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PubMed1995

'Compensation neurosis' revisited: outcome studies of the effects of litigation.

Although the term 'compensation neurosis' has been frequently used to describe personal injury litigants, its clinical validity--and the assumptions about individuals described by this label--have not been critically examined. This article reviews the concept of 'compensation neurosis' and follow-up studies of claimants for compensation following the finalisation of their legal proceedings. A follow-up study of 760 litigants found that, of the 264 subjects who were not working at the time of conclusion of litigation and who could be traced, 198 (75%) were not working after an average of 23 months following the finalization of their cases.

Adjustment Disorders↗
PubMed1979

Phobic symptoms in an elderly woman: a multidisciplinary case conference.

A 67-year-old woman, previously self-sufficient, became housebound by phobic symptoms. During the patient's hospitalization for treatment of these disabling symptoms, a multidisciplinary case conference served to identify the underlying psychodynamic issues, which were related to separation anxiety. Treatment included helping the patient understand her relationships with her daughter and her own mother, and behavior modification to reduce the secondary gains of her symptoms. After treatment, the patient successfully returned to self-care.

Activities of Daily Living↗
PubMed1985

Informed consent--mandating the consultation.

This article illustrates how a mandatory consult procedure identified treatable psychiatric problems. Using a computerized data-based format, 372 (37.4%) patients (the "judgment" group) of 996 psychiatric consultations were identified as referred to assess the patient's capacity to execute a consent form for a medical or surgical procedure. One hundred twenty-nine (35%) of the 372 patients thus referred by hospital mandate were given psychiatric diagnoses (DSM-II) by the consultant and received recommendations for primary psychiatric treatment. The "judgment" group had significantly more organic brain syndrome and psychoses associated with CNS conditions (p less than 0.001), whereas the "nonjudgment" group was diagnosed as exhibiting significantly more neurosis, alcoholism, psychophysiologic disorders, transient situational reactions, and personality disorders (p less than 0.001). Without a required psychiatric consultation sanctioned by administrative hospital mandate, the majority of the "judgment" cases with major psychopathology would not have been identified. The use of the mandated psychiatric consultation in the general hospital is discussed.

Aged↗
PubMed1988

Psychiatric consultation in the family physician's office. Advantages and hidden benefits.

Family physicians spend up to 40% of their time dealing with emotional and psychiatric problems and may be the only caretaker for 60% of all episodes of psychiatric illness. One way of strengthening the role of the family physician in managing psychiatric problems in their practices is by involving them in an initial psychiatric assessment, which may entail the patient being seen in the primary care setting. This intervention, offered by a community mental health center (CMHC) in Ontario, Canada, was evaluated by examining all cases referred by family physicians over a 3-year period and comparing those seen in consultation in family physicians offices with those seen in consultation in the CMHC. While the office consultation appears to be a cost-effective intervention, the main factor that determined whether it took place appeared to be the attitude of the referring physician rather than the nature of presenting problem. Other benefits arising from such a liaison-consultation relationship are also discussed.

Adult↗
PubMed1990

Patterns of psychiatric consultations in Kuwait general hospitals.

Two hundred and nineteen consecutive referrals to psychiatric consultation services from all general hospitals in Kuwait over a 3-month period were studied and compared with a control group of 100 patients who were not referred for psychiatric consultation. The two groups differed significantly in age, sex, marital status, employment, and past psychiatric treatment. Inpatients were more often referred than outpatients with an overall low referral rate of 0.3%. The department of general medicine referred 74.4% of patients in contrast to 11.4% referred by the department of general surgery. The most common reason for referral was for assessment of a suicide attempt in the inpatient group, and the absence of organic cause for patients' physical symptoms in the outpatient group. Acute situational disturbance that resulted in a suicide attempt was the most common psychiatric diagnosis (26%), followed by depressive illness (19.5%) and organic psychotic disorders (8.2%). Our findings are similar to those reported in the literature, and the present study suggests a national underutilization of psychiatric consultation services in general hospitals.

Adult↗
PubMed1991

Psychogenic abdominal pain.

A series of 25 patients referred for psychiatric consultation with nonspecific abdominal pain (NSAP) are compared with a prospectively admitted series who were not referred. The referred patients had a longer duration of pain and also had high levels of psychiatric illness. The referred patients had more life events associated with the onset of their pain than controls. Inquiry about previous psychiatric history, childhood abuse, and a symptom model would increase the detection of NSAP patients who require psychiatric evaluation. Outcome after recommended treatment is also addressed.

Abdominal Pain↗
PubMed1991

Child psychiatry consultations to pediatric inpatients: a literature review.

While the prevalence of psychiatric disorders in clinical pediatric populations is high, only a few studies have systematically examined child psychiatry consultations to pediatric inpatients. This paper reviews this body of literature and indicates important areas for further study. Some of the studies did not report basic data such as the number of consults, age, sex, or race of referrals, and referral rate. Without such basic data, it is impossible to make adequate comparisons between studies. Several studies did not report economic status or admission diagnosis of the child, psychiatric intervention/treatment on the ward, or psychiatric referral after discharge. Mostly the samples were small, including data on less than 100 inpatient consults. There is a need for greater consistency in the classification of reasons for referral, so that accurate and meaningful comparisons can be made across sites. The examination of psychiatric diagnoses was complicated by the wide range of diagnostic classifications that have been used. Standardization on the DSM-III-R/IV diagnostic system would make for greater comparability between studies. It would be useful in planning for services if future studies included cost as well as efficacy studies with a randomized control group.

