Showing papers in "International Journal of Psychiatry in Medicine in 1977"
TL;DR: Although vulnerability increased with advanced staging and many symptoms, at the time of diagnosis psychosocial distress crossed diagnostic and prognostic boundaries, enabling investigation to predict within limits those patients who will cope effectively or fail to cope with cancer and its ramifications.
Abstract: The Existential Plight in cancer is a poorly recognized but significant period. It starts with the definite diagnosis and continues for two to three months into the illness, approximately 100 days....
662 citations
TL;DR: Two groups — identified as “good control�” and “poor control” — of 40 diabetic youth, between 6 years and 18 years, matched for age, sex and duration of diabetes, were interviewed by a child psychiatrist who was not aware of the status of their diabetic control.
Abstract: Two groups — identified as “good control” and “poor control” — of 40 diabetic youth, between 6 years and 18 years, matched for age, sex and duration of diabetes, were interviewed by a child psychiatrist who was not aware of the status of their diabetic control. After each interview psychiatric diagnoses, interpersonal conflicts and noninterpersonal conflicts were determined. At the same time, mothers completed a children's behavorial-emotional symptom checklist. Six psychiatric diagnoses were made (7 ½ per cent occurrence): four in the poor control group and two in the good control group, not a significant difference. Fifty per cent of the psychiatric diagnoses were found in the prepubertal girls who had the earliest onset of diabetes. A significantly greater number of patients in poor control had interpersonal conflicts compared with patients in the good control group. Mothers of patients in poor control had checked significantly more behaviors as slight and considerable-severe problems compared to mothe...
58 citations
TL;DR: It has been proposed that psychological acceptance is related to a patient's psychological acceptance of the organ, and it is shown that patients who experience depression in the early postoperative period are more likely to accept the organ than those who do not.
Abstract: The literature on psychological reactions to renal transplantation in adult donors and recipients is reviewed. Although the psychiatric complications of kidney transplantation appear to be fewer than in renal dialysis, the operation represents a threat to the donor, recipient and extended family. Donors, despite altruistic motivations for offering their kidney, often harbor resentment toward the recipient and commonly experience depression in the early postoperative period. Recipients often unrealistically expect the homograft to be a panacea for their emotional stresses. Anxiety and depression are common reactions when a physical complication, particularly rejection, does occur. It has been proposed that psychological acceptance is related to a patient's psychological acceptance of the organ.
39 citations
TL;DR: A competency-based model for training in consultation-liaison psychiatry is presented which addresses the issues of how residents are taught to collect and formulate patient data and the implications of this approach to some of the issues that surround residency training in this field.
Abstract: In the first of three papers, the authors present a competency-based model for training in consultation-liaison psychiatry which addresses the issues of how residents are taught to collect and formulate patient data. This model emphasizes the use of behavioral statements to describe the process of how a consultation is done. By comparing the resident's performance with prestated behavioral objectives, a method for residency supervision is offered. The second paper carries this one step further with the application of the model to clinical intervention strategies. The final paper discusses the implications of this approach to some of the issues that surround residency training in this field.
26 citations
TL;DR: It is concluded that patients who present with psychologic identification with the deceased have a distinct clinical syndrome (grief-related facsimile illness) for which recognition is important to institute proper management.
Abstract: One aspect of the grief process which is frequently mentioned in the literature on mourning but has not yet received adequate clinical attention is the tendency for the bereaved to assume symptoms ...
23 citations
TL;DR: Preliminary results reported by a feedback component of an independent evaluation team attached to the program suggest that the interns are receptive to the psychiatric input and that they consider the initial contribution by psychiatry to have as much usefulness to their training in primary care as the more traditional pediatric and medical components.
Abstract: Increasing development of postgraduate primary care training programs to meet manpower needs is supported by flexibility in the Boards of Internal Medicine and Pediatrics to include experience in psychiatry; with this change, liaison psychiatrists will become progressively more involved and closely integrated into such training. This report outlines the first year experience of a psychiatrist in one innovative three year program in pediatrics and medicine, and describes some common problems and issues, along with teaching goals and some developing methodologies.Although the number of trainees in this first year cohort is small, preliminary results reported by a feedback component of an independent evaluation team attached to the program suggest that the interns are receptive to the psychiatric input and that they consider the initial contribution by psychiatry to have as much usefulness to their training in primary care as the more traditional pediatric and medical components.
