Showing papers in "International Journal of Psychiatry in Medicine in 1985"
TL;DR: Specific problems that family members confront over the course of the patient's illness will be identified and specific strategies that have been used to assist family members to cope with the cancer experience will be reviewed.
Abstract: Although trends in health care point to the increasing involvement of the family in caring for the ill family member, little attention has been directed toward the needs of other healthy family members or the impact that cancer has on their lives. In this article, literature on the impact of cancer on the family will be reviewed and specific problems that family members confront over the course of the patient's illness will be identified. During the initial phase of cancer family members feel excluded from care, have difficulty communicating with staff and experience considerable emotional tension. In the adaptation phase family members have problems with lifestyle changes, meeting the needs of well family members and living with uncertainty. In the terminal phase family members experience role strain, communication problems on the subject of death and feelings of loss. Intervention strategies that have been used to assist family members to cope with the cancer experience are also reviewed. Finally, how p...
173 citations
TL;DR: In this paper, twenty post-mastectomy women and their husbands were examined for adjustment and family relations. Adjustment was assessed by the Psychosocial Adjustment to Physical Illness (PAIL) test.
Abstract: In this preliminary study, twenty post-mastectomy women and their husbands were examined for adjustment and family relations. Adjustment was assessed by the Psychosocial Adjustment to Physical Illn...
105 citations
TL;DR: It is more fruitful to search for different risk factors and ‘suspicious’ signs instead of deducting preventive measures from any linear theory of causation, and pay particular attention to early recognition of (pre) anorexics.
Abstract: Recent research supports the current idea that the incidence of anorexia nervosa and related eating disorders is increasing in Western societies. This phenomenon raises questions regarding the possibilities of prevention. It seems difficult, if not impossible, to change sociocultural influences such as the fashion of slenderness, and upper/ middle-class family characteristics. It is more fruitful to search for different risk factors and ‘suspicious’ signs instead of deducting preventive measures from any linear theory of causation. Specific attention should be paid to early recognition of (pre)anorexics, but this secondary prevention is seriously hampered both by patient delay and doctor delay. Rational and effective preventive measures require a knowledge of causation and the possibility of intervening in the causal chain at an early stage. The concepts of prevention currently in use derive from Caplan’s [ 11 discussion of primary, secondary, and tertiary prevention. The corresponding tasks of health care practitioners may be characterized respectively as humanistic, medical, and rehabilitative [2] .Primary prevention focuses on the reduction or elimination of those (risk) factors that cause or contribute to the occurrence of disorders. Secondaly prevention aims to reduce the morbidity and chronicity of mental disorders through early identification and intervention in the initial stages of the development of the disorder. Tertialy prevention addresses itself to the reduction of mental disorders in the community through rehabilitation of 191
53 citations
TL;DR: A comparison was made of the demographic and clinical characteristics of patients who were referred for psychiatric consultation in a general hospital, and it was found that for almost all of the referrals, either a physician or more frequently a nurse recorded well-known signs of delirium in their notes.
Abstract: Delirium is the organic mental disorder most often encountered by psychiatrists and other physicians. Early recognition and management of patients with this condition is critical. Its presence in medically ill patients is highly correlated with an increased mortality rate. In our study of patients who were referred for psychiatric consultation in a general hospital, a comparison was made of the demographic and clinical characteristics of those patients with delirium and those with other psychiatric disorders. We found that for almost all of the referrals (93%), either a physician or more frequently a nurse recorded well-known signs of delirium in their notes. The physicians indicated the possibility of an organic psychiatric condition in only one-third of the referrals, suggesting that doctors either may overlook the nurses' notes or they may not recognize the signs recorded as signs of delirium. A review of the literature suggests that physicians tend to overlook and misdiagnose this disorder. Possible r...
46 citations
TL;DR: Reliability and validity data are presented on the Chronic Illness Problem Inventory (CIPI) which demonstrate its ability to document accurately patient's specific problems in areas of physical limitations, psychosocial functioning, health care behaviors and marital adjustment.
