Exploring Personality and Readiness to Change in Patients With Substance Use Disorders With and Without ADHD.

Objective: To explore personality and readiness to change among substance use disorders (SUD) patients with and without ADHD. Method: SUD + ADHD versus SUD - ADHD patients consecutively entering treatment between 2010 and 2012 were compared concerning personality (Temperament and Character Inventory) and readiness to change (Stages of Change Readiness and Treatment Eagerness Scale). Results: Among 103 SUD patients (76 men, age M = 43.3, SD = 11.1), 16 (15.5%) were diagnosed with ADHD. SUD + ADHD patients reported significantly elevated eagerness to effort (p = .008) compared with SUD - ADHD patients, who reported significantly elevated fear of uncertainty (p < .000). SUD + ADHD patients reported higher ambition (p = .025), self-forgetfulness (p = .029), and lower recognition (p = .022). They were younger (p = .019) and showed more often amphetamine addiction (p = .022) compared with SUD - ADHD patients. Conclusion: The distinct characteristics found in SUD + ADHD and SUD - ADHD patients underline the need for differentiated treatment interventions.

A systematic review of quality of life research in medicine and health sciences.

PURPOSE: Quality of life (QOL) is an important concept in the field of health and medicine. QOL is a complex concept that is interpreted and defined differently within and between disciplines, including the fields of health and medicine. The aims of this study were to systematically review the literature on QOL in medicine and health research and to describe the country of origin, target groups, instruments, design, and conceptual issues. METHODS: A systematic review was conducted to identify research studies on QOL and health-related quality of life (HRQOL). The databases Scopus, which includes Embase and MEDLINE, CINAHL, and PsycINFO were searched for articles published during one random week in November 2016. The ten predefined criteria of Gill and Feinstein were used to evaluate the conceptual and methodological rigor. RESULTS: QOL research is international and involves a variety of target groups, research designs, and QOL measures. According to the criteria of Gill and Feinstein, the results show that only 13% provided a definition of QOL, 6% distinguished QOL from HRQOL. The most frequently fulfilled criteria were: (i) stating the domains of QOL to be measured; (ii) giving a reason for choosing the instruments used; and (iii) aggregating the results from multiple items. CONCLUSION: QOL is an important endpoint in medical and health research, and QOL research involves a variety of patient groups and different research designs. Based on the current evaluation of the methodological and conceptual clarity of QOL research, we conclude that the majority QOL studies in health and medicine have conceptual and methodological challenges.

Drinking patterns, psychological distress and quality of life in a Norwegian general population-based sample.

BACKGROUND: The purpose of this study was to investigate possible relationships between drinking patterns, psychological distress and quality of life (QoL) in a general population-based sample in Norway. METHODS: A random sample of 4,000 Norwegian citizens, aged 18 to 79, was drawn from the National Register held by Statistics Norway. RESULTS: Males consumed significantly more alcohol and reported more drinking-related problems with more negative consequences, compared to females. Psychological distress increased, and all QoL domain scores decreased with increasing alcohol consumption within the group drinking alcohol at all. The excessive drinkers demonstrated the highest level of psychological distress and lowest QoL in the psychological, social relationships and environment domains. Non-drinkers reported to have poorest QoL in the physical health domain, whereas light and moderate drinkers demonstrated lowest psychological distress and best QoL. Psychological distress demonstrated substantial more importance for QoL than socio-demographic variables, alcohol consumption, alcohol dependency and negative consequences of alcohol use did. CONCLUSION: The findings indicate the need for a focus on psychological distress and its negative impact upon all QoL domains. Attention should also be paid to excessive drinkers who have poor QoL (psychological, social relationships and environment domains) and a high level of psychological distress. In addition, non-drinkers reported poor physical health. Further research is needed concerning the relation between alcohol consumption, psychological distress and QoL both in general population studies and in more specific samples.

Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study.

Women with breast cancer are naturally exposed to strain related to diagnosis and treatment, and this influences their experienced quality of life (QoL). The present paper reports the effect, with regard to QoL aspects, of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer. The women were randomized to an intervention group with individual art therapy sessions for 1 h/week (n = 20), or to a control group (n = 21). The WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, were used for QoL assessment, and administrated on three measurement occasions, before the start of radiotherapy and 2 and 6 months later. The results indicate an overall improvement in QoL aspects among women in the intervention group. A significant increase in total health, total QoL, physical health and psychological health was observed in the art therapy group. A significant positive difference within the art therapy group was also seen, concerning future perspectives, body image and systemic therapy side effects. The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer.