21 citations
TL;DR: This paper argues that an individual's language may similarly determine his conception of disease, and suggests that the bipolar structure of Indo-European languages may play a part in the persistence of the mind-body dichotomy and restrict the holistic perception of man with nature.
Abstract: The Sapir-Whorf hypothesis, well-known in anthropological linguistics, postulates that language may not only describe the world we inhabit but also mould the way we experience it. This paper argues that an individual's language may similarly determine his conception of disease. Possible relationships between linguistic features and disease concepts are cited for the Eskimo, the Navaho, and the Chinese, and it is suggested that, in European languages, the extensive use of spatial metaphors to express abstract concepts may encourage a more rigid categorization of disease and inhibit the ability to conceive of multiple factors in disease causation. The use of nouns rather than verbs to express the idea of illness could lead to a static view of disease and tends to separate illnesses as distinct entities rather than defining them as aspects of bodily functioning. The bipolar structure of Indo-European languages, setting subject against predicate and noun against verb, may play a part in the persistence of the...
19 citations
TL;DR: The emergence of the eclectically trained psychiatrist as the most acceptable consultant in the general hospital is discussed and disparities between the need for and the availability/utilization of consultation services are examined.
Abstract: Studies are reviewed documenting increased interest in psychiatric consultation services in the general hospital, and disparities between the need for and the availability/utilization of consultation services are examined. The emergence of the eclectrically trained psychiatrist as the most acceptable consultant in the general hospital is discussed. An exploratory attiduinal questionnaire, developed and circulated to a sample of attending physicians in a midwestern university teaching hospital, yielded the following data. Thirty-nine per cent (N=96) of the 244 physicians who received the questionnaire responded. Ninety-nine per cent of the respondents agreed that readily available psychiatric consultation services should be fully operative in all large general hospitals; 88% agreed that psychiatric consultations in the general hospital must be performed by a physician with special training in psychological medicine; 50% indicated a preference for a biologically-oriented psychiatrist, and 26% preferred a family practitioner or internist who had subsequently become a psychiatrist. The majority of respondents indicated that between July 1974 and July 1975, 1-5% of their private hospitalized patients received inhospital psychiatric consultation. Eighty-six per cent of the respondents felt the patients should be billed directly at a rate equal to other medical/surgical consultations. These data are correlated with issues involved in the utilization of psychiatric consultation in the general hospital.
16 citations
TL;DR: The hypothesis advanced by some investigators that vasectomized men exaggerate their masculinity in an overcompensating maneuver to reduce a perceived threat to their masculinity was not supported; instead, men volunteering for vasectomy exhibited as many masculine traits prior to the operation as after it.
Abstract: The effects of vasectomy on psychosocial adjustment assessed by interviews, and on physical health assessed by physicians and other medical personnel, were examined by comparing 33 vasectomized men with a matched group of 33 non-vasectomized men in a pre-paid health plan. Consistent with favorable self-reports in earlier studies, the vasectomized men experienced no greater marital, job, or general living stress than the non-vasectomized men. In fact the psychosocial adjustment of the vasectomized men appeared superior to that of the non-vasectomized men, perhaps because of reduced anxiety about unwanted pregnancy. The hypothesis advanced by some investigators that vasectomized men exaggerate their masculinity in an overcompensating maneuver to reduce a perceived threat to their masculinity was not supported; instead, men volunteering for vasectomy exhibited as many masculine traits prior to the operation as after it. There was no evidence that vasectomy led to either impairment or enhancement of medical health.
14 citations
TL;DR: The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses concerns that affect the training of consultation-liaison psychiatrists.
Abstract: In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.
13 citations
TL;DR: In this article, the authors continue the application of the competency-based model of training to the problems of clinical intervention and present behavioral objectives as a focus for residency supervision and their application to a clinical situation is illustrated.
Abstract: Although psychological and pharmacological intervention is an important aspect of the treatment of patients seen in consultation on medical and surgical wards, little attention has been directed to the method of training psychiatric residents in these areas. In this paper, the authors continue the application of the competency-based model of training to the problems of clinical intervention. Behavioral objectives are presented as a focus for residency supervision and their application to a clinical situation is illustrated. The objectives are designed to consider the activities of the consulting psychiatrist as he relates to the patient as well as other members of the treatment milieu.
