Showing papers in "International Journal of Psychiatry in Medicine in 1978"
TL;DR: A one month study of the surgical and psychiatric service of a university hospital emergency room identified thirty-seven women coming for treatment as a result of physical abuse.
Abstract: A one month study of the surgical and psychiatric service of a university hospital emergency room identified thirty-seven women coming for treatment as a result of physical abuse. Thirty-three of the thirty-seven women presented at the surgical services and represented 3.8 per cent of surgical admissions in the emergency room.These women came from all ages, social and ethnic groups. They usually presented with contusions or other injuries to the head and neck. The majority would not accept psychiatric treatment but were willing to discuss the problem with the emergency room physician if encouraged. The preventive implications of these findings for the nonpsychiatric physician are discussed.
89 citations
TL;DR: A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that many first-order relatives of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis.
Abstract: A study of patterns of communications in families with a terminal cancer patient being treated at three urban institutions revealed that many first-order relatives (spouses, children, siblings) of patients did not have a communication link to the physician, especially if direct communication was not established at the time of diagnosis. Family members were frequently critical of the way information was communicated, yet relied upon the physician's interpretation of the patient's status to form their own opinion of the patient's future. Intra-familial communications regarding illness and dying were frequently discordant and guarded, leading to perceptions that the patient was withdrawing, and fostering a reliance upon the hospital for terminal care. More than half of the family members were uncomfortable visiting the patient in the hospital, experiencing feelings of helplessness, or sensing helplessness in the patients. Bearing the patient's pain was seen as particularly difficult.
69 citations
TL;DR: A significant interaction between the social, psychological and biological factors determining survival on chronic renal hemodialysis, beginning with the treatment decision and continuing throughout the course of treatment is suggested.
Abstract: Two groups of patients undergoing hemodialysis for chronic renal failure were prospectively studied for twenty-four months. Group A patients (n=12) were dialyzed on Mondays and Thursdays; Group B patients (n=9) on Tuesdays and Fridays. Although patients were supposedly assigned to dialysis groups on a random basis, over a twenty-four month period Group A had significantly more deaths (7 patients) than did Group B (none). This phenomenon is interpreted in the framework of an ongoing intergroup interaction among patients and between patients and staff, as conceptualized in the Tavistock Model propounded by Bion. It is hypothesized that in the dialysis unit, unconscious splitting by the staff led to a bias in patient-group assignment, such that those patients with more severe personality disruption, and “bad” in that sense, were assigned to Group A. Since patients in Groups A and B did not differ significantly in biological or demographic parameters at time of entry into the study, it is suggested that the i...
37 citations
TL;DR: Analysis of physical factors, medication and depression showed no clear association with sexual dysfunction, suggesting the importance of psychosocial factors and a trial of sex therapy in renal patients is proposed.
Abstract: Eighteen chronic hemodialysis patients were interviewed by staff trained in sex therapy. Compared with the pre-uremic phase, sexual satisfaction was less in nine subjects, greater in four; frequency of intercourse had declined in ten subjects. Dysfunctions of sexual response were reported by five men and six women. Analysis of physical factors, medication and depression showed no clear association with sexual dysfunction, suggesting the importance of psychosocial factors. A trial of sex therapy in renal patients is proposed.
30 citations
TL;DR: Intelligence, level of education, and the tendency to perceive sources of conflict in the outer world rather than within oneself, were found predictive of subsequent adaptations for the whole group and were interpreted to support the general working hypothesis.
Abstract: As part of an intensive psychiatric and psychological examination before starting hemodialysis, forty-seven patients with terminal renal failure, thirty-one men and sixteen women with an age range ...
27 citations
TL;DR: An initial project examining the psychological effects of mastectomy on women and their spouses has been undertaken and it is anticipated that these findings will be helpful in identifying some of the problems encountered and aid in the success of the program in attaining the desired results.
Abstract: The traumatic experience of the discovery of a lump in the breast, the diagnosis of cancer and eventual mastectomy have focused medical attention on the importance of providing adequate psychosocia...
26 citations
TL;DR: Evidence is presented in support of the hypothesis that in many families failure of normal mother-child interaction, paternal deprivation, culturally dependent maternal oral interests and significant stress factors in the home where abundant lead-containing material is available are etiologically related to the development of pica in lead poisoning.
