Reliability Measures in Distorting Body-Image

This study is the first to make a direct comparison between the distorting mirror and the distorting videocamera with the same group of nonclinical subjects. It also establishes the internal consistency, the test-retest reliability and the convergent validity of both techniques. Analysis indicates, as with other studies, that perceived image is consistently over-estimated and ideal image is consistently underestimated by both techniques. With the distorting mirror, the frontal orientation is repeatable over four days and with the video the profile is the more reliable orientation. A comparison between profile and frontal orientations on any single test occasion (internal consistency) indicates that the results correlate well so either orientation is acceptable for experimental purposes. The extent to which both techniques were measuring the same aspect (convergent validity) was more marked for the ideal image. A researcher using the distorting mirror can be confident that the ideal image is reliable over time using either orientation but that the perceived image requires a frontal orientation. The frontal or profile orientation is acceptable for the ideal image using the distorting video, but the profile orientation is advisable if one wishes a reliable perceived image. The researcher should also be cautious in assuming that both techniques are measuring an identical body-image construct.

Taking responsibility for cancer treatment

One hundred and fourteen consecutive patients with early breast cancer were entered into a study on the psychological effects of involvement in treatment choice. All women were offered counselling throughout. One group of women (n = 34), were advised to undergo mastectomy, due to the nature or position of the tumour. These women fared less well psychologically when compared on a battery of measures, before and after surgery, with women who were involved in choosing their own treatment (n = 80). The latter group itself was randomly allocated into two groups for taking explicit responsibility for treatment choice, using a double-blind procedure. These were a Patient Decision Group (n = 41) and a Surgeon Decision Group (n = 39). Results support the hypothesis that over and above the benefits of receiving their preferred treatment, women can further benefit from taking explicit responsibility for their treatment choice.

A comparison of the long-term effectiveness of distraction and focusing in the treatment of auditory hallucinations

Cognitive-behavioural interventions for patients experiencing neuroleptic resistant auditory hallucinations have fallen into two main categories: those which encourage distraction as a coping strategy, and those which encourage patients to focus on or expose themselves to their hallucinations. A 20-session distraction treatment was compared with an equal length focusing treatment for 19 patients who were experiencing chronic auditory hallucinations. Patients were followed-up for approximately 2 years. No differences were observed between the groups for outcome on symptom severity overall, although the focusers showed a greater belief that their voices were their own thoughts at the final follow-up point. When the two groups were combined, there was a significant reduction in the frequency of hallucinations and the disruption to life caused by them during treatment, although this was not maintained at follow-up. During treatment, there was a significant increase in self-esteem for focusers but a significant decrease for distracters. At 2-year follow-up, both focusers and distracters showed a reduction in self-esteem in comparison to the end of therapy. The results show no overwhelming advantage of one treatment over the other and confirm previous observations of the difficulty of treating hallucinations with cognitive-behaviour therapy (CBT). However, there was some indication that CBT influenced some important clinical variables and further investigation is warranted.

The behavioural effects of corticotropin-releasing factor-related peptides in rats

The present study determined the behavioural effects of the corticotropin releasing factor (CRF)-related peptides, human/rat CRF (h/rCRF), ovine CRF (oCRF), sauvagine (SAUV), urotensin I (UT) and the recently discovered neuropeptide, rat urocortin (rUCN). All of the peptides dose-dependently increased motor activity in a familiar environment and reduced feeding in hungry rats. There was no apparent relationship between potency/affinity at CRF2 receptors and effects in these two tests. In a comparison of h/rCRF and rUCN upon discrete spontaneous behaviours, both peptides (3.0 microg i.c.v.) increased activity and grooming, induced a fore-paw tremor and reduced the incidence of motionlessness. However, h/rCRF reduced motionlessness to a greater extent and was a more potent inducer of defaecation, weight loss, oral movements and fore-paw tremor than rUCN. In the elevated X maze, both h/rCRF and rUCN (1.0 microg i.c.v.) had anxiogenic-like effects upon behaviour. In contrast, h/rCRF (1.0 microg i.c.v.), but not rUCN (1.0-10 microg i.c.v.) increased the startle response to an acoustic stimulus. In summary, all the CRF-related peptides increased motor activity and reduced feeding in rats in a similar manner and both rUCN and h/rCRF induced anxiogenesis. However, there were some behavioural differences between rUCN and h/rCRF which require further study. Further pharmacological investigation of the role of CRF receptor subtypes requires the use of subtype selective antagonists.

A dual process model of perfectionism based on reinforcement theory

This article begins with a brief review of the current literature on the structure and measurement of perfectionism. It is concluded from this review that two major types can be distinguished, a normal/healthy form and a pathological form. These two forms are then defined as positive and negative perfectionism and related directly to Skinnerian concepts of positive and negative reinforcement. The positive/negative distinction is then further elaborated on in terms of approach/avoidance behavior, goal differences, self-concept involvement, emotional correlates, and the promoting environment. Finally, some of the more obvious theoretical and practical implications are briefly explored.

