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Biomedical subjects

C P Kimball

Publications and source records attributed to C P Kimball.

At least 19 recordsLinked to original sources
PubMed1987

Depression in intensive care units.

There is thought to be a high incidence of depression in intensive care units (ICUs), both as a result of the psychological toll of serious illness and threat to life as well as the physiologic derangements caused by illnesses and treatments. The authors outline a strategy to classify ICU depressions into major depressive illness, adjustment disorders, dysthymic disorder, or organic affective syndrome. Other psychiatric disturbances which may simulate depression are also discussed. A summary of environmental, behavioral, psychotherapeutic, and psychopharmacologic treatments for these disorders and their special application in the ICU setting is presented. The limitations and precautions with antidepressant drugs in this clinical site are reviewed.

Adjustment Disorders↗
PubMed1984

Symptom formation.

The issue of symptom formation in patients is discussed in terms of evolution relating to cultures and changes in disease patterns. Determinants of symptoms depend upon a host of factors including the individual's developmental history and personality, the setting in which illness develops, the contemporary social status of the individual, the cognitive and affective state, and the resources based on learning that the individual has in coping and adapting to stressful situations threatening the stability of the organism.

Arousal↗
PubMed1983

Psychosomatic education: the University of Chicago's program in liaison psychiatry.

Psychiatric education for the medical student addresses itself to students' and potential non-psychiatric physicians' needs in identifying and addressing the biopsychosocial aspects of patient care. The education is best based on the clinical method, using the extended interview to identify the relationship of environmental and social circumstances to the anlage, onset and reaction to illness in the patient. Within this pattern, genetic, epigenetic developmental patterns, earlier illness, behavioral and personality patterns are identified. In addition, family and social variables, including the effects of treatment procedures, hospitalization and interaction with the health team are reviewed. To whatever extent possible, the student is sensitized to this approach at the earliest phase of his(her) education, preferably in the preclinical years. The approach is reinforced during the introduction to clinical medicine and physical diagnosis. In the clinical years, individual patient consultations are arranged for students working with medical, surgical, pediatric and obstetrical patients on these services in which they review with patients their illness experiences. This is viewed as both an analytic and synthetic experience having an educational value for the student and a therapeutic one for the patient. Preceptors of such programs need thorough grounding in general and sometimes specialty medical disciplines as well as considerable exposure to psychological, behavioral and psychiatric medicine. Evaluation and support of these programs remain in question and should be addressed in discussion.

Chicago↗
PubMed1983

The biopsychosocial approach. Liaison medicine and its models.

Liaison psychiatry is an outgrowth of consultation psychiatry which it extends by emphasizing its teaching function with the physicians, nurses, and patients it has contact. Liaison teaches methods of identification, assessment, diagnosis, and therapy based primarily on an open-ended interview technique. This form serves in and of itself, as well as by extension, as a brief psychotherapeutic process. The liaison model utilizes a general systems approach in its study of the patient pursuing the latter's problem from the molecular through organ systems, intrapsychic processes and interactions with the social milieu. The biopsychosocial approach to the patient is one of addressing the patient and the significant others in the sequential stages of illness; acute, convalescent, and rehabilitative. These are largely influenced by the environments and the processes occurring therein. Liaison psychiatry might well be called ecumenical psychiatry inasmuch as it utilizes conceptual approaches derivative of the social sciences, psychoanalysis, behavioral medicine, neuroscience, and psychopharmacology. In addition, the function of the liaison consultant seems to be increasing as one in which he/she functions as an arbiter when there are conflicts between colleagues around decision-making processes. These frequently involve ethical problems affecting the behavior of staff and patients. The processes engaged in by the liaison psychiatrist will be elaborated.

Behavior Therapy↗
PubMed1982

Stress and psychosomatic illness.

Increasing attention has been addressed to the relationship of stress and illness during the past several decades. Despite extensive and intensive research in this area leading to statistically significant correlations, the specificity of the relationship remains vague. Some of the difficulty evolves from the definition of stress and illness. What is stress? How is it defined? Can it be defined independent of an identifiable reaction or change in behavior? How is illness defined? How does stress as a phenomenon relate to its perception and cognition and on what levels? To what extent do the physiological-worded concepts of Selye and Levi relate to the social and psychological ones of Holmes, Rahe and others? What do we mean by psychosomatic illness? How specific is it in terms of discrete entities. If we are in agreement that there is something there--something relating to change in behavior, conceptualized in social, psychological and biological terms with an event occurring external or internal to the individual, what greater precision can we strive for in determining and identifying specificity and the particulate? Is it possible to define a new model of relationships that will assist in identifying, determining and intervening in stress-related illness situations?

Behavior↗
PubMed1982

The concept of behavioral specificity: three concepts.

A brief review of specificity theories in relationship to illness is identified. Psychosomatic medicine has gradually moved from unitary-specificity relationships to multi-specificity ones. This movement has been determined by the increasing number of factors that are temporally and sequentially related to illness. The relationship of specific factors to disease is seen as derivative, generative or coincidental. Particular attention is addressed to the social life field in which illness develops, is responded to by the patient and treated by the physician. The emerging field of behavioral analysis allows for the identification of discrete factors which may be correlated with specific behaviors. Such relationships are amenable to behavioral interventions which are specific. Change is measurable. The patient takes an active part in the therapy by noting the relationship of environmental events to specific reactions. As these are recognized through encouragement, relaxation, desensitization and reinforcement, maladaptive responses are replaced by adaptive ones.