Adolescent↗
PubMed1985

Sex differences in minor psychiatric morbidity: a survey of a homogeneous population.

Epidemiological methods of psychiatric assessment were used to examine whether there is a sex difference in the constitutional vulnerability of the male and female phenotype to minor psychiatric morbidity. In order to minimise the effect of environment and of sex roles and stereotypes as far as possible, a sample of relatively homogeneous employed men and women are studied. No sex difference in prevalence of minor psychiatric morbidity or its outcome was found in this population of men and women of similar age, education, occupation and social environment. However, women did report significantly more somatic symptoms of psychogenic origin.

Adult↗
PubMed1979

Psychological disturbance and pain report differences in both organic and non-organic low back pain patients.

Patients with undiagnosable low back pain have been observed to differ from patients with proven low back pain in their clinical description of pain and in their psychological status. More variable and diffuse pain qualities are emphasized in their clinical reports and more psychological disturbance characterizes them as a group, suggesting an association between pain expression and psychological disturbance. One hundred and two patients with low back pain were administered a standardized pain questionnaire to determine more systematically the association between pain expression and psychological disturbance in patients with and without demonstrable organic disease. Patients with psychological disturbance differed significantly from patients without psychological disturbance in the following ways. They used more words in their description of pain, distributed these words over more pain factors, and endorsed significantly more pain of the affective and skin pressure variety. The results underscore previous clinical impressions and suggest that patients without either organic or psychological findings may be cases of undiagnosed organic disease.

Adult↗
PubMed1982

Psychiatric factors influencing the treatment of pain with peripheral conditioning stimulation.

Sixty-six patients treated with transcutaneous nerve stimulation (TNS) for pain symptoms were studied with respect to the incidence of different psychiatric factors and physical disorders in relation to success or failure of the treatment. In a blind screening procedure, mental illness and pathological personality traits were negative in relation to treatment success, while a state of reactive decompensation was not. Patients without any relevant physical cause of their pain were generally treatment failures and they had an excess of pathological personality traits, mostly of a hysterical nature.

Adjustment Disorders↗
PubMed1994

General practitioners' decision making for mental health problems: outcomes and ecological validity.

A major problem in the field of medical decision making is the ecological (external) validity of the results. In a Judgement Analysis study on mental health, vignettes were used to capture the decision strategies of 28 General Practitioners (GPs). Two different decision strategies for mental health problems could be distinguished. Although the results were statistically satisfactory and met the assumptions of Judgement Analysis, it was considered necessary to determine the ecological validity of the vignettes. Video tapes (n = 90) of GP consultations were scored in terms of the units of information (cues) which had been used in the vignette study. Additional data gave access to the judgements of the GPs, which were comparable to the judgements obtained in the vignette study. Results showed that the weights given to the different cues in the vignette study were situated within the confidence interval of the weights from the video study. Thus indicating that the results obtained from the vignette study have ecological validity.

Cues↗
PubMed2003

[Psychosomatic gynaecology or gynaecology and psychosomatics?].

Such an interrogation might well seem vain or even absurd, although one cannot deny that it does mean a different vision of medicine, if not an entirely different conception of it. Considering the sick person as a whole and not only the sickness of one organ means practicing a true holistic approach, far from a limited somatic medicine addressing the psyche only in case of failure, as a last resort. Rather than artificially applying to the soma some would-be psychological recipes, let us try and take up that bet: a simultaneous use, in time and space, of body and mind medicine. Psychosomatic gynaecology certainly requires will and training, disponibility and curiosity, but it might well be the best protection against boredom and routine, as well as a true source of pleasure. Can such a satisfying way of practicing our art be anything else than a bonus for our patients?

Female↗
PubMed2006

The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health.

Perseverative cognition, as manifested in worry and rumination, is a common response to stress, but biopsychological models of stress and health have largely ignored it. These models have generally focused on physiological activation that occurs during stress and have insufficiently addressed effects that occur in anticipation of, or following, stressful events. We argue that perseverative cognition moderates the health consequences of stressors because it can prolong stress-related affective and physiological activation, both in advance of and following stressors. We review evidence that worry, rumination, and anticipatory stress are associated with enhanced cardiovascular, endocrinological, immunological, and neurovisceral activity. The findings yield preliminary support for our hypothesis, suggesting that perseverative cognition might act directly on somatic disease via enhance activation via the cardiovascular, immune, endocrine, and neurovisceral systems.

Anxiety↗
PubMed2005

Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders.

BACKGROUND: PMD are disabling, but lack any generally accepted treatment strategies. DESIGN/METHODS: Ten patients with PMD received treatment with Psychodynamic Psychotherapy. Patients were assessed with psychiatric rating scales and the movement disorder was rated by a blinded rater with the Psychogenic Movement Disorder Rating Scale (PMDRS). RESULTS: Total mean PMDRS (p = 0.0195), total PMDRS function scores (p = 0.0142), Hamilton depression scores (p = 0.009), Beck anxiety scores (p = 0.002), and GAF (p = 0.0083) all improved with psychotherapeutic intervention. CONCLUSIONS: Psychotherapy and appropriate use of adjunct psychiatric medication can be a successful intervention for PMD.

Adolescent↗