Biomedical subjects
Publications and source records attributed to G G Lloyd.
A series of 18 patients who attempted suicide by jumping is reported. All were diagnosed as being psychiatrically ill and 14 received psychiatric treatment after the episode. These patients differ in several important aspects from those who harm themselves by drug-overdose.
Three groups of patients were identified during a study of men who had recently suffered an acute myocardial infarction: those with psychiatric morbidity antedating the infarction and those with no significant psychopathology. Compared to the other two groups, patients with psychiatric morbidity before the infarction were more likely to be unmarried, unemployed and to have received previous psychiatric treatment. They also obtained higher scores for neuroticism and psychoticism on personality assessment. Patients whose symptoms have been precipitated by the infarction resembled the psychologically healthy group with regard to their demographic characteristics and personality. Their symptoms tended to be transient, improving without special psychiatric treatment.
Using a standardized interview, psychiatric morbidity was diagnosed in 35 our of 100 consecutive male patients one week after admission to hospital following a first acute myocardial infarction. Sixteen of these patients had been psychiatrically ill before the infarction and their psychiatric symptoms and social difficulties persisted throughout the 12 month period of observation. In contrast, patients whose psychiatric morbidity had been precipitated by the infarction tended to have transient symptoms and fewer problems of social adjustment. Measures of psychiatric morbidity one week after the attack did not predict subsequent mortality or difficulty in returning to work. Only a history of heavy smoking was significantly associated with mortality during the ensuing 12 months. Patients who regarded their illness as a loss or a threat had greater psychiatric morbidity than those who regarded it as an insignificant event.
Sixteen socially phobic outpatients underwent a 4-week course of social skills training that attempted to maximize rehearsal in real-life settings. The therapy was largely conducted by nonprofessional volunteers after a 2-hour training workshop. It consisted of multiple role-played practice in the clinic, followed immediately by rehearsal in a real-life setting in the company of a nonprofessional therapist and a fellow patient. Subsequently, patients were randomly paired to perform further rehearsals between sessions. Drug therapy was controlled by double blind assignment to propranolol or inert placebo throughout the course of treatment. Measures of specific fears, generalized social anxiety, self-image, and global tension and anxiety were administered 1 month before treatment, immediately before and after treatment, and at 6 months follow-up. During a 4-week drug-free period prior to active treatment no improvement was noted on any measures. After the 4-week treatment period significant improvement had occurred on all outcome measures. Propranolol and placebo subgroups showed very similar results. Treatment gains were sustained at follow-up. It was concluded that repeated behavior rehearsal, both in the clinic and in real life is a cost-effective treatment procedure for many social phobias. The approach is straightforward and can be applied by nonprofessionals, including the patients themselves, after limited training and with minimal supervision.
Some differences in the organization of liaison psychiatry between the United States and the United Kingdom are discussed. The fact that much psychiatric morbidity in general hospital patients is unrecognized justifies an expansion of liaison services particularly where referral rates are currently low, as they are in British hospitals. However, it is important that there should be an evaluation of these services together with an assessment of the complementary role of the liaison nurse. It is also suggested that liaison psychiatrists could make a greater contribution to medical student teaching than they do presently.
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.
Consecutive patients attending hospital for the first time with backache were entered into a prospective study, provided that certain defined causes (infective, neoplastic, metabolic and inflammatory etc.) were not apparent at the first visit. Amongst 188 available for analysis, 65% were discharged and 28% defaulted, together making a total of 93% who 'recovered uneventfully' (in the sense that they were no longer attending hospital) on average in about three months, 4% came to 'myelography' (radiculography using Dimer-X or Amipaque) including 2% to discectomy, 1.5% proved to have treatable underlying diseases accounting for their backache while 1.5% became 'chronic attenders'. Information available at the first visit (patient characteristics, history, examination, radiographs and psychological questionnaire) provided few pointers to what the outcome would be or how long the patient would attend hospital. In particular, routine X-ray examination did not provide clues to any important conditions not already suspected by the clinicians. A case is made for reserving routine radiography for patients who have not recovered within about three months.
One week after a first myocardial infarction 35 out of 100 consecutive men patients aged under 65 were found by standardised clinical interview to have psychiatric morbidity. In 16 the morbidity had been evident before the infarct, and these patients showed a wider range of psychopathology than those whose symptoms had been precipitated by the infarct. The results suggest that psychiatric morbidity in patients with heart disease is not necessarily a result of the disease process. Thus characterising psychiatric morbidity and identifying the patients' individual needs are important if rehabilitation is to be effective.
Explore the source record for details and available documents.
An experiment is described in which depressed patients were asked to recall pleasant or unpleasant experiences from their past life in response to a standard series of stimulus words. The ratio between the time for recall of pleasant and unpleasant experiences was found to fall progressively with increasing severity of depression or of "neuroticism" and to be significantly related to each. Among patients who scored relatively low on depression or neuroticism pleasant memories were recalled more speedily than unpleasant; among those who scored high this relationship was reversed. Possible mechanisms to account for these findings are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.