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Biomedical subjects

A J Krakowski

Publications and source records attributed to A J Krakowski.

At least 19 recordsLinked to original sources
PubMed1987

Panic disorder associated with mitral valve prolapse: psychosomatic implications.

Findings of the second part of the clinical study initiated in 1982 are presented. Both aimed to determine possible clinical differences among panic disorder, agoraphobia with panic attacks and mitral valve prolapse syndrome (MVPS). Such clinical psychiatric differences could be useful because MVPS poses potentially dangerous consequences in patients with a high rate of serious cardiac and neurological complications. The first part of the study included 35 patients, 20 of whom were confirmed MVPS. This group appeared distinguishable by the increased frequency of fear of doing something uncontrolled and, even more so, by the anger-rage symptoms manifested during the attacks. In the present study of 100 patients, 36 of whom were documented MVPS, fear of doing something uncontrolled was not greater, although attacks of anger and rage were again higher than in the other two groups and exceeded 5% standard deviation. In all other psychological dimensions, the three groups did not differ from one another. This paper considers possible causes and consequences of symptoms seen in the MVPS.

Adult↗
PubMed1984

Stress and the practice of medicine. III. Physicians compared with lawyers.

Stresses of medical practice, recognized as severe, do not increase physical morbidity and mortality of physicians but are know to have deleterious effects upon their mental well-being. This has been documented by a study of 100 physicians reported by the author previously. The hypothesis of motivation for the choice of medical profession as a vocation was explored from the point of view of personality vulnerability due to reaction formation to the fear of death and resulting compulsivity. In search of validity of vulnerability a study was undertaken on 50 lawyers residing in the same community as the studied physicians. A structured interview identical to the one used in the study of physicians was employed and computer analyzed. Results of this comparative study are reported in the current presentation.

Adult↗
PubMed1984

Psychosomatic parameters and the problem-oriented approach to biopsychosocial management.

While rigid systemization in the method of psychosocial management of patients in the general hospital is not recommended, guidelines to such management are of value to facilitate collaboration between members of the medical-surgical teams and liaison psychiatrists. The method utilizes psychosomatic parameters: biological, social, and psychological, in the framework of the problem-oriented approach. When used by the medical-surgical specialists, the method is conducive to facilitating diagnosis and decision-making for either the direct management by the physicians or selection of cases which may require more specialized intervention by liaison psychiatrists. The method also has considerable value for didactic and research purposes.

Diagnosis, Differential↗
PubMed1982

Schizophrenia and psychosomatic illness.

In order to explore the possibility of a mutually exclusive relationship between schizophrenia and certain psychosomatic disorders, 354 adult schizophrenic patients, both acute and chronic, were studied with regard to lifetime prevalence of peptic ulcer, bronchial asthma, neurodermatitis and rheumatoid arthritis. Significant evidence to support the hypothesis of mutual exclusivity was found only in the case of peptic ulcer in the overall sample. Prevalence was higher in younger, more acute patients than in older, chronic patients, but this finding was difficult to interpret. Parallel enquiry into the prevalence of schizophrenia and the same disorders among close family members of the patients yielded inconclusive results.

Adult↗
PubMed1982

Stress and the practice of medicine--the myth and reality.

The nature of stress is reviewed in its role of producing physical illness and mental maladaptations with an emphasis on physician's morbidity from both. A review of existing studies indicates that physicians compare favorably with the general population in mortality from physical illness but unfavorably with regard to mental illness, notably the affective, suicide and addiction. The definition of illness is examined with relation to stress, physical and psychosocial. It is accepted that disease presupposes the existence of special vulnerability. In mental illness, however, the vulnerability stems from inner sources. In the doctor this consists of a neuroticism originating in the fear of death which has motivated him to become a physician in the first place. A study of the writer supports these theoretical assumptions. It is proposed that the neuroticism thus created facilitates various degrees of maladaptive patterns. It is, however, also a direct effect of negative personality features created by it in the first place. Stress of medical practice does influence the emotional adjustment but does not seem to exert a greater negative influence on the physical health of doctors than does stress encountered in other occupations. This may be due to the better car physicians are able to secure for themselves.

Death↗
PubMed1982

Stress and the practice of medicine. II. Stressors, stresses, and strains.

Stresses of medical practice, recognized as severe, do not increase morbidity and mortality of physicians due to physical illness; the rates of substance dependence, divorces, and mental illness, however, exceed those in the general population. This study was undertaken to explore the effect of stress on physicians and to determine its role in the personal and occupational parameters of adaptation. 100 physicians of various specialties were randomly chosen and their responses to a standard questionnaire were computer analyzed. The previous hypothesis of the motivation of the choice of medicine as a vocation was explored from the point of view of personality features and responses to stress. All physicians reported considerable compulsivity. Its continuous utilization leads to failure of adaptation apparently responsible for further emotional and mental maladaptation. On the whole, the group under study did not show severe psychopathology equal to what has been reported in many other studies. Theoretical and practical aspects of this study are elucidated in the paper.

Adult↗
PubMed1982

International comparison of the prevalence of psychosomatic disorders in schizophrenic patients.