Abstract: Two studies are presented which describe the development of a problem-oriented psychosocial screening instrument for use in health care settings. Reliability and validity data are presented on the Chronic Illness Problem Inventory (CIPI) which demonstrate its ability to document accurately patient's specific problems in areas of physical limitations, psychosocial functioning, health care behaviors and marital adjustment. A study is also presented which compares the problems of patients with three distinct chronic illnesses: pain, obesity, and respiratory ailments. Results indicate a significantly greater severity of problems for pain patients and especially patients with multiple pain complaints. Problem areas common to all three illness groups are discussed in the context of providing better comprehensive treatment for chronically ill patients.
45 citations
TL;DR: A case is presented in which the catatonic-like behavior and extrapyramidal sequelae of the neuroleptic malignant syndrome responded to combined treatment with anticholinergics and levodopa/carbidopa.
Abstract: The clinical manifestations, differential diagnosis, and treatment of the neuroleptic malignant syndrome and neuroleptic-induced catatonia are discussed. A case is presented in which the catatonic-like behavior and extrapyramidal sequelae of the neuroleptic malignant syndrome responded to combined treatment with anticholinergics and levodopa/carbidopa. Differential diagnosis and theories regarding the development of these neuroleptic-induced disorders are reviewed.
37 citations
TL;DR: It is suggested that Ganser syndrome may be linked inappropriately with the concept of factitious illness, and paralogia and related psychological symptoms are better classified as associated features of Atypical Dissociative Disorder.
Abstract: The past and present nosology of Ganser's syndrome is discussed. The anomaly is defined as the presence of approximate answers with hallucinations, clouded sensorium, somatic conversion, and amnesia. The characteristic symptom of the syndrome, paralogia, is appreciated as an associated feature of Factitious Disorder with Psychological Symptoms. It is suggested that Ganser syndrome may be linked inappropriately with the concept of factitious illness. Two new cases of the Ganser syndrome are presented, and an additional forty-one case reports are reviewed. A high correlation between the presence of paralogia and amnesia is revealed, which suggests that paralogia and related psychological symptoms are better classified as associated features of Atypical Dissociative Disorder.
36 citations
TL;DR: It is suggested that brain research in the field of somatoform disorders look to the second somatosensory area (SII), which appears to be especially suited to the types of neurophysiological and neuropsychological dynamics that are generally presumed to underlie this class of maladies.
Abstract: Clinical descriptions of somatoform disorders tend to fall largely into the two main categories of conversion disorder and hypochondriasis. These disorders frequently occur in the context of other psychopathology and also tend to have a significant association with CNS disease. Evidence implicating alterations in brainstem reticular arousal and attentional mechanisms in the etiology of these disorders is reviewed. Relevant studies investigating cerebral asymmetry of function have tended to associate right hemisphere information processing style with the sensory, attentional and affective changes that characterize conversion disorders. It is suggested that brain research in the field of somatoform disorders look to the second somatosensory area (SII), which appears to be especially suited to the types of neurophysiological and neuropsychological dynamics that are generally presumed to underlie this class of maladies. Finally, it is argued that a biopsychosocial approach to the understanding of somatoform disorders requires the incorporation of neuropsychological data into a multidimensional conceptual framework.
36 citations
TL;DR: The results of this investigation underscore the importance of a neuropsychiatric evaluation as part of a comprehensive diagnostic workup and medical management program for patients with chronic liver disease.
Abstract: Patients suffering from primary biliary cirrhosis and a control group of patients with Crohn's disease were compared with respect to neuropsychological, psychiatric and psychosocial functioning. While the two groups did not differ on tests of intelligence, the primary biliary cirrhosis patients evidenced significant deficits on certain measures of functional neuropsychological capacity, including attentional, visuospatial and perceptual-motor abilities. These patients also reported several behavioral impairments consequential to their illness, although their emotional and psychiatric status were relatively unimpaired. In addition, the similarities in neuropsychological functioning of primary biliary cirrhosis patients and individuals suffering from chronic alcoholic cirrhosis are discussed. The results of this investigation underscore the importance of a neuropsychiatric evaluation as part of a comprehensive diagnostic workup and medical management program for patients with chronic liver disease.
