Biomedical subjects
Publications and source records attributed to C V Ford.
The authors report a case in which pathological lying is associated with right hemithalamic dysfunction as shown by [99mTc]HMPAO SPECT brain scanning. This association has not been demonstrated previously and is noteworthy because it supports the hypothesized roles of the thalamus and associated brain regions in the modulation of behavior and cognition.
Persons with psychological problems who translate their distress into somatic symptoms (somatize) are frequent users of medical care. These patients often have underlying depression, anxiety, obsessive--compulsive symptoms, or personality disorders. Descriptions of the somatizing syndromes are provided in association with recommendations as how to recognize and manage the patient with somatization.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Pseudologia fantastica has not been reviewed in the English literature in over 50 years, but the term is still used, for example, among the diagnostic criteria for the Munchausen syndrome. Based upon a review of 72 cases of pseudologia fantastica collected from 26 reports since its initial description in 1891, pseudologia is distinguished from other types of lying. Pseudologia fantastica is typified by these characteristics: (1) the stories are not entirely improbable and are often built upon a matrix of truth; (2) the stories are enduring; (3) the stories are not told for personal profit per se and have a self-aggrandizing quality; and (4) they are distinct from delusions in that the person when confronted with facts can acknowledge these falsehoods. The authors compile phenomenological data about "the pseudolouge", who is represented equally males and females. Intelligence varies, but at least 40% have evidence of central nervous system dysfunction. The authors suggest that disease simulation, peregrination, and imposture are secondary behavioral manifestations of pseudologia, which is deserving of additional study.
The authors discuss the phenomenon of lying, a common psychic process that has received remarkably little scrutiny. The ubiquity of lying and others forms of deception suggests that they have "normal" aspects, but lying which is persistent or destructive to the quality of a person's life becomes pathological. Lying has many determinants, including developmental, biological, social, and psychodynamic. Antisocial, histrionic, narcissistic, borderline, and compulsive personalities have been associated with lying. The treatment of lying needs to be individualized according to the overall symptom complex in which it is embedded.
The authors present recommendations for educating medical students and psychiatric residents in geropsychiatry. They are primarily concerned with the objectives and methods rather than the content of training. Proposals are structured in terms of training objectives and educational settings in which such training takes place. The proposals are intended to be specific enough to be truly useful and at the same time sufficiently generalizable to adapt to geropsychiatric training in a variety of institutions. Priority is given to integrating knowledge of normal and abnormal aging with the clinical skills and empathy necessary to approach patients with competence and understanding.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The desirability of obtaining written informed consent for low-risk radiologic procedures has been the subject of controversy. A group of 80 patients was studied to evaluate the effect of informed consent for excretory urograms on: (1) incidence of contrast reactions; (2) discomfort during the procedure; (3) level of patients' anxiety before and after the procedure; (4) patients' perception of the procedure; and (5) desirability of informed consent from the patients' viewpoint. Results revealed no statistically significant difference between the 2 groups in the incidence of reactions, discomfort, perception of the examination, or anxiety level prior to the procedure. The informed consent group had a statistically greater factual knowledge of the procedure evaluated objectively (P less than 0.01). Of the patients who received the written consent form, 83% regarded it as helpful and none viewed it as harmful or refused the examination. In the control group, 32% desired more information.
We periodically evaluated 27 interns for mood states and psychophysiologic functions during their internship year. At the end of the year they were questioned as to what they had found to be stressful and/or supportive during the year. Stressful issues were inadequate sleep, inadequate time to pursue personal matters, and inadequate personal interest and support from attending physicians. Helping to reduce stress were support from, and camaraderie with, fellow house officers. Those interns who had more emotional distress experienced less support from others and felt more isolated. The amount of sleep did not differentiate those who were more dysphoric from those who had less distress. We conclude that the major issue in determining the amount of distress experienced during the internship is the quality of the individual's social support system.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We reviewed psychiatric consultations (N = 195) for patients aged 60 years or more from a consecutive series of 1,000 psychiatric consultation requests. Consultations for geriatric patients were requested disproportionately less frequently than for nongeriatric patients and significantly more frequently for elderly women than for elderly men. The most frequent primary psychiatric diagnoses were organic psychiatric and depressive spectrum disorders. The referring primary care physician had either misdiagnosed or failed to recognize an underlying organic psychiatric disorder in more than half the patients with organic psychiatric illness. The study highlights the prevalent psychiatric disorders of the elderly medical/surgical patient, and opines that psychiatric consultants can be of significant assistance in the medical care of these patients.
Of a consecutive series of 1,000 psychiatric consultation requests, 195 were for patients 60 years of age or older. The most frequent psychiatric diagnoses assigned by the consultant were organic psychiatric and depressive spectrum disorders. This communication reviews frequently encountered syndromes and the other major clinical issues relevant to geriatric psychiatry and provides illustrative cases. The mental status examination is a sensitive diagnostic tool that can improve the clinician's diagnostic skills. We conclude that screening the elderly medically ill patient for these psychiatric disorders will improve patient care and significantly diminish morbidity.
Explore the source record for details and available documents.