The selective 5-HT1B receptor inverse agonist 1'-methyl-5-[[2'-methyl-4'-(5-methyl-1,2, 4-oxadiazol-3-yl)biphenyl-4-yl]carbonyl]-2,3,6,7-tetrahydro- spiro[furo[2,3-f]indole-3,4'-piperidine] (SB-224289) potently blocks terminal 5-HT autoreceptor function both in vitro and in vivo

5-HT1 receptors are members of the G-protein-coupled receptor superfamily and are negatively linked to adenylyl cyclase activity. The human 5-HT1B and 5-HT1D receptors (previously known as 5-HT1Dbeta and 5-HT1Dalpha, respectively), although encoded by two distinct genes, are structurally very similar. Pharmacologically, these two receptors have been differentiated using nonselective chemical tools such as ketanserin and ritanserin, but the absence of truly selective agents has meant that the precise function of the 5-HT1B and 5-HT1D receptors has not been defined. In this paper we describe how, using computational chemistry models as a guide, the nonselective 5-HT1B/5-HT1D receptor antagonist 4 was structurally modified to produce the selective 5-HT1B receptor inverse agonist 5, 1'-methyl-5-[[2'-methyl-4'-(5-methyl-1,2, 4-oxadiazol-3-yl)biphenyl-4-yl]carbonyl]-2,3,6, 7-tetrahydrospiro[furo[2,3-f]indole-3,4'-piperidine] (SB-224289). This compound is a potent antagonist of terminal 5-HT autoreceptor function both in vitro and in vivo.

Chronic low back pain rehabilitation programs: a study of the optimum duration of treatment and a comparison of group and individual therapy

STUDY DESIGN

Eighty-four patients with chronic low back pain were treated using cognitive behavioral principles on a pain management program. Outcome data were collected at four points: 10 weeks before treatment, immediately before and immediately after treatment, and 6 months after treatment. In part 1 of the study, patients were assigned randomly to group or individual treatment contexts. In part 2 of the study, patients were assigned randomly to programs of 15, 30, or 60 hours duration.

OBJECTIVES

To identify the differences in outcome between programs that treated patients as part of a group and those that treated patients individually and the effects of duration of treatment on outcome.

SUMMARY OF BACKGROUND DATA

Cognitive behavioral programs have been shown to be an effective means of managing chronic low back pain. The literature is concerned with group programs, however, the duration of which vary widely.

METHOD

Psychological and functional variables were measured before and after treatment and at the 6-month follow-up visit. Changes in these variables were measured, and comparisons were made between group and individual programs and between 15-, 30-, and 60-hour programs.

RESULTS

Data analysis showed a significant, beneficial effect of intervention in terms of the majority of variables; however, these changes were generally independent of whether patients were treated as part of a group or individually and whether patients completed a 15-, 30-, or 60-hour program.

CONCLUSIONS

Cognitive behavioral rehabilitation programs have been demonstrated to be an effective means of reducing psychological distress, of changing cognition, and of improving the function of patients with chronic low back pain; however, the length of program and whether patients were treated individually or as part of a group did not affect outcome. This finding has clinical and economic implications.

Stimulation of 5-HT1B receptors causes hypothermia in the guinea pig

The selective, brain penetrant, 5-HT(1B/D) (formerly 5-HT(1D beta/alpha)) receptor agonist SKF-99101H (3-(2-dimethylaminoethyl)-4-chloro-5-propoxyindole hemifumarate) (30 mg/kg i.p.) causes a dose related fall in rectal temperature in guinea pigs which previous studies have shown to be blocked by the non-selective 5-HT(1B/D) receptor antagonist GR-127935 (N-[4-methoxy-3-(4-methyl-1-piperazinyl) phenyl]-2'-methyl-4'-(5-methyl-1,2,4-oxadiazol-3-yl) [1,1'biphenyl]-4-carboxamide oxalate). The present study shows that the hypothermic response to SKF-99101H is dose-dependently blocked by SB-224289G (1'-methyl-5-(2'-methyl-4'-[(5-methyl-1,2,4-oxadiazol-3-yl)bipheny l-4-yl]carbonyl)-2,3,6,7-tetrahydrospiro[furo[2,3-f]indole-3,4'-pi peridone] hemioxalate) (0.3-10.0 mg/kg p.o.) (ED50 3.62 mg/kg), which is the first compound to be described which is more than 60 fold selective for the 5-HT1B receptor over the 5-HT1D receptor. SB-216641A (N-[3-(2-dimethylamino) ethoxy-4-methoxy-phenyl] 2'-methyl-4'-(5-methyl-1,2,4-oxadiazol-3-yl)-(1,1'-biphenyl)-4-car boxamide hydrochloride) (0.6-20.0 mg/kg i.p.), which is somewhat less selective (30 fold) for the 5-HT1B receptor over the 5-HT1D receptor had a similar effect (ED50 4.43 mg/kg). The brain penetrant 5-HT1D selective receptor antagonist, BRL-15572 (4-(3-chlorophenyl)-alpha-(diphenylmethyl)-1-piperazineethanol+ ++ dihydrochloride) (0.3-100.0 mg/kg i.p.) was inactive. When administered alone neither BRL-15572 (0.1-10 mg/kg i.p.) nor SB-224289G (2.2-22 mg/kg p.o.) had an effect on body temperature. These data demonstrate that 5-HT1B (formerly 5-HT(1D beta)) and not 5-HT1D (formerly 5-HT(1D alpha)) receptors mediate the hypothermic response to SKF-99101H (30 mg/kg i.p.) in guinea pigs. The compounds described are useful pharmacological tools for distinguishing responses to 5-HT1B and 5-HT1D receptors.

