An annotated bibliography for ethics training in consultation-liaison psychiatry.

The expanding field of bioethics has created a need in psychiatry for rapid access to the complex bioethics literature. This is especially true in consultation-liaison work. An annotated bibliography was created by a task force of the Academy of Psychosomatic Medicine charged with exploring how psychiatrists function on bioethics committees. The bibliography is organized into headings that reflect how bioethical problems came to the attention of psychiatrists. Introductory references allow the reader an overview of the history of bioethics and a selection of useful textbooks. References are provided explaining how ethical principles are used. References are also organized by areas of medical work frequently visited by consultation-liaison psychiatrists.

Screening for somatizing patients in the pulmonary subspecialty clinic.

Somatizing patients present a history of vague, unexplained medical symptoms. This study compared somatizing patients with pulmonary control subjects by using the Diagnostic Interview Schedule (DIS-III-R), the Illness Attitude Scales (IAS), and the Minnesota Multiphasic Personality Inventory (MMPI-2). The groups differed in the number of somatization symptoms reported and in the frequency of somatization disorder diagnoses when the screening criteria were used. The somatizing group obtained higher scores on the bodily preoccupation and hypochondriacal beliefs subscales of the IAS; no differences were found on the MMPI-2. These findings indicate that the DSM-III-R somatization screening items can be useful for detecting somatization when patients present with unexplained respiratory complaints.

Health care utilization of somatizing patients in a pulmonary subspecialty clinic.

Somatizing patients present with medically unexplained physical complaints, repeat clinic visits, and a history of prior extensive testing. The authors reviewed 1,908 pulmonary consultation reports for 1990-1991 for evidence of somatization, yielding a group of 41 (2%) patients for study. Billing records were obtained and were compared to asthmatic patients and those in a health maintenance organization (HMO). Health care costs for the somatizing patients were significantly higher than the average cost for HMO patients and comparable to the health costs for patients with asthma. Half of the somatizing patients had psychological problems indicated in their medical records, but few received psychiatric referral or treatment. Management of the somatizing patient within the specialty clinic and on-site psychiatric treatment are suggested as ways to decrease unnecessary health care utilization.

Psychological factors relevant to the prehospital and in-hospital phases of acute myocardial infarction.

Recognition and treatment of psychological factors relevant to the acute prehospital and in-hospital phases of myocardial infarction (MI) are reviewed. Various emotions and personality characteristics can be both risk factors for and consequences of acute MI. Components of the Type A behavior pattern and levels of somatic and emotional awareness have been linked with excessive treatment-seeking delay for MI patients. Psychiatric conditions such as panic disorder may mimic symptomatic presentation of MI and therefore have implications for differential diagnosis in the emergency room. Additionally, anxiety, depression, and neurobehavioral disorders such as delirium are relatively common during the hospitalization period and may contribute to potentially lethal complications of MI. Because psychological factors are associated with prognosis during each phase of MI, the identification and treatment of such factors are crucial in providing comprehensive care for MI patients.

Memory performance of chemical workers exposed to polybrominated biphenyls.

Twenty-five chemical workers who manufactured polybrominated biphenyls (PBB's) were given objective tests of learning and memory. Although this group had high concentrations of PBB's in adipose tissue, mean scores on all memory tests were normal. The PBB concentration was not correlated with memory performance; the most contaminated workers showed no evidence of memory dysfunction.

Detection of metastatic thyroid carcinoma after the administration of a therapeutic dose of 131-iodine.

A patient with thyroid cancer is described whose metastases were detected only after the administration of a large therapeutic dose of 131 Iodine. This suggests that very high doses of 131 Iodine might permit diagnoses of metastatic lesions not otherwise detected. This phenomenon may be explained by the improved counting statistics which occur with the use of a higher dose of the isotope. In such cases, exceedingly high doses of 131 Iodine might be necessary for successful tumor ablation.

Effect of unilateral pulmonary hypovascularity on the bone scan: case report.

Two patients who had decreased pulmonary artery blood flow to the right lung showed increased clarity of rib detail on a bone scan over the affected hemithorax as contrasted with the uninvolved side. Decreased blood background is postulated to result in enhancement of rib detail on the affected side.