Showing papers in "International Journal of Psychiatry in Medicine in 1983"
TL;DR: A new classification of phobic disorders is proposed based on the presence or absence of an endogenous anxiety syndrome with the phobias, which has heuristic merit in guiding research efforts and discussions and in directing the clinician to a simple and practical solution of his patient's phobic disorder.
Abstract: The history of classification of phobic disorders is reviewed. Problems in the ability of current classification schemes to predict, control and describe the relationship between the symptoms and other phenomena are outlined. A new classification of phobic disorders is proposed based on the presence or absence of an endogenous anxiety syndrome with the phobias. The two categories of phobic disorder have a different clinical presentation and course, a different mean age of onset, distribution of age of onset, sex distribution, response to treatment modalities, GSR testing and habituation response. Empirical evidence supporting this proposal is cited. This classification has heuristic merit in guiding research efforts and discussions and in directing the clinician to a simple and practical solution of his patient's phobic disorder.
75 citations
TL;DR: A review of the literature from 1953–1981 about breast cancer and sexual functioning is presented with an emphasis on the reported research in this field, and the effect of treatment upon the patient's ability to maintain her previous level of sexual functioning.
Abstract: A review of the literature from 1953-1981 about breast cancer and sexual functioning is presented with an emphasis on the reported research in this field Based on the literature there is evidence to suggest that women with breast cancer are at risk for developing sexual difficulties as a result of their illness and its subsequent treatment The existing research indicates that the study of breast cancer and sexual functioning is in its infancy Most of the research is found to be lacking in an appreciation for the complexity of variables which may contribute to sexual difficulties in this population An outline of such variables, which are drawn from patient, partner and health provider sources, is presented Particular attention is given to the effect of treatment upon the patient's ability to maintain her previous level of sexual functioning Implications for future research are given throughout the discussions of those variables and throughout critiques of the previous studies
50 citations
TL;DR: The most frequent causal explanations given by post myocardial infarction subjects in this study were related to life style, which could be interpreted as self-blame or self responsibility for what had happened to them.
Abstract: When individuals are confronted with a diagnosis of serious disease, they try to understand why it has happened to them. The degree to which any individual can control his or her susceptibility to disease is not clear, but different diseases carry with them varying degrees of implied personal responsibility. For example, certain diseases (heart attack, stroke, cancer) have associated risk factors. Presumably, avoiding these risk factors will have some effect on a person's chance of developing those diseases. The purpose of this secondary analysis was to describe patients' attributed causes for two groups of individuals recently diagnosed with either lung cancer or myocardial infarction. Content analysis was done on the responses to an open-ended question about the cause of their disease for 108 subjects at Interview 1 and for 100 subjects at Interview 2.The most frequent causal explanations given by post myocardial infarction subjects in this study were related to life style, which could be interpreted as...
49 citations
TL;DR: The psychological effects of three doses of intranasal cocaine hydrochloride with cocaine plasma concentrations with a topically active placebo indicated that acute tolerance by tachyphylaxis occurred after single doses.
Abstract: We compared the psychological effects of three doses of intranasal cocaine hydrochloride (.2, .75, and 1.5 mg/kg) with cocaine plasma concentrations in four volunteers. Intranasal lidocaine hydrochloride (.2 mg/kg) was used as a topically active placebo. Peak “high” ratings were related to both dose and peak plasma concentrations. At a given plasma concentration, “high” ratings were greater when plasma levels were increasing than when they were decreasing. This indicates that acute tolerance by tachyphylaxis occurred after single doses. The cocaine “high” was a pleasant feeling but was without distinctive sensations. The dramatic effects of intranasal cocaine on the street may be related to larger or repeated doses as well as the setting.
46 citations
TL;DR: This survey of the psychological literature on Artificial Insemination by Donor pays particular attention to the secrecy, with specific recommendations to create an ambience in which openness is possible, and which will allow in-depth research of the Psychological aspects of AID.