Abstract: An important factor associated with lead poisoning in children is the habit of eating non-food substances, a condition termed pica. In search for underlying mechanisms involved in the pathogenesis of pica, this investigation presents evidence in support of the hypothesis that in many families failure of normal mother-child interaction, paternal deprivation, culturally dependent maternal oral interests and significant stress factors in the home where abundant lead-containing material is available are etiologically related to the development of pica in lead poisoning. Other factors, which have been thought to be associated with pica, are nutritional deficiencies and maladaptive behavior patterns. A multifocal treatment approach is considered to be most effective.
20 citations
TL;DR: In this paper four categories are theorized as representing the implicit working assumptions of nonpsychiatric housestaff in clinical formulation as well as potential uses of this global scheme for evaluating liaison programs.
Abstract: The author suggests that the goal of liaison psychiatry as well as its organizational and clinical properties require the use of measures which are non-reactive and developmental in nature. In this paper four categories are theorized as representing the implicit working assumptions of nonpsychiatric housestaff in clinical formulation. By analyzing the overt and latent assumptions of the questions presented to a liaison psychiatrist in patient care conferences, the author illustrates how the assumptions can change through six levels of development. Changes within the assumptions are then used as criteria for program effectiveness since the working assumptions represent preconditions to holistic care. Potential uses of this global scheme for evaluating liaison programs are suggested.
17 citations
TL;DR: The adaptive value of denial in coronary patients is challenged from the long-term perspective of rehabilitation and the physical and psychological benefits of this approach are reviewed.
Abstract: The use of denial has been widely accepted as an adaptive and protective coping mechanism in the acute phase of myocardial infarction. Although instrumental in lowering anxiety and mortality in the...
16 citations
TL;DR: It is hypothesized that these men reacted to injury or illness with a crumbling of previous defenses against massive dependency wishes and that their symptoms are perpetuated by ambivalent relationships with employers and physicians.
Abstract: Eight selected male patients with disability neurosis are presented. Past histories were remarkably similar in that they indicated childhood deprivation, premature independence and early excessive ...
14 citations
TL;DR: The author discusses the psychological variables involved in the rehabilitation of patients who have undergone a mastectomy and the importance of body image in the recovery.
Abstract: The author discusses the psychological variables involved in the rehabilitation of patients who have undergone a mastectomy. The scope of the problem, the psychological meaning and fears suffered by mastectomy patients, and importance of body image is discussed along with the psychological treatment.
TL;DR: A twenty-seven year old woman with meningo-encephalitis and paranoid symptoms is presented and the positive family history was given inappropriate emphasis, while the good pre-morbid adjustment of the patient and the symptoms of confusion and headache were inadequately considered.
Abstract: A twenty-seven year old woman with meningo-encephalitis and paranoid symptoms is presented. The patient was admitted to a psychiatric unit where, two months previously, her brother had been under treatment for a paranoid schizophrenic episode. The diagnostic lumbar puncture was performed after several days of increasing periods of disorientation, stupor, incontinence, posturing, and perseveration. There was no fever, no signs of meningeal irritation, and no localizing neurologic deficit. The problem of recognizing organic brain disease presenting as an acute psychotic episode is discussed. In this case, the positive family history was given inappropriate emphasis, while the good pre-morbid adjustment of the patient and the symptoms of confusion and headache were inadequately considered. Viral meningo-encephalitis, particularly that due to herpes simplex, often presents with a picture of behavioral abnormalities and minimal physical signs, and is easily confused with a functional process.
TL;DR: It is recommended that the liaison model of teaching directed to house and attending staffs be applied to the teaching of medical students during their clerkships throughout the general hospital, with a concomitant de-emphasis of training solely on the psychiatric service.
Abstract: Considerable dissatisfaction of students and educators exists in regard to the teaching of psychiatry in medical school. This paper recommends that the liaison model of teaching directed to house and attending staffs be applied to the teaching of medical students during their clerkships throughout the general hospital, with a concomitant de-emphasis of training solely on the psychiatric service.
TL;DR: Through the use of selected case histories, the author has attempted to illustrate how utilization of these skills, obtained during a supervised fellowship program, leads to psychological growth and better understanding of his role as physician.
