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Showing papers in "International Journal of Psychiatry in Medicine in 1973"


Journal ArticleDOI
TL;DR: It is proposed that the symptoms comprising Munchausen syndrome are a defense against psychosis or infantile anxiety and are precipitated by either real or threatened separations from ambivalently regarded object relations.
Abstract: Four new cases of Munchausen syndrome are described and compared to prior reports in the literature. Remarkable is the high frequency of childhood histories which include rejecting or sadistic pare...

57 citations


Journal ArticleDOI
TL;DR: Major literature in the areas of neurophysiology, endocrinology and biochemistry is reviewed and placed within a dynamic model which draws heavily upon ideas previously put forward by Meyer and von Bertalanffy.
Abstract: An attempt is made to provide a cohesive conceptual frame upon which may be placed the recent advances in our understanding of the psychobiology of the affective disorders. Major literature in the ...

49 citations


Journal ArticleDOI
TL;DR: The early results from the group therapy experience have provided important information and are reported here to illustrate the psychological physiology of the rehabilitation process and emphasize patients' special needs, too often ignored during their convalescence.
Abstract: A controlled experiment of the utility of group therapy as an adjunct to the medical outpatient management of patients following myocardial infarction has been in progress for nearly a year. The lo...

49 citations


Journal ArticleDOI
TL;DR: It is argued that such a model has useful application for the consultant psychiatrist who typically concerns himself with multiple sources of data in his clinical tasks.
Abstract: A number of concepts fundamental to a general systems model are reviewed and illustrated. The problems and issues of psychiatric consultation in the general hospital are then discussed in the light of a general systems approach. It is argued that such a model has useful application for the consultant psychiatrist who typically concerns himself with multiple sources of data in his clinical tasks.

47 citations


Journal ArticleDOI
TL;DR: This comparative study fails to support the proposition that the intensive care unit environment per se causes psychological disturbance.
Abstract: Thirty-two patients admitted to a general medical intensive care unit were compared to twenty patients, matched for age, sex, type and severity of illness, treated in a conventional medical ward. No meaningful difference in incidence of delirium was noted. Neither sensory monotony nor sleep deprivation could be correlated with occurrence of delirium. An organic base was present in all four cases of delirium which occurred in the ICU. By use of a specially devised scale to measure levels of anxiety or depression in medically ill patients, no higher levels of anxiety or depression were found in ICU patients than in comparably ill patients treated in a ward. This comparative study fails to support the proposition that the intensive care unit environment per se causes psychological disturbance.

30 citations


Journal ArticleDOI
TL;DR: Emphasis is placed upon the role of the partial deafness in the creation of a potentially objectless state which predisposes to the experiencing of the affect depression-withdrawal under conditions of additional stress.
Abstract: The case histories of several patients whose ulcerative colitis was preceded by partial deafness are presented. It is assumed that the partial deafness had an etiological significance and a series of four steps leading from the communication difficulties created by the deafness to the ulcerative colitis is described. Emphasis is placed upon the role of the partial deafness in the creation of a potentially objectless state which predisposes to the experiencing of the affect depression-withdrawal under conditions of additional stress. Presumably somatic correlates of this affect interact with unknown somatic vulnerabilities to produce ulcerative colitis.

22 citations


Journal ArticleDOI
TL;DR: The changes in the functioning of the psychiatric component of a general hospital emergency room were assessed over the past decade and the effect of its incorporation into a community mental health center as its emergency service was seen to exert a significant increase in its utilization.
Abstract: The changes in the functioning of the psychiatric component of a general hospital emergency room were assessed over the past decade. The effect of its incorporation into a community mental health center as its emergency service was seen to exert a significant increase in its utilization. Admissions increased threefold over the ten year period and the 15–21 age group increased by twice that amount. Analysis of census and social class data showed a significant effect of distance on only the lower socioeconomic groups. Diagnostic and dispositional shifts were seen as showing an increase in utilization by less disturbed patients who use the emergency room as their primary treatment resource. The rise in the drug addictions is striking and may mask other diagnoses.

21 citations


Journal ArticleDOI
TL;DR: It was confirmed that critical attitudes towards the use of placebos correlated with older age of physicians, more time spent in private practice, less research activity, and degree of defensiveness about treatment.
Abstract: A questionnaire was sent to 240 physicians in large cities throughout the United States to assess ethical attitudes towards the use of placebos in treatment and research. Confirmed hypotheses were that critical attitudes towards the use of placebos correlated with older age of physicians, more time spent in private practice, less research activity, and degree of defensiveness about treatment.The major attitudinal difference between clinicians and researchers was found in clinical graduate psychoanalysts and analytically-oriented researchers.

