Showing papers in "International Journal of Psychiatry in Medicine in 1986"

Positive Emotional States and Enhancement of the Immune System

Abstract: Salivary immunoglobulin A (IgA) concentration increased significantly after subjects viewed a humorous videotape and did not change significantly after they viewed a didactic videotape. Scores on a...

Symptoms and EEG Findings in the Borderline Syndrome

Abstract: Symptomatology and electroencephalographic abnormalities were examined in thirty-nine individuals with borderline personality disorder, compared with twenty unipolar depressed patients. Borderline individuals showed a much higher incidence of symptoms commonly seen in complex partial seizures or episodic dyscontrol, and in addition had a much higher incidence of EEG abnormalities, particularly posterior sharp activity. These findings suggest that neurophysiological dysfunction may contribute to the borderline syndrome.

A Global Assessment of Recent Stress (GARS) Scale

Abstract: The Global Assessment of Recent Stress (GARS) Scale was developed to assess current stress perception. Most measurements of environment are derived from life event scales that capture amount of stress or change associated with stressful events that have occurred over the past six to twenty-four months. A scale that provides a more immediate estimate of stress is needed when physiological tests and perceived stress are studied together. The GARS has been subjected to a series of studies concerning its reliability, validity, and factor structure. Results suggest that it may be a useful instrument for helping individuals assess their current feelings of stress.

Drug Abuse and Bipolar Disorders

Abstract: Abuse of multiple substances can coexist in many patients who present with symptoms indistinguishable from any Bipolar Disorder. Failure to recognize and treat this coexistent substance abuse may p...

The Subsequent Pregnancy after Stillbirth: Anticipatory Parenthood in the Face of Uncertainty

Abstract: Interviews were conducted with fifteen couples who had experienced a previous neonatal death and a subsequent successful pregnancy. Discussions focused on the stresses that were unique to the subsequent pregnancy, and parental adaptation to them. Results show that parents experienced markedly increased anxiety that was difficult for them to manage. Parental coping involved vigilant exploration of possible negative outcomes, and a withdrawal from outward signs of investment in the pregnancy. This did not appear to impair adaptation to parenthood, however, although anxiety regarding the child's health continued for several months after delivery. Implications of these findings for clinicians are discussed.

Bromocriptine Treatment for Cocaine Abuse: The Dopamine Depletion Hypothesis

Abstract: The authors review the evidence that cocaine exerts its rewarding effects through the acute activation of dopamine (DA) pathways in the brain. Chronic cocaine administration is hypothesized to lead...

A preliminary study of the relationship between preoperative depression and weight loss following surgery for morbid obesity.

Abstract: Fifty-two consecutive morbidly obese patients were evaluated psychiatrically before they were scheduled to undergo gastroplasty and again an average of twenty-six months later Ten patients did not undergo surgery; six patients who did undergo gastroplasty were unavailable for follow up In the remaining thirty-six patients, there was a statistically significant correlation between the degree of clinically estimated preoperative depression and the percent of body weight lost following surgery Amount of preoperative weight was also correlated with postoperative weight loss, but depression before surgery was a more significant predictor of postoperative weight loss Patients who expressed less distress prior to surgery tended to lose less weight after surgery and were more likely to manifest increased psychiatric distress postoperatively

Is Tinnitus a Psychological Disorder

Abstract: There have been consistent reports in the psychosomatic literature indicating that a patient's perception of tinnitus as well as differential response to various treatment modalities may be affected by personality variables. The present study examined several personality correlates of subjective tinnitus in forty-five male patients referred to the Audiology Clinic of a large VA Medical Center with constant tinnitus of at least six months duration. Information was also collected on etiology, onset and chronicity, medications, prior treatment and related medical problems. Four standard psychological tests (MMPI, Cattel's 16 PF, Rotter's Locus of Control and Holmes and Rahe Life Stress Scale) were administered to all patients in the study, in addition to a comprehensive audiologic and otologic evaluation. Correlational analyses were used to examine the relationship between personality profiles and the demographic, medical and audiologic data. The expected psychosomatic characteristics of this patient populat...

L-DOPA in the Treatment of Negative Schizophrenic Symptoms: A Single-Subject Experimental Study

Abstract: Adjunctive Sinemet (L-DOPA plus carbidopa) therapy was assessed for a neuroleptic nonresponsive schizophrenic with a longstanding negative syndrome. A twenty-seven week double-blind placebo-controlled reversal design found significant improvement specifically for negative symptoms while treated with combined haloperidol-Sinemet as compared against haloperidol-placebo. The eight-week adjunctive treatment reversed a worsening trend in attention, abstract thinking, passive withdrawal, psychomotor retardation, and a cluster of seven negative parameters, while positive symptoms were unaffected. This seemed to represent more than simple reversal of drug-induced akinesia and underscores the importance of distinguishing between positive and negative syndromes in psychopharmacological research.

