A description and evaluation of an outpatient intensive psychotherapy center.

The intensive psychotherapy center described and evaluated in this paper is unique because of its intensity and the fact that available treatment modalities are integrated into the program. Pateints are literally immersed in therapy on a full-time basis for an average of 3 weeks. Assessment of the program through the use of questionnaires completed by 335 patients at the time of discharge showed significant improvement in their presenting symptoms, interpersonal relationships, ability to work, and general level of comfort. An 8-month follow-up study of 171 patients revealed that this improvement was retained.

Personality characteristics in obesity: relation of MMPI profile and age of onset of obesity to success in weight reduction.

A group of 142 obese subjects was seen in an obesity clinic over a 2-year period. Of these, 116 had assessment of personality factors by the Minnesota Multiphasic Personality Inventory (MMPI), and 71 were followed for periods of 4 to 28 months in order to determine success at weight reduction by means of a conventional dietary regimen. The MMPI profiles of the obese subjects were compared to those of a general medical population of 50,000 patients seen in the Department of Internal Medicine at the Mayo Clinic. Obese male subjects had significantly higher scores on the F and MA scales. Obese female subjects had significantly higher scores on the F, PD, PA, SC, and MA scales, and a significantly lower score on the Q scale than the reference population. Even though these findings show that certain personality traits as measured by the MMPI may occur more frequently in obese persons, the individual MMPI profile codes point out the presence of diverse behavior patterns among obese persons rather than a single personality pattern characteristic of obesity. There were no apparent differences in the success in achieving a loss of 10% or more of initial weight among the male and female obese subjects having normal or abnormal MMPI profiles. Obese subjects having onset of obesity before age 12 years were slightly more successful in weight reduction than those whose obesity began later than this, but the differences were not statistically significant for either the male or female subjects.

Is there a characteristic personality profile in amyotrophic lateral sclerosis? A Minnesota Multiphasic Personality Inventory study.

A comparison of the Minnesota Multiphasic Personality Inventory profiles of 21 men and 17 women who had amyotrophic lateral sclerosis (ALS) with the profiles of 50,500 general medical patients showed no marked deviations. The validating scales of the men and the women were similar to those of the general medical population. There was no evidence of increased defensiveness in the group with ALS, as measured by either the L or the K scale, when compared with the general medical population. Individual patient interviews also showed no characteristic personality profile for ALS patients.

The use of a self-administered alcoholism screening test (SAAST) in a medical center.

A self-administered alcoholism screening questionnaire was given routinely to 100 patients admitted to an alcoholism treatment unit as well as to 100 randomly selected patients in a medical population. The questionnaire differentiated the alcoholic group from the general medical group of patients. It was also successful in identifying the "hidden alcoholic" in the general medical population. It is concluded that this device would be a valuable part of a general medical screening questionnaire to detect the presence of alcoholism in the general medical-surgical patients.

Low back pain patients in a psychiatric population.

Thirty-one patients with low back pain resistant to medical and surgical treatment were studied. On admission to the psychiatric service, these patients revealed apparent features of conversion and hysterical personality, as characterized also by the MMPI profile. During hospitalization, however, there was increased appearance and recognition of anxious-depressive features. We suggest that these patients should be treated by the combined approach of supportive psychotherapy and physiotherapy, with appropriate use of antidepressants.

Diagnosis of alcoholism with a self-administered alcoholism screening test: results with 1,002 consecutive patients receiving general examinations.

Since 1972 we have used the Self-Administered Alcoholism Screening Test (SAAST) in impatient alcoholics and their spouses and in patients from a general medical population. The SAAST, a 35-item test with a yes/no format, was administered to 1,002 consecutive Mayo Clinic patients who generally were not acutely ill and were requesting an annual examination or a general reexamination for chornic but stable problems. Of the 1,002 patients, 5.4% gave responses to the SAAST that would indicate the presence of possible or probable alcoholism. The medical record review on a random selection of patients revealed a false-negative rate of 6.7%. We believe that the SAAST is an effective tool for the detection of alcoholism and that it can be used in the general medical setting.

Program for managing chronic pain. II. Short-term results.

A program for treating inpatients who had chronic pain resulted in significant improvement in 79% of them by the time of their dismissal. At the time of short-term follow-up (6 months), however, this improvement rate had diminished to 50%. It was observed that this type of chronically disabled person can return home and increase work-related activity without returning to previous patterns of drug use and repeated hospitalizations.

