The psychomotor effects of single and repeated doses of hypnotic benzodiazepines.

Benzodiazepine hypnotics are used for short periods in low doses in healthy people when stressed and in patients with insomnia. This study examined psychomotor impairment in healthy young males and females after 1 and 7 nights of flunitrazepam (1 mg), nitrazepam (2.5 mg) and temazepam (10 mg). There were substantial inter-individual variations. Results showed that no drug significantly affected psychomotor performance at these doses after single or repeated administration. The number and severity of side-effects were significantly greater after the first night with temazepam and 7 nights with nitrazepam, although this may reflect a statistical artefact rather than a significant clinical finding. The difficulties in performing adequately controlled psychopharmacological studies at low doses are highlighted. Given the large intra- and inter-subject variances, small drug effects would necessitate large sample sizes (21 to 600 subjects at the 95% level of chance of detection) depending on the variable. The study suggests there is minimal impairment with low dose hypnotic drugs and a need to individualize treatment.

Treatment effectiveness of hypnosis and behaviour therapy in smoking cessation: a methodological refinement.

Studies in smoking cessation have generally failed to adequately control for active treatment effects and have assumed that measures of smoking behaviour (i.e., estimated smoking rate, self-monitoring and chemical analysis) are equally reliable measures. Sixty smokers were randomly assigned to one of four different smoking cessation treatment groups: hypnosis, focussed smoking, attention placebo and a waiting list control. Subjects were asked to estimate and monitor their own smoking behaviour. Blood samples were also taken for thiocyanate analysis before treatment. Smoking rates were similarly measured directly, at 3 months and 6 months after treatment. The results indicate that the three measures of smoking behaviour were all highly correlated. No significant differences were found between treatments, directly after treatment or at the 3- and 6-month follow-ups. These results suggest that active treatment effects may not be responsible for behavioural change in a smoking cessation program. The implications of these findings are discussed.

Professional training in the practice of hypnosis--the Australian experience.

Increasingly around the world as clinicians and researchers alike become more sophisticated in their understanding of the hypnotic process, there is developing a conviction that the hypnotic state or process itself poses no inherent dangers for patients but that its inexpert use may. The solution to prevent potential patient harm is to ensure that all clinicians of whatever discipline have adequate and appropriate clinical training prior to being allowed to practice. Since 1985, in all the Australian states, the appropriate disciplines, already licensed to practice their profession, have completed 2 years part-time academic and clinical training in the nature and nuances of hypnosis (30 hours), practical experience of direct and indirect approaches, and supervised clinical case management (50 hours). At the end of the training they complete a 3 part examination of competence (clinical cases reports, written examination, and oral examination) in order to be accepted as members of the Australian Society of Hypnosis. Only by completing this training and peer reviewed assessment are clinicians able to receive the backing of the Society and recommendation to patients of their competence as clinicians using hypnosis. Recently in the states of Victoria and South Australia (and soon in the state of Queensland), the training program of the Australian Society of Hypnosis has been incorporated into a university diploma course, giving formal academic recognition to the approach to training. The University of Melbourne diploma course will be discussed with a view to illustrating these recent developments.

Measuring medical students' empathy skills.

Empathy is an important skill for the medical practitioner or medical students to develop when interviewing patients. It helps the interviewer establish effective communication, which is important for accurate diagnosis and patient management. Two facets of medical education limit students' development of accurate empathy: the traditional format of interviewing training and the social ethos of medical training and medical practice, which stress clinical detachment. A number of researchers and educators have developed consulting skills training programmes, designed to enhance students' empathic skills and ability. One difficulty for researchers has been the conceptual complexity of the term 'empathy' and greater difficulty in measuring the dimension. This paper reviews the range of approaches to the measurement of empathy and reports on a research study designed to evaluate a two-stage measurement technique, involving a pencil-and-paper test of empathy and independent observer ratings of medical students' actual interview behaviours. Results lead to the conclusion that pencil-and-paper tests of empathy cannot incorporate the range of complex cognitive, emotional and behavioural components of the empathy construct. On the other hand, trained observers have been able to use items on a specially developed History-taking Rating Scale to discriminate between the empathic behaviours of a group of students trained in consulting skills with those of a group of control students who each carried out videotaped history-taking interviews with hospitalized patients.

Effects of communication skills training on students' diagnostic efficiency.

