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Is anxiety the prime response to stress in all instances? Can depression be a prime response to stress? This paper is concerned with the relationship of stress to the quantitative degree of anxiety, the various components of anxiety, and the interrelationship of anxiety and secondary symptoms and signs. A stress leads to anxiety leads to depression axis is suggested and illustrated through the medium of the masked-depression pathway.
This paper is a review of a 17-year study of 1,465 patients who had severe masked depression. It offers a description of the most frequently found symptoms and signs that are characteristic of patients with this disorder. A very distinctive syndrome is outlined.
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The authors briefly describe biofeedback techniques such as EMG feedback, temperature feedback, and heart rate feedback, along with reports from the literature about their application to specific problems such as subvocalization while reading, Raynaud's disease, cardiac arrhythmias, and epilepsy. Many clinical applications of biofeedback are aimed at inducing relaxation, a state that has important psychotherapeutic potential. The authors suggest that biofeedback could be used to reduce a patient's general level of arousal or as an adjunct to behavior therapy or insight therapy. While there have been no reports in the literature of any harmful effects secondary to feedback training, the authors caution that some patients may respond negatively to an objectively measured state of relaxation.
A number of studies in recent years have examined the relationship between economic trends and mental and physical health. This review focuses specifically on the impact of unemployment and job loss on employees and their families. The author cites studies by Brenner and others showing a strong association between unemployment and loss of self-esteem, increased suicide rates, state mental hospital admissions, state prison admissions, and increased incidence of physical illness. He concludes that unemployment has a profound impact on emotional and physical health, and that clinicians should begin now to apply the knowledge gained from these studies to patient care.
Medical and surgical inpatients with coexisting psychiatric disorders pose several challenges to the consulting mental health professional in the general hospital. A major challenge is determining whether presenting signs and symptoms have a medical or psychiatric basis. Making such a determination requires a careful history, a mental status examination, and the utilization of bedside screening and diagnostic instruments. Recommended treatments include psychotherapy, psycho-education, and pharmacotherapy. However, psychotropic drugs must be used with caution because of potential interactions with drugs prescribed for medical conditions. Studies indicate that timely psychosocial interventions can improve the medical patient's mental health and have the potential to reduce length of hospital stay and utilization of health services.
Although it is not uncommon in bronchoesophagological practice to be consulted in cases of unexplained atelectasis, patients presenting with painful atelectasis are indeed rare. Three such cases will be described. The first case, previously unreported, for which Dr. M. E. Avery suggested the term "pulmonary migraine" is that of a 14-year-old Caucasian female with a history of recurrent "asthma" chest pain, atelectasis and migraine headache. On investigation there was demonstrable spastic obliteration of the lumen of a lobar bronchus. Two similar cases are described.
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The authors analysed the psychiatric profile of 208 general hospital patients referred for psychiatric consultation, about half of these patients presented with parasuicidal behaviour. The diagnoses of depression and adjustment disorders predominated. Characteristics of the referred patients, source of referral and main forms of psychiatric intervention are documented. Means to promote good relationships between psychiatrists and physicians are suggested. The need for a better liaison psychiatric service is emphasised.
The composite MMPI profiles of 42 successfully-treated and 42 unsuccessfully-treated female patients with MPD syndrome were compared statistically. The profiles did not differ in configuration, but that of the unsuccessful patients was significantly higher than that of the successful group, indicating a greater degree of emotional distress. The pattern of deviation from normal for both groups was diagnostic of a psychophysiological disorder marked by repression and somatization.
The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.
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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.