TL;DR: A group-oriented mental health consultation program which was established for the staff of a pediatric special care nursery is described, reviewing implications for crisis intervention to help mitigate families' mental stress and to facilitate the emotional attachment to their infants.
Abstract: The paper describes a group-oriented mental health consultation program which was established for the staff of a pediatric special care nursery. The initial phase of consultation was designed 1) to...
TL;DR: The psychiatric consultant, recognizing the conflicts that make the requests seem inappropriate, seeks to substitute higher-level cognitive operations and coping behaviors in the staff for distortion, projection, over-identification, reaction formation, and turning against the self.
Abstract: Seven cases of psychiatric consultations on medical and surgical wards are reviewed to show how intrapsychic conflicts in the staff may make the consultation request appear inappropriate. On deeper examination, such requests may signify staff dysfunction caused by arousal of conflictual feelings about the behavior or illness of the patient. Mutilated, mute patients appear to arouse fear of aggression in their caregivers, who in turn reject such patients, see them as alien and violent, and become illogical in their management. Patients who publicly display sexual behaviors appear to arouse shame over exhibitionism, voyeurism, and masturbation; their caregivers become too passive to effect common-sense measures appropriate to the situation. Very sick and dying patients and ungrateful, demanding patients can arouse anger and despair. Their caregivers may become depressed about failure, feeling helpless and out of control; using projection, they can see such patients as evil or suicidal, and may eventually tu...
TL;DR: The dilemmas involved in mental health interventions and consultation in a treatment program for end-stage renal disease are described and Psychotherapeutic approaches are presented to illustrate the flexible use of a number of treatment modalities including brief crisis-oriented intervention which emphasizes the patient's cognitive mastery of procedures.
Abstract: The increasing number of pediatric patients with end-stage renal disease who undergo dialysis and transplantation have necessitated the development of psychological interventions to lessen the emotional impact of these procedures. This report describes the dilemmas involved in mental health interventions and consultation in a treatment program for end-stage renal disease. Case illustrations of a young child's severe anxiety reaction to dialysis, an adolescent's depression, and a family's withdrawal document the varied patterns of adaptation to treatment for renal failure. Psychotherapeutic approaches are presented to illustrate the flexible use of a number of treatment modalities including brief crisis-oriented intervention which emphasizes the patient's cognitive mastery of procedures. The development of viable mechanisms of professional collaboration improves the quality of patient adaptation by lessening the fragmentation of care and problems of interdisciplinary communication often associated with the...
TL;DR: This paper describes the experience of a full-time psychiatrist in a hospital-based primary health care setting and suggests that this role is an effective way to bring supportive and educational psychiatric services to patients and providers of all levels of sophistication and need.
Abstract: Psychiatrists have, for years, offered consultation to their nonpsychiatrist colleagues in many settings and have worked with them in a variety of ways. The development of new programs in primary medical care offers new challenges and opportunities to the liaison psychiatrist. This paper describes the experience of a full-time psychiatrist in a hospital-based primary health care setting. Special problems are encountered in developing working relationships with patients, physicians, nurses, social workers, administrators, and other members of the health care team. Effective resolution of these problems makes it possible to offer comprehensive mental health services as an integral part of primary health care. This psychiatrist's role differs from other consultation-liaison functions by virtue of full-time economic, patient care, academic, geographic and administrative assimilation into the primary health care setting itself. It is suggested that this role is an effective way to bring supportive and educatio...
TL;DR: A multidisciplinary liaison team operating within a pediatric teaching hospital is described, where consultants work as a team in close collaboration with each other and with the psychiatric nurse clinician and an occupational therapist.
Abstract: Psychiatrists, psychologists and social workers are often consulted about the same hospitalized patient. Since each may differ in their training, orientation and experience, the opinions expressed by them to the consultee may differ. The authors have described a multidisciplinary liaison team operating within a pediatric teaching hospital. The consultants work as a team in close collaboration with each other and with the psychiatric nurse clinician and an occupational therapist. The team approach has specific advantages. It allows for a concise and unified approach to the emotional and social needs of the patients. It presents a forum for informal consultations and interdisciplinary meetings. In addition, teaching opportunities are many as each discipline learns from the other.
TL;DR: During five years of self-medication with Prednisone, a forty-one-year old asthmatic businessman experienced periods of euphoria, psychomotor hyperactivity, and poor judgment; a period of depression and anxiety during temporary steroid withdrawal; and finally, with resumption of Prednis one, episodes of grandiosity and bizarre fugue-like behavior, with adoption of a second identity and culminating in an irrational crime.
