==================================HSR30================================== 30. Depression as a component of medical illness and/or post-operative surgical recovery (not general population numbers): - incidence - impact on recovery - effective treatment approaches. Incidence of suicide (and attempted suicide) among patients in general hospital settings. Indicators of suicidal risk; strategies for prevention of suicide. Medical/nursing liability in suicide. 1 UI - 87124814 AU - Farge D ; Turner MW ; Roy DR ; Jothy S TI - Dyazide-induced reversible acute renal failure associated with intracellular crystal deposition. AB - Acute interstitial nephritis due to Dyazide therapy, ie, a combination of hydrochlorothiazide (25 mg) and triamterene (50 mg), has been recently reported in the literature. This had been characterized by nonoliguric renal failure after a long latent period (weeks) following exposure to the drug. Pathologic data have indicated a drug-induced hypersensitivity reaction. We report here one case of oliguric acute renal failure after a massive Dyazide intoxication. Based on the results of the renal biopsy and clinical course, we propose that the oliguria was secondary to a direct toxic effect on the tubules, and intrarenal obstruction was secondary to triamterene crystals and crystal-laden cells. In addition, pathologic findings also suggested a moderate hypersensitivity reaction. After hemodialysis and short-term steroid therapy, the patient achieved complete recovery of renal function within 12 days. Recent knowledge of triamterene-induced nephrolithiasis helps to explain the pathogenesis of acute renal failure in this patient, and is briefly reviewed here. MH - Adult ; Biopsy ; Case Report ; Crystallization ; Drug Combinations/ POISONING ; Female ; Human ; Hydrochlorothiazide/*POISONING ; Kidney Failure, Acute/*CHEMICALLY INDUCED/PATHOLOGY ; Kidney/*PATHOLOGY ; Suicide, Attempted ; Triamterene/METABOLISM/*POISONING SO - Am J Kidney Dis 1986 Dec;8(6):445-9 2 UI - 87124119 AU - Curtis JL ; Millman EJ ; Joseph M ; Charles J ; Bajwa WK TI - Prevalence rates for alcoholism, associated depression and dementia on the Harlem Hospital Medicine and Surgery Services. AB - Current prevalence rates for alcoholism, and associated depression and dementia, were determined on random samples of approximately 200 patients admitted to the Medicine Service, and a similar sample to the Surgery Service, of the Harlem Hospital Center. The Medicine patients averaged 51 years of age, significantly older than the Surgery sample's average age of 44 years. Surgery patients also had a significantly greater proportion of patients (46.8 percent) who had achieved at least a high school education compared to Medicine (32.1 percent). The alcohol prevalence rate of 30.2 percent for Medicine was significantly greater than the 18.3 percent Surgery prevalence. Both Medicine and Surgery patients showed that a progressively serious pattern of drinking was associated with progressively serious depression. Progressive dementia was associated with progressive severity of drinking in the Medicine sample, but this finding was not demonstrated in the Surgery patients. Medicine and Surgery patients demonstrated dissimilar profiles of principal admitting diagnoses. Patient management is seriously handicapped by problems of alcoholism and associated problems of depression and dementia. MH - Adolescence ; Adult ; Age Factors ; Aged ; Alcoholism/COMPLICATIONS/ *OCCURRENCE ; Child ; Child, Preschool ; Dementia/*COMPLICATIONS ; Depressive Disorder/*COMPLICATIONS ; Female ; *Hospitals, General ; Human ; Infant ; Infant, Newborn ; Inpatients/PSYCHOLOGY ; Male ; Middle Age ; New York City ; Sex Factors ; Surgery, Operative/PSYCHOLOGY SO - Adv Alcohol Subst Abuse 1986 Fall;6(1):45-64 3 UI - 87107627 AU - Aoyama H ; Yoshida M ; Yamamura Y TI - Acute poisoning by intentional ingestion of thallous malonate. AB - A 26-year-old man who ingested 10 g of thallous malonate was treated by gastric lavage and combined haemodialysis and haemoperfusion. At a blood flow of 100 ml/min, the average of thallium clearance values obtained by combined haemoperfusion and haemodialysis at two different times were 50.2 and 60.4 ml/min. Forty hours after ingestion, he died of cardiac failure. A higher concentration of thallium was found in the heart than in other organs, suggesting that the heart is the main target of thallium in the early stage of acute poisoning. MH - Acute Disease ; Adult ; Case Report ; Heart/DRUG EFFECTS ; Hemodialysis ; Hemoperfusion ; Human ; Male ; *Suicide, Attempted ; Thallium/BLOOD/ *POISONING SO - Hum Toxicol 1986 Dec;5(6):389-92 4 UI - 87077377 AU - Fallowfield LJ ; Baum M ; Maguire GP TI - Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. AB - Psychiatric morbidity was assessed in 101 women treated for early breast cancer (T0,1,2,N0,1,M0). Patients had expressed no strong preference for treatment, so were randomised to either mastectomy or breast conservation. The incidence of anxiety states or depressive illness, or both, among women who underwent mastectomy was high (33%) and comparable with that found in other studies. Slightly more of the patients who underwent a lumpectomy followed by radiotherapy had affective disorders, 38% having an anxiety state, depressive illness, or both. These findings question the view that mutilating treatment is predominantly responsible for the measurable psychiatric morbidity reported previously. Counselling services should be provided for all women treated for breast cancer, not just those who undergo mastectomy. MH - Adult ; Affective Disorders/*ETIOLOGY ; Aged ; Anxiety Disorders/ETIOLOGY ; Breast Neoplasms/*PSYCHOLOGY/THERAPY ; Breast/*SURGERY ; Communication ; Depression/ETIOLOGY ; Female ; Human ; Mastectomy/ADVERSE EFFECTS/ *PSYCHOLOGY ; Middle Age ; Psychosexual Dysfunctions/ETIOLOGY ; Retrospective Studies ; Support, Non-U.S. Gov't SO - Br Med J [Clin Res] 1986 Nov 22;293(6558):1331-4 5 UI - 87069765 AU - Troelsen S ; Rybro L ; Knudsen F TI - Profound accidental hypothermia treated with peritoneal dialysis. AB - In five women and two men, profound accidental hypothermia--core temperature on admission 24-28 degrees C--was treated with peritoneal dialysis. In two cases 16 gauge intravenous catheters were used, without difficulty, for the dialysis. Six of the seven patients were intoxicated by hypnotics, and four also by alcohol. Two patients died--one 38 hours after admission due to acute myoglobinuric renal failure arising from gangrene of an arm, and the other after 71 hours, due to cerebral herniation. The remaining five patients recovered without cerebral sequelae. Peritoneal dialysis is a useful procedure for rewarming patients with profound accidental hypothermia. MH - Adolescence ; Adult ; Aged ; Arrhythmia/PREVENTION & CONTROL ; Case Report ; Female ; Heat/THERAPEUTIC USE ; Human ; Hypothermia/*THERAPY ; Male ; Middle Age ; *Peritoneal Dialysis/METHODS ; Suicide, Attempted SO - Scand J Urol Nephrol 1986;20(3):221-4 6 UI - 87055481 AU - Blythe BJ ; Erdahl JC TI - Using stress inoculation to prepare a patient for open-heart surgery. AB - Patients' emotional adjustment to illness may be a critical variable in their successful recovery. In a single-case study using stress inoculation to counter a patient's anxiety and depression before open-heart surgery, intervention was effective in reducing emotional distress. The value of applying stress inoculation in health care settings to combat stress related to illness is suggested. MH - Behavior Therapy/*METHODS ; Case Report ; Cognition ; Depressive Disorder/ THERAPY ; Female ; Heart Surgery/*PSYCHOLOGY ; Human ; Middle Age ; Relaxation Technics ; Stress, Psychological/*THERAPY SO - Health Soc Work 1986 Fall;11(4):265-74 7 UI - 87050668 AU - Hughson AV ; Cooper AF ; McArdle CS ; Smith DC TI - Psychological impact of adjuvant chemotherapy in the first two years after mastectomy. AB - Psychological symptoms were assessed over two years in a randomised trial of three forms of treatment given to women after mastectomy for stage II breast cancer. The treatments were: three weeks' radiotherapy; one year's adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; and radiotherapy followed by chemotherapy. Analysis of the results on an intention to treat basis showed no substantial differences in depression or anxiety among groups at one, three, or six months after the operation. At 13 months, however, patients who had been allocated chemotherapy had significantly more symptoms, especially depression, than control patients treated with radiotherapy alone. Conditioned reflex nausea and vomiting increased considerably during the second six months of chemotherapy and persisted for up to a year afterwards. The psychological morbidity of adjuvant chemotherapy could be substantially reduced if courses of treatment were restricted to about six months. MH - Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE ; Anxiety Disorders/ETIOLOGY ; Breast Neoplasms/DRUG THERAPY/*PSYCHOLOGY/ THERAPY ; Clinical Trials ; Combined Modality Therapy ; Comparative Study ; Depression/ETIOLOGY ; Female ; Human ; *Mastectomy ; Menopause ; Mental Disorders/*ETIOLOGY ; Patient Acceptance of Health Care ; Random Allocation ; Support, Non-U.S. Gov't ; Time Factors SO - Br Med J [Clin Res] 1986 Nov 15;293(6557):1268-71 8 UI - 87050446 AU - Alagaratnam TT ; Kung NY TI - Psychosocial effects of mastectomy: is it due to mastectomy or to the diagnosis of malignancy? AB - Twenty-three consecutive married and sexually active Chinese women treated for breast cancer were compared with a randomly selected group of 34 female patients suffering from different kinds of malignancies. A structured interview was used to study both groups. The breast cancer group were found to be less depressed and more emotionally stable than those suffering from other malignancies, suggesting that the diagnosis of malignancy was the more important factor in the psychosocial morbidity of these patients. MH - Adult ; Breast Neoplasms/COMPLICATIONS/*PSYCHOLOGY/SURGERY ; Depression/ ETIOLOGY ; Family ; Female ; Human ; Mastectomy/ADVERSE EFFECTS/ *PSYCHOLOGY ; Middle Age ; Role ; Stress, Psychological SO - Br J Psychiatry 1986 Sep;149:296-9 9 UI - 87046998 AU - Anthony T ; Jastremski M ; Elliott W ; Morris G ; Prasad H TI - Charcoal hemoperfusion for the treatment of a combined diltiazem and metoprolol overdose. AB - We describe the management of a 49-year-old woman who ingested 1,200 mg diltiazem and 500 mg metoprolol. The patient was bradycardic and hypertensive, requiring large doses of inotropic agents and temporary transvenous pacing. Charcoal hemoperfusion was used as an adjunct technique to hasten drug elimination; it rapidly lowered plasma drug levels, with a parallel improvement in the patient's clinical condition. MH - Alcohol, Ethyl ; Case Report ; *Charcoal/*THERAPEUTIC USE ; *Diltiazem ; Electrocardiography ; *Emergencies ; Epinephrine/THERAPEUTIC USE ; Female ; Hemodynamics/DRUG EFFECTS ; *Hemoperfusion ; Human ; *Metoprolol ; Middle Age ; *Substance Abuse ; Suicide, Attempted SO - Ann Emerg Med 1986 Nov;15(11):1344-8 10 UI - 86303839 AU - McCarty T ; Schneider-Braus K ; Goodwin J TI - Use of alternate therapist during pregnancy leave. AB - Women therapists involved in the long-term treatment of severely disturbed patients can be faced with interruptions due to childbearing. In the following cases, use of an alternate therapist during pregnancy-related leaves of absence was helpful in bridging the therapeutic pause and allowed the patients to make significant gains. MH - Abortion, Induced/PSYCHOLOGY ; Adult ; Borderline Personality Disorder/ THERAPY ; Case Report ; Depressive Disorder/THERAPY ; Female ; Human ; Multiple-Personality Disorder/THERAPY ; *Pregnancy ; *Professional-Patient Relations ; *Psychoanalytic Therapy ; Referral and Consultation ; Support, Non-U.S. Gov't ; Transference (Psychology) SO - J Am Acad Psychoanal 1986 Jul;14(3):377-83 11 UI - 86303254 AU - Devins GM ; Binik YM ; Mandin H ; Burgess ED ; Taub K ; Letourneau PK ; Buckle S ; Low GL TI - Denial as a defense against depression in end-stage renal disease: an empirical test. AB - End-stage renal disease (ESRD) is recognized as imposing severe psychosocial stresses upon patients with the result that depression is believed to be highly prevalent. A number of studies have reported low levels of depression, however, and this contradictory finding has been explained via the construct of defensive denial-i.e., patients may minimize the impact of illness-related experiences upon their overall experiences of life. The present study tested this hypothesis in a sample of seventy ESRD patients. Participants rated a series of twelve life dimensions (e.g., work, family and martial relations, recreation) in terms of perceived intrusiveness and control as well as indicating their perceived similarity using a card sort task. Standard measures of depression, positive and negative moods, somatic symptoms of distress, self-esteem, and life happiness were also obtained via structured interviews. A multidimensional scaling analysis applied to the card sort data indicated that ESRD patients do, indeed, perceive illness-related and nonillness aspects of life as independent. However, an analysis of partial variance-controlling for age and nonrenal health-failed to provide evidence of defensive denial. The suggestion