28 citations
TL;DR: Two head injury patients who experienced the onset and/or exacerbation of post-concussion symptoms associated with increased environmental stress are presented and provide insight into the complex interaction between neurological and psychological factors following head injury.
Abstract: Two head injury patients who experienced the onset and/or exacerbation of post-concussion symptoms (i.e., headache, confusion, and memory difficulty) associated with increased environmental stress are presented. The cases provide insight into the complex interaction between neurological and psychological factors following head injury. Patients should be made aware of cognitive limitations during the recovery period so as to better determine acceptable levels of environmental stress. The development or exacerbation of post-concussion symptoms during convalescence signals the physician that a discrepancy exists between the patient's cognitive capacities and environmental demands. Timely intervention to modify environmental stress would help alleviate problems with post-concussion symptoms.
20 citations
TL;DR: It is concluded that serial laboratory determinations of serum electrolytes remains the only satisfactory method of monitoring body tonicity in SIWIS patients.
Abstract: A quantitative assessment of cognitive state (Folstein's “mini-mental state” scores) was correlated with serum sodium concentration in four patients with the syndrome of self-induced water intoxica...
TL;DR: Subjects classified as high loss/grief experienced more intense and extended sadness than did those who had not had significant losses and displayed more apprehension, anger, shame-guilt, giving-up, anxiety, and irritation.
Abstract: “What Happened to Pity?,” a BBC documentary on the grief responses to the Aberfan disaster in 1966, powerfully affects viewers and is an effective tool for the study of sadness. Observations in the classroom and in the laboratory demonstrate that the great majority of viewers experienced some degree of sadness along with anger and sympathy. Subjects classified as high loss/grief experienced more intense and extended sadness than did those who had not had significant losses. They also displayed more apprehension, anger, shame-guilt, giving-up, anxiety, and irritation. Subjects experiencing the most sadness, compared with those less affected, were more initiating and talkative and their relationships in the laboratory were closer, more gratifying, task-oriented, therapeutic, and trusting. With the film they displayed more sympathy, role-identification, personalization, and like, but felt more drained. With respect to stable personality features they were warm, sharing, introspective, dependent, and more per...
TL;DR: Evidence exists for dopaminergic, cholinergic and opiate-like activity of PCP in both laboratory and clinical studies, and clinical interventions are recommended according to various symptom clusters.
Abstract: The authors present different antidotal strategies in treating phencyclidine (PCP) intoxication based upon specific symptomatic presentation. Evidence exists for dopaminergic, cholinergic and opiate-like activity of PCP in both laboratory and clinical studies. Reviewing these studies, clinical interventions are recommended according to various symptom clusters.
TL;DR: Two cases that typify the psychiatric disturbances seen in patients with Acquired Immune-Deficiency Syndrome (AIDS) are described and it is recommended that psychiatrists become more familiar with its psychiatric manifestations.
Abstract: Two cases that typify the psychiatric disturbances seen in patients with Acquired Immune-Deficiency Syndrome (AIDS) are described. Given the increasing incidence of this disorder, the authors recommend that psychiatrists become more familiar with its psychiatric manifestations.
TL;DR: A comparison study of self-concept was done with hemophiliacs ages six to twenty-four and twenty-one control subjects, examining the effects of the first year of a home-infusion treatment program on self-esteem.
Abstract: A comparison study of self-concept was done with twenty-one hemophiliacs ages six to twenty-four and twenty-one control subjects, examining the effects of the first year of a home-infusion treatmen...
TL;DR: The results suggest that depressions of an endogenous nature are unlikely to respond to placebo and when they do respond, the vegetative symptoms are least likely to improve.