Dental erosion, oral hygiene, and nutrition in eating disorders

OBJECTIVE

To determine the influence of oral hygiene practices and additional fluoride on erosive tooth wear in eating disorders. The proportional dietary intake of carbohydrates, fats, and proteins was also investigated.

METHOD

Tooth wear was measured with the use of the tooth wear index (TWI). All subjects completed a questionnaire on past dental history as well as a 1-week diet sheet. A total of 33 subjects participated in the study, 20 of whom were follow-ups, allowing the progress of dental erosion to be made. All subjects were referred from the Department of Clinical Psychology.

RESULTS

Oral hygiene practices between subjects with and without severe erosion were not significantly different. Only 8 bulimics spent more time brushing after vomiting than at other times. The pH of vomitus from 6 subjects ranged between 2.9 and 5.0, with a mean of 3.8, well below the critical pH for enamel demineralization to occur. Of the 20 follow-up subjects, 12 (60%) exhibited worsening tooth wear. The mean values for daily carbohydrate, protein, and fat intake were not significantly different at baseline and at recall, and the proportional dietary intake was similar to recommended energy provision at 47%, 40%, and 13%, respectively.

DISCUSSION

The contribution by toothbrush abrasion to the overall wear in the eroded dentition of bulimics is not significant. Therefore, immediate post-vomiting oral hygiene practices can be recommended. The proportional nutritional intake values of carbohydrates, fats, and proteins in this group of bulimics are acceptable.

A computer-controlled apparatus for measuring and analysing myoclonic jerk activity in guinea pigs

Guinea pigs respond to 5-hydroxytryptophan (5-HTP) with a complex behavioural syndrome which includes distinctive whole-body jerks (myoclonic jerks). These are species-specific, involve all major muscle groups, are highly rhythmic and can occur with relatively high frequency (1-2/s). Current methods of quantifying the response, which rely on observer ratings are unsatisfactory. We report the development of a fully automated, PC-based system for detecting and analysing myoclonic jerks. Floor-mounted accelerometers generate a movement signal and detection is performed by an algorithm based on a detailed analysis of the topography of myoclonic jerk responses. The system can monitor the output from 10 purpose-built test enclosures and it provides for pseudorandom treatment allocation, flexible control of experimental parameters and automated data output to a spreadsheet which generates appropriate graphs, statistical summaries and data analysis. This robust response provides a useful means of exploring the role of novel 5-HT receptor subtypes in guinea-pig behaviour.

The role of 5-HT1D and 5-HT1A receptors in mediating 5-hydroxytryptophan induced myoclonic jerks in guinea pigs

Systemic administration of 5-hydroxytryptophan (5-HTP) to guinea pigs causes species-specific, rhythmic, whole body jerks (myoclonic jerks), the frequency and amplitude of which were measured in an automated apparatus. The brain penetrant 5-HT1D receptor agonist 3-(2-dimethylaminoethyl)-4-chloro-5-propoxyindole hemifumarate (SKF 99101H) (3-30 mg/kg i.p.) and the selective 5-HT1A receptor agonist (+/-)8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) (0.3-3 mg/kg s.c.) dose dependently potentiated the frequency and intensity of myoclonic jerks caused by 5-HTP (100 mg/kg). Cotreatment of guinea pigs with 8-OH-DPAT (3 mg/kg s.c.) and SKF 99101H (30 mg/kg i.p.), which were inactive when given alone, gave a marked myoclonic jerk response. Conversely, the myoclonic jerk response to higher doses of 5-HTP (150 mg/kg i.p.) was dose dependently blocked by the 5-HT1D receptor antagonist GR 127935 (N-[4-methoxy-3-(4-methyl-1-piperazinyl)phenyl]-2'-methyl-4'-(5-methyl-1 ,2,4-oxadiazol-3-yl)[1,1'-biphenyl]4-carboxamide oxalate) (ED50 0.32 mg/kg i.p.) and the selective 5-HT1A receptor antagonist WAY 100635 (N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridinyl) cyclohexanecarboxamide trihydrochloride) (ED50 0.33 mg/kg i.p.). The response to 5-HTP (150 mg/kg i.p.) was also blocked by ritanserin (0.01-0.3 mg/kg i.p.). Our data therefore confirm previous reports concerning the effects of 5-HT2A/2C receptor blockade on 5-HTP induced myoclonic jerks and suggest that both 5-HT1D and 5-HT1A receptors play an important role in mediating this behavioural response.