An epidemiological survey was carried out in Montreal (Canada). Plattsburgh (USA) and Lodz (Poland) to test the hypothesis that certain psychosomatic disorders show a low lifetime prevalence in schizophrenic patients (total n = 665). The same method for collection and evaluation of demographic and clinical data was used in order to establish the lifetime prevalence of peptic ulcer (PU), bronchial asthma (BA), neurodermatitis (ND) and rheumatoid arthritis (RA) in the patients as well as in their nuclear families. Low values of lifetime prevalence were found in schizophrenic patients in chronic hospitals as compared with those in general-university hospitals. Similarities were found in age- and sex-related patterns of these psychosomatic disorders in both samples. However, PU showed higher prevalence, and BA, ND and RA showed lower prevalence in the Polish sample.

Adult↗
PubMed1979

Definition, practice, and teaching of psychosomatics. A global survey.

Two sets of overlapping questionnaires were distributed world-wide via college members to 200 psychiatrists and 200 physicians. 50% of psychiatrists (n = 101) and 30% of physicians (n = 63), replied, representing 25 countries. Areas surveyed include definitions of 'psychosomatics', physician-psychiatrist attitudes, liaison activities, teaching patterns and methods, and professional affiliation of respondents. Comparative statistical analysis of the two groups reveals significant response differences in certain conceptualizations of 'psychosomatics' and in the diagnostic distribution of referred patients. Cross-continental comparisons revealed greater acceptance of the term 'psychosomatics' by respondents from Asia, differences between North American and European conceptualizations, and a stronger attachment of the field in the Far East to academic departments of medicine as compared with the West.

Attitude to Health↗
PubMed1979

Liaison psychiatry in the West: the view from 1977.

Current status of consultation-liaison psychiatry in the West is reviewed. Its aims, functions, and scope in diagnosis and treatment of general hospital patients outside of psychiatric departments are described. A critical appraisal is made with regards to the triadic relationship of its participants. Its benefits vis-à-vis resistances are illuminated in the context of psychosocial process. Its role in research and medical education is recounted. Thoughts about its future developments are offered.

Forecasting↗
PubMed1979

Liaison psychiatry: a service for averting dehumanization of medicine. Recent psychosocial changes in medicine.

Recent technical advances of medical science have become responsible for the altered role of the physician and changes in the practice of medicine. As the practice has become hospital-centered, the importance of the individual physician and the prestige of the medical profession have markedly decreased. Dehumanization of medicine has been a natural outcome of these changes, for as the scientific approach to patient care increased the psychosocial support of the physician and significant others decreased. Liaison psychiatry, the therapeutic arm of psychosomatic medicine, utilizes the holistic principle which incorporates the psychosocial nuances of human behavior into the medical model. It is felt that this service must be utilized with increased frequency if further dehumanization of medical practice is to be prevented.

Ethics, Medical↗
PubMed1979

Psychiatric consultation for the geriatric population in the general hospital.

The first part of this paper is based on a study by the author in 1975--1976. The conclusions were that liaison psychiatry with geriatric patients differs from that with other age groups in the following ways: (1) referrals occur primarily when behavior becomes disturbing; (2) organic causes are often overrated but psychological and social causes and functional disorders are underestimated; (3) psychopharmaceutical agents and vasodilators are overused, while psychotherapy and other forms of treatment are underutilized. Attitudes towards consultations among these patients, their families and consultees do not differ from those of younger groups. Liaison psychiatry with a situation-oriented approach is well suited to the needs of all concerned. Review of the psychosomatic parameters of aging is summarized as a basis of the proposed psychosomatic differential model for management.

Aged↗
PubMed1975

Consultation-liaison psychiatry: a psychosomatic service in the general hospital.

Consultation psychiatry, an outgrowth of the tenets of psychosomatic medicine that followed the departure from mental-hospital psychiatry to the general-hospital-based psychiatric units, is similar to those consultation services in other specialties available on medical-surgical wards. Its primary aim is to interpret the psychosocial phenomena of health and illness and to redirect the physician from disease- to patient-orientation and to a comprehensive approach. Its functions are diagnostic-therapeutic, instructional and research directed. The psychosomatic orientation is a sine qua non in the understanding of the psychosocial meaning of physical illness, its effect on psychic disability, the psychosocial adjustment of the patient and his family and his ability to adapt to illness and the hospital. An essential feature is the evaluation of the doctor-patient relationship, especially when severe illness requires serious interventions, including the consultation and its reciprocal effect upon the doctor-patient relationship. Liaison activity consists of interpretive-therapeutic mediation between the patient and the therapeutic team when strain endangers their satisfactory cooperation. The therapeutic activity must be short-term and so construed as not to interfere with the primary treatment. The instructional aspect is for the sake of the usual recipients of the service, as well as residents and students. Teaching the interview techniques, especially to students, should demonstrate the holistic approach, comprehensive diagnosis and the need of avoiding orthodox one-sidedness. This paper reviews briefly the scope and role of consultation psychiatry, compares its North American model with its status elsewhere and explores the resistances to it.

Adaptation, Psychological↗