Abstract: During five years of self-medication with Prednisone, a forty-one-year old asthmatic businessman experienced periods of euphoria, psychomotor hyperactivity, and poor judgment; a period of depression and anxiety during temporary steroid withdrawal; and finally, with resumption of Prednisone, episodes of grandiosity and bizarre fugue-like behavior, with adoption of a second identity and culminating in an irrational crime. Steroids were then withdrawn, and the patient resumed his premorbid personality, but had amnesia for much of his previous behavior. The literature on hysterical fugues and corticosteroid-induced mental disturbance is reviewed. The patient's reactions are analyzed in terms of his premorbid neurotic conflicts, the psychological stresses acting upon him, and the effects of Prednisone on his central nervous system.
TL;DR: Diagnostically, a detailed early life history is necessary to uncover the presence of a sensory screen memory of a trauma and so avoid diagnostic medical search for organic causation.
Abstract: All children experience trauma. The age, state of development and constitutional factors will determine whether some children will have a traumatic effect. Trauma occurring before the age of three, at a time when the ego has not developed its synthetic and integrative functions, may be reproduced in later life as an isolated symptom, by selected sensations involved in a sensory imprint or screen sensation of the trauma as a simple recording. After the age of three, under the influence of a more mature ego, excessive traumatic stimuli will be integrated and elaborated in symptom formations as phobias or other conditions and extended as part of the total personality. Recurrence in later life is triggered by events related not only to the original experience, but also to the content of its elaboration.The earlier in life the trauma occurs, the more likely that somatic imprints of primitive physiological symptoms would result as an archaic, biological defense or screen sensations.Recurrent sensory imprints or...
TL;DR: It is hypothesized that physical change is more basically related to sense of self-continuity and hence more threatening to experience and observe.
Abstract: The paper reports on the psychoanalytically-oriented psychotherapy of a very obese woman who, after a rather prolonged therapy, "decided" to reduce. During the weight loss process, significant reactions were noted from her son, daughter, brothers, sisters-in-law, customers, employees, husband, and therapist, which became crucial interferences with the continuing weight loss and specific resistances in the therapy. The identification of and the working through of these resistances significantly increased and consolidated her self-understanding. In that the response to major psychological changes was minimal as compared to the response to her physical change, it is hypothesized that physical change is more basically related to sense of self-continuity and hence more threatening to experience and observe.
TL;DR: Four ulcerative colitis patients with pre-existing organic problems affecting their mental status with long-standing partial deafness are presented, two of which are severely mentally retarded and one has rapidly advancing multiple sclerosis.
Abstract: In this second investigation of psychological factors in the etiology of ulcerative colitis, the author again utilizes unusual cases characterized by limited variables preceding illness. The first investigation involved several patients whose partial deafness antedated their illness. A significant point was that prior to developing their illness, all these patients had arrived at a state of objectlessness which was abetted by the deafness. This report presents four ulcerative colitis patients with pre-existing organic problems affecting their mental status. Two of the patients are severely mentally retarded. A third patient has rapidly advancing multiple sclerosis, and a fourth--actually an addition to the earlier study--has long-standing partial deafness. Aside from the objectlessness which was also prominent in the earlier group, all four patients demonstrate a consistent pattern of vicious self-directed rage. This paper takes into account the interaction between the rage and the state of objectlessness in the production of illness. Language: en
TL;DR: Attention to the unusual, as illustrated through experience in training-cum-research seminars, can enhance the doctor's satisfaction with his professional life while offering improved care to his patients.
Abstract: The psychoanalyst has much to contribute to medicine, more through the teaching of observational skills and an appreciation of relationships than through the teaching of psychoanalytic technique or language itself. The analyst can promote tolerance in the physician of the unusual, an examination of the impediments of habitual ways of working and seeing, and a facility in the patient to “be himself.” Attention to the unusual, as illustrated through experience in training-cum-research seminars, can enhance the doctor's satisfaction with his professional life while offering improved care to his patients. When psychoanalyst, physician and patient interact in their roles as people, there is hope of an improved quality of human existence for all.
TL;DR: A follow-up after about a year of group and individual psychotherapy showed that the symptoms were still in remission, and that the patient was functioning personally and occupationally on a significantly improved level.