Abstract: This survey of the psychological literature on Artificial Insemination by Donor (AID) pays particular attention to the secrecy. Studies of couples beforehand do not arrive at criteria for choosing psychologically suitable couples. Follow-up questionnaires are superficial and cannot inform us which couples and what percentage of couples encounter psychological difficulties. Case reports of couples who encountered difficulties are too few to permit generalization and cannot specify AID's role in generating symptoms. A second look at the data suggests that, although overlooked, the secrecy surrounding AID may create psychological difficulties, a view supported by the findings at our clinic. A plea is made with specific recommendations to create an ambience in which openness is possible, and which will allow in-depth research of the psychological aspects of AID.
40 citations
TL;DR: The findings suggest that early hospitalization is related to the genesis of both depressive illness and intractable pain: in the former occurring in the preschool years and in the latter, during school age.
Abstract: Three groups of patients have been studied in order to elucidate the relationship between childhood hospitalization and chronic intractable pain in adults. The groups were: patients referred to a pain clinic, psychiatric patients with a depressive illness, and patients attending a rheumatology clinic. The findings suggest that early hospitalization is related to the genesis of both depressive illness and intractable pain: in the former occurring in the preschool years and in the latter, during school age. The significance of these relationships is discussed.
30 citations
TL;DR: The authors suggest that the main benefit of such informal approaches may lie in gaining initial attitudinal and administrative acceptance by nonpsychiatric physicians of liaison teaching programs.
Abstract: The ability to assess psychosocial problems of a group of primary care internal medicine residents education in a relatively unstructured psychiatric liaison program was compared to a group of internists who had no specialized psychiatric training. The primary care residents did not demonstrate a superior ability to assess patients' psychosocial problems when compared to internists without such training. The effectiveness of such unstructured liaison experiences (i.e., the Balint model of group supervision and teaching conferences) is questioned. The authors suggest that the main benefit of such informal approaches may lie in gaining initial attitudinal and administrative acceptance by nonpsychiatric physicians of liaison teaching programs. Formally structured, supervised learning experiences are probably necessary to effectively enhance internists' clinical skills and behaviors in dealing with the psychosocial and psychiatric aspects of medical care.
22 citations
TL;DR: The most common reason that psychiatric consultation was requested was depression, followed by pain and narcotic-related problems, and four suggestions regarding psychiatric management of this group of patients are presented and discussed.
Abstract: This article is a report of the authors' experience with a series of forty-six patients with Crohn's disease seen in psychiatric consultation over a nine year period. We treated twenty-two of these patients in either long term or short term psychotherapy in addition to the initial psychiatric evaluation. A brief literature review of previous studies on the psychiatric aspects of Crohn's disease is also presented. The most common reason that psychiatric consultation was requested was depression, followed by pain and narcotic-related problems. Factors which appeared to contribute to psychiatric morbidity were the following: duration of Crohn's disease, frequent hospitalizations and surgical procedures, presence of an ostomy, history of proctocolectomy, current psychosocial stress unrelated to Crohn's disease and a history of traumatic childhood experiences. Four suggestions regarding psychiatric management of this group of patients are presented and discussed.
21 citations
TL;DR: Mislabeling of symptoms was studied in a group of 587 chronic asthmatic patients, with mislabelers being 40 per cent more likely than nonmislabelers to be rehospitalized for their asthma within six months of discharge.
Abstract: Mislabeling of symptoms was studied in a group of 587 chronic asthmatic patients. Results indicated a wide variation in both the frequency and type of mislabeling, with over 26 per cent of the patients mislabeling one or more nonairways obstruction symptom clusters as being an asthma attack. Several demographic and personality factors were found to correlate with mislabeling. Finally, mislabeling was associated with medical outcome, with mislabelers being 40 per cent more likely than nonmislabelers to be rehospitalized for their asthma within six months of discharge.
20 citations
TL;DR: The psychological stages a renal transplantee goes through in the first few months postoperatively is explored and the role of the mental health consultant is examined.
Abstract: Renal transplantation offers the patient with end stage renal disease an alternative treatment to dialysis. A successful graft can lead to a greatly improved quality of life. Physicians, staff and ...
19 citations
TL;DR: A selected review of the pertinent literature and case examples is reviewed to demonstrate reactive, clinical and masked depression and also depression as an affect or symptom.
Abstract: Depression is commonly associated with chronic pain patients. How common is it and what are its manifestations? Research findings are unclear. Besides, depression is defined by some as a syndrome and by others as an affect or symptom. This leads to further confusion. This paper attempts to answer those questions by a selected review of the pertinent literature and case examples to demonstrate reactive, clinical and masked depression and also depression as an affect or symptom. Some of the treatment issues are considered.