Importance of “Significant Others” in Predicting Cooperation with Diabetic Regimen

Abstract: Patients' cooperation with their medical regimen is of prime importance in the treatment of a chronic illness such as diabetes. A psychosocial model of behavioral prediction developed by Fishbein w...

Sociocultural factors in MI recovery: an exploratory study.

Abstract: The reported study examines the influence of socioeconomic status (SES) and ethnicity in coping with a first acute myocardial infarction (MI). The study employed a panel design in which seventy-five patients were interviewed during acute hospitalization and six months later, and sixty of those were interviewed again at one year post-MI. Using the analysis of variance test, gradients in anxiety, functional status, and self-reported health status were found among lower SES Blacks, Hispanics, Anglos and upper SES Anglos as well as statistically significant differences in personal sense of control, beliefs about recovery, coping responses, and social support systems. More important, analysis of covariance documents that associations between coping variables and post-MI recovery outcomes vary among the different socioculturel groups.

Cost-effectiveness of providing mental health services: the offset effect.

Abstract: An offset effect occurs when the provision of one type of service leads to a reduction in the use of other related services. This article examines the offset which occurs in medical utilization whe...

Effects of cortical lesion location on psychiatric consultation referral for depressed stroke inpatients.

Abstract: Although post-stroke depression occurs with lesions to either cortical hemisphere, increasing evidence supports the view that depression is more prevalent after left hemispheric damage. This retrospective study of depressed post-stroke inpatients referred for psychiatric consultation shows a significantly higher referral rate for patients with right-hemispheric lesions. The results suggest an underutilization of psychiatric consultation to patients with left-sided lesions, and perhaps underrecognition of affective disorders in these patients. Various reasons for this underutilization are proposed, including the greater likelihood of speech impairment in left-sided brain-damaged stroke patients, who may have greater difficulty verbally communicating their psychic distress. Increased physician awareness of the clinical presentations of post-stroke depression will result in more patients benefitting from available treatments.

Methylphenidate for medical in-patients.

Abstract: Methylphenidate (Ritalin Hydrochloride) has been recommended as a treatment for depressed medical and geriatric patients. The rationale for this treatment includes both its safety (even in patients with contra-indications that prevent the use of other antidepressants) and its quick onset of action. In addition the drug can be withdrawn after a few weeks of treatment without the danger of a recurrence of depression. The author reports having used the drug safely in depressed medically ill patients with a success rate of at least 50 percent.

Clonazepam: A Novel Therapeutic Adjunct:

Abstract: Clonazepam, a unique benzodiazepine with anticonvulsant and serotonin enhancing capacity, can be used in conjunction with conventional psychopharmacologic agents to treat a variety of psychiatric conditions including schizophrenia, borderline personality disorder, and psychotic mania. Three representative case studies are presented and specific guidelines for the use of clonazepam are discussed.

Empirical study on an inpatient psychogeriatric unit: diagnostic complexities.

Abstract: Retrospective analysis of the phenomenology and the diagnostic process of 112 consecutive psychogeriatric admissions revealed the majority (61%) were suffering from affective illness. In 53 percent, the reason for admission was depression and 8 percent were in the manic phase of a bipolar disorder. Dementia was diagnosed in 32 percent, with a third of these patients having an associated depression. The remaining 7 percent had a schizophrenic or paranoid disorder. Ninety-two patients (82%) were found to have at least one coexisting medical and/or neurological disorder(s) requiring early intervention. Associated acute organic brain syndromes were common (18%) and often difficult to diagnose. The AOBS was at times the only sign of an underlying active medical condition. The diagnosis of this condition often required serial observations for fluctuations in mental status accompanied by appropriate laboratory investigations. These findings underscore the complexity of the diagnostic process in psychogeriatric patients suffering from concomitant medical and psychiatric disorders. High index of awareness is recommended for the need to search for coexisting delirium, which may be masked at times by the major psychiatric disorder.

