Emotional aspects of cataract surgery.

A retrospective study of fourteen elderly patients, all of whom had undergone cataract extractions with lens implantation was undertaken. Issues pertaining to pre-, post-, and intraoperative anxiety were investigated as were questions about changes in mood, energy level, activity, and severity of non-ophthalmologic medical conditions. Also, an investigation was made into the accuracy of the patient's perception of the technical aspects of the procedure and the extent to which they found technical information on the procedure either desirable or anxiety provoking. Little effect was found in terms of changes in mood, general perceptions of health, or activity. Issues somewhat peripheral to the actual surgical procedure were found to be the most anxiety provoking while confidence in the surgeon and reassurance from friends who have had the procedure were found to be the most anxiety relieving. The well-educated patients seemed to lack any technical knowledge of the procedure itself and in many cases found this information to be anxiety provoking.

Depression and diethylstilbestrol exposure in women.

Fifty women exposed to diethylstilbestrol (DES) in utero, 50 of their unexposed sisters (sister controls) and 43 women with abnormal Papanicolaou smears (population controls) were tested using the Diagnostic Interview Schedule to assess differences in depression and other kinds of psychologic impairment possibly associated with DES exposure. There were significant differences between DES-exposed women and their sisters in major depression and major recurrent depression. Papanicolaou controls were more depressed in comparison to sister controls. However, there were no significant differences in depression between Papanicolaou controls and the DES exposed, suggesting that major and recurrent depressions are more likely to result from concern about reproductive and other gynecologic problems than from the hormonal effects of intrauterine exposure to DES. Differences in amphetamine abuse/dependence were also noted between the DES exposed and the sister controls.

Medically induced drug addiction.

Iatrogenic, or medically induced, drug addiction is a problem affecting both patients and physicians. We describe the function of a new center devoted solely to managing iatrogenic addiction. The center accepts patients on physician referral only. The addiction usually arises as a complication of a medical disorder that is accompanied by pain and requires comprehensive and multidisciplinary evaluation and treatment. Detoxification from the offending medication, provision of chronic analgesia, and maintenance are managed with methadone. All appropriate modalities of treatment including psychotherapy, physical therapy, and relaxation techniques are employed.

Insomnia and the physiology of sleep.

Sleep is a vital human physiologic process. Insomnia can be caused by obsession and depression states, pain, or worry over everyday problems. Because of their pharmacologic action, alcohol and high doses of soporifics used as remedies may produce REM-deficit sleep and actually prolong insomnia. If the true cause of sleeplessness is not recognized and properly treated, insomnia may develop into a severe sleep problem. Since benzodiazepines and chloral hydrate do not suppress REM sleep, they are the medications of choice in the therapy for insomnia.