==================================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