is forwarded that previous findings of a high prevalence of depression in ESRD may be in error due to the misidentification of uremic symptoms as symptoms of depression. MH - *Denial (Psychology) ; Depression/*COMPLICATIONS ; Hemodialysis/ PSYCHOLOGY ; Human ; Kidney/TRANSPLANTATION ; Kidney Failure, Chronic/ COMPLICATIONS/*PSYCHOLOGY ; Support, Non-U.S. Gov't SO - Int J Psychiatry Med 1986-87;16(2):151-62 12 UI - 86271505 AU - Israel M TI - Depression in dialysis patients: a review of psychological factors. AB - A review of the literature reveals that the incidence and prevalence of depression among dialysis patients is unknown but that estimates may vary from 20 to 50 percent. Diagnostic and methodological problems related to the population are examined and the notion that depression in this population may represent a qualitatively different entity, is evaluated. Finally, several theoretical models of depression are described and their particular relevance to depression among dialysis patients is discussed. MH - Adaptation, Psychological ; Behaviorism ; Conflict (Psychology) ; Depression/ETIOLOGY/*OCCURRENCE ; Depressive Disorder/DIAGNOSIS/ETIOLOGY/ *OCCURRENCE ; Electroencephalography ; Hemodialysis/*PSYCHOLOGY ; Human ; Internal-External Control ; Models, Psychological ; MMPI ; Personality Inventory ; Professional-Patient Relations ; Review ; Sleep, REM/ PHYSIOLOGY ; Suicide/OCCURRENCE SO - Can J Psychiatry 1986 Jun;31(5):445-51 13 UI - 86264713 AU - Levine S TI - The management of resistant depression. AB - Between 10 and 30% of depressed patients, mostly bipolar, develop a therapy-resistant illness. The known causes of such chronic evolutions are discussed: misdiagnosis (underlying schizophrenia, personality disorder or dementia), drug-induced depression (neuroleptics), systemic disease (hypothyroidism, multiple sclerosis, cardiovascular or neoplastic disease etc.), or lack of efficacy (drug compliance, insufficient dosage). Remedies are suggested: adequate dosage, drug combination (Newcastle cocktail. tricyclic antidepressant + MAOI, imipramine + T3), carbamazepine in lithium-resistant cases, alprazolam, reduction in vanadium intake, sleep deprivation, psychosurgery. MH - Antidepressive Agents, Tricyclic/THERAPEUTIC USE ; Bipolar Disorder/ *THERAPY ; Depressive Disorder/DIAGNOSIS/*THERAPY ; Diagnostic Errors ; Electroconvulsive Therapy ; Female ; Human ; Lithium/THERAPEUTIC USE ; Male ; Monoamine Oxidase Inhibitors/THERAPEUTIC USE ; Psychosurgery ; Sleep Deprivation ; Triiodothyronine/THERAPEUTIC USE SO - Acta Psychiatr Belg 1986 Mar-Apr;86(2):141-51 14 UI - 86251332 AU - Gottlieb SE ; Barrett DE TI - Effects of unanticipated cesarean section on mothers, infants, and their interaction in the first month of life. AB - The impact of an unanticipated primary cesarean section on the mother, on the infant, and on their interaction was studied during the perinatal period and at 1 month following delivery. Thirty-four mother-infant pairs participated in the study. Fourteen subjects delivered by nonelective, nonemergency cesarean section. Twenty mothers, who delivered vaginally, served as the controls. All subjects had attended a series of prepared childbirth classes. Maternal questionnaire and infant observational data were collected on day 2 and on day 30. Mother-infant interactions in teaching and play sessions were assessed on day 30. The cesarean group was found to have a higher number of obstetrical complications, an increased incidence of maternal depression, and a more difficult convalescence. Previous experience with children emerged as an important mediating variable in the analysis of maternal affective status. No infant behavioral differences were detected as a function of mode of delivery. The discussion highlights the interventions that can be utilized to minimize the negative emotional consequences for women who deliver by cesarean section. MH - Adult ; Cesarean Section/*PSYCHOLOGY ; Child Development ; Depression/ OCCURRENCE ; Female ; Follow-Up Studies ; Human ; Infant, Newborn/ *PSYCHOLOGY ; *Mother-Child Relations ; Mothers/*PSYCHOLOGY ; Play and Playthings ; Pregnancy ; Puerperal Disorders/OCCURRENCE ; Pursuit, Smooth SO - J Dev Behav Pediatr 1986 Jun;7(3):180-5 15 UI - 86218482 AU - Wright N ; Gupta RN TI - The role of the laboratory in acute poisoning: case histories. AB - We describe case histories and management of four patients poisoned with different compounds. The role of the laboratory, particularly