on the inpatient unit can more readily be anticipated or identified earlier and a consistent staff approach prepared. A psychodynamically informed management approach on the inpatient unit can help to anticipate challenging interpersonal experiences such as enactments. Psychodynamic thought has developed in a manner so as to be applicable in an increasingly wide range of clinical situations, not only in terms of the varieties of patients who are deemed to be able to benefit from psychodynamic treatment per se, but also regarding the clinical venues in which psychodynamic concepts can be usefully applied.

Personality traits as a potential predictor of willingness to undergo various orthodontic treatments

To establish an association between patient personality traits and potential willingness to undergo various orthodontic treatments. One hundred adolescent individuals aged 12-16 years completed an anonymous electronic questionnaire via Survey Monkey. The 24-item questionnaire contained three major sections: patient demographics, a modified Big Five Inventory (BFI)-10 personality index, and a willingness to undergo treatment assessment. Multiple-variable linear regression analyses were used to determine the associations among age, gender, ethnicity, and the five personality traits simultaneously with willingness to undergo treatment. Statistical significance was set at P ≤ .05. Ninety-six of the 100 individuals were included in the statistical analysis. Age, ethnicity, and gender failed to correlate with potential willingness to undergo orthodontic treatment. Several personality dimensions within the modified BFI-10 (agreeableness, conscientiousness, and neuroticism) were significantly associated with willingness to undergo various orthodontic treatments (P ≤ .05). Agreeableness demonstrated positive correlations with five treatment modalities, while both conscientiousness and neuroticism exhibited negative associations with a single treatment modality. Openness and extraversion were the only personality dimensions that failed to associate with any of the treatment modalities. Four of the nine treatment modalities had no association with patient demographics or a patient's personality dimensions. Personality traits are useful in predicting a patient's potential willingness to participate in various orthodontic treatments. The agreeableness dimension provided the most utility in predicting patient willingness. Age, ethnicity, and gender were not significant in predicting patient willingness.

Standardization meets stories: Contrasting perspectives on the needs of frail individuals at a rehabilitation unit

BackgroundRepeated encounters over time enable general practitioners (GPs) to accumulate biomedical and biographical knowledge about their patients. A growing body of evidence documenting the medical relevance of lifetime experiences indicates that health personnel ought to appraise this type of knowledge and consider how to incorporate it into their treatment of patients. In order to explore the interdisciplinary communication of such knowledge within Norwegian health care, we conducted a research project at the interface between general practice and a nursing home.MethodsIn the present study, nine Norwegian GPs were each interviewed about one of their patients who had recently been admitted to a nursing home for short-term rehabilitation. A successive interview conducted with each of these patients aimed at both validating the GP's information and exploring the patient's life story. The GP's treatment opinions and the patient's biographical information and treatment preferences were condensed into a biographical record presented to the nursing home staff. The transcripts of the interviews and the institutional treatment measures were compared and analysed, applying a phenomenological–hermeneutical framework. In the present article, we compare and discuss: (1) the GPs’ specific recommendations for their patients; (2) the patients’ own wishes and perceived needs; and (3) if and how this information was integrated into the institution's interventions and priorities.ResultsEach GP made rehabilitation recommendations, which included statements regarding both the patient's personality and life circumstances. The nursing home staff individualized their selection of therapeutic interventions based on defined standardized treatment approaches, without personalizing them.ConclusionWe found that the institutional voice of medicine consistently tends to override the voice of the patient's lifeworld. Thus, despite the institution's best intentions, their efforts to provide appropriate rehabilitation seem to have been jeopardized to some extent.

Impact of type D personality on adherence to oral appliance therapy for sleep-disordered breathing

Type D personality, defined as a combination of social inhibition and negative affectivity, has been associated with poor medication adherence and lower adherence to continuous positive airway pressure in patients with sleep-disordered breathing. Up to this date, the association of patient's personality with adherence with a mandibular advancement device (MAD) has not been studied. The purposes of this study were to examine the association between type D personality and poor adherence to MAD treatment and to examine the impact of type D personality on perceived side effects during this treatment. Eighty-two patients out of 113 patients with a known baseline type D scale who have started MAD treatment between June 2006 and December 2009 were included. Information about side effects and adherence were collected via a postal questionnaire. Thirty-three patients were using a monobloc MAD and 49 patients were using a duobloc MAD. Forty-five percent of type D patients discontinued MAD treatment, whereas only 15 % of non-type D patients reported treatment discontinuation. The odds ratio for treatment discontinuation was 6.03 (95 % confidence interval 1.22-29.81; p = 0.027) for type D personality, adjusted for age, gender, MAD type (monobloc or duobloc), and decrease in apnea severity. In continuing MAD users, no significant difference in perceived side effects was reported between the personality types. This is the first study to examine the relationship between type D personality and adherence to MAD treatment. Type D patients reported a significantly higher discontinuation rate when compared to patients without type D personality.

Cautious notification and continual monitoring of patients with mild cognitive impairment

Mild cognitive impairment (MCI) is defined as 'a condition between a normal state and dementia indicated by a cognitive decline in comparison to previous results'. MCI groups as a whole are not necessarily in the prodromal stage of dementia. However, when patients are notified of their condition, communication must be cautious and account for the patient's personality, mental status, and examination findings. Hurriedly notifying patients may give the incorrect impression that they will certainly have dementia in the future and cause worry or emotional tension. The efficacy of pharmacotherapy and non-pharmacotherapy, such as cognitive function training, in preventing dementia in MCI patients has not yet been confirmed. As no particular types of intervention are currently shown to be effective for MCI, it is believed that periodically monitoring patients and providing lifestyle guidance, while also treating lifestyle-related diseases, is an appropriate treatment strategy for those with MCI.

Current suicidality and previous suicidal attempts in patients with schizophrenia are associated with different dimensions of temperament and character

Suicide is a major public health problem and the leading cause of premature death in patients with schizophrenia. Information about the patient's personality is helpful for assessing the risk of suicide attempts and suicidal ideation. The sample consisted of 120 outpatients with a diagnosis of schizophrenia, 29 of whom had previously attempted suicide. We used the Temperament and Character Inventory to assess personality differences between patients who had previously attempted and had not previously attempted suicide and between patients who had and did not have current suicidal ideation. Current suicidal ideation was assessed using the four-point severity scale, which is item nine from the Beck Depression Inventory. The character dimension Self-transcendence was shown by logistic regression to be a predictor of lifetime suicide attempts. Low Self-directedness was shown to be a predictor of current suicidal ideation. To prevent suicidal behaviour, it is important to better understand the personality traits associated with suicidal ideation and suicide attempts. Suicide attempts and suicidal ideation in schizophrenia may not represent the same phenomenon ranging on a single continuum. The importance of these results suggests that further study is needed.

Shock and Patient Preimplantation Type D Personality Are Associated With Poor Health Status in Patients With Implantable Cardioverter-Defibrillator

Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component.

Unveiling the hidden self: Developmental trauma and pathological shame

This article focuses on the role played by developmental trauma in generating impairing feelings of shame as observed in several psychological disorders. An understanding of pathological shame is indeed critical for evaluating the psychic functioning of patients who have experienced parental neglect or abuse. A clinical vignette of a patient who suffered emotional neglect and intense role reversal during his childhood will help elucidate how developmental trauma can dramatically affect the patient's personality and behaviours, and ultimately lead to negative expectations towards interpersonal relationships, disturbing feelings of shame, and a sense of a defective self. Shame experiences deriving from the internalisation of bad or unworthy parents are subsequently linked to some psychopathological manifestations, such as withdrawal from social contacts, narcissistic rage, addiction and perversions.