The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting

STUDY DESIGN

Three hundred patients, attending their general practitioners with attacks of acute low back pain, formed the subject population for a study of fear avoidance and other variables in the prediction of chronicity. Follow-up was at 2 and 12 months.

OBJECTIVE

The hypothesis to be tested was that evidence of psychological morbidity, particularly fear-avoidance behavior, would be manifest from the outset of the presenting attack in susceptible subjects.

SUMMARY OF BACKGROUND DATA

While back pain is an almost universal human experience, only about 5% of sufferers seek medical advice. Most of these respond to conservative treatment. However, approximately 10% of those who experience an acute attack of low back pain go on to become chronic sufferers.

METHODS

Psychosocial and physiological data (including fear-avoidance measures) were collected from a sample of 300 acute low back pain patients within 1 week of presentation and at 2 months, to try to predict 12 month outcome.

RESULTS

Data analysis showed that subjects who had not recovered by 2 months were those who went on to become chronic low back pain patients (7.3%). Using multiple regression analyses, fear-avoidance variables were the most successful in predicting outcome. Using multiple discriminant function analyses, the results suggest that the outcome in terms of the future course of low back pain can be correctly classified in 66% from fear-avoidance variables alone and in 88% of patients from all variables.

CONCLUSIONS

The results suggest that, at the earliest stage of low back pain, fear of pain should be identified by clinicians and, where this is severe, pain confrontation should arguably form part of the approach to treatment.

5-HT 1D receptors mediate SKF 99101H-induced hypothermia in the guinea pig

The selective, brain penetrant, 5-HT(1D) receptor agonist SKF 99101H (10-30 mg/kg i.p.) caused a dose-related fall in rectal temperature in guinea pigs which lasted longer than 2 h. Sumatriptan (1.0-100 mg/kg i.p.), a selective 5-HT(1D) agonist which does not penetrate the brain, did not produce hypothermia, suggesting that peripheral mechanisms are not critically involved in the response. The hypothermia induced by SKF 99101H (30 mg/kg i.p.) was dose-dependently blocked by the 5-HT(1D) receptor antagonists GR 127935 (0.01-1 mg/kg i.p.) and GR 125743 (0.01-3 mg/kg i.p.), confirming the role of 5-HT(1D) receptors. Mianserin (0.3-10.0 mg/kg i.p.) and granisetron (0.1-3.0 mg/kg i.p.) were inactive, suggesting that 5-HT(2A/2B/2C) or 5-HT( 3) receptors play no significant role in the generation of the hypothermic response. Nor was the hypothermia reversed by prazosin (0.03-1.0 mg/kg i.p.), idazoxan (0.03-1.0 mg/kg i.p.) or scopolamine (0.01-0.3 mg/kg i.p.), thereby excluding mediation by α(1)- and α(2)-adrenoceptors and muscarinic receptors. WAY 100635 (0.1-1.0 mg/kg) significantly potentiated the effect of SKF 99101H. The antagonists, when given alone, had no effect on body temperature, with the exception of prazosin (0.1 and 1.0 mg/kg). Three days of treatment with parachloroamphetamine (30 mg/kg i.p.) depleted forebrain 5-HT by ∼ 75% in frontal cortex, hypothalamus, hippocampus and striatum, but failed to alter the hypothermic response to SKF 99101H. The hypothermia is, therefore, unlikely to be mediated by 5-HT(1D) receptors located on 5-HT neurons. SKF 99101H-induced hypothermia in the guinea pig may serve as a useful model for investigation of centrally acting 5-HT( 1D) receptor antagonists.

Body-image perception in pre- and postadolescent females

The purpose of this study was to examine both perceived and ideal body-image to establish if the process of adolescence was a contributory factor. A distorting mirror and silhouette pictures were used to examine the image in two groups of 59 pre- and 41 postadolescent girls. The girls' perception of themselves was reasonably accurate yet both groups had a significantly slimmer mean ideal image, irrespective of adolescent status. The differences between the two groups were nonsignificant whether using the distorting mirror or the pictures. The only difference to be observed was when using a body-satisfaction scale. The postadolescents were significantly less satisfied about their nonhead body parts. Scores from the mirror and the pictures question the assumption that body-image dissatisfaction is a postadolescent phenomenon. This should be a cause for concern as eating disorders, which appear to be linked to body-image, are being observed in younger children. The comparability between scores for the pictures and the distorting mirror opens the possibility of home-based therapy in the treatment of perceptual and eating disorders.