of toxicological analysis, in the management of poisoned patients is examined. MH - Acetaminophen/BLOOD/POISONING ; Acute Disease ; Adolescence ; Adult ; Amitriptyline/BLOOD/POISONING ; Case Report ; Ethylene Glycols/BLOOD/ POISONING ; Female ; Hemodialysis ; Hemoperfusion ; Human ; Male ; Phenytoin/BLOOD/POISONING/URINE ; Poisoning/*BLOOD/THERAPY ; Suicide, Attempted SO - Clin Biochem 1986 Apr;19(2):127-31 16 UI - 86231354 AU - Nagib MG ; Rockswold GL ; Sherman RS ; Lagaard MW TI - Civilian gunshot wounds to the brain: prognosis and management. AB - The extent of treatment for the victims of gunshot wounds to the brain remains quite controversial, particularly when these patients present with extensive neurological dysfunction. We propose guidelines regarding the degree and aggressiveness of therapy. The factors that seem to have a significant impact on the patient's final outcome are the neurological examination at the time of admission, the radiological findings, and the motivation for the shooting. Thus, the authors propose a nonsurgical line of therapy for comatose patients with unilateral or bilateral cerebral gunshot wounds where bone or metal fragments are visualized away from the bullet path on computed tomography scan, particularly when these individuals are suicide victims. MH - Adolescence ; Adult ; Aged ; Brain Injuries/PHYSIOPATHOLOGY/*SURGERY ; Cerebral Hemorrhage ; Child ; Child, Preschool ; Coma/PHYSIOPATHOLOGY ; Female ; Human ; Intracranial Pressure ; Male ; Middle Age ; Postoperative Complications ; Prognosis ; Suicide ; Tomography, X-Ray Computed ; Wounds, Gunshot/MORTALITY/PHYSIOPATHOLOGY/*SURGERY SO - Neurosurgery 1986 May;18(5):533-7 17 UI - 86227470 AU - Postlethwaite R ; Stirling G ; Peck CL TI - Stress inoculation for acute pain: a clinical trial. AB - The study attempted a clinical evaluation of the efficacy of stress inoculation training for postoperative pain control using patients undergoing coronary artery graft surgery. A treatment group receiving stress inoculation training was compared to attention-education and no-treatment control groups. No differences were found between the groups on two pain rating measures, analgesic intake, or measures of state anxiety and depression. The ineffectiveness of stress inoculation in this study may be due to the difference between experimental and clinical pain, the multiple demands of the preoperative period, possible memory difficulties which some patients may have experienced, or the possibility that the procedure is not sufficiently potent for the intensity of this type of pain. MH - Acute Disease ; Analgesics/THERAPEUTIC USE ; Anxiety/THERAPY ; Aortocoronary Bypass/*PSYCHOLOGY ; Coronary Disease/SURGERY ; Depression/ THERAPY ; Human ; Male ; Middle Age ; Pain/*THERAPY ; Postoperative Complications/THERAPY ; *Relaxation Technics ; Stress/*THERAPY SO - J Behav Med 1986 Apr;9(2):219-27 18 UI - 86206636 AU - Burton HJ ; Kline SA ; Lindsay RM ; Heidenheim AP TI - The relationship of depression to survival in chronic renal failure. AB - The authors examine the relationship between psychosocial factors and factors and survival of patients with chronic renal failure, while considering simultaneously the influence of parameters of physiologic functioning. Psychosocial and physiologic variables selected for discriminant analysis were extracted from data on 285 home-dialysis patients in Ontario, Canada. This analytical procedure defined which variables best discriminated between the survivor and nonsurvivor groups. The findings suggest that demographic and psychosocial factors may be more important than physiologic variables in determination of survival on home dialysis. The severity and type of depression is of particular importance to outcome. MH - Adjustment Disorders/*PSYCHOLOGY ; Hemodialysis, Home/PSYCHOLOGY ; Human ; Kidney Failure, Chronic/MORTALITY/*PSYCHOLOGY ; Ontario ; Patient Compliance ; Prognosis ; Suicide/PSYCHOLOGY SO - Psychosom Med 1986 Mar-Apr;48(3-4):261-9 19 UI - 86200292 AU - K:oppel C ; Baudisch H ; Beyer KH ; Kl:oppel I ; Schneider V TI - Fatal poisoning with selenium dioxide. AB - Two hours after suicidal ingestion of an unknown amount of selenium dioxide, a 17-year-old male was admitted to hospital with asystolia and apnea. Attempts at resuscitation failed and the patient was pronounced dead. Findings at autopsy included congestion of lungs and kidneys, diffuse swelling of the heart, and brain edema. The most impressive finding