This study evaluates the impact of a training programme in communications skills on subsequent diagnostic efficiency. Videotaped history-taking interviews conducted by groups of specially trained and control groups of students were rated for their diagnostic efficiency by two medical practitioners. Students in the trained group had shown greatly increased skills in interviewing and interpersonal effectiveness as a result of their training. A comparison of ratings given by the two experimentally naive, independent observers revealed that trained students were significantly better at eliciting full, relevant data from patients--they were diagnostically more efficient, but took no longer than their control group counterparts to elicit the information. Further research with the medical interview rating scale will clarify the skills required of medical students in interviewing and diagnosis and facilitate remedial training for students who show poor interview skills.

Affective, cognitive and subjective changes in patients undergoing cardiac surgery--a preliminary report.

Neuropsychiatric change following open-heart surgery has been investigated and emboli proposed as a major causative factor. However, few studies have thoroughly evaluated patients' status prior to surgery. The subjective experiences and neuropsychological status of five open-heart surgery patients was documented both pre- and postoperatively. It was found that prior to surgery patients presented with a wide range of cognitive and emotional problems, some of which were exacerbated by surgery. In particular psychomotor slowing was observed and persisted at six weeks following surgery. This report highlights the importance of conducting preoperative assessments in research which aims to evaluate the effects of different medical procedures on neuropsychiatric functioning.

Psychological tests to measure the effects of medical education on students' interpersonal skills.

The consulting skills required of medical students and practitioners have been categorized into a number of specific skills, two of which are: students' ability to empathize with the patient; and ability to decode non-verbal cues given by the patient in the interview. Training programmes to improve students' consulting skills are usually evaluated using analysis of students' actual interview behaviours with patients. Broad psychological and personality tests have also been used to measure changes in students' interviewing skills, but have generally not been successful. The hypothesis is advanced that more specific tests of the skills of interviewing, such as non-verbal sensitivity and empathy, would detect changes in students' ability to display these skills. As part evaluation of a consulting skills training programme, clinical students completed psychological tests of empathy and non-verbal sensitivity. Subsequent comparisons between trained and control student groups revealed no clear pattern in test results. These data suggest that specific psychological tests of empathy and non-verbal sensitivity may be no more effective in detecting changes in students' interpersonal skills than global personality measures.

A communication skills programme for increasing patients' satisfaction with general practice consultations.

The research literature on patient perceptions of general practice consultations shows that, while patients are generally satisfied with the treatment they receive from doctors, they report less satisfaction with the amount and clarity of information they receive and doctors' expression of caring and respect. In the surgery, inadequate information transmission during the interaction also has the effect of increasing the level of anxiety reported by patients after their consultations. A communication skills programme was developed, incorporating variables from both the emotional and cognitive domains of the consultation. A group of GPs undertook training in this programme. It was hypothesized that patients of the trained doctors would report greater satisfaction and less anxiety, compared with patients of untrained general practitioners. Subsequent randomized interviews with patients of the trained doctors showed that these patients were significantly more satisfied with their consultations. Patients of the trained doctors also reported less state anxiety immediately following their consultations, as measured using the State-Trait Anxiety Inventory. Attempts by doctors to communicate more effectively in consultations therefore increased patients' positive feelings and reduced anxiety.

The use of depot neuroleptic haloperidol decanoate.

Twenty-nine patients were treated with haloperidol decanoate, the dosage ranging from 100 to 300 mg i.m. once a month, with duration of treatment ranging from 3-7 months. It seems that haloperidol decanoate could be useful in schizo-affective disorder/depressed type and also in manic disorder. The investigators were impressed by the relative lack of side effects.

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students.

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.

The sexual side-effects of antidepressant medication: a double-blind comparison of two antidepressants in a non-psychiatric population.

Clinical reports have suggested that antidepressant medication may contribute to the sexual dysfunction experienced by some depressed patients. A double-blind trial in a non-psychiatric male population compared amitriptyline (tricyclic), mianserin (tetracyclic) and placebo for their effects on nocturnal sexual arousal. In a three-way crossover design active drug or placebo were taken for two weeks preceding measurement of the frequency, amplitude and duration of nocturnal penile tumescence and synchronous sleep indices. Both active compounds significantly decreased the amplitude and the total duration of nocturnal erections. The effects on sleep indices were as previously reported. Few differences were found between the tricyclic and tetracyclic drugs. Some implications of these findings are considered.