Abstract: Our modern health care system has tended to emphasize technological competence and subspecialization. The primary care internist/family physician has received limited training in the behavioral aspects of medicine and, resultingly, is less able to obtain and apply the knowledge and skills necessary to effectively help the patient handle those mutually interacting somatic, psychological and sociological dimensions of his illness. Through the use of selected case histories, the author has attempted to illustrate how utilization of these skills, obtained during a supervised fellowship program, leads to psychological growth and better understanding of his role as physician. Ultimately this effects clinical improvement in his medical patients with longstanding difficulties.
TL;DR: A sequential program of video playbacks, live interviews and case conferences was developed, and the residents' four-month rotation in psychiatry proved essential for developing comfort with psychological and familial aspects of physical illness.
Abstract: This paper describes a method of teaching family psychodynamics in a new family practice center. Initially, there were difficulties in engaging staff because of inappropriate teaching methods and personal and professional identity conflicts. Ultimately, a sequential program of video playbacks, live interviews and case conferences was developed. The residents' four-month rotation in psychiatry proved essential for developing comfort with psychological and familial aspects of physical illness.
TL;DR: A program involving the utilization of basic techniques of supportive group therapy in the discussion of recurrent themes which have emerged as major concerns among amputees is initiated and incorporated into the routine of an inpatient amputee unit.
Abstract: There is a complex interplay between physical and emotional factors in the rehabilitative process after amputation of a limb. Although this is recognized by those working in the field of rehabilitation medicine, an overview of the literature indicates that there is comparatively little psychosocial research, education, and innovative programming. The authors have initiated such a program and have incorporated it into the routine of an inpatient amputee unit. The approach involves the utilization of basic techniques of supportive group therapy in the discussion of recurrent themes which have emerged as major concerns among amputees. Experienced amputees help new patients to anticipate potentially stressful situations, thus encouraging increased reliance. Having professionals present allows for the clarifying of medical and/or technical issues and the group setting provides a relaxed atmosphere conducive to educative discussion of physical and psychosocial concerns.
TL;DR: Changes in the perceptual-cognitive and affective components of the body image were studied in women who had undergone jejuno-ileal bypass surgery, finding that as weight loss occurs, the cognitive body schema adjusts readily to the patients' new reality.
Abstract: Changes in the perceptual-cognitive and affective components of the body image were studied in ten women who had undergone jejuno-ileal bypass surgery. As weight loss occurs, the cognitive body schema adjusts readily to the patients' new reality, whereas the affective component remains essentially unchanged during the first year after surgery. Implications of findings are discussed.
TL;DR: The psychiatric aspect of a child's dying from terminal illness is considered, with the need for more integration of theoretical, clinical, and empirical work, including all aspects of a dying child's environment.
Abstract: This brief review considers the psychiatric aspect of a child's dying from terminal illness. Much of the literature is largely theoretical, illustrated by case histories and clinical observations. Only recently has research been published based on empirical analyses of grief reactions in the child. There is no corresponding empirical research on the grief reactions of parents and siblings, or of the medical staff that cares for the terminally ill child. A review in this area points out the need for more integration of theoretical, clinical, and empirical work, including all aspects of a dying child's environment.
TL;DR: The organization and operation of a comprehensive clinic, staffed by both internists and psychiatrists, designed to provide total care for patients with both medical and psychiatric illnesses, presented a challenge to the physician's traditional role and required careful attention to specific aspects of the doctor-patient relationship.
Abstract: Patients who have both medical and psychiatric illnesses often present very difficult diagnostic and treatment problems. Cross referrals by the two or more specialties necessarily involved in their management are often perceived by these patients as rejection and not only may induce in them feelings of frustration, helplessness and anger, but may also lead to a worsening of their medical and psychiatric symptomatology. This paper describes the organization and operation of a comprehensive clinic, staffed by both internists and psychiatrists, designed to provide total care for these patients. The patient population comprises patients with independent or unrelated medical and psychiatric illnesses, patients with interdependent medical and psychiatric symptoms, patients with reactive psychological problems and patients with somatizations as an expression of psychological conflicts. Case reports illustrate the approach used in patient management and some of the encouraging results that can be achieved at such...