A follow-up study of problem drinkers offered a goal choice option

Patients (N = 100) who had been admitted to behaviorally oriented residential treatment for their drinking problems were followed up for 1 year. A treatment goal option of controlled drinking was explicitly catered for. Overall outcome, in which 27% of those available for follow-up were categorized as "successful," 35% as "equivocal" and 38% as "failure," does not appear to be markedly dissimilar to that reported from other agencies. The distribution of approximately equal abstinent and nonabstinent successful outcomes is similar to that found following treatment programs that promote a single goal. Sociodemographic variables were less influential in predicting outcome than were treatment variables--with frequency of aftercare attendance being particularly significant. Those who had received previous hospital treatment for their problem, those who habitually drank in company and those who had abnormal blood test results prior to entering treatment had poorer outcome.

An application of the fear avoidance model to three chronic pain problems

The Fear Avoidance Model of Exaggerated Pain Perception was developed in an attempt to explain how, and why, some individuals develop a more substantial psychological overlay to their low back pain problem than do others. The present paper describes a study in which three chronic pain groups, consisting of Post-Herpetic neuralgia patients, Reflex Sympathetic Dystrophy patients and chronic low back pain patients were compared with three pain-free comparison groups using the Fear Avoidance Model of Exaggerated Pain Perception. The results show statistically significant differences between the chronic groups and the recovered comparison groups. These results demonstrate the usefulness of the Fear Avoidance Model as an explanation of psychological overlay in chronic pain conditions regardless of pathology.

Motivation to comply with infection control procedures

This paper addresses the critical issue of motivating hospital staff to comply with standard infection control procedures. Previous psychological assessment of infection control knowledge, attitudes and behaviour has indicated that the reasons for non-compliance are very basic and reflect inter alia a low perception of the importance of the measures and a lack of motivation. It is argued that, although staff have a theoretical awareness of the value of complying with such procedures, in practice these seem to have a low priority. Compliance levels, therefore, are variable and generally of a low order. If recent advances in the fields of social psychology, behavioural psychology and clinical psychology could be imported to hospital medicine, they could have a dramatic impact in infection control. The Elaboration Likelihood Model, an effective theoretical approach to message-based persuasion, and the energizing effects of intrinsic and extrinsic motivational processes are defined. Finally, the implications of these concepts for persuasive intra-hospital communication in infection control are highlighted. They can provide a framework for developing effective infection prevention programmes.

Self-esteem and aesthetics

Self-esteem/self-concept and aesthetics were measured in three groups. One group prior to orthodontic treatment, one group following completion of active orthodontic treatment and an untreated group. Improvement in dental and/or facial aesthetics does not necessarily lead to an increase in self esteem.

An experimental analysis of perfectionism and dissatisfaction

The striving after perfection has been often mentioned in clinical literature; however, there have been few systematic analyses of the concept. In the present study, a questionnaire measure of Perfectionism and General Dissatisfaction (the SCANS) together with the Eysenck Personality Questionnaire and measures thought to gauge aspects of perfectionistic thinking, were administered to a mixed group of 148 subjects, including 25 eating disorder patients. Perfectionism was found to correlate negatively with Psychoticism (as measured by the EPQ) and positively with the Lie scale. Thus Perfectionism appears to be associated with a tendency to deny personally deviant behaviour and to present oneself in the best possible light. It is also associated with greater accuracy in a visual search task. General Dissatisfaction was correlated significantly with Neuroticism, Introversion and Psychoticism. It thus appears to be related to a combination of 'neurotic introversion' and 'personality deviance'. It is also associated with a tendency to be under-inclusive, that is to find difficulty in ruling out irrelevant stimuli when forming categories. Dissatisfaction was also associated with increased reaction time in the visual search task, perhaps also a reflection of an inability to ignore irrelevant stimuli. Only the EPQ N and P scales successfully differentiated neurotic or dissatisfied perfectionists from normal or satisfied perfectionists, although several measures derived from the visual search task produced results which were approaching significance.

Sex differences in body-image perceptions

Data of 30 men and 30 women in college show similar body-image perception which is associated with abnormalities of eating or psychological instability.

The specific psychosocial effects of orthognathic surgery

This study was to test the validity of patients' opinions and provide a more accurate method than previously reported of assessing the specific psycho-social effects of orthognathic surgery. Questionnaires were used preoperatively and postoperatively providing a longitudinal sample, while those patients who only completed questionnaires either before or after surgery provided cross-sectional samples. Different questionnaires were used to provide data on a 'Body Satisfaction Scale', 'Fear of Negative Evaluation', 'Social Avoidance and Distress', and a 'General Health Questionnaire'. The results indicate that surgery produced an improvement in body image, particularly in the evaluation of facial attractiveness.