TL;DR: Pertinent literature on suicide evaluation and management is reviewed with an emphasis toward the clinical applicability in emergency settings.
Abstract: The author offers a sequential protocol for the evaluation and care of suicidal behavior in emergency settings. This protocol contains the following components: 1) a review of the limitations of clinical and demographic risk factors; 2) an exploration of frequent negative reactions that arise during the suicidal encounter in clinicians; 3) an objective schema for grading suicidal behavior; 4) an understanding of chronic suicidal behavior; and 5) a flexible treatment approach. Pertinent literature on suicide evaluation and management is reviewed with an emphasis toward the clinical applicability in emergency settings. Language: en
TL;DR: Hostility was significantly higher in postpartum patients than employees and did not differ significantly from that of women with hyperprolactinemic amenorrhea, while anxiety and depression was significantly lower than in the amenorrheic patients.
Abstract: In a previous study ten women with hyperprolactinemia and amenorrhea had significantly higher Symptom Questionnaire scores for depression, hostility and anxiety than patients with amenorrhea only and a matched nonpatient employees group. The hyperprolactinemic patients and employees were compared with ten women on their seventh day after childbirth who had been matched for sociodemographic variables and had similar prolactin levels. Hostility was significantly higher in postpartum patients than employees and did not differ significantly from that of women with hyperprolactinemic amenorrhea. Postpartum hyperprolactinemic women did not differ significantly from the employees for anxiety and depression, which was significantly lower than in the amenorrheic patients. In several mammals aggression occurs concurrently with lactation. The studies in humans suggest an association of high prolactin levels with hostility.
TL;DR: There is a need for prospective studies, in which women with pelvic pain of whatever etiology are evaluated, in order to provide contextual data and to identify predictors of treatment response.
Abstract: Chronic pelvic pain is a common presenting complaint in gynecology clinics. In a proportion of cases no pathology or sufficient pathology can be found to account for the level of complaint. This paper reviews the evidence on the psychological characteristics of patients presenting with chronic pelvic pain without obvious pathology. Methodological considerations are identified in order to guide future research. There is a need for prospective studies, in which women with pelvic pain of whatever etiology are evaluated, in order to provide contextual data and to identify predictors of treatment response.
TL;DR: A clinically derived system of judging cancer patients' engagement, reality testing and degree of arousal during a pretreatment consultation was found predictive of psychosocial problems or no problems reported by sixty cancer patients one month after starting radiation therapy.
Abstract: A clinically derived system of judging cancer patients' engagement, reality testing and degree of arousal during a pretreatment consultation was found predictive of psychosocial problems or no problems reported by sixty cancer patients one month after starting radiation therapy. Independent ratings of psychosocial problems by the treating oncologists, nurses and radiation therapists three months after starting treatment were also found significantly associated with the pretreatment composite.Disease, treatment and demographic factors were not predictive of psychosocial problems and were not associated with the pretreatment clinical composite.Follow-up observations at six months and eighteen to twenty-four months of forty-four and twenty-four of the original patients available for study revealed there was no continuing association between their pretreatment clinical composites and psychosocial problem ratings.
TL;DR: A literature review of cases seems to substantiate the frequency for the association between the development of psychogenic seizures and loss/depressive symptomatology.
Abstract: A review of the diagnostic and treatment approaches to psychogenic seizures has been offered. Two case reports of psychogenic seizures precipitated by loss and associated with depressive symptomatology have been presented. A literature review of cases seems to substantiate the frequency for the association between the development of psychogenic seizures and loss/depressive symptomatology. Symptom relief can be achieved with the utilization of a crisis intervention style psychotherapy. Antidepressant medication may also have a useful role in the treatment of some psychogenic seizures.
TL;DR: Clinicians are alerted to the dangerous, uncommon neuroleptic malignant syndrome (NMS) and mental health workers and administrators are encouraged to retain generous medical staffing for the inpatient setting.
Abstract: This paper makes three emphases. Clinicians are alerted to the dangerous, uncommon neuroleptic malignant syndrome (NMS). Mental health workers and administrators are encouraged to retain generous medical staffing for the inpatient setting. A case presentation is made to show how difficult the diagnosis of NMS is considering the multiple diagnoses that are possible.
