The problem of somatization in family practice.

Patients with somatization disorder, in the full-blown or subsyndromal form, are high users of health care and often receive expensive, unnecessary tests and treatments. Their multiple somatic complaints do not have a biomedical basis but, instead, reflect underlying emotional conflicts that the patient is unable to face. Treatment of these patients is difficult, with no approach showing a good cure rate. However, if the underlying psychosocial etiology is understood and modest goals are set, much can be done to limit the problem and reduce symptoms. Management includes setting clear limits on the patient's access to the physician, while maintaining an empathetic and supportive doctor-patient relationship. Behavioral cognitive psychotherapy and short-term intensive psychotherapy may help the patient understand the underlying conflicts and thereby reduce the symptoms.

A direct comparison of the defense mechanisms of nondepressed people and depressed psychiatric inpatients.

This report presents a direct comparison of defensive styles (as measured by the Defense Mechanisms Inventory [DMI]) in a sample of depressed psychiatric inpatients and samples of nondepressed male and female normative groups. Consistent with the "depressive realism" literature, nondepressed men and women were more likely than their depressed counterparts to bias their perceptions in an overly cheerful, optimistic direction. Counternormative sex differences were also found. Depressed men were more likely to use internalizing defenses and depressed women were more likely to use externalizing defenses than their respective nondepressed comparison groups. Overall, as has been speculated, there was a relationship within depressed subjects between depression severity and the amount of negatively biased self-perception.

Comparison of three depression rating scales.

We directly compared scores on the self-rated Beck Depression Inventory with two other common rating scales that assess a wider range of psychopathology, including depression, the self-rated Symptom Check List-90--R (SCL-90--R), and the clinician-rated Brief Psychiatric Rating Scale for 71 inpatients who suffered from depression (n = 50) and other disorders. All measures of depression showed robust correlations among themselves. The self-rated scales correlated better between themselves than with the clinician-rated scale. Since the SCL-90--R assesses depression as well as the Beck inventories, is also a self-report instrument, yet provides a richer description of psychopathology with little extra effort, it may have some advantage over the latter.

Further evidence for the significance of a childhood abuse history in psychiatric inpatients.

The high prevalence of histories of childhood sexual and physical abuse in inpatient psychiatric populations is documented. In the present study, 38 female inpatients on a psychiatric unit in a teaching hospital were administered an abuse questionnaire and standard measures of psychological distress. Seventy-six percent of the women reported some history of abuse before the age of 16. As predicted, women who reported a childhood history of physical or sexual abuse scored significantly higher on measures of symptomatology and psychopathology as compared with women who did not report an abuse history. Findings confirm the reports of previous researchers, providing further evidence of the generalizability of these observations.

Practical application of a patient satisfaction survey.

Patient satisfaction surveys are a practical method for studying one aspect of quality of care in an HMO. This report details the use of a patient satisfaction survey for this purpose. The focus is on the instrument chosen and the type of analyses carried out. Despite the interest and potential usefulness of the data obtained, the organizational response to the study can be the rate-limiting factor for using the findings. In general, the method can be used for periodic monitoring and as a valid method for detecting or confirming suspected trouble spots in the system. To be successful, the data must be interpreted in the spirit of a shared commitment to quality care.

The current literature on inpatient psychotherapy.

In a review of the current literature on inpatient psychotherapy, the authors discuss shortened length of stay and the interdisciplinary team approach as factors affecting psychotherapy in the inpatient setting. They examine the literature in the frameworks of long-term intensive and short-term focused psychotherapy, including arguments presented in favor of each. Much of the current literature focuses on special problems posed by patients who have severe personality disorders and are treated by long-term inpatient care with intensive psychotherapy.

Venesection as a rare form of self-mutilation.

This case history records a rare form of self-mutilation, venesection. Underlying psychopathological mechanisms are presented, and contrasted with findings in the only other similar case reported in the English literature. The complex etiology of self-mutilating is reviewed with reference to this case report.

Successful use of a soya-maize mixture in the treatment of kwashiorkor.

Forty-eight children aged 5 years or less admitted consecutively with a clinical diagnosis of kwashiorkor were randomly allocated to two groups. One group was treated with milk while the other group was fed soya-maize porridge; both groups received the same supportive treatment. The recovery rate in both groups was comparable. Protein intake and the rate of rise in serum albumin and transferrin concentrations were greater in the milk-fed group. The incidence of diarrhoea was significantly less in the children fed soya-maize. Soya-maize porridge is recommended as an effective and inexpensive treatment for kwashiorkor.