Abstract: Fifty-three depressed inpatients received placebo treatment as part of a multicenter double-blind placebo-controlled study of an investigational antidepressant, bupropion. Groups of placebo responders and nonresponders were identified based on percentage change on the Hamilton Depression Scale and validated against the Clinical Global Impression Scale. Although the diagnostic and demographic features of responders and nonresponders were generally similar, some differences emerged. Placebo nonresponders were more often associated with male gender, lack of college education, diagnosis of manic-depressive illness and greater lack of insight at baseline. Placebo responders largely consisted of females with a diagnosis of depressive neurosis. When the individual symptoms as measured by the Hamilton Depression Scale were examined, the nonresponders showed improvement only in psychological symptoms (i.e., lack of interest, guilt, and suicide). The responders showed consistent improvement in most symptoms except ...
TL;DR: The temporal persistence of illness behavior evident soon after myocardial infarction was examined over an eight month period in a cohort of survivors of MI, as indicated by significant correlations between illness behavior scores soon after MI and those obtained eight months later.
Abstract: The temporal persistence of illness behavior evident soon after myocardial infarction [MI] was examined over an eight month period in a cohort of survivors of MI. Persistence was evident in seven of eight patterns of illness behavior, as indicated by significant correlations between illness behavior scores soon after MI and those obtained eight months later. The importance of this finding is discussed in the light of the role of illness behavior soon after MI in determining patterns of outcome.
TL;DR: In this article, the authors propose that the supervisory relationship is best understood as a social learning system, with its own characteristic structure, rules of organization, hierarchical order and mode of extracting influence.
Abstract: What is presently known about the supervision of psychotherapy is described from a systems point of view. Supervision is conceptualized as a dynamic interchange between two individuals whose differing sets of expectations can profoundly affect the process. The authors propose that the supervisory relationship is best understood as a social learning system, with its own characteristic structure, rules of organization, hierarchical order and mode of extracting influence. Research reports on the supervisory process are also reviewed. Finally, given the emphasis placed on the supervised practice of psychotherapy by training programs, certification requirements and licensure laws, the need for further investigation is emphasized.
TL;DR: In the framework of a routine examination of elementary school pupils with the TPE teacher questionnaire, G6PD deficient boys showed significantly more hyperkinesis, writing problems, aggression and a strong trend towards mood changes.
Abstract: G6PD deficiency is a genetic enzymatic defect, which affects approximately one hundred million people. The Mediterranean variants are known to be associated with hemolysis, particularly in childhood. However, hemolysis also occurs in Black American G6PD deficient children. It can cause kernicterus, especially in the presence of factors which enhance the passage of bilirubin through the blood-brain barrier. In the framework of a routine examination of elementary school pupils with the TPE teacher questionnaire, thirty-seven G6PD deficient boys from one school and thirty-seven paired matched controls from the same school were examined for brain dysfunction. The G6PD deficient boys showed significantly more hyperkinesis, writing problems, aggression and a strong trend towards mood changes. Speech defects also occurred more often in the G6PD deficient children. The findings are discussed.
TL;DR: A psychotherapeutic approach to severe burn injury based upon an adaptive coping model is proposed and specific adaptive tasks required to adjust to severeBurn injury and therapeutic interventions considered best suited to facilitate adaptation are presented.
Abstract: Aspects of severe burn injury which distinguish it from other injuries or physical illnesses are outlined, and psychosocial issues in hospitalization and rehabilitation are discussed. With this as background, a psychotherapeutic approach to severe burn injury based upon an adaptive coping model is proposed. Specific adaptive tasks required to adjust to severe burn injury and therapeutic interventions considered best suited to facilitate adaptation are presented.
TL;DR: No single issue characterized a majority of encounters, and the nature of the help requested was diverse, but female physicians were more likely to initiate encounters that dealt with personal feelings about themselves or their patients.
