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Biomedical subjects

D G Folks

Publications and source records attributed to D G Folks.

At least 37 records · Page 2Linked to original sources
PubMed1988

Cognitive dysfunction after coronary artery bypass surgery: a case-controlled study.

Twenty-two patients screened from a sample of 391 having coronary artery bypass grafting (CABG) showed significant declines on the Mini-Mental State Examination (MMSE) administered preoperatively and four days postoperatively. The MMSE is a 30-point cognitive function screening instrument for dementia and delirium. These patients were compared with 22 matched control subjects who exhibited intact cognitive function postoperatively. The study assessed the association between postoperative cognitive dysfunction and socioeconomic status, potential effects of selected surgical/anesthetic factors, and preoperative anxiety and depression (Zung Anxiety and Center for Epidemiologic Studies-Depression [CES-D] self-rating scales). The results indicate that a higher preoperative level of depression reported on the CES-D (mean score of study patients 22.1 versus 12.7 for controls) is significantly associated with the development of postoperative cognitive dysfunction (P less than .01). The educational and occupational levels of study patients were significantly below those of controls (P less than .01, P less than .02). Occurrence of a postoperative complication was the only surgical/anesthetic factor found to be significantly associated with cognitive dysfunction (P less than .01). These findings suggest that preoperative depression significantly increases the risk for immediate postoperative cognitive dysfunction, and that lower socioeconomic status may confer greater risk for postoperative cognitive morbidity.

Adult↗
PubMed1988

Denial: predictor of outcome following coronary bypass surgery.

Using a modified version of the Hackett-Cassem denial scale we measured preoperative denial in 121 patients scheduled for CABG surgery. A significant inverse relationship was found between the denial scale and Hamilton Anxiety measures four days postoperatively (p less than .02). Longitudinal assessments were carried out using the Spielberger State Anxiety Inventory (SSAI), the Zung Self-Rating Depression Scale (Zung SDS) and the Psychosocial Adjustment to Illness Scale (PAIS). Six months following the surgery, significant negative relationships between denial and these self-report outcome measures were observed as follows: denial and SSAI (p less than .001), denial and Zung SDS (p less than .01), and denial and PAIS (p less than .01). However, the same analysis at twelve months showed no statistically significant correlations between denial and these psychologic outcome measures. Our findings suggest that denial serves as an adaptive mechanism, especially in the immediate postoperative period. Furthermore, higher levels of denial may be predictive of improved psychologic outcome for up to six months following surgery. Subsequently, however, other events, unrelated to the surgery, may be of greater importance than preoperative denial in determining psychological outcome from CABG surgery.

Anxiety Disorders↗
PubMed1986

Factitious disorder and coexisting depression: a report of successful psychiatric consultation and case management.

The authors present a case illustrating factitious illness with a coexisting depressive disorder. The factitial presentation involved self-mutilation that served to procure and prolong patient status, while obscuring the recognition of a major depressive episode. The importance of accurate assessment and prompt recognition of factitious illness is discussed, with emphasis upon the identification of contributing psychodynamics, underlying psychopathology and ongoing psychosocial stressors. Psychiatric consultation efforts were successful, but in the context of considerable morbidity. Psychotherapeutic gains occurred only after vigorous antidepressant drug therapy and substantial psychotherapeutic efforts that empathically addressed the patient's masochism and dependency.

Adult↗
PubMed1986

Coronary artery bypass surgery in older patients: psychiatric morbidity.

Coronary artery bypass grafting in older patients usually results in a favorable surgical outcome. To assess whether age confers greater risk for postoperative psychiatric symptoms in these patients, we retrospectively examined 58 cases (mean age 62.5 years) comparing pertinent clinical features of the index patients to matched controls (mean age 51.7 years). Analysis of the data, including scores on preoperative and postoperative scales measuring anxiety, depression