21 citations


Journal ArticleDOI
TL;DR: Review of published reports and study of three cases newly presented have revealed characteristics with enough consistency for proposal of a psychiatric syndrome in hypoglycemia.
Abstract: Unauthorized self-administration of hypoglycemic agents produces a unique clinical situation. Because the symptoms and laboratory findings are consistent with a functioning adenoma of the pancreas, there is a significant hazard of unnecessary surgery. By appropriate laboratory tests, however, the alert physician may be able to justify suspicion that the disorder is self-induced.Accurate diagnosis may be further facilitated by recognizing certain similarities in these patients. Review of published reports and study of three cases newly presented have revealed these characteristics with enough consistency for proposal of a psychiatric syndrome. In hypoglycemia, factitial causation is suggested by the combination of female sex, single status, medical knowledge derived from experience as a diabetic or from vocational or family contacts, and features of the hysterical personality.

21 citations


Journal ArticleDOI
TL;DR: In this paper, seven principles governing the selection and organization of data during the process of psychiatric consultation are presented based upon conceptual decisions implicitly made by the psychiatrist during his clinical investigation, followed by discussion which focuses on the pragmatic considerations influencing how these decisions are made.
Abstract: Seven principles governing the selection and organization of data during the process of psychiatric consultation are presented. These are based upon conceptual decisions implicitly made by the psychiatrist during his clinical investigation. Three case examples illustrate the principles, followed by discussion which focuses on the pragmatic considerations influencing how these decisions are made. Three additional case examples serve to illustrate the effects of the pragmatic factors. The entire analysis is based upon the general systems model developed in Part I.1

20 citations


Journal ArticleDOI
TL;DR: The psychometric properties of the death anxiety questionnaire, along with other findings, suggest need for more attention to measurement problems, heretofore largely ignored.
Abstract: Nurses' attitudes toward death and dying are of increasing interest as management of dying patients becomes a focus of concern. A death anxiety questionnaire tapping six conceptually distinct aspects of attitudes toward death was developed from work of previous investigators and administered along with other measures to 188 hospital nurses. This sample proved not to express very much anxiety about death; older nurses especially were found to express less anxiety about death of others and more acceptance of conventional medical procedures for managing the dying patient. No aspect of death anxiety was related to death rate on the unit on which the nurse worked, to any of several personality variables, or to peer rating of death anxiety. Finally, the psychometric properties of the death anxiety questionnaire, along with other findings, suggest need for more attention to measurement problems, heretofore largely ignored.

Journal ArticleDOI
TL;DR: It is suggested that the liaison psychiatrist may assume the role of a coordinator of comprehensive child care in many of these “disintegrated” ward situations and this role can be adopted more easily by those psychiatrists who have had previous experience in pediatrics or general medicine.
Abstract: This paper describes the development of a child psychiatry liaison service to pediatrics in a university hospital setting and discusses the authors' preference for the liaison type of relationship over strictly consultative psychiatry.The success of the liaison service in promoting comprehensive pediatric care can be related to an effective team approach which includes a pediatric social worker and a child psychiatry nurse specialist. In addition to the usual methods of handling consultation requests for psychiatric services, weekly teaching conferences on the pediatric wards were established to draw the house officers' attention to a bio-psycho-social approach to pediatric care, to allow ventilation of intradepartmental conflicts, and to enable nurses and residents to express their feelings freely about difficult patient problems such as the chronically ill and the dying child.The common lack of continuity of house officers and attendings on the pediatric wards hampers efforts to provide well planned and...

Journal ArticleDOI
TL;DR: It is suggested that if psychiatrists work together, some of the stresses might be reduced, and the knowledge and understanding of the psychological aspects of chronic hemodialysis would be greatly enhanced.
Abstract: This study concentrates on the role and functions of the psychiatrist in chronic hemodialysis. These functions include participating in the selection and treatment of patients, collecting observations on patients' reactions to chronic dialysis, and working with their families and the medical team. A great deal of information, often contradictory, has been reported so far in the areas of treatment and observation. The lack of information in other areas is attributed to insufficient objectivity and neutrality on the part of the psychiatrist, caused by the intense emotional impact of working in chronic hemodialysis units. It is suggested that if psychiatrists work together, some of the stresses might be reduced, and the knowledge and understanding of the psychological aspects of chronic hemodialysis would be greatly enhanced.