MMPI-2 subgroups in a sample of chronic pain patients.

MMPI-2 scores of 307 female and 161 male chronic pain patients were analyzed by gender using a multivariate clustering method. Two subgroups were found for both sexes replicating previous results. The major subgroup corresponded to the classical "Conversion V" and the minor corresponded to the "Generally elevated" profile. The results also indicated a satisfactory internal consistency and a high discriminant validity of the Swedish version of the MMPI-2.

Validation of the 'Vienna List' as a proxy measure of quality of life for geriatric rehabilitation patients.

The reason for the study was to investigate the discriminative, content- and criterion-related validity of the 'Vienna List', a newly developed proxy-rating measurement for quality of life in very old and severely demented persons. The total population of patients of a geriatric rehabilitation clinic of one year (from November 2001 to October 2002; n = 687) was evaluated at admission and discharge by means of this proxy rating method together with the mini mental state examination, the timed up and go test, the Tinetti measure, the Barthel Index, and the Katz activities of daily living list. Differences, mainly on factors communication, mobility, aggression, and negative affect, appeared between seven diagnostic groups as well between several care-related categories and destination after discharge. The five factors of the measurement explained a significant amount of variance with a high specificity and more than 50% of the Barthel Index scores. The 'Vienna List', originally developed for the assessment of quality of life in severely demented patients, proved to be a useful, differentiating, less time-consuming and practical tool for the documentation of the outcome of geriatric inpatient rehabilitation, as well.

Quality of life as an indicator for successful geriatric inpatient rehabilitation-a validation study of the 'Vienna List'.

Quality of life (QoL) appears as an adequate outcome measure of geriatric rehabilitation since it reflects its major goals in terms of improvement in self-service, mobility, interpersonal behavior and communication. The objective of the present study was the application of a newly developed instrument, the 'Vienna List', in this context. Its sensitivity to detect changes during geriatric rehabilitation and the ability to differentiate between various diseases and disturbances of functional abilities has been investigated. The total population of patients of one geriatric rehabilitation clinic of 1 year (from November 2001 to October 2002; N=683) was evaluated at admission and discharge by means of this proxy rating. Several reasonable differences appeared between seven diagnostic groups as well as between admission and discharge concerning crucial areas, which are the focus of geriatric rehabilitation such as communication and mobility and which reflect an improved QoL. On the other hand, some factors remained mostly unaffected, e.g. negative affect and bodily contact. The 'Vienna List' which was originally developed for the assessment of QoL in severely demented patients, proved to be a useful, differentiating, less time-consuming and practical tool for the documentation of the outcome of geriatric inpatient rehabilitation.

Parental rearing and individual vulnerability to drug addiction: a controlled study in a Swedish sample.

In a convenience sample of 81 healthy subjects vs. a group of 81 heroin addicts from the Methadone program in Stockholm, Sweden, the hypothesis of a possible link between experiences of dysfunctional parental rearing and the subsequent development of dysfunctional assumptions concerning self and others was tested. The subjects (n=162) completed the EMBU to report perceptions of parental rearing behaviour, two measures of dysfunctional assumptions and dysfunctional working models, the Dysfunctional Attitude Scale (DAS) and the DWM-S, and the Screening Drug Career Questionnaire (SDCQ) for assessing different aspects of the drug career in the sample of addicts. Four predictions were made: 1) parental emotional warmth should be negatively correlated with DAS and DWM-S scores; 2) experiences of dysfunctional parental rearing activities should be correlated with high scores on the DAS and the DWM-S; 3) there should be significant differences between the group of addicts and the control group on the EMBU first-order factors Rejection, Emotional warmth, Overprotection, and on the EMBU midparent subscale and finally 4) the results should support the hypothesis of an overprotecting mother and a rejecting father. The four predictions were supported by the results. The inter-group differences in quality of rearing shown in this study support the assumption of the impact of parental rearing on the development of dysfunctional working models of self and others. Accordingly, the presented data confirm that a parental rearing behaviour perceived both as Rejecting and Overprotective represents a link between dysfunctional parenting and the development of maladaptive psychosocial behaviour like drug addiction.

Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model.

