ABSTRACT
As Consultation-Liaison Services continue to develop and expand in general hospitals, psychiatrists must be aware of pitfalls and pratfalls inherent in dealing with medical colleagues and other allied health professionals, as well as with the patients. Practical considerations in answering consultation requests are discussed with respect to "hidden agendas" of the consultee, role and expectations of the psychiatrist, and problem referrals. It is only through mutual respect and collaboration that Consultation-Liaison Services can truly be effective.
Subject(s)
Psychophysiologic Disorders/therapy , Referral and Consultation , Sick Role , Adaptation, Psychological , Hospitals, General , Humans , Mental Disorders/psychology , Physician-Patient Relations , PsychotherapyABSTRACT
A 55 year old man developed an acute confusional state with grossly impaired short-term memory accompanied by a Status Petit Mal epilepsy pattern on EEG, one to two weeks after abruptly discontinuing a large amount of oxazepam and a smaller amount of alcohol. Both his mental status and EEG pattern normalized markedly after intravenous diazepam. On 5 year follow-up the patient was seizure-free and medication-free without any significant residual cognitive deficit.
Subject(s)
Cognition Disorders/chemically induced , Confusion/chemically induced , Oxazepam/adverse effects , Status Epilepticus/chemically induced , Substance Withdrawal Syndrome , Acute Disease , Diazepam/administration & dosage , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Substance Withdrawal Syndrome/drug therapy , Time FactorsABSTRACT
The authors report three cases of depression associated with ranitidine. These illustrate that ranitidine, like cimetidine, may produce an organic affective disorder. The authors discuss clinical implications for the treatment of depression in patients with peptic ulcer disease.
Subject(s)
Depressive Disorder/chemically induced , Ranitidine/adverse effects , Adult , Aged , Female , Humans , Male , Peptic Ulcer/drug therapy , Peptic Ulcer/prevention & control , Ranitidine/therapeutic use , Substance-Related Disorders/etiologyABSTRACT
Amoxapine, a member of the dibenzoxazepine drugs which includes loxapine, has recently been introduced for the treatment of depression. We present five cases of amoxapine failure after an initial good response, which showed severe deterioration with an increase in dosage. The dopamine-blocking effects of amoxapine metabolites are discussed. The mechanism of failure may be related to either the appearance of akinetic depression or a strong neuroleptic effect.
Subject(s)
Amoxapine/therapeutic use , Antipsychotic Agents , Depressive Disorder/drug therapy , Dibenzoxazepines/therapeutic use , Adult , Aged , Amoxapine/pharmacology , Bipolar Disorder/drug therapy , Female , Humans , Male , Middle AgedSubject(s)
Biofeedback, Psychology , Headache/therapy , Adult , Biofeedback, Psychology/physiology , Female , Headache/physiopathology , Humans , Male , Retrospective StudiesABSTRACT
Over the past three years we have seen twelve patients who have become depressed while taking cimetidine. Clinically the depression is similar to that seen in a Primary Affective Disorder. Two representative cases are presented. It is suggested that cimetidine has precipitated a depressive reaction is vulnerable patients. Tricyclic antidepressants are effective in relieving the depression. It is postulated that cimetidine, by blocking H2 receptors in the CNS, produces an imbalance between H1 and H2. This imbalance may be an etiological factor in precipitating the depression. Tricyclic antidepressants have little effect on H2 but are potent H1 receptor blockers. This H1 blockade could restore the balance between H1 and H2, thereby relieving the depression.
Subject(s)
Cimetidine/adverse effects , Depressive Disorder/chemically induced , Guanidines/adverse effects , Adult , Aged , Cimetidine/therapeutic use , Esophagitis, Peptic/drug therapy , Female , Humans , Male , Peptic Ulcer/drug therapyABSTRACT
This paper will discuss some of the effects that psychological factors have on chest pain during and following myocardial infarction: 1. Psychological factors and the development of a myocardial infarction; a) the relationships of personality and other high risk factors, b) the onset situation of hopelessness and helplessness, c) immediate psychological precipitants (fact and fantasy), d)denial and delay. 2. Psychological factors during recovery; a)problems associated with the Type A personality, b) critical periods, c)absence of angina and denial, d) the effect of post M.I. angina, e) co-existence of angina and psychogenic pain. 3. How reaction of the marital partner can affect the patient and his experience of pain. 4. Factors which tend to minimize psychogenic invalidism.
Subject(s)
Myocardial Infarction/psychology , Pain/psychology , Adult , Attitude to Health , Female , Humans , Male , Marriage , Middle Aged , Myocardial Infarction/complications , Pain/etiologyABSTRACT
The authors review the literature on Munchausen's syndrome and speculate about possible underlying psychological mechanisms. The proposed DSM III classification of factitious illnesses suggests a continuum from hysteria on one end of the spectrum to malingering on the other. Two case studies are presented which represent variants of this syndrome. Both patients were given a sodium amytal interview, a procedure not previously reported in the Munchausen's literature. The procedure was helpful in eliciting a more accurate history and a clearer sense of the underlying dynamics. Some suggestions for further research are made.