Journal ArticleDOI
TL;DR: An important implication of the study is the need to question the ways in which nonpsychiatrists are encouraged and expected to assume more responsibility for the care of patients with emotional problems.
Abstract: In the last two decades psychiatrists in liaison work have asked nonpsychiatrists to accept a greater role in the management of mental illness, sponsoring educational programs and offering consultative services to provide assistance in diagnosis and management of patients. The triadic doctor-doctor-patient relationship and transference-countertransference phenomena often have more influence on the consultation process and the effectiveness of didactic methods than real problems like the degree of availability of consultants. Such factors as 1) the circumstances of the choice of medicine as a profession, 2) the special meaning of the choice of specialty, and 3) personality factors have great influence upon the relationship between the consultant and the consultee, the quality of the consultation, and the effectiveness of educational methods used in liaison psychiatry.The results of an attitudinal survey of fifty physicians, conducted to explore conscious motivations for choosing the medical profession, att...

Journal ArticleDOI
TL;DR: The studies reviewed indicate that marijuana, like alcohol, has persisting effects on neuronal activity and presumably on its underlying neurochemical regulation and that caution should be employed in advising the public about the use of marijuana.
Abstract: Both marijuana and alcohol have effects on sleep which can be clinically important if either drug is used heavily. A number of polygraphic studies of both drugs' effect on sleep demonstrate that both are rapid eye movement (REM) sleep suppressors and that both effect the REM sleep deprivation response for days after the acute effects have ceased. Marijuana also increases slow wave sleep compared to alcohol which decreases it. The studies reviewed indicate that marijuana, like alcohol, has persisting effects on neuronal activity and presumably on its underlying neurochemical regulation. Also, the studies suggest that caution should be employed in advising the public about the use of marijuana.

Journal ArticleDOI
TL;DR: A comparative psychiatric evaluation of eighteen women with similar backgrounds who sought legal abortion suggests that the delay of the decision until second trimester involves multiple psychological factors.
Abstract: A comparative psychiatric evaluation of eighteen women with similar backgrounds who sought legal abortion suggests that the delay of the decision until second trimester involves multiple psychological factors. The eight women who presented late had a pattern of disturbed parental relationships, reliance on denial as a defense mechanism and ambivalence towards the pregnancy. They related strong feelings of identification with their “baby” and post-abortion expressed a sense of loss. Professional staff dealing with these patients need their own support system to intervene effectively in the crisis situation.

Journal ArticleDOI
TL;DR: The introduction of behavioral science principles through patient-centered conferences with the non-physician staff of an oncology clinic revealed the unique pressures experienced by these personnel and the key role they play in the psychosocial management of chronically ill patients.
Abstract: Biweekly patient-centered conferences with the non-physician staff of an oncology clinic revealed the unique pressures experienced by these personnel and the key role they play in the psychosocial management of chronically ill patients. The introduction of behavioral science principles through these conferences was useful in promoting improved staff morale and more appropriate patient management and suggests a model for the development of a comprehensive health delivery system.

Journal ArticleDOI
TL;DR: Clinical examples are presented which highlight the importance of attachment to loved ones and magical wishful thinking in the experience of loss in the hospital setting and the psychiatric-orthopedic liaison helps to increase staff awareness of psychological processes so that the patient's emotional difficulties can be defined and minimized.
Abstract: The psychological tasks facing the amputee war casualty change according to the phases of rehabilitation from wound healing through ambulation and the transition to civilian life. Psychiatric exper...

Journal ArticleDOI
TL;DR: The advantages of staff members' confining performance expectations as much as possible to the treatment area and of helping patients to maintain direction and control of their personal affairs, including decisions concerning employment, are stressed.
Abstract: Home dialysis is considered as work and as the home patient's main job. Reasons for the belief of many staff members that employment is the only acceptable form of work and some of the effects this has on patient attitudes and planning are discussed. The physical and emotional stresses under which dialysis patients have to live are described as being similar to those of soldiers in combat. Helping patients to develop and utilize financial and other resources is viewed as an aid in reducing the incidence of “combat fatigue” and as fostering positive patient-staff relationships. The advantages of staff members' confining performance expectations as much as possible to the treatment area and of helping patients to maintain direction and control of their personal affairs, including decisions concerning employment, are stressed.