was an orange-brown discoloration of the skin and all viscera, probably due to hemolysis and/or pigmentation related to ingestion of selenium dioxide. Selenium blood and tissue levels were increased by a factor of 100-1000 as compared to normal. The highest concentrations were found in pancreas, spleen, liver, and adipose tissue. For elucidation of the chemical nature of selenium in tissues, a new analytical method which was based on carbon disulfide extraction was developed. Carbon disulfide is a good solvent for non-polar selenium compounds like elemental selenium and selenium disulfide, but not for polar compounds like selenite and selenoproteins. A major fraction of selenium in tissues was extractable by carbon disulfide, which seems to indicate the presence of elemental selenium and/or selenium disulfide. The color of these substances is red and orange, respectively. This might explain at least part of the discoloration of skin and tissues. In vitro experiments suggested that trace amounts of hydrogen selenide, which is an intermediate of selenite metabolism, probably induced hemolysis. For evaluation of the therapeutic value of hemoperfusion in selenium poisoning in vitro hemoperfusion experiments were performed, which revealed only a moderate effect on selenium blood levels. MH - Adolescence ; Case Report ; Child, Preschool ; Female ; Hemolysis ; Hemoperfusion ; Human ; Male ; Selenium/ANALYSIS/BLOOD/*POISONING ; Spectrophotometry, Atomic Absorption ; Suicide ; Tissue Distribution SO - J Toxicol Clin Toxicol 1986;24(1):21-35 20 UI - 86184254 AU - Bauer MS ; Whybrow PC TI - The effect of changing thyroid function on cyclic affective illness in a human subject. AB - Thyroid function abnormalities are common in persons with rapid-cycling bipolar affective illness. Some women who cycle rapidly respond to thyroxine, but there is scant evidence that the people who have thyroid abnormalities are the ones who respond to thyroid treatment. The authors report successful thyroxine treatment of a man whose rapid cycling began and resolved after changes in his thyroid status. The period of his affective cycle was altered by both lithium and thyroxine. The authors suggest that CNS thyroid status may determine the clinical course of some persons with a fixed cycle of affective episodes. MH - Adult ; Bipolar Disorder/DRUG THERAPY/PHYSIOPATHOLOGY/*PSYCHOLOGY ; Case Report ; Human ; Hypothyroidism/DIAGNOSIS/*DRUG THERAPY/PHYSIOPATHOLOGY ; Lithium/THERAPEUTIC USE ; Male ; Periodicity ; Support, Non-U.S. Gov't ; Thyroid Function Tests ; Thyroid Gland/PHYSIOPATHOLOGY ; Thyroidectomy ; Thyroxine/*THERAPEUTIC USE SO - Am J Psychiatry 1986 May;143(5):633-6 21 UI - 86173723 AU - Smith PL ; Treasure T ; Newman SP ; Joseph P ; Ell PJ ; Schneidau A ; Harrison MJ TI - Cerebral consequences of cardiopulmonary bypass. AB - 55 patients undergoing coronary-artery bypass surgery (CABS) and a comparison group of 20 patients having thoracic or major vascular surgery were investigated preoperatively and 8 days and 8 weeks postoperatively for changes in neuropsychological status, psychiatric state, cerebral blood flow, and neurological signs, this last being assessed also at 24 h. Major persisting neurological changes were rare, but minor abnormalities were significantly more common after CABS than after thoracic or vascular surgery. Neuropsychological deficits were common at 8 days in both CABS and comparison groups, and in about a third of all patients persisted at 8 weeks. Cerebral blood flow was reduced at 8 days in some CABS patients, but this was not significant for the group. Pre-existing cerebrovascular disease was not predictive, but low perfusion pressure and long bypass time were associated with postoperative deficits. MH - Adult ; Aged ; Anxiety/ETIOLOGY ; Brain Diseases/*ETIOLOGY ; Cardiopulmonary Bypass/*ADVERSE EFFECTS ; Cerebrovascular Circulation ; Depressive Disorder/ETIOLOGY ; Female ; Human ; Male ; Middle Age ; Neurologic Examination ; *Postoperative Complications ; Prospective Studies ; Support, Non-U.S. Gov't ; Time Factors SO - Lancet 1986 Apr 12;1(8485):823-5 22 UI - 86161308 AU - Patterson C TI - Iatrogenic disease in late life. AB - Iatrogenic diseases are common in the elderly, particularly in the hospitalized patient. Adverse outcomes may be induced by poor communication with patients, inadequate history and examination, and inappropriate use of diagnostic resources. However, even when resources are used appropriately, adverse