Biomedical subjects
Publications and source records attributed to F J Stoddard.
Even with the decreasing lengths of stay, primary nurses and their patients become attached. These issues of "involvement" can be sources of stress and can complicate primary nursing. Recognizing psychological issues leads to greater job satisfaction and professional identity.
Recent medical and surgical advances allow many severely burned patients to survive who formally would have died. Assessment of psychiatric outcomes with these patients may provide ways of measuring effects of acute burn care methods on later quality of life, specify more accurately their emotional needs during rehabilitation, and stimulate further research. Thirty children, aged 7 to 19, with severe burns are compared with 30 nonburned subjects matched for age, sex, SES, and parents' marital status according to DSM-III criteria. The burned children had significantly higher levels of overanxious disorder, phobias, and enuresis, but they had the same rates of present depressive disorders.
The results of a diagnostic outcome study of children and adolescents with severe burns are presented. The positive research findings include evidence of present and lifetime full and partial anxiety and depressive disorders and statistically significant within-sample, burn-related, and demographic differences. The negative findings are less depression and post-traumatic stress disorder by DSM-III criteria than expected, the presence of a subgroup of severely burned children who appeared to be functioning well with only a few or no diagnoses, and absence of significant differences on many variables on within-group comparisons. Based on these data, periodic psychiatric evaluation or reevaluation and specifically targeted followup treatment are indicated for many burned children, adolescents, and their families.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The Massachusetts Mandatory Mental Health Insurance Act requires all health insurance plans in the state to cover mental illness. Because of their concerns that this law might be taken as a national model, the authors describe the problems encountered in implementing it and the conflicts between the insurance carriers and psychiatry. The authors attribute the problems to some insurance carriers' failure to deal directly with organized psychiatry in obtaining screening guidelines, the absence of psychiatrists on the carriers' central committees, and psychiatrists' generally indifferent and hostile attitudes toward the carriers. The authors describe recent improvements and recommendations based on 10 years of experience.
Explore the source record for details and available documents.
The treatment of children aged 1-18 who experienced physical pain from an acute burn and the emotional pain of disfigurement offers a prototype for treatment of pain and understanding its impact on the child's emotional life. The author presents an initial report on differential response to and treatment of burn pain in infancy, the preschool years, latency, preadolescence, and adolescence. He describes the basic therapeutic interventions for such children, including psychological preparation, consistent "holding" relationships, selective reinforcement of denial, tolerance of regression, medications, and hypnosis or relaxation techniques.
The hypotensive drug clonidine, which stimulates central alpha-adrenergic receptors, was administered to psychiatric patients in a preliminary double-blind study. Two schizophrenic patients became more agitated and aggressive during the trial. The drug showed some antidepressant effects in three of five depressed patients. Clonidine withdrawal appeared to potentiate symptoms in a manic patient. Drug treatment reduced blood pressure and rapid eye movement sleep. Interpretation of behavioral effects of clonidine is limited by uncertainty about the balance of its pre- and postsynaptic effects.
Biochemical and electrophysiological factors were studied longitudinally in a rapidly cycling manic-depressive patient. Slow changes in mood, motor activity, sleep, and urinary norepinephrine levels during the course of each depressed and manic episode are reported, as well as rapid alterations in many variables at the time of mood switch. Urinary concentrations of norepinephrine and its metabolite, 3-methoxy-4-hydroxyphenyl glycol (MHPG) were significantly lower in depression than in mania; norepinephrine but not MHPG excretion increased prior to the switch. We postulate that the slow behavioral and biological changes preceding switches in this patient are an important manifestation of the cyclic process in manic-depressive illness.
A distinctive pattern of clinical change during eight affective episodes is reported in a rapidly cycling manic-depressive patient. After a rapid switch to near maximal intensity of affective symptoms, slow changes in symptomatology were documented by significant slopes and correlation coefficients over the course of each episode. Decreases in depression, anxiety, drowsiness, helplessness/hopelessness, anger, and sadness preceded the switches into mania; decreases in mania, euphoria, seeking others, and talking preceded the switches into depression. Psychologically important events appeared to regularly precede rapid mood switches. It is suggested that the consistent, slow clinical changes which occur during affective episodes may reflect part of an underlying rhthmic biological process and that environment events may be capable of triggering a final common pathway for the mood switch during a vulnerable period.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.