Journal ArticleDOI
Hoyle Leigh1
TL;DR: The anxiety-provoking dilemma to tell or not to tell the “truth” to cancer patients should depend on an accurate understanding of the patients' communications, so that doctors feel more uncomfortable and more avoidant of the patient afterwards.
Abstract: Psychiatric liaison on an inpatient neoplastic service provides unique opportunities for medical and nursing staff to gain psychological understanding of patients in general and to improve communication for the welfare of the patient. The natural anxiety generated by facing dying patients can work as a catalyst in bridging the conceptual gap between medicine and psychiatry. The psychiatrist can point out in a group setting that such anxiety is shared by everyone, including the psychiatrist. The anxiety-provoking dilemma to tell or not to tell the “truth” to cancer patients should depend on an accurate understanding of the patients' communications. “Telling the truth” does not always relieve the physician's anxiety; many doctors feel more uncomfortable and more avoidant of the patient afterwards because they are unprepared to deal frankly with the topic of death once it has been exposed.

Journal ArticleDOI
TL;DR: The role of a liaison psychiatric consultant and the practical usefulness of psychiatric expertise in an ongoing hemodialysis program is illustrated by means of an individual patient study.
Abstract: The role of a liaison psychiatric consultant and the practical usefulness of psychiatric expertise in an ongoing hemodialysis program is illustrated by means of an individual patient study. Initially, the psychiatrist concentrated on establishing a diagnosis and defining the etiological significance of a variety of factors that were influencing the patient's behavior. Consequently, changes in the patient's medical program were suggested in an attempt to modify the patient's psychiatric status. The psychiatrist also needed to help the dialysis unit staff understand the patient and make a decision on feasibility of a kidney transplant.

Journal ArticleDOI
TL;DR: This Medical Psychology Forum deals with the response of a patient to the symptoms of myocardial infarction, to hospitalization and convalescence, and the assessment of anxiety and depression in the CCU.
Abstract: This Medical Psychology Forum deals with the response of a patient to the symptoms of myocardial infarction, to hospitalization and convalescence The problem of delay is examined in the prehospita

Journal ArticleDOI
TL;DR: Outstanding characteristics of the physicians who had taken courses compared to those who had not were a higher percentage in general practice than in a specialty, greater confidence in their own psychiatric diagnostic and therapeutic skills, and higher estimates of psychiatric disorders in their practices.
Abstract: 720 primary (nonpsychiatrist) physicians responded to a mail distributed questionnaire investigating their attitudes to and practices with psychiatric education, psychiatrists and emotionally disturbed patients. Respondents were divided into two groups on the basis of whether or not they had attended postgraduate courses in psychiatry. Outstanding characteristics of the physicians who had taken courses compared to those who had not were: 1) a higher percentage in general practice than in a specialty, 2) greater confidence in their own psychiatric diagnostic and therapeutic skills, 3) higher estimates of psychiatric disorders in their practices, 4) more willingness to treat emotionally disturbed patients, including aftercare patients, 5) more competent use of psychoactive drugs for depression and schizophrenia, 6) greater interest in psychiatry, 7) stronger subjective needs for help with the management of their disturbed patients, and 8) higher frequency of personal psychotherapy. The two groups did not differ in: 1) evaluations of their previous educational experiences in psychiatry, 2) the hours per week devoted to medical practice, or the number of patients seen per day, 3) indications for intervention or preferred modes of treatment with psychiatric cases, 4) attitudes towards the usefulness of psychiatry, 5) frequency of making psychiatric referrals, and 6) skill with psychoactive drugs for anxiety.

Journal ArticleDOI
TL;DR: A model using a small group system to integrate the multiple ward functions in light of the complicating factors, including heterogeneity of patient population, a large and diverse staff, and a pivotal role for inexperienced first-year residents is described.
Abstract: The functions of an acute, general hospital psychiatric inpatient teaching unit include patient evaluation and treatment, resident training and the staff communication necessary to both. On our ward, this work is complicated by heterogeneity of patient population, a large and diverse staff, and a pivotal role for inexperienced first-year residents. This paper describes a model using a small group system to integrate the multiple ward functions in light of the complicating factors. The ward is divided into two teams, and the staff and patients of each meet together four times weekly; a post-group staff meeting follows. The patient meeting is oriented around the realities of daily living. The post-group flexibly covers four areas: diagnosis and management; group process and techniques; intra-staff conflict; and ward issues. Converging on the system are multiple and overlapping observations which can be used to integrate ward functions. The simultaneous presence of all the staff increases the efficiency and ...

