The psychosocial impact of cervical cancer among affected women and their partners.

This study aimed to assess the range and intensity of psychosocial concerns experienced by women with cervical cancer and their male partners. A cross-sectional survey assessed 26 couples where the woman had invasive cervical cancer stage I-IV, up to 2 years posttreatment, using a concerns questionnaire and widely used psychosocial questionnaires. Respondents indicated their concerns about the impact of the disease and treatment as well as general psychosocial impact. Women with cervical cancer and their male partners expressed equal intensities of concern regarding the illness and its treatment, rating sexuality, prognosis, and communication with the treatment team most highly in terms of current concerns. Couples where the patient had a more advanced stage of cancer expressed higher concerns than those with earlier stage disease. Although women with cervical cancer reported more fatigue and illness intrusiveness than their male partners, both experienced disruptions in relationships, intimacy, and instrumental life domains. With increased time posttreatment, concerns differed subtly between affected women and their male partners. Effective psychosocial support for cervical cancer must be provided for both the affected woman and her male partner. Support and information should address the most salient concerns of patients and partners as these evolve over significant clinical milestones.

Integrating clinical and research psychiatry.

Residents involved in clinical research are frequently unprepared for the problems which may arise in relation to the dual roles of clinician-investigator and patient-subject. Common problems for the clinician-investigator will be outlined including: 1. enlisting patients; 2. using treatment one does not necessarily consider first choice; 3. being blind to treatment prescribed; 4. adhering to a fixed treatment protocol; and 5. deciding when to terminate a trial. Possible solutions will also be offered. In addition, the altered role of the patient as subject will also be considered as it affects patient care within trials.

Alexithymia, depression, and treatment outcome in bulimia nervosa.

Disturbances in emotional awareness, sometimes referred to as alexithymia, have been hypothesized to contribute to the development of binge/purge symptoms among women with bulimia nervosa (BN) and/or are considered secondary to the state of depression and/or disordered eating. The present study was designed to assess alexithymia among women with BN, to evaluate the interrelationship between alexithymia, depression, and somatic symptoms, and to determine whether an intensive group psychotherapy program contributes to a reduction in the degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were administered pretreatment and posttreatment questionnaires. Findings from this clinical sample were compared with those from 20 non-eating-disordered women who completed the same battery. Using the Toronto Alexithymia Scale (TAS), significantly more BN women were alexithymic at pretreatment (61.3%) and post-treatment (32.3%) than in the comparison group (5.0%), even when depression was controlled for. At discharge, abstinence from binge/purge episodes was associated with a significant reduction in alexithymia, although there was a significant correlation between TAS scores, depression, and vomit frequency. Alexithymia among BN women is not simply a concomitant of disordered eating. Its partial reversibility following an intensive psychotherapy program may be a direct effect of the treatment and/or may be secondary to a reduction in depressive and/or binge/purge symptoms.