Paradoxical effects of prophylactic phenothiazine antiemetics in children receiving chemotherapy.

The effectiveness of prophylactic phenothiazine antiemetics on reduction of nausea and vomiting was assessed for 23 children (age, 9-17 years) who had intermittently received antiemetics (ie, for one course but not for another). Each patient was his own control and the courses with antiemetics were compared to the matched courses without antiemetics (Wilcoxon matched-pairs, signed-ranks test). In each case, the matched courses with and without antiemetics were temporally consecutive and equivalent for chemotherapeutic agents and dosages. Significantly higher ratings for severity of nausea (P less than .004), vomiting (P less than .02), and the extent to which these symptoms bothered patients (P less than .001) were found during courses with prophylactic antiemetics. Duration (in hours) of nausea and vomiting was analyzed for the last eight consecutive study patients; in eight of eight patients, a significantly longer duration of nausea (P less than .05) and vomiting (P less than .02) was found for the courses in which antiemetics were given prophylactically. This study suggests that prophylactic phenothiazine antiemetics do not predictably reduce children's nausea and vomiting and may even be associated with an increase in symptoms. Further studies in children are needed to determine which patients might benefit most from antiemetic intervention.

The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy.

Fifty-one children 6-17 years of age rated the severity of nausea, vomiting, and the extent to which chemotherapy bothered them during each course of chemotherapy. Sixteen patients had no symptoms and the doses administered to 16 others were not constant so that matched courses could not be assessed. After baseline measurement of two matched courses, the remaining 19 patients were randomized to receive hypnosis or supportive counseling during two more matched courses. An additional course with no intervention was assessed in half of the patients. No significant reduction of symptoms was demonstrated prior to intervention. However, intervention with both hypnosis and supportive counseling was associated with significant reductions in nausea, vomiting, and the extent to which these symptoms bothered patients (all p less than 0.001). Also, after termination of intervention, symptom ratings remained significantly lower than baseline. The data indicate that chemotherapy-related nausea and emesis in children can be reduced with behavioral intervention and that reductions are maintained after intervention has been discontinued.

A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer.

Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.

Neuropsychological assessment of children with medulloblastoma.

There is little information available about specific psychological deficits experienced by children with medulloblastoma. Most of the data reported so far are based on standardized intelligence tests which are only a partial representation of a child's total behavioral repertoire. Clinical neuropsychological assessment is a well-standardized and accurate means of identifying specific deficits. However, this psychometric approach to assessment must also be combined with an individualized, subjective assessment of each patient. These data must be obtained longitudinally in order to show changes over time.

Pediatrics and psychology: a collaboration that works.

The growing relationship between pediatrics and psychology is described. Differences and similarities in training and orientation between psychologists and pediatricians are discussed, as well as three different models of collaboration. Pediatrician-psychologist collaboration can result in significant improvements in: comprehensive primary health care, treatment of psychosomatic disorders, and management of children suffering from a combination of medical, family, and adjustment problems. Research and health care legislation are two additional areas where collaboration between pediatrics and psychology is proving to be valuable.

The role of imagery in the treatment of dying children and adolescents.

The care of terminally ill children and adolescents is often complicated by depression and the patient's inability to express needs and fears verbally. The patient's own mental imagery provides an alternate means of communication. Clinical cases illustrate some of the ways in which imagery may play a crucial role in helping these young patients to express age-appropriate needs and fears regarding helplessness, separation from loved ones, and death.

Use of traditional medicine in Mongolia: a survey.

OBJECTIVES: To conduct a pilot investigation of the frequency with which individuals visit practitioners of Western and traditional Mongolian medicine and their motivations for making these visits. DESIGN: Survey based interviews were conducted in a sample of 90 adults. SETTING: Darkhan, Mongolia. MAIN OUTCOME MEASURES: Measures included the annual frequency of visits to practitioners of traditional and Western medicine as well as ratings of the importance of seven factors in choosing what type of practitioner to use. RESULTS: During the past year, 51% of subjects interviewed had used Western services exclusively, 8% had used traditional services exclusively, and 38% had used both types of services. Users and non-users of traditional medicine did not vary in terms of age, gender, occupation or rural vs urban residence. Traditional medicine users rated the knowledge base of traditional practitioners higher than did nonusers (5.3/7 vs 4.5/7, P < 0.01). A patient's specific illness appears to be important in deciding what type of treatment he will seek. CONCLUSIONS: Traditional medicine appears to be a more significant component of Mongolian health care than is reported in the international literature and consequently may deserve additional attention in future studies of the country's medical system.

The hypnotic dreams of healthy children and children with cancer: a quantitative and qualitative analysis.

In this study, the Stanford Hypnotic Clinical Scale for Children was administered to 52 healthy children and 47 children and adolescents with cancer. Responses to the dream item of this scale were analyzed for the type and detail of imagery. The hypnotizability scores of both groups were similar. However, children with cancer reported more pleasant than unpleasant fantasy in their hypnotic dreams, and their dream reports tended to contain less fantasy and detail overall. Rescoring the dream item based on extent of fantasy and detail resulted in a lower pass rate for that item, especially for children with cancer. Regardless of health status, older children experienced more self-involvement in their hypnotic dreams compared to younger children.

Psychosomatic problems in adolescents. Why they occur, how to intervene.

Primary care physicians who are willing to trust their own intuition and abilities can adequately evaluate and treat many psychosomatic problems of adolescence. Most of these problems reflect normal developmental stress rather than major psychiatric disorders. Thus, obtaining an adequate history and listening to the patient before embarking on a "rule out organic disease" pathway are basic. As Sir William Osler said, "It is more important to know what sort of patient has a disease than what sort of disease a patient has." By applying this maxim, primary care physicians may find treatment of adolescents with psychosomatic disorders a rewarding, rather than a frustrating, experience.

Paternalistic vs egalitarian physician styles: the treatment of patients in crisis.

According to previous reports, the quality of the physician-patient relationship plays an important role in medical outcome. A patient's responsiveness to suggestions, perceptions of treatment, and physical distress may be affected both by the type of interpersonal relationship and by the patient's anxiety. To test these hypotheses, 57 women who received elective abortions were treated by the physician in either a "paternalistic" or "egalitarian" interpersonal style. Each patient was tested for responsiveness to suggestions regarding changes in somatic perception such as heat or pain; a measure of psychological dependency on the physician was also obtained in addition to ratings of discomfort and signs of physiological distress during the medical procedure. Patient anxiety was not related to any of these variables, but patients treated in a paternalistic manner had higher responsiveness to suggestibility (P less than .001), felt they could depend more on the physician and perceived him as warmer and more supportive (P less than .01), had less discomfort during the procedure (P less than .05), and had a lower incidence of physiological distress compared with patients treated in an egalitarian manner. It was concluded that, for patients in crisis, paternalistic treatment by a physician may promote positive psychological and medical outcome.