The Fear Survey Schedule-III (FSS-III) was administered to a total of 5491 students in Australia, East Germany, Great Britain, Greece, Guatemala, Hungary, Italy, Japan, Spain, Sweden, and Venezuela, and submitted to the multiple group method of confirmatory analysis (MGM) in order to determine the cross-national dimensional constancy of the five-factor model of self-assessed fears originally established in Dutch, British, and Canadian samples. The model comprises fears of bodily injury-illness-death, agoraphobic fears, social fears, fears of sexual and aggressive scenes, and harmless animals fears. Close correspondence between the factors was demonstrated across national samples. In each country, the corresponding scales were internally consistent, were intercorrelated at magnitudes comparable to those yielded in the original samples, and yielded (in 93% of the total number of 55 comparisons) sex differences in line with the usual finding (higher scores for females). In each country, the relatively largest sex differences were obtained on harmless animals fears. The organization of self-assessed fears is sufficiently similar across nations to warrant the use of the same weight matrix (scoring key) for the FSS-III in the different countries and to make cross-national comparisons feasible. This opens the way to further studies that attempt to predict (on an a priori basis) cross-national variations in fear levels with dimensions of national cultures.

Personality characteristics of physicians and end-of-life decisions in Russia.

OBJECTIVE: To explore the relationships between personality characteristics, underlying attitudes, and treatment decisions for severely ill elderly patients in a sample of Russian doctors. DESIGN: Survey. SETTING: Group sessions during meetings or individual presentations of questionnaire. SUBJECTS: A convenience sample of 231 physicians from the Archangelsk region in northern Russia who frequently encounter treatment situations with incompetent elderly patients. MEASUREMENTS: Temperament and Character Inventory (Cloninger et al, 1994) for assessing personality dimensions. The questionnaire on decision-making is based on the original developed by Molloy and coworkers from McMaster University in Canada. In a case-vignette, the condition of an 82-year-old man with acute gastrointestinal bleeding is described comprehensively in combination with 3 different levels of information about the patient wishes (no information, DNR order, advance directive). Questions about importance of legal concerns, patient and family wishes, hospital costs, patient's age and level of dementia, and physician's religion for the doctor's decision-making are added. MAIN RESULTS: No significant relationship was found between chosen treatment options and personality traits in any of the 3 situations. However, personality characteristics such as self-directedness, cooperativeness, and self-transcendence, in particular, show significant relationships with attitudes underlying these decisions. CONCLUSIONS: Physicians should be trained to improve their cooperative abilities in the treatment of severely ill elderly patients to be better prepared for their decision-making and coping concerning end-of-life decisions and the use of do-not-resuscitate orders and advance directives. Ethical values in clinical practice, especially patient autonomy, should be addressed during the early stage of the medical curriculum.

Attitudinal patterns determining decision-making in severely ill elderly patients: a cross-cultural comparison between nurses from Sweden and Germany.

To explain determinants in the decision-making of nurses in the treatment of severely ill incompetent patients and to describe underlying attitudes, consecutive samples of nurses from Germany and Sweden have been investigated by means of a case scenario and a questionnaire. Whereas the level of dementia emerged as the only factor being significantly related with the treatment option within the Swedish group, patient's age, patient's wishes and ethical concerns were correlated among German nurses. The more the nurses have been able to participate in the provision of the available do-not-resuscitate order or of an advance directive, the less frequent they would perform CPR against the patient's wishes.

Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany.

OBJECTIVES: The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes. PARTICIPANTS AND MEASUREMENT: Five hundred and thirty-five physicians were surveyed in Sweden (Umeå), Germany (Rostock and Neubrandenburg), and in Russia (Arkhangelsk) by a questionnaire. The participants were recruited according to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains three case vignettes about an 82-year-old Alzheimer patient with an acute life-threatening condition; the questionnaire includes different levels of information about his treatment wishes. We have added various questions about attitudes determining doctors' decision making process (legal and ethical concerns, patient's and family wishes, hospital costs, patient's age and level of dementia and physician's religion). RESULTS: Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. Swedish physicians would perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest less frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countries. CONCLUSIONS: The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter.

Vulvar vestibulitis: a multi-factorial condition.

OBJECTIVE: To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non-symptomatic control group. DESIGN: A case-control study conducted in 1998. SETTING: Two clinics in northern Sweden. SAMPLE: Thirty-eight women, 18-25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls. METHODS: The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints. RESULTS: Regarding personality aspects the women with vulvar vestibulitis scored significantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a significantly higher number of somatic complaints in several areas. CONCLUSIONS: The findings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might influence their experience and management of pain and stress. A multi-factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.