outcomes do occur, hence the price paid for sophisticated medical and surgical techniques. Medications offer a great potential for adverse reactions, and careful prescribing and knowledge of the pharmacokinetic changes that occur with aging, particularly impaired renal excretion of drugs, together with the use of the minimum number of drugs and maneuvers to improve compliance, can reduce this risk. Complications of surgery should be anticipated and promptly recognized and managed. MH - Aged ; Confusion/CHEMICALLY INDUCED ; Delirium/ETIOLOGY ; Depression/ ETIOLOGY ; Diagnostic Tests, Routine ; Diet Therapy/ADVERSE EFFECTS ; Drug Interactions ; Drug Therapy/ADVERSE EFFECTS ; Hospitalization ; Human ; Hypotension, Orthostatic/CHEMICALLY INDUCED ; *Iatrogenic Disease/ PREVENTION & CONTROL ; Kidney Diseases/CHEMICALLY INDUCED ; Parasympatholytics/ADVERSE EFFECTS ; Postoperative Complications/ETIOLOGY ; Review ; Seizures/CHEMICALLY INDUCED ; Support, Non-U.S. Gov't ; Thrombosis/ETIOLOGY SO - Clin Geriatr Med 1986 Feb;2(1):121-36 23 UI - 86151880 AU - Folks DG ; Franceschini J ; Sokol RS ; Freeman AM 3d ; Folks DM TI - Coronary artery bypass surgery in older patients: psychiatric morbidity. AB - Coronary artery bypass grafting in older patients usually results in a favorable surgical outcome. To assess whether age confers greater risk for postoperative psychiatric symptoms in these patients, we retrospectively examined 58 cases (mean age 62.5 years) comparing pertinent clinical features of the index patients to matched controls (mean age 51.7 years). Analysis of the data, including scores on preoperative and postoperative scales measuring anxiety, depression, and cognitive function, showed a statistically significant difference in the cognitive performance of the elderly as shown by lower scores on the Mini Mental State examination (chi-square, P less than .025). Our findings support future efforts to address the clinical relevance of cognitive dysfunction in older coronary bypass patients. MH - Age Factors ; Aged ; Anxiety/ETIOLOGY ; *Aortocoronary Bypass/PSYCHOLOGY ; Chronic Disease ; Cognition Disorders/*ETIOLOGY ; Depression/ETIOLOGY ; Human ; Middle Age ; Occupations ; *Postoperative Complications ; Retrospective Studies ; Support, Non-U.S. Gov't SO - South Med J 1986 Mar;79(3):303-6 24 UI - 86140918 AU - Freeman AM 3d ; Fleece L ; Folks DG ; Sokol RS ; Hall KR ; Pacifico AD ; McGiffin DC ; Kirklin JK ; Zorn GL ; Karp RB TI - Alprazolam treatment of postcoronary bypass anxiety and depression. AB - The effectiveness of alprazolam in treating symptoms of anxiety and depression in 60 patients undergoing coronary bypass surgery was assessed in a double-blind, placebo-controlled study. The results indicate that alprazolam treatment for anxiety following coronary bypass surgery, particularly symptoms occurring in the immediate postoperative period, can significantly affect patient outcome. Specifically, only modest but statistically significant improvement was observed in the alprazolam-treated groups at 1-month follow-up; however, alprazolam-treated patients were significantly more likely to experience a very rapid anxiolytic effect by postoperative day 8. The implications of this study are discussed with respect to patient management and models for future studies of anxiety in postoperative patient populations. MH - Adult ; Aged ; Antidepressive Agents/*THERAPEUTIC USE ; Anxiety/*DRUG THERAPY/ETIOLOGY ; Aortocoronary Bypass ; Benzodiazepine Tranquilizers/ *THERAPEUTIC USE ; Benzodiazepines/*THERAPEUTIC USE ; Clinical Trials ; Depression/*DRUG THERAPY/ETIOLOGY ; Double-Blind Method ; Female ; Human ; Male ; Middle Age ; *Postoperative Complications ; Psychiatric Status Rating Scales ; Random Allocation ; Support, Non-U.S. Gov't ; Time Factors SO - J Clin Psychopharmacol 1986 Feb;6(1):39-41 25 UI - 86121497 AU - Carney RM ; Wetzel RD ; Hagberg J ; Goldberg AP TI - The relationship between depression and aerobic capacity in hemodialysis patients. AB - Depression and a reduction in the performance of pleasant activities have been reported in patients with end-stage renal disease receiving hemodialysis therapy. The purpose of this study was to examine the relationship between depression and the patients' capacity to engage in physical activity. The patients' VO2max, or maximal oxygen consumption, was found to be positively associated with three standardized self-report measures of depression in a sample of 15 patients receiving