TL;DR: The dexamethasone suppression test is a valuable tool in the diagnosis of major affective disorders, differentiating them from other types of psychopathology.
Abstract: Catatonic stupor is a cluster of symptoms and not necessarily a disease entity It may be seen not only in schizophrenia, but in major affective disorders, conversion disorders, organic brain syndr
TL;DR: Therapy with carbamazepine ameliorated the patient's psychosexual disorder and cured his organic personality disorder and partial complex seizure disorder.
Abstract: The authors evaluated a thirty-four year-old man who had an organic personality disorder, partial complex seizure disorder, and several paraphilias. After unsuccessful treatment with dilantin and p...
TL;DR: The study raises research and clinical issues pertinent to understanding the experience of pain associated with cancer and suggests that locus of control expectancies are important mediating variables in the reattribution of cancer pain and discomfort.
Abstract: The psychological aspects of cancer pain have been largely neglected except in the treatment related research literature. The present study examines the role of attribution theory in illuminating the experience of cancer pain. Twenty-five cancer patients were administered pain and discomfort vertical visual analogue scales and a measure of locus of control. Data pertaining to intensity and perceived source (cancer, cancer therapy or unrelated benign conditions) of pain and discomfort, per cent attribution to each and physician ratings as to source were also obtained. While results indicate that a variety of reattributional phenomena do occur in cancer patients, such cognitive reappraisal does not diminish pain intensity. The findings further suggest that locus of control expectancies are important mediating variables in the reattribution of cancer pain and discomfort. The study raises research and clinical issues pertinent to understanding the experience of pain associated with cancer.
TL;DR: Using a systemic model (with the hospital as the focus of consultation) can lead to the development of a more comprehensive science of consultation which will lead to an increase of gratification for the psychiatrist and a more healthy functioning hospital system.
Abstract: Consultation psychiatry has long offered the potential for psychiatrists to impact on the mental health of large numbers of individuals. However, workers in consultation psychiatry have often described it as a stressful, ungratifying experience. Over the last fifty years, since the initiation of consultation psychiatry, a series of models of consult work has been presented in the literature. These models have increasingly become more complex in the system of organization in which they operate. Moreover, there has been a constant movement toward viewing the function of the psychiatrist as intervening in behavior outside of the patient. After reviewing the history of consultation psychiatry, the authors conclude that a logical development would be a systemic model in which the entire hospital system is seen as the focus of consultation and in which the goal of the consultant's work is seen as creating a more open and flexible hospital system. The authors, therefore, describe a systemic model in which the potential crisis offered by any request for consultation work is seen as a tool for intervening with the hospital system. The difficulties of attaining the objectivity necessary for implementing a systemic intervention are discussed. A method of systemic diagnosis of the hospital is presented as well as a number of strategies of intervention with the hospital system. The authors conclude that using a systemic model (with the hospital as the focus of consultation) can lead to the development of a more comprehensive science of consultation which will lead to an increase of gratification for the psychiatrist and a more healthy functioning hospital system.
TL;DR: The authors recommend using DSM-III diagnostic criteria applicable to these syndromes in formulating educational programs for primary care physicians.
Abstract: One-hundred seventy-seven family physicians were surveyed regarding their perceptions of the types of psychosocial problems encountered in their practices, the amount of time they felt they devoted to each problem, and their interests regarding continuing psychiatric education. Patients with “multiple somatic complaints” and “symptoms of emotional distress” were reported as being encountered most frequently. Marital and family problems, alcoholism and sexual dysfunction were also ranked highly. The physicians indicated the highest interest in managing these disorders in addition to treatment of the suicidal patient. The implications of these results for psychiatric educators and liaison psychiatrists are discussed. The authors recommend using DSM-III diagnostic criteria applicable to these syndromes in formulating educational programs for primary care physicians.
TL;DR: This article describes the first reported psychotherapeutic group for hospitalized burn patients, based upon an adaptive coping model, and body image and resultant self-esteem issues are a major theme.
