Biomedical subjects
Publications and source records attributed to P Reich.
Catatonic stupor occurred in two psychiatric inpatients, predisposing them to staphylococcal pneumonia, venous thrombosis, and pulmonary embolism. Disastrous outcomes ensued. Catatonic stupor can lead to fatal complications, and aggressive medical and psychiatric therapy is indicated.
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A movement disorder specifically associated with dreaming sleep was observed in an otherwise healthy young woman. It was characterized by gross head movements, nightly occurrence, and no awakening. The patient had a lifelong history of the disorder, as did her brother.
A 39-year-old man twice experienced ventricular fibrillation and exhibited numerous ventricular premature beats. Coronary arteries were normal, and no impaired cardiac function was found upon catheterization. Evidence was adduced that the ventricular premature beats were related to higher nervous activity. The patient had serious psychiatric problems; the ventricular premature beats were provoked by psychophysiologic stress, increased during REM sleep, were reduced by meditation, and were controlled by beta-adrenergic blockade, phenytoin and digitalization. We conclude that psychologic and neurophysiologic factors may predispose to life-threatening cardiac arrhythmia in the absence of organic heart disease. Effective management of the recurrent ventricular arrhythmia involved; acute drug testing for assessing antiarrhythmic efficacy; use of programmed trendscription to provide on-line information on drug action; a treatment program involving more than one agent; and use of measures to reduce sympathetic nervous activity.
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To characterize siucidal behavior among hospitalized medical and surgical patients, all suicide attempts in the Peter Bent Brigham Hospital were surveyed for seven years. Seventeen attempts occurred, non of them fatal. Only four patients were seriously ill, two with neoplasia. All the attempts were impulsive and were associated with stress and disturbances of impulse control. Anger, not depression, was the effect most often seen before the attempts. In all cases the precipitating stress was loss of emotional support. However, patient vulnerability to suicide seemed to be the key determinant. Fifteen patients had mental disorders, including eight with personality disorders, three with schizophrenia, three with organic brain syndromes, and one with manic depressive psychosis. Seven were psychotic, and six had made prior suicide attempts. These findings suggest that the characteristics of impulsive suicide should be considered when a suicide prevention program is being developed for a general hospital.
Myocardial flow and oxygen consumption are reduced during cardiopulmonary bypass. In ventricular fibrillation both flow and O2 consumption are higher than in the empty beating heart; after the fibrillation flow remains elevated although O2 consumption decreases. Aortic pressure is the major determinant of the myocardial flow rate, especially in hemodilution.
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