Journal ArticleDOI
TL;DR: Open heart surgery has been shown to have a rate of occurrence of postoperative psychopathological phenomena many times greater than that of general surgery.
Abstract: Open heart surgery has been shown to have a rate of occurrence of postoperative psychopathological phenomena (9 percent-57 percent) many times greater than that of general surgery (1/1500). These phenomena result from an interplay of organic, environmental, psychological, and social factors which act on the integrative and coping capacity of the ego.Treatment is accomplished through support of the ego by: 1) establishment of a relationship, 2) reassurance, 3) environmental support, 4) consultative relationships with staff, 5) ventilation of feelings, 6) medical measures in support of somatic function, and 7) anti-anxiety drugs. Such supportive measures are usually effective in bringing about a rapid remission of these psychopathological phenomena.

Journal ArticleDOI
TL;DR: The severe depression of a patient critically ill with myasthenia gravis necessitated psychiatric intervention and therapy based on the therapist's presentation of himself as an all-powerful healing figure was utilized.
Abstract: The severe depression of a patient critically ill with myasthenia gravis necessitated psychiatric intervention. Over a period of two years three different approaches were utilized by three therapists: 1) intensive psychotherapy, 2) limited supportive psychotherapy, and 3) therapy based on the therapist's presentation of himself as an all-powerful healing figure. Improvement occurred in phase one, severe regression in phase two and marked improvement and death in phase three. Transference and countertransference factors were of critical importance in each phase.

Journal ArticleDOI
TL;DR: The present case demonstrates how an ecological approach resulted in the effective removal of symptoms in a 9-year-old child with intermittent esophageal stenosis.
Abstract: In contrast to traditional “interdisciplinary” methods of consultation where independent assessment and treatment are carried out by different treating agencies, the “ecological” approach involves continuing cooperation between all systems affecting the maintenance of the symptom in the patient-biological, psychological, individual, familial, social and community. The present case demonstrates how such an ecological approach resulted in the effective removal of symptoms in a 9-year-old child with intermittent esophageal stenosis. While there had been earlier consultations in the “interdisciplinary” sense by both the Department of Ear, Nose and Throat and the Department of Child Psychiatry, it was only when the family and all disciplines working with them were brought together on the same physical premises face to face that directives became fused and united. This enabled the family to mobilize its resources and effectively deal with its problems, resulting in the alleviation of the manifest symptoms.

Journal ArticleDOI
TL;DR: In the most recent group studied, five residents who taught psychology of adolescence to undergraduate education majors initially experienced considerable anxiety, followed by immediate relief, a progressive sense of mastery and enthusiasm, and a reluctance to end the elective.
Abstract: For seven years, first year residents in psychiatry have been followed in their initial teaching effort. In the most recent group studied, five residents who taught psychology of adolescence to undergraduate education majors initially experienced considerable anxiety, followed by immediate relief, a progressive sense of mastery and enthusiasm, and a reluctance to end the elective. At the conclusion, all reported that the experience was extremely worthwhile and wished to continue teaching to try out new ideas. All of twenty undergraduate students who responded to an anonymous questionnaire rated their resident-instructor “above average” in comparison with previous instructors in high school and college, and 45 percent rated him “one of the best.” The faculty documented the residents' learning by behavioral changes over the observational period.In our experience, brief but active involvement in teaching has proven to be the best starting point. Educators as supervisors help the resident bypass threatening i...

Journal ArticleDOI
TL;DR: This is a patient's autobiographical account of her illness while hospitalized at the place of her employment, raising such issues as the reluctance of physicians to recommend psychiatric consultation, the obstacles to effective communication and patient care posed by medical territorialism, and the complications that arise when a health worker must assume the role of patient.
Abstract: This is a patient's autobiographical account of her illness while hospitalized at the place of her employment. She discusses her emotional reactions to her illness experience–her anxiety and depression over seizure activity and concomitant debilitation, her frustration over her failure to communicate with the staff, her request for psychiatric consultation, and her eventual rehabilitation. She raises such issues as the reluctance of physicians to recommend psychiatric consultation, the obstacles to effective communication and patient care posed by medical territorialism, and the complications that arise when a health worker must assume the role of patient, cared for by fellow staff members.

Journal ArticleDOI
TL;DR: The case of a 35-year-old woman who “knew” of her advanced metastatic carcinoma of the breast was presented and the realistic problems of medical and psychological management were discussed.
Abstract: The case of a 35-year-old woman who “knew” of her advanced metastatic carcinoma of the breast was presented. The realistic problems of medical and psychological management were discussed, with emphasis on the impact of such a task on her helpers.