Good and bad clinicians: supervisors' judgements of trainees' competence

Experienced supervisors of trainee clinical psychologists used 24 scales to rate four concepts: 'your stereotype of a good trainee'; "a good trainee well known to you'; 'a bad trainee well known to you'; and 'your stereotype of a bad trainee'. Similar ratings were given for both the good trainee concepts, which were rated differently from both the bad concepts, which were also rated differently from each other. Factor analysis revealed that the supervisor's judgements fell across two interpretable dimensions.

Reliability measures in distorting body-image

This study is the first to make a direct comparison between the distorting mirror and the distorting videocamera with the same group of nonclinical subjects. It also establishes the internal consistency, the test-retest reliability and the convergent validity of both techniques. Analysis indicates, as with other studies, that perceived image is consistently over-estimated and ideal image is consistently under-estimated by both techniques. With the distorting mirror, the frontal orientation is repeatable over four days and with the video the profile is the more reliable orientation. A comparison between profile and frontal orientations on any single test occasion (internal consistency) indicates that the results correlate well so either orientation is acceptable for experimental purposes. The extent to which both techniques were measuring the same aspect (convergent validity) was more marked for the ideal image. A researcher using the distorting mirror can be confident that the ideal image is reliable over time using either orientation but that the perceived image requires a frontal orientation. The frontal or profile orientation is acceptable for the ideal image using the distorting video, but the profile orientation is advisable if one wishes a reliable perceived image. The researcher should also be cautious in assuming that both techniques are measuring an identical body-image construct.

The multidimensional nature of schizotypal traits: a factor analytic study with normal subjects

Fourteen published scales of psychotic traits or symptoms (measuring various delusional states, magical ideation, perceptual aberration, disposition towards hallucination, hypomanic personality, schizotypal personality, borderline personality and anhedonia) were combined with the Eysenck Personality Questionnaire to form a Combined Schizotypal Traits Questionnaire (CSTQ) which was administered to 180 normal subjects. Two factor analyses were carried out on the scale scores. The first analysis excluded symptom scores derived from the Delusions Symptoms States Inventory of Foulds and Bedford and yielded a three-factor solution which appeared to measure traits relating to (i) positive psychotic symptomatology; (ii) negative psychotic symptomatology; and (iii) aspects of schizotypy involving social anxiety and cognitive disorganization. The Foulds scales were included in the second analysis which yielded a four-factor solution. The first three factors were similar to those obtained from the first analysis; the fourth factor seemed to measure an asocial component of schizotypy. This last factor was mainly accounted for by the P scale from the EPQ. These results support previous findings suggesting that different schizotypy scales relate to different underlying aspects of schizophrenia. The findings also indicate that psychotic traits are distributed along at least three dimensions.

Threat and loss in breast cancer

The psychological well-being of forty-four breast cancer patients was assessed shortly before and after surgery, and at three and twelve months post-operatively. Regression analysis revealed type of treatment, control over treatment and concern for appearance as significant predictors of nature of subsequent mood state. Results are discussed with reference to the theoretical position that type of severe life event can predict the nature of ensuing psychological disorder.

The orodental status of anorexics and bulimics

This study aims to assess the dental status of anorexics and bulimics by comparison to age-matched controls. One hundred and eight individuals participated, of which 58 had an eating disorder. This group were further subdivided into bulimics who induced vomiting (33), bulimics who did not vomit (7), and anorexics (18). The caries experience (DMFS), plaque levels, gingival inflammation and buffering capacity of saliva were assessed and total vomiting episodes estimated from the product of vomiting frequency and duration. Statistical analysis (one way ANOVA) revealed no significant differences with most of the dental variables between the eating disorder groups and the controls. A linear association (Pearson correlation coefficient) between vomiting frequency, duration or total vomiting episodes and tooth wear was not found, although the frequency of pathological tooth wear is significantly high in the vomiting bulimic group, especially if the total number of vomiting episodes is greater than 1100.

The relationship between body-image and body-fat in adult women

Measures of body-fat or adiposity, body-image, and other psychological variables were obtained from a sample of 100 female volunteer subjects. The measures of adiposity included surface anthropometry, underwater weighing and a new electrical impedance method. Body-image measures were derived from two experimental techniques, namely the visual-size estimation (or calliper) method and a distorting-mirror, and also from a self-report body-satisfaction scale (BSS). The main findings were that measures of adiposity were positively and significantly related to each other. But, that by contrast, measures of body-image separated out into three distinct sets, namely: (i) 'mirror' accuracy, (2) 'callipers' accuracy, and (3) 'dissatisfaction/desire for change'. The 'accuracy' measures were found to be unrelated to measures of adiposity or other psychological variables: while the 'dissatisfaction' measures were found to relate to both of these. The implications of these findings for future studies of weight and eating disorder groups are discussed.