Cadaveric Renal Transplant Failure: The Short-Term Sequelae

Abstract: Quality of life was evaluated in 103 patients initially when each was placed on the waiting list for a cadaveric transplant. Patients who were not transplanted were reassessed six months after being placed on the waiting list. Patients who received a transplant were reassessed six months after the surgery. Cadaveric transplantation was performed in sixty-three patients by the time of follow-up. The mortality rate of 12.7 percent in transplanted patients after six months was more than twice that in patients who remained on the waiting list without a transplant, but this difference was not statistically significant. There was a graft failure rate of 23.6 percent among transplanted patients who survived six months. Graft failures were associated with some deterioration in subsequent physical activity (F = 5.4, p < 0.03) but not in psychosocial functioning. Successful cadaveric transplants were associated with a marked and significant improvement in psychosocial well-being (F = 10.5, p < 0.002) after six mont...

Effects of ACTH and Prednisone on Mood: Incidence and Time of Onset:

Abstract: Prior studies of mood and cognitive changes produced by ACTH and glucocorticoids have not characterized accurately the incidence or time of onset of these changes. In this study mood and cognitive reactions of fifteen medical patients treated with ACTH or prednisone were studied prospectively. ACTH produced a lessening of dysphoria by the third treatment day, and mild euphoric reactions occurred in three of seven of the patients treated. Prednisone produced a reduction of dysphoria by the seventh day, but no euphoric reactions in the eight patients treated with it. Neither medical symptom improvement nor elevation of plasma cortisol levels in the patients given ACTH appeared to account for the results. The mechanism of the observed mood change remains to be elucidated.

Portal-Systemic Encephalopathy: Neuropsychiatric Manifestations:

Abstract: Portal-systemic encephalopathy, which occurs as a consequence of cirrhosis of the liver, is associated with a variety of neuropsychiatric symptoms. Problems related to the differential diagnosis and medical management of portal-systemic encephalopathy, as compared to other more usual psychiatric disorders, are discussed. Also addressed are issues of particular concern to psychiatry, such as the use of pharmacotherapeutics and the rehabilitation of alcoholism, which are commonly seen in individuals with portal-systemic encephalopathy and liver disease, as well as in the general psychiatric patient population.

Empirical study on an inpatient psychogeriatric unit: biological treatment in patients with depressive illness.

Abstract: A study of 112 psychogeriatric admissions identified seventy patients sufficiently depressed to require biologic treatment. Twenty-four patients completed a primary treatment trial with TCA's and seventeen with ECT. ECT proved to be more effective, (81.4% versus 62.5%), even though overtly psychotic and medically unstable patients preferentially received this treatment. The ECT response rate is comparable to other reports of its efficacy in the treatment of delusional depression. A higher morbidity rate of 27 percent in the TCA-treated group was observed. The authors conclude that ECT is a highly beneficial treatment modality for the carefully selected elderly patient with major depressive illness. They found that a higher number of ECT treatments than expected were required in their psychogeriatric patients, but did not find a higher morbidity other than increased confusion with more treatments. Careful repeated assessment of response to treatment combined with readiness for assertiveness, in spite of th...

Coping with serious illness on integrating constructs to enhance clinical research assessment and intervention

Abstract: Empirical research suggests that given relatively similar illness contingencies, patients who cope successfully with serious illness have access to and use effectively social network support, believe events are to some extent within their control, perceive themselves to be effective, and employ an array of flexible coping strategies. Based on a selective literature review, the argument is made that more integrative conceptual frameworks are needed to advance theory and to enhance the applied value of research data. Clinical implications for assessment, intervention, and evaluation are set forth.

Long-Term Follow-up of Chronic Pain Patients: A Preliminary Study

Abstract: Patients who participated in a structured outpatient pain management program were followed for twenty-four to forty-three months with a mean of 31.8 months. Patients who were evaluated only were compared with patients who terminated prematurely or completed treatment. Patients completing treatment reported greater ability to handle domestic and occupational tasks, and greater tolerance for exercise. There appeared to be no significant effect of treatment on the subjective experience of pain, but patients who completed treatment reported markedly reduced use of medical resources for diagnosis and treatment of pain. Limitations of the present study are discussed.

Enhanced Interpretation of Nonverbal Cues in Male Cocaine Abusers

Abstract: Chronic alcoholics have been known to possess increased ability to interpret nonverbal facial cues. This has been hypothesized to account for the high rate of alcohol recidivism. Since cocainism is also associated with a high rate of recidivism, the authors examined nonverbal reception in twenty-five cocaine abusers and in an equal number of matched controls. All subjects were asked to view videotapes of individuals gambling and to determine, solely on the basis of facial cues, the size of the jackpot at risk during a specific trial. The cocaine abusers were found to be more accurate at interpreting nonverbal cues. Possible reasons for this finding are discussed.