TL;DR: A model of inpatient psychiatric care in a rural general hospital which has successfully overcome many of the constraints of the rural setting using a four member psychiatric consultation team is described.
Abstract: Rural areas face severe problems related to the inadequate distribution of psychiatrists. This paper describes a model of inpatient psychiatric care in a rural general hospital which has successfully overcome many of the constraints of the rural setting using a four member psychiatric consultation team. Using the medical community and its resources as the basis for care, a strong emphasis is also placed on continuing education for care providers. Important factors in the system include allowing all physicians to admit and care for psychiatric patients and the use of the emergency room physicians as interim admitting doctors when patients have no family physician. Other factors in the program are discussed. Problem areas have included continuity of care and treatment of certain types of patients. The results of the project have been an increase in the number of psychiatric patients admitted (140 to 268 per year) and a decrease in the number of patients sent to the state institution. Consultations requested...
TL;DR: A patient treated with hemodialysis developed psychotic episodes, including visual hallucinations and delusions, as well as symptoms similar to the fatal dialysis dementia, which seems to demonstrate an original organic dysfunction with behavioral sequelae that were perpetuated by psychological difficulties.
Abstract: A patient treated with hemodialysis developed psychotic episodes, including visual hallucinations and delusions, as well as symptoms similar to the fatal dialysis dementia. His hospital course seems to demonstrate an original organic dysfunction with behavioral sequelae that were perpetuated by psychological difficulties. His tendency to overdramatize his disability and to adopt an excessively helpless and passive role made treatment difficult. A one-year followup is provided along with a discussion of the relationship of his case to dialysis dementia.
TL;DR: At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service and seven of fifteen patients considered to be “normal” by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses.
Abstract: At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service. Only 78 of 242 psychiatric diagnoses given the 205 patients were reflected correctly in the medical discharge diagnoses. In addition, seven of fifteen patients considered to be “normal” by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses. Psychophysiological disorders, psychoses and special symptom diagnoses were likely to be correctly reflected in the discharge diagnoses, while depression and adjustment reaction were not. Possible reasons why the psychiatrist's diagnostic opinion is not correctly reflected in the discharge diagnosis in over one-half of the referrals are discussed. Pediatricians may be reluctant to label their patients “neurotic” for life, or may consider the problem transient—that is, only a “passing phase.” But these theories are discounted by the fact that seven patients consid...
TL;DR: Cardiovascular rehabilitation as described is a productive area for psychiatric liaison, through individual consultation, group therapy sessions and team meetings which address the psychosocial issues of convalescence.
Abstract: Depression, anxiety and fear of recurrence following myocardial infarction often lead to disability in excess of actual cardiac impairment in a large number of patients. The high social, economic and emotional cost of psychogenic cardiac invalidism has stimulated the development of cardiovascular rehabilitation programs throughout the country. The liaison psychiatrist can play a critical role in the rehabilitation effort. This paper describes the psychological impact of the rehabilitation process in combating psychogenic cardiac disability. The conflicts of the post-infarction patient and their management by the rehabilitation team are presented from the perspective of the team psychiatrist. Cardiovascular rehabilitation as described is a productive area for psychiatric liaison, through individual consultation, group therapy sessions and team meetings which address the psychosocial issues of convalescence.
TL;DR: An unusual version of liaison psychiatry is described in which the object of the liaison is the practicing physician in the hospital setting, and the processes and principles of teaching psychological medicine in this way are described and exemplified.
Abstract: An unusual version of liaison psychiatry is described in which the object of the liaison is the practicing physician in the hospital setting. Hospital work rounds were used as teaching rounds at frequent intervals over a relatively long time span. The paper demonstrates the usefulness and feasibility of such a project. The processes and principles of teaching psychological medicine in this way are described and exemplified.
TL;DR: The Hahnemann Pediatric Ward and patient population are described as are the functions of a weekly group meeting for school aged hospitalized children led by a child psychiatrist and aspects of the children's behavior and verbal productions in the group are discussed from a psychodynamic viewpoint.
Abstract: The multiple sources of psychological stress to the hospitalized child are reviewed with references to the literature. The Hahnemann Pediatric Ward and patient population are described as are the f...