The aging MMPI: development of contemporary norms.

Twenty-five years of experience with the Mayo Clinic computerized system for the Minnesota Multiphasic Personality Inventory (MMPI) have accrued since Swenson , Rome, and their colleagues proposed this innovation in 1959. Although it is the most respected, widely used, and thoroughly researched objective personality-assessment instrument that has been developed to date, the MMPI is aging. Work on the MMPI began in 1937, and the original normative base was established in the late 1930s and early 1940s . To develop new norms, we selected a random sample of 1,408 subjects, not under care for any physically or mentally handicapping condition and ranging in age from 18 through 99 years, from parts of Iowa, Wisconsin, and Minnesota in a 50-mile radius surrounding Rochester, Minnesota. MMPI responses obtained from this sample were used to develop normalized T-score tables for specific age ranges, and for adults in general, for the 13 basic scales of the MMPI.

Program for managing chronic pain. I. Program description and characteristics of patients.

A program for the management of patients with treatment-resistant pain involves behavior modification, physical treatment, medication management, and counseling. The first 50 patients were characterized by pain of many years' duration, multiple operations, treatment failures, prolonged disability, compensation factors, and dependency on medication. In addition, they demonstrated loss of intellectual efficiency and were more psychologically deviant than the general medical population. Management problems were encountered in the following areas: patient acceptance, drug seeking, complicating psychopathology, complicating physical disorders, group dynamics, family reactions, and staff morale. Fifty-four percent of patients achieved moderate to marked improvement.

Alcoholism in physicians.

The Self-Administered Alcoholism Screening Test was completed by physicians attending an annual continuing medical education meeting. Of the responding physicians, 12% were identified as abstainers, 81% were classified as not alcohol-dependent drinkers, 5% were classified as possibly alcoholic, and 2% were classified as probably alcoholic. These results were similar to those obtained in a nonphysician general medical patient population previously given the same questionnaire. The data show that the prevalence of alcoholism among a group of physicians is not substantially different from that in a general medical population.

Persistent Nausea without organic cause.

The onset of functional nausea among 77 patients was frequently related to an organic disease or to a psychophysiologic response to stress. Later, the nausea had obvious features of conversion, hypochondriasis, or an hallucination. The patients had significant psychiatric disorders as assessed by the Minnesota Multiphasic Personality Inventory (MMPI) and by clinical examination. While in the hospital most patients experienced symptomatic improvement but they did not accept a psychologic explanation for their nausea.

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures. One of the 10 patients had moderate renal insufficiency at follow-up. We present herein an additional 19 patients who underwent LRV division predominantly for aneurysmal disease of the abdominal aorta. Sixteen patients were available for follow-up. Three patients died in the intraoperative and early postoperative periods. Multivariate analysis of variance of preoperative, postoperative, and follow-up laboratory data--serum creatinine and BUN--showed no significant change in renal function as assessed.

Ovarian arteriovenous fistula. An unusual cause of abdominal pain.

Arteriovenous fistulae of the ovarian artery may develop after gynecologic surgery. A case that occurred 9 years after hysterectomy with bilateral oophorectomy is presented and discussed. It illustrates an unusual cause of left lower quadrant abdominal pain. Surgical removal of the ovarian arteriovenous fistula resulted in complete relief of the patient's symptoms. This uncommon entity must be considered when dealing with lower quadrant pain and a past history of hysterectomy.

Snowmobile trauma: an eleven-year experience.

Records of 88 patients with snowmobile injuries from 1977 to 1987 were reviewed to identify the types of trauma. Data collected included age, sex, method and degree of injury, use of safety attire, and risk factors. There were 77 males and 11 females. Seventeen (19.3%) were children under the age of 16. Poor driving judgment involved in the hitting of obstacles led to the majority of injuries. There were 106 fractures in 71 patients. Eighteen patients (25%) had more than one fracture. Eleven patients had loss of consciousness. Eighty-eight other injuries resulted for a total of 205 injuries. There were three fatalities. Results indicate that inexperience, prior use of alcohol, driver carelessness, excessive speed, and poor adherence to manufacturer recommendations were the leading contributors to the accidents.

Spouse response to a self-administered alcoholism screening test.

A self-administered, expanded version of the Michigan Alcoholism Screening Test was completed by a group of hospitalized alcoholics and by their spouses and counselors, describing the patients. The data obtained from spouse responses was accurate in 90% of the cases; the spouse may be a more reliable source of information about drinking problems than the alcoholic.