The role of brief instructions and suggestibility in the elicitation of auditory and visual hallucinations in normal and psychiatric subjects

The present study is an investigation of the elicitation of auditory and visual hallucinations by brief instructions and the relationship of the report of hallucinatory-type experiences to standard measures of suggestibility. Two experiments were carried out. The first used normal subjects predisposed or not predisposed to hallucinate, as assessed by the Launay-Slade Hallucination Scale (LSHS-A). The second used hallucinating and nonhallucinating psychiatric patients. The high LSHS-A scorers and the hallucinating psychiatric patients were significantly more likely to hear suggested sounds than were their respective controls. High LSHS-A scorers were also significantly more likely to see suggested objects than were their respective controls, although this finding was not replicated in the psychiatric subjects. No significant differences on measures of suggestibility were found between the groups, although in the psychiatric group Barber Test Suggestion and Subjective Involvement scores correlated positively with LSHS-A scores.

Treatment and follow-up variables discriminating abstainers, controlled drinkers and relapsers

A group of behaviorally treated abstainers, controlled drinkers and relapsers who had been followed up for a minimum of 1 year were compared on eight treatment and 11 posttreatment variables. Discriminating characteristics of abstainers were their goal of abstinence at discharge and length of attendance at aftercare facilities. Controlled drinkers had a goal of controlled drinking and were most likely to have had controlled drinking training during treatment. Relapsers were most likely to have been discharged from treatment prematurely, to receive further treatment and to use psychotropic medication. No controlled drinkers attended Alcoholics Anonymous or received residential care during follow-up in contrast to a small proportion of abstainers and relapsers who did. Some aspects of the drinking behavior of controlled drinkers and relapsers were also studied. Controlled drinkers were more likely to have a period of initial abstinence and for a longer period of time. Of the controlled drinkers, 66% drank at least once per week and 86% set themselves drinking limits; average consumption of alcohol was 48 and 32 g/day by men and women, respectively. The majority of controlled drinkers changed their preferred beverage and their social and physical drinking environment after treatment in accordance with therapeutic advice.

Anorexia nervosa and dysmorphobia. A case study

Anorexia nervosa is frequently associated with neurotic traits and symptoms. The symptomatology and history of a housebound 20-year-old woman with anorexia nervosa and dysmorphophobia are described. The role of the family in maintaining the problems, use of external cues to control behaviour, overvalued somatic ideas and the definition of dysmorphophobia are discussed.

Predictors of outcome type in treated problem drinkers

Fifty successful controlled drinkers, 45 abstainers and 44 relapsers who had been followed up intensively for a minimum of 1 year were compared on 32 pretreatment variables in an attempt to isolate those which would be predictors of outcome type. Treatment was behaviorally oriented, and all subjects except for those with liver damage were left to make their own choice of treatment goal. The results showed that the best predictors of abstinence were: previous contact with Alcoholics Anonymous (A.A.); medium period of previous abstinence; having been initiated to seek help by a specialist; having been a periodic drinker, and drinking exclusively alone or socially. Controlled drinkers were more likely to be continuous drinkers, were not likely to have attended A.A. or to have abstained for a significant period of time, were likely to have relatives with a drinking problem, to have been motivated to seek help by a friend or a relative and to be less discriminating about the social drinking environment. Relapsers were more likely to be unemployed, to have a history of A.A. attendance and to have had a short period of previous abstinence. They were most likely to have liver damage and therefore advised to abstain. The results were interpreted as suggesting that outcome is likely to be influenced by the subjects' cognitions, by past behavioral expectations and experience of abstinence, as well as having the freedom of a choice of goals for recovery.

Reality testing and auditory hallucinations: a signal detection analysis

The hypothesis that hallucinators are deficient in the metacognitive skill of reality testing was tested using the methodology of signal detection theory. In Expt 1 undergraduate subjects scoring high or low on a scale measuring predisposition to hallucination were tested on an auditory signal detection task. High scorers on the scale were found to differ from low scorers on a measure of perceptual bias but not on a measure of sensitivity. In Expt 2 a similar methodology was used with hallucinating and non-hallucinating schizophrenic patients, with similar results. These results support the hypothesis that hallucinators or subjects highly disposed towards hallucination are deficient in reality testing and are therefore prone to identify imaginary events as real.