Behavior↗
PubMed1980

The experience of hemodialysis and renal transplantation.

A clinical case method for teaching medical students and physicians is presented, utilizing a patient's self-report which describes his experiences from onset of illness through hemodialysis, renal transplant, and post-transplant phases. The authors correspondingly cite medical, psychological, and social issues characteristic of hemodialysis patients' experience, thus providing didactic material as well as clinical content for discussion.

Adaptation, Psychological↗
PubMed1979

Psychotherapeutic intervention in acute medical situations.

Psychotherapy in the extreme medical situation is an extension of the interviewing process. The interviewer must expeditiously and sometimes briefly assist the patient in elaborating his complaint, obtain information about the development of the complaint, and assess the patient's reactions to it. Past history, developmental patterns, reactions to previous illness and crises, the patient's present life situation, and past and present relationships may all be relevant and require evaluation. The interactive process requires that the therapist call upon specific knowledge as he engages with the patient, facilitates the expression of concern, appropriately reassures, instructs, and prepares, clarifies, and leads the patient to some insight about his altered state. Attention to the affective correlates of acute illness can enhance convalescence and the rehabilitative process.

Acute Disease↗
PubMed1979

Changing concepts in psychosomatic theory. I. Historical analysis.

Psychosomatic medicine has utilized static, linear, two-dimensional models in attempting to identify a causative relationship between psychosocially conceptualized events and biologically conceptualized ones. This has led to inherent difficulties that are logistically unresolvable. For example, the different language systems lend themselves to overlap with the possibility of addressing themselves to describing manifestations of the same phenomenon from dissimilar conceptual orientations. The problem is further complicated by attempting to link these together in a temporal sequence suggesting a causal relationship. We have ignored both feedback processes in terms of a sequential process modifying a preceding one and the possibility that a reverse order of relationships might explain some processes. In our quest for specificity, we have ignored that disease states are not static ones any more than is life but change over time, suggesting that alterations will occur in the original relationships proposed among our different systems of conceptualization. Among the remedies suggested for a reordering of our thinking are: (a) a revision of linear unidirectional causative models to cyclical bidirectional models; (b) a reformulation of two-dimensional temporal linear relationships toward three-dimensional spherical ones which overlap in time; (c) the relating of these aspects not to each other but to a third factor, common to the three which remains to be identified; (d) the development of a language that bridges the psychological, social and biological.

History, 19th Century↗
PubMed1979

Liaison psychiatry as a systems approach to behavior.

In this overview, the psychosomatic theory is discussed from an evolutionary perspective. From its initial concern with relationship between emotions and physiology through psychopathology and anatomo-physio-pathology to socio-psycho-pathophysiology, psychosomatic medicine and its theory is presently viewed as an empiric science utilizing a number of conceptual approaches derived from developmental psychology, classical psychiatry, physiology, sociology and anthropology. These are applied to the study and care of patients in ambulatory and inpatient settings, which are the arenas of the consultation-liaison activity and may be viewed as the clinical laboratories of psychosomatic medicine. In these laboratories, a new language has developed which is largely phenomenological and which attempts to utilize theoretical concepts from several disciplines in explaining the illness illness phenomenon in the present. As such, the practitioner of Liaison Psychiatry is a general systems analyst who analyzes the illness situation of the patient and his attendants in an attempt to decipher the identified problem, explaining it by utilizing selected theoretical concepts from the basic sciences of behavior. Psychosomatic theory is seen as an evolving and bridging science attempting to integrate and combine particulate theory into a more comprehensive synthesis.

Adaptation, Psychological↗
PubMed1979

Teaching medical students psychosomatic medicine: of substances and approaches.

The author describes a curriculum in which the emphasis is on teaching of medical students a general systems approach to health and illness from the first year of medical school through the fourth year. In the first year, a three-part course in behavioral science includes: Introduction to the Patient; Social and Ethical Issues in Medicine; Exercises in Decision-Making; and a didactic lecture series, Determinants of Behavior. This is followed in the second year by a course in psychopathology taught from environmental, psychological and social perspectives. The third-year clerkship emphasizes a liaison approach where students return to the medical and surgical services to work-up patients from a broad multidimensional perspective. The formal program in psychiatry and behavioral science is supported by more than 40 electives in human development, biological, social and psychological psychiatry, including behavior. During these phases the student has experience in working as a member of a team. She/he approaches the health of an individual in terms of the life phase of the individual, the present life of the individual, his/her past experiences, previous personality, reaction to the current illness phenomenon while following the illness through the hospital phase of the present illness, studying coping and adaptational processes.

Education, Medical, Graduate↗
PubMed1978

Psychiatric screening in a medical clinic. An evaluation of a self-report inventory.

A self-report symptom inventory, the Hopkins Symptom Checklist, was used as a screening test for psychiatric disorder in a group of 82 new patients in a university hospital outpatient medical clinic, and the results were compared with interviewer diagnoses. The prevalence of psychiatric disorder in the group was high (83%). Both parametric (discriminant function analysis) and nonparametric (contingency table) methods produced screening results from the patient self-ratings that were statistically significant but of limited accuracy in separating psychiatrically ill from well patients. Comparison of patient and interviewer ratings of symptoms indicated substantial agreement, suggesting that the screening accuracy of the symptom inventory is limited by the absence of historical and observational data.

Adult↗