Abstract: Although the Stiff Man Syndrome has been traditionally viewed as a neurologic disorder, a number of recent articles have documented a pattern of familial, interpersonal, and intrapsychic stress which suggests that this disease may be, to a considerable degree, psychosomatic in origin. The present paper reviews several recent articles and focuses on a single case study. Although the medical diagnosis was earlier confirmed, an in-depth psychiatric evaluation and extensive psychological assessment showed many psychopathological concomitants associated with the severe muscle spasm and stiffness. A follow-up after about a year of group and individual psychotherapy showed that the symptoms were still in remission, and that the patient was functioning personally and occupationally on a significantly improved level.
TL;DR: It is suggested that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from non referred fellows discharge with a psychiatric diagnosis.
Abstract: Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.
TL;DR: Two cases are presented to show that witchcraft beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or Psychological Dysfunctions.
Abstract: “Witchcraft illness” is a widespread belief among many people, even after acculturation to technological concepts of illness etiology. Two cases are presented to show that such beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or psychological dysfunctions. In both instances, witchcraft beliefs take on a dynamic of their own and must be resolved both in terms of the patient's culture as well as the clinician's treatment plan. Considering such phenomena from the vantage point of family systems provides useful insights into etiology as well as amelioration. The latter requires engaging all parties in the health care system—clinician, patient, family, and indigenous health caretakers.
TL;DR: The psychiatric Day Hospital offers a forum for working out bereavement issues of terminally ill patients and coordination of medical, surgical, and psychiatric treatment of dying patients is enhanced by Day Hospital educational and treatment programs which afford continuity of care at the interface area between treatment specialties.
Abstract: The psychiatric Day Hospital offers a forum for working out bereavement issues of terminally ill patients. Through individual and group psychotherapy, patients and their families are assisted in coping with the issues of death and dying. Coordination of medical, surgical, and psychiatric treatment of dying patients is enhanced by Day Hospital educational and treatment programs which afford continuity of care at the interface area between treatment specialties.
TL;DR: In the discussion of the case, the patient's desire to be taken care of is seen as a major dynamic, causing her to fabricate illness.
Abstract: A twenty-four-year-old woman is presented with multiple previous hospitalizations for joint and muscle pains. Guarded in her description of symptoms, she reports that "lupus" has been diagnosed at several hospitals over the past few years, unable to recall the name of any other than on previous hospital. The medical work-up failed to show any abnormality except that compatible with previously diagnosed von Willebrand's disease. In the discussion of the case, the patient's desire to be taken care of is seen as a major dynamic, causing her to fabricate illness. The diagnoses of Munchausen Syndrome, malingering, conversion reaction and hypochondriasis are discussed and differentiated from each other, and the treatment of Munchausen Syndrome is discussed.
TL;DR: The psychotherapy of a juvenile onset diabetic patient, who initially presented with problems of poor diabetic management and depression, is discussed, and she was able to gain insight into the dynamics of her behavior and from then on succeeded in adequate management of her diabetes.
Abstract: The psychotherapy of a juvenile onset diabetic patient, who initially presented with problems of poor diabetic management and depression, is discussed Pertinent details of the first two years of treatment are presented to show the interrelationship between the medical and psychiatric problems The patient severely mismanaged her illness around the tenth anniversary of her father's death The patient's behavior and attitude toward her own illness were associated with guilt relating to the death of her father, also diabetic During the anniversary period the patient was able to gain insight into the dynamics of her behavior, and from then on, succeeded in adequate management of her diabetes The events in this case are linked to relevant literature
TL;DR: Delays in requesting psychiatric consultation were examined to determine why children referred for psychiatric evaluation remained in hospital longer than the nonreferred, and may be on the psychiatrist to increase the medical staff's awareness of the possibility that emotional factors often contribute to their patient's ills.
Abstract: Delays in requesting psychiatric consultation were examined, in relation to 220 referrals from a medical ward in a pediatric hospital, to determine why children referred for psychiatric evaluation remained in hospital longer than the nonreferred. Request delays did not correlate with age, sex, or length of hospitalization, but were likely to be shorter for acutely ill patients and those whose admission diagnosis evidenced the pediatrician's awareness of the possibility of significant emotional factors. The onus may be on the psychiatrist to increase the medical staff's awareness of the possibility that emotional factors often contribute to their patient's ills. This increased awareness may result in prompt referrals to psychiatry, and shorter, less costly hospitalization.