Biomedical subjects
Publications and source records attributed to O S Surman.
Dialysis patients experience considerable psychologic stress, but practical issues impede delivery of psychiatric care. The authors describe five cases in which the use of hypnosis for symptom reduction provided the basis for beneficial psychiatric intervention.
The authors describe two HLA identical sibling pairs with panic disorder. To their knowledge, this is the first report of histocompatibility testing in patients with anxiety disorders.
Of 51 patients with panic attacks, 11.8% (7.8% with a correction factor) had a positive dexamethasone suppression test. This is significantly lower than the rate for melancholia. This difference suggests that panic attacks and major depression may be associated with different biological mechanisms.
The authors describe the use of monoamine oxidase inhibitors (MAOIs) in eight patients with severe obsessive-compulsive disorder. In four cases, the MAOIs produced rapid and sustained remission of symptoms; no response was seen in four other patients. All patients who responded to MAOIs, but none of the nonresponders, had phobic anxiety and/or panic attacks. Thus, a trial of MAOIs is indicated in obsessive-compulsive disorder, especially when phobic anxiety or panic attacks form part of the clinical picture.
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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.
Explore the source record for details and available documents.
Psychoactive drugs provide an essential intervention in the care of organ transplant recipients, yet little is known of their effect on immunological function. Human and animal data on immunological effects of neuroleptic (e.g., haloperidol, phenothiazines) and antidepressant agents (e.g., tricyclic antidepressants, fluoxetine) lead to conflicting hypotheses. Lithium carbonate acts through the phosphoinositide system and has a bipolar effect on neuronal activity. Lithium is known to have immune-enhancing properties and is difficult to administer in the peritransplant period but nonetheless deserves study for possible beneficial effects on allograft function.
Psychiatry plays an essential role in the selection and preoperative care of liver transplant patients. Unique to liver transplantation are the preponderance of candidates with alcoholic end-stage organ failure and also the reversibility of encephalopathy with postoperative normalization of hepatic function. The expense of liver transplantation necessitates documentation of quality of life among recipients. It can also be postulated that a "ripple effect" does occur, in which favorable operative outcomes provide a meaningful and beneficial effect on social networks of transplant candidates and on society in general.
Although cytomegalovirus (CMV) is rarely cultured from peripheral-blood leukocytes of immunocompetent patients, it may be cultured from up to 60% of renal transplant recipients, 1 to 4 months after transplantation. During this same period, renal transplant recipients are often referred for psychiatric evaluation. Since CMV may infect the central nervous system, the relationship between isolation of CMV from peripheral-blood leukocytes (viremia) and psychiatric evaluation was investigated in 80 renal allograft recipients at the Massachusetts General Hospital. Five of 16 (31%) patients with viremia and 7 of 64 (11%) patients without viremia required psychiatric consultation (P = 0.04, two-tailed Fisher exact test). CMV viremia may be an important but treatable contributor to psychiatric symptoms in the transplant recipient.
The expanding field of bioethics has created a need in psychiatry for rapid access to the complex bioethics literature. This is especially true in consultation-liaison work. An annotated bibliography was created by a task force of the Academy of Psychosomatic Medicine charged with exploring how psychiatrists function on bioethics committees. The bibliography is organized into headings that reflect how bioethical problems came to the attention of psychiatrists. Introductory references allow the reader an overview of the history of bioethics and a selection of useful textbooks. References are provided explaining how ethical principles are used. References are also organized by areas of medical work frequently visited by consultation-liaison psychiatrists.
OBJECTIVE: The aim of this study was to examine the awareness of resting heartbeat in heart transplantation recipients, compare it with that found in other medical populations, and determine whether clinical characteristics are associated with accurate heartbeat awareness. METHODS: Eligible patients underwent a research battery consisting of a heartbeat detection task and self-report questionnaires assessing cardiac symptoms, psychosocial variables, and cognitive function. The accurate awareness of resting heartbeat was determined by presenting the patients with auditory stimuli at each of six different delays following the R wave on the ECG. Patients then selected the tones that they thought coincided with the sensation they had of their heart beating. The patients' physicians rated their cardiac morbidity. The results were contrasted with comparable data obtained in previous work with other ambulatory medical populations. RESULTS: Forty-one consecutive heart transplantation recipients who survived for at least 3 months after surgery were eligible. Thirty-four (82.9%) of them were studied and complete data were obtained on 26 (63.4%). Nine patients (34.6%) were reliably able to detect their resting heartbeat. When compared with the 17 patients who were not accurately aware of their heartbeat, the two groups did not differ significantly in cardiac morbidity, cognitive brain dysfunction, generalized psychiatric distress, depression, somatization, or hypochondriacal attitudes. A significantly higher proportion of heart transplantation recipients were accurately aware of their heartbeat than was found in a sample of general medical outpatients and in asymptomatic, nonpatient volunteers. CONCLUSIONS: One-third of heart transplant recipients are accurately aware of resting heartbeat, despite the absence of cardiac innervation.
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