Abstract: This article describes the first reported psychotherapeutic group for hospitalized burn patients The rationale for the group is based upon an adaptive coping model Issues typically dealt with in groups include feelings toward hospital staff, emotional reactions to treatments, and feelings concerning their burn injury Body image and resultant self-esteem issues are a major theme The importance of clinical services for burn injured patients and the involvement of mental health professionals in service delivery is emphasized
TL;DR: Fourteen of nineteen tricyclic trials and nine of ten courses of ECT resulted in unequivocally positive clinical response and there were no statistically significant relationships between tricycling response and either test abnormality.
Abstract: We examined retrospectively the response to tricyclic antidepressants and/or electroconvulsive therapy (ECT) in twenty-seven inpatients with major depressive disorder, primary unipolar subtype who had a thyrotropin-releasing hormone (TRH) test and dexamethasone suppression test (DST) prior to treatment. Thirteen failed to suppress on the DST and had a blunted thyroid stimulating hormone (TSH) response to TRH; nine had one test abnormality; and five had neither abnormality. Physicians selected ECT for patients with abnormalities on both tests significantly more frequently than for patients with one or neither test abnormalities. Fourteen of nineteen tricyclic trials and nine of ten courses of ECT resulted in unequivocally positive clinical response. There were no statistically significant relationships between tricyclic response and either test abnormality.
TL;DR: The Heimler Scale of Social Functioning (HSSF) is an effective instrument for evaluating psychosocial stress and dysfunction and has excellent potential for use as a screening instrument by primary care physicians in clinics and medical centers, psychotherapists in various clinical settings, and psychiatric professionals in outpatient services.
Abstract: The Heimler Scale of Social Functioning (HSSF) is an effective instrument for evaluating psychosocial stress and dysfunction. When tested, the HSSF clearly differentiated between two different patient groups: those who had scheduled initial appointments for outpatient psychotherapy and those who were participating in a multiphasic health examination. Both groups were composed of members of the same prepaid health plan, utilizing the same medical center, and were comparable to each other in all respects except age. This scale has excellent potential for use as a screening instrument by primary care physicians in clinics and medical centers, psychotherapists in various clinical settings, and psychiatric professionals in outpatients services.
TL;DR: Results replicated and extended previous findings, suggesting both a “dissociation” between expressed and experienced happiness and an abnormal degree of “association’ between express and experienced sadness for depressives and possibly “low normals.”
Abstract: Sixty right-handed adult subjects, divided equally into three groups (mildly depressed, normal, and "low normal") on the basis of the Zung self-Rating Depression Scale, were exposed for forty seconds each to forty-eight imagery items designed to reflect happy, sad, angry, and fearful situations. Expressed emotion (facial electromyography) and experienced emotion (self-report) were measured. Results replicated and extended previous findings, suggesting both a "dissociation" between expressed and experienced happiness and an abnormal degree of "association" between expressed and experienced sadness for depressives and possibly "low normals."
TL;DR: Specific suggestions for the detection of marital discord in medical practice and its management will be presented.
Abstract: Recent studies of marriage focusing on the development of marital intimacy and its role in the family as it influences emotional and physical health are reviewed. Marital pathology is increasingly presented in diverse and often covert ways to almost all physicians. Specific suggestions for the detection of marital discord in medical practice and its management will be presented.
TL;DR: Three case studies of patients treated on a combined medicine-psychiatric inpatient unit, and who presented with complex psychobiological illnesses, are presented and the usefulness of the DST in the hospital management of these patients is discussed.
Abstract: The dexamethasone suppression test (DST) appears to be a sensitive and specific biological marker for endogenous depression that can have important diagnostic and treatment implications. The authors present three case studies of patients treated on a combined medicine-psychiatric inpatient unit, and who presented with complex psychobiological illnesses. They discuss the usefulness of the DST in the hospital management of these patients from a diagnostic and treatment perspective.
TL;DR: A case of combined tetracyclic-neuroleptic and anticholinergic drug interaction is presented and major clinical signs of intoxication were disturbed consciousness and severe cardiac arrythmias which required temporary pacemaker implantation.
Abstract: A case of combined tetracyclic-neuroleptic and anticholinergic drug interaction is presented. Major clinical signs of intoxication were disturbed consciousness and severe cardiac arrythmias which required temporary pacemaker implantation. Possible pathogenetic mechanisms and drug interactions are discussed.