Abstract: The kinds of help primary care physicians requested from a psychiatric consultant in an ambulatory medical clinic are described. Based upon data from 173 encounters involving fifty-four physicians ...
TL;DR: Psychological reactions to the crash of a commercial airliner, resulting in the deaths of 145 people in San Diego in September of 1978, are presented and universal themes expressed were the experience of loss of control and identification with the deceased.
Abstract: Psychological reactions to the crash of a commercial airliner, resulting in the deaths of 145 people in San Diego in September of 1978, are presented. Emotional sequelae of the crash included psychophysiologic concomitants of stress (headaches, sleep disturbances, hyperventilation, nightmares, gastrointestinal disturbances), disorientation, depressive symptoms, phobias, emotional dyscontrol, obsessions and psychotic manifestations. In addition, there were re-emergences of reactions to past traumatic events. A full range of psychological defenses was mobilized to help deal with the stress. Universal themes expressed were the experience of loss of control and identification with the deceased. Brief crisis intervention techniques, which included ventilation, support, clarification, interpretation, and particularly education, appeared helpful.
TL;DR: In a follow-up study, five ex-addicts on naltrexone for five to twelve months had reproducable appetite suppression and a sustained ten to twenty pound weight loss from a baseline of 5 percent to 30 percent above their ideal weight.
Abstract: In a follow-up study, five ex-addicts on naltrexone for five to twelve months had reproducable appetite suppression and a sustained ten to twenty pound weight loss from a baseline of 5 percent to 30 percent above their ideal weight.
TL;DR: A selected review of the literature pertaining to migraine and tension headache of the past thirty or more years is presented and existence of “migraine” personality is explored.
Abstract: Presented is a selected review of the literature pertaining to migraine and tension headache of the past thirty or more years. Existence of “migraine” personality is explored. Association between p...
TL;DR: A case which presented originally as anorexia nervosa was found on further examination to be a major depressive disorder secondary to iron deficiency, and resolved promptly after parenteral iron therapy.
Abstract: A case which presented originally as anorexia nervosa was found on further examination to be a major depressive disorder secondary to iron deficiency. Clinical signs of iron deficiency anemia as a part of the Plummer-Vinson syndrome and severe depression resolved promptly after parenteral iron therapy.
TL;DR: Conceptual and methodological issues related to definition of pain populations and methods for their comparison, utilizing McGill Pain Questionnaire data, are examined and suggestions for future research are offered.
Abstract: Issues relevant to more precise definition of pain syndromes are identified. Previous research approaches to the definition of clinical pain groupings or syndromes are examined. Emphasis is placed on the importance of matching definition of the clinical pain sample under study with the specific research question(s) being addressed. Problems inherent in the study of cancer and low back pain groups are discussed in detail. Conceptual and methodological issues related to definition of pain populations and methods for their comparison, utilizing McGill Pain Questionnaire data, are examined and suggestions for future research are offered.
TL;DR: This article discusses the technique and use of biopsychosocial “mapping” with medical students doing a psychiatric consultation-liaison rotation and its usefulness as an aid in combating reductionistic thinking and in improving diagnostic formulations and treatment.
Abstract: This article discusses the technique and use of biopsychosocial “mapping” with medical students doing a psychiatric consultation-liaison rotation. The “mapping” exercise is a visual aid used to help the students develop a broader biopsychosocial perspective as well as help them find such biopsychosocial formulations more wieldy. The drawing up of such a “map” seems to encourage the students to direct their attention to psychosocial as well as biological issues. A brief case example is presented with an accompanying sample biopsychosocial “map.” Its usefulness as an aid in combating reductionistic thinking and in improving diagnostic formulations and treatment is discussed.
TL;DR: Three clinical vignettes of patients helped by carbamazepine are presented and future research directions are suggested to help improve the treatment of psychiatric patients.
Abstract: Carbamazepine, a drug initially used for the treatment of seizure disorders, is currently being investigated for its usefulness with psychiatric patients. Affectively disturbed patients in particul...