Breast Cancer — Patient Choice of Treatment: Preliminary Communication

Forty patients who have undergone treatment for breast cancer (mastectomy or lumpectomy plus radiotherapy) were assessed, both preoperatively and at intervals up to one year following surgery, using tests of anxiety, depression, body satisfaction, marital adjustment, self-esteem, sociability and life change. The women were also interviewed to assess degree of concern about the disease, appearance and treatment. Wherever appropriate, patients were given a choice of treatment. Very little adverse psychosocial reaction has been found. It would appear that this is largely because most patients could opt for treatment which resulted in minimal disfigurement.

Sensory deprivation and clinical psychiatry

Sensory deprivation as a scientific procedure was conceived in the early 1950s, intensively studied in the early 1960s, and applied in a limited way in the 1970s. From a consideration of the data, it is clear that clinical psychiatry could benefit from its more general application in the 1980s.

Role of grammatical clues in multiple choice questions: an empirical study

Some dangers of the use of multiple choice questions are described. In particular, carefully selected questions drawn from published sources contain grammatical clues which enable examinees with a particular sort of linguistic knowledge to gain extra marks.

The effects of varying auditory input on schizophrenic hallucinations

The present report is of the effect of variations of auditory input on hallucinatory experiences in seven schizophrenic patients. Nine experimental conditions, each of two minutes' duration were compared with a control condition. At the end of each period subjects were required to rate the duration, loudness, and clarity of hallucinations during that time. Experimental conditions varied according to the amount of structure present in the material and in its attention-commanding properties. One condition required the active monitoring of material presented and resulted in the greatest decrease in hallucinatory experiences. For the passive conditions, findings were broadly consistent with predictions, indicating that it is not stimulation per se, but rather the extent to which structure is present and attended to, that is important in determining the occurrence of hallucinatory phenomena.

Some conceptual difficulties with the term 'schizophrenia': an alternative model

The term 'schizophrenic' is used in two distinct ways: namely to describe a particular type of illness and also as a label for the person suffering from this illness. If we concentrate on the 'illness' conception of schizophrenia it readily becomes apparent that its definition and nature varies somewhat from one proponent to another. Added to this is the problem that the major conceptions of schizophrenia are based on disjunctive concepts. The basic argument of this paper is that while all clinical conceptions of schizophrenia have assumed the existence of a disease-entity syndrome, no attempt has ever been made to test its logical alternative: namely a random-symptom model. Some data will be presented which are at least compatible with this alternative and some of the theoretical implications spelt out.

Psychological aspects of dialysis: a semantic differential study

As a consequence of technological advances over the last 15 years, patients suffering from terminal renal failure are now being kept alive for considerable periods of time, either by renal haemodialysis or, where appropriate and possible, by renal transplantation. The former necessarily imposes restrictions on the patients' lives which may be manifest at various levels. The basic aim of the study to be reported was to conduct an exploratory investigation of the psychological impact of dialysis on such patients, together with some of the factors that may influence their reactions to it. Using a Semantic Differential technique, 21 patients on dialysis were compared with a group of 21 healthy control subjects in terms of the personal meaning of selected concepts. Both groups were then subdivided on the basis of age, sex and, in the case of the patients, in terms of length of time on dialysis. Subgroup comparisons were then conducted. The findings suggest various hypotheses which have both theoretical and clinical implications.

Comparative double-blind trial of mianserin hydrochloride (Organon GB94) and diazepam in patients with depressive illness

1. The antidepressant action of mianserin was tested in a double-blind clinical trial lasting 6 weeks. Forty-six patients with moderate to severe degrees of depression were treated at random with mianserin or diazepam. Patients who failed to improve by week 3 were taken out of the trial. 2. Mianserin was more effective than diazepam in reducing scores on the Hamilton Rating Scale for depression. Fewer patients allocated to mianserin had to be withdrawn from the trial on account of failure to improve. Mianserin was more effective than diazepam in reducing symptoms of 'retarded depression' and as effective as diazepam in reducing symptoms of 'anxious depression'. 3. Mianserin did not cause any more side-effects than diazepam, very few side-effects being encountered with either drug. 4. The design of this trial on antidepressant drugs is commended on ethical grounds.

A reappraisal of body perception disturbance in anorexia nervosa

Previous research has suggested that patients suffering from anorexia nervosa tend to overestimate their body size, whereas normal females tend to be very accurate in this respect. This paper presents the results of further investigations of body perception amongst anorexic and normal females. The results, in contrast to earlier findings, indicate no such difference between groups. Detailed analysis of the data, however, points to the likelihood of certain differences between the present group of anorexic patients and previous groups. Moreover, it seems that body perception disturbance is not a consistent feature of anorexia nervosa and is only present amongst some patients at certain stages during their illness. On subdividing the anorexic group it was demonstrated that patients who vomit tend to overestimate their size more than do non-vomiters. It also seems likely that normal females are far from homogeneous in terms of body perception. In line with previous findings, a direct relationship was found between marked overestimation of body size and an early relapse. Evidence is also discussed which suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.