Factors Affecting Anxiety and Depression in Psychiatric Consultation Patients

Abstract: Factors that contribute to dysphoric affects in patients seen on a consultation-liaison service were investigated. Eighty-five subjects were studied to assess the role of character style, locus of control and seriousness of medical illness upon the magnitude of depression and anxiety each patient experienced. Results indicated that the obsessoid individual as well as individuals in pain reported significantly more depression and anxiety than their hysteroid counterparts. The severity of illness did not correlate with greater dysphoria. Those individuals who were more externally located were found to be in greater subjective pain. Furthermore, psychiatric consultants significantly tended to ignore the issue of the pain more often than anxiety and depression. The implications of these findings are discussed as they relate to a patient's personality style and the experience of illness and hospitalization.

On the Early Recognition of Neuroleptic Malignant Syndrome

Abstract: Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.

A pilot study of women's attitudes towards breast-conserving surgery with primary radiation therapy for breast cancer

Abstract: Breast-conserving surgery ("lumpectomy") with primary radiation therapy is gaining acceptance as an alternative to mastectomy for breast cancer. Currently, little is known about the specific immediate and long-range biopsychosocial effects of breast-conserving therapy as compared to more traditional mastectomy procedures. Physicians' speculations about the women who chose breast-conserving treatment as opposed to mastectomy seem to have been influenced by the scientific debate concerning the efficacy of this procedure. This study is a preliminary investigation of the attitudes and experiences of women receiving breast-saving therapy for carcinoma of the breast.

Affect Cognizance and the Type a Behavior Pattern: Labeling, Cognitive Effort or Phenomenological Loss?

Abstract: Forty-eight subjects were requested to remember three idiosyncratic emotion-laden memories (eliciting Anger, Anxiety and Contentment). Objective (change in tonic skin conductance) and subjective (rated success at achieving each emotion) measures of arousal were taken for each condition as well as subjectively rated use of cognitive content (verbal and visuospatial modes). An “Affect Cognizance Index” (group-calculated T-score for objective arousal minus group-calculated T-score for subjective arousal) correlated positively with a measure of Type A Behavior during Anxiety and Contentment but not Anger, with or without cognitive effort statistically controlled. However, cognitive content may influence affect cognizance independent of its relationship with the Type A syndrome. Those subjects reporting greater verbal content showed augmented experience of affect-induced arousal during Anger. Visuospatial content augmented subjective experience of affect-induced arousal during Contentment.

The attribution of affect in pain clinic patients: a psychophysiological study of the conversion process.

Abstract: In a study to examine the relationship between the conversion process and physiological correlates of emotional arousal, three key elements of conversion were assessed separately in patients experiencing chronic pain for which no adequate somatic cause could be demonstrated. Thirty-seven patients referred to a pain clinic were categorized as members of either high, intermediate, or low conversion groups on the basis of their scores on the Disease Conviction, Affective Disturbance and Denial scales of the Illness Behaviour Questionnaire (IBQ). All patients scored in the high range on Disease Conviction. High conversion patients acknowledge little dysphoric affect and denied life problems apart from physical illness. Intermediate conversion patients also denied life problems other than somatic, but acknowledged high levels of dysphoria. Low conversion patients reported dysphoria and acknowledged life problems which they did not attribute to physical illness. The prediction that the high conversion group would show lower levels of resting skin conductance than the low conversion group was confirmed. Patients in the intermediate conversiongroup resembled those in the high conversiongroup in that their resting skin conductance was significantly lower than that observed in members of the low conversion group. These findings are consistent with those of previous studies of conversion disorders. They point to the importance in these conditions of the interaction between dysphoria and the cause to which it is attributed by the patient.

Psychosomatic Aspects of Myocardial Infarction and Implications for Treatment

Abstract: Psychosomatic intervention with patients who have suffered myocardial infarction is directed toward prevention of complications, development of realistic coping strategies, working through emotions, reduction of stress, and modification of coronary prone behavior.

Fenfluramine and mazindol: acute reversible cardiomyopathy associated with their use.

Abstract: An unusual side effect of amphetamine-like drugs is described. A patient with acute cardiomyopathy was discovered to have been taking Fenfluramine and Mazindol at the prescribed dose. Within a week after abstention from the drugs and appropriate cardiac treatment her cardiomyopathy resolved. The authors suggest that this effect is due to the combination of the two drugs and represents a drug interaction.