The short-EMBU in East-Germany and Sweden: a cross-national factorial validity extension.

The factorial stability and reliability of the 23-item s(hort)-EMBU previously demonstrated to be satisfactory in samples of students from Greece, Guatemala, Hungary and Italy, were extended with 791 students from East-Germany and Sweden. Previous findings on factorial validity, internal reliability and correlations among scales were replicated. The 23-item form thus continues to be recommended as a reliable functional equivalent to the early 81-item EMBU, when the clinical and/or research context does not adequately permit application of time-consuming test batteries.

Conduct problems in Russian adolescents: the role of personality and parental rearing.

The purpose of the present study was 1) to assess the predictive value of conduct problems prior to the age of 12 for the severity of antisocial behaviour during adolescence, and 2) to investigate the relationships between personality traits/parental rearing and childhood conduct problems/teenage antisocial behaviour. A group of 193 delinquents was assessed by means of the Antisocial Behavior Checklist (ABC), the Retrospective Childhood Problems (RETROPROB), the Temperament and Character Inventory (TCI) and the EMBU questionnaire on parental rearing. The extreme groups of delinquents as defined by childhood conduct problems, differed significantly on the experience of a rejecting father and a self-directed character. Furthermore, some specific predictive patterns for current antisocial behaviour by childhood conduct disorder and both personality dimensions and parental rearing factors emerged. The findings are discussed in the light of the interactive nature of relations between personality and parental rearing in the development of antisocial behaviour among adolescents.

Stability of memories of parental rearing among psychiatric inpatients: a replication based on EMBU subscales.

With regard to information about parental rearing, retrospective data are exclusively available among adults. These data are vulnerable due to various biases. This study was performed in order to replicate the findings of overall stability of three perceived parental rearing factors of the EMBU (Swedish acronym for 'own memories of childhood upbringing') based on 14 rather detailed subscales. A consecutive sample of 220 depressive inpatients were investigated on admission and at discharge by means of the EMBU, the Beck Depression Inventory and the Dysfunctional Attitude Scale. Perceived parental rearing scores showed high stability despite clinically significant changes in the severity of depression, except for 'tolerance', 'guilt engendering', 'performance orientation' and 'shaming' parenting with probable gender-specific effects which were found to covary with dysfunctional attitudes. Recall of parenting should be taken as a subjective truth when it is assessed by standardised behaviour-oriented questionnaires like the EMBU.

Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden.

OBJECTIVE: Do-not-resuscitate orders (DNR orders) and advance directives (AD) have been developed and their use by patients is increasing. The objective of the study was to evaluate the compliance with patient's wishes and doctors' and nurses' agreement on decision-making in the treatment of elderly patients from a cross-cultural perspective. DESIGN AND PARTICIPANTS: One hundred and four Swedish physicians and 122 nurses as well as 192 German physicians and 182 nurses from teaching and university hospitals were surveyed by a questionnaire based on a case-vignette with three scenarios of available information about patient's wishes for treatment. RESULTS: A relationship between the perceived level of help and the chosen treatment option was established for all four samples, especially for the scenario in which an AD was available. Two patterns of closely related determinants appeared: (a) 'patient's wishes', 'ethical concerns', and 'family wishes'; and (b) 'patient's age', 'level of dementia', and 'hospital costs'. CONCLUSIONS: An intensive and continuous education of physicians and nurses in medical ethics is required to promote patient autonomy in clinical practice. The ethical implications of patient's age and level of dementia in relation to hospital costs should constitute important topics of these educational programs.

Coping styles and psychosomatic problems: are they related?

A number of recent studies have shown avoidant coping to be related with diverse types of somatic and mental pathology. In order to investigate the relevance of coping for both psychological and somatic problems in delinquent subjects, 185 boys from juvenile correction and 96 boys from secondary schools in Arkhangelsk, Northern Russia, were assessed by means of the Coping Scale for Children and Youth, the Youth Self-Report and the Giessen Subjective Complaints List - youth form. The results from the delinquent subjects partly confirmed previous findings on the dominant role of behavioural avoidance in the relationships between coping styles and both behavior/emotional problems and somatic complaints. Further implications of the results are discussed.