TL;DR: Two patients who presented to a psychiatric inpatient unit and were later found to be digitoxic are discussed, advising Psychiatrists to consider digitalis as a possible cause of mental abnormalities and reminded that psychiatric signs may be the first indication of a potentially lethal drug toxicity.
Abstract: Digitalis is a ubiquitous drug in modern clinical medicine and digitoxicity is one of the more common iatrogenic disorders. Psychiatric problems are often overlooked as manifestations of digitalis excess and may range from mild disorientation, lethargy, or restlessness to full blown delirium. In this paper we discuss two patients who presented to a psychiatric inpatient unit and were later found to be digitoxic. Psychiatrists are advised to consider digitalis as a possible cause of mental abnormalities and are reminded that psychiatric signs may be the first indication of a potentially lethal drug toxicity. Psychiatric patients may also be at special risk for the development of digitoxicity because of erratic drug taking, electrolyte imbalance or increased autonomic tone.
TL;DR: Results indicated that the experimental subjects significantly decreased their diastolic blood pressures between pre- and post-treatment measures (spanning a period of four weeks), whereas the control subjects showed no such change.
Abstract: This study examines the use of a behavior modification program as an adjunct to the medical treatment of essential hypertension. The subjects, outpatients with medically treated, but uncontrolled, essential hypertension, were exposed to group interaction (including such processes as peer reinforcement, peer competition, and cognitive dissonance), individual blood pressure monitoring, stimulus control, and direct social influence. The control subjects received only routine medical treatment for their hypertension. Results indicated that the experimental subjects significantly decreased their diastolic blood pressures between pre- and post-treatment measures (spanning a period of four weeks), whereas the control subjects showed no such change. Thus it appears possible to use behavior modification to help in the treatment of essential hypertension.
TL;DR: A psychiatric and biochemical study was undertaken at the request of two patients who were thought to be terminally ill by the medical staff and one patient accepted dying and expired from her disease and the other patient wished to continue living and did not die.
Abstract: A psychiatric and biochemical study was undertaken at the request of two patients who were thought to be terminally ill by the medical staff. One patient accepted dying and expired from her disease. The other patient wished to continue living and did not die. The dying patient exhibited abnormally high levels of catecholamine excretion which were not associated with verbal reports of anxiety or discomfort and did not seem upset or uncomfortable to the physician and nurses caring for her. The patient who lived had relatively low levels of catecholamine excretion and was anxious, irritable and uncomfortable. The behavior of these two patients differed during the period of acute respiratory failure. The dying patient had given up and felt that she was engaging in goal-directed activity which she would or could not shut off. The patient who lived was frightened of dying and felt that she would overcome her current difficulties and that she was not ready or willing to die. The major cardiovascular differences ...
TL;DR: The purpose in this particular narrative is to review the author's experience with a life-long illness and to relate it to his longstanding psychiatric interest and work with patients with chronic disease.
Abstract: It is not particularly profound to note that one's choice of a professional career is related to unconscious motivational forces, and that a desire to become a physician may stem from a wish to conquer one's own illness and the inevitability of death. Once one becomes a physician his personal experience with illness may, but not be means necessarily, place him in the position of being empathetic with the sick patient. My purpose in this particular narrative is to review my experience with a life-long illness and to relate it to my longstanding psychiatric interest and work with patients with chronic disease. I trust the confessional quality will be instructive and not taken as maudlin or pseudo-Proustian.
TL;DR: This syndrome was present in five of nine patients between the ages of sixteen and forty-five who underwent traction for more than three weeks admitted to the UCLA Orthopedic Service during calendar year 1975.
Abstract: Traction Intolerance Syndrome is defined as a behavioral and/or emotional reaction related to skeletal traction severe enough to require psychiatric consultation and/or the use of major psychiatric medication for prolonged periods in the absence of pre-existing major psychiatric illness. Patients often attribute these reactions to the predicament of traction. This syndrome was present in five of nine patients between the ages of sixteen and forty-five who underwent traction for more than three weeks admitted to the UCLA Orthopedic Service during calendar year 1975. Moreover, all the patients were between sixteen and twenty-six years of age, and all the patients in that age range developed the syndrome. The multiple contributions to the pathogenesis of these reactions are described, and the interventions of the liaison psychiatrist in intervention at the biological, psychological, family and hospital staff levels are discussed.