hemodialysis. The clinical and theoretical implications of this finding are considered. MH - Adult ; Aged ; Depression/*PHYSIOPATHOLOGY/PSYCHOLOGY ; Exertion ; Female ; Hemodialysis/*PSYCHOLOGY ; Human ; Male ; Middle Age ; Oxygen/ PHYSIOLOGY ; *Physical Fitness ; Support, U.S. Gov't, P.H.S. SO - Psychosom Med 1986 Jan-Feb;48(1-2):143-7 26 UI - 86114961 AU - Hickey AJ TI - Maxillofacial prosthetic rehabilitation following self-inflicted gunshot wounds to the head and neck. AB - Management of gunshot wounds to the head and neck is a challenge for the maxillofacial prosthodontist. Care of these patients can be divided into early, intermediate, and definitive phases. Psychologic management is often the most important aspect of treatment in ultimately resolving patient needs. MH - Dental Prosthesis ; Human ; Maxillofacial Injuries/REHABILITATION/ *THERAPY ; *Maxillofacial Prosthesis ; Neck/*INJURIES ; Patient Care Planning ; Splints ; Suicide, Attempted ; Wounds, Gunshot/*THERAPY SO - J Prosthet Dent 1986 Jan;55(1):78-82 27 UI - 86111657 AU - Koo JY ; Chien CP TI - Coma following ECT and intravenous droperidol: case report. AB - A 60-year-old man with psychotic depression became comatose following the administration of intravenous droperidol given for post-ECT delirious agitation. The differential diagnosis, which included neuroleptic malignant syndrome and the possibility that droperidol may have uniquely detrimental effects in the context of post-ECT delirium, are discussed. In light of recent publications advocating droperidol as the pharmacologic treatment of choice for severe agitation, this case illustrates a need for greater caution in its use for the treatment of post-ECT delirium. MH - Case Report ; Coma/*CHEMICALLY INDUCED ; Delirium/*DRUG THERAPY/ETIOLOGY ; Depressive Disorder/THERAPY ; Droperidol/*ADVERSE EFFECTS ; *Electroconvulsive Therapy/ADVERSE EFFECTS ; Human ; Male ; Malignant Hyperthermia/DIAGNOSIS ; Middle Age ; Neuroleptic Malignant Syndrome/ DIAGNOSIS ; Psychomotor Agitation/DRUG THERAPY/ETIOLOGY SO - J Clin Psychiatry 1986 Feb;47(2):94-5 28 UI - 86109483 AU - Trappler B ; Viswanathan R ; Sher J TI - Alzheimer's disease in a patient on long-term hemodialysis: a case report. AB - This case report describes a progressive dementia in a 49-year-old black male on long-term hemodialysis. The initial presentation simulated depression. The dementia persisted after an unsuccessful cadaver homograft transplant. The character of the dementia was nonspecific but typical features of dialysis dementia were lacking. Autopsy revealed a ruptured cerebral aneurysm, polycystic kidneys, moderately severe atherosclerosis, miliary tuberculosis, and neurofibrillary degeneration of the hippocampus. The significance of a possible relationship between end-stage renal disease (ESRD), hemodialysis, and Alzheimer's disease in this case is discussed. MH - Alzheimer's Disease/*COMPLICATIONS/DIAGNOSIS ; Case Report ; Cerebral Aneurysm/COMPLICATIONS ; Depressive Disorder/*DIAGNOSIS ; Diagnostic Errors ; *Hemodialysis/PSYCHOLOGY ; Human ; Kidney Failure, Chronic/ *COMPLICATIONS/PSYCHOLOGY ; Male ; Middle Age ; Subarachnoid Hemorrhage/ COMPLICATIONS ; Support, Non-U.S. Gov't SO - Gen Hosp Psychiatry 1986 Jan;8(1):57-60 29 UI - 86105062 AU - Mai FM ; McKenzie FN ; Kostuk WJ TI - Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. AB - The contribution of a liaison psychiatrist to a cardiac transplant programme is described. Ninety one patients were referred to the transplant unit for assessment over four years, and of these, 86 were assessed by the psychiatrist. A high prevalence of preoperative anxiety and depression was found. Thirty four transplants were performed on 33 patients during the study and 22 patients survived. Six patients developed transient delirious episodes during the first 10 postoperative days, three showed symptoms of considerable anxiety, and three developed social and behavioural problems during the convalescent period. Subjects with higher scores on the somatic scale of the general health questionnaire showed increased postoperative mortality. In conclusion, the liaison psychiatrist is useful in evaluating and managing heart transplant patients before and after operation. MH - Anxiety Disorders/*ETIOLOGY ; Coronary Disease/COMPLICATIONS/*PSYCHOLOGY ; Depressive Disorder/*ETIOLOGY ; Female ; Heart/*TRANSPLANTATION ; Human ; Male ; Postoperative Care ; Preoperative Care SO - Br Med J [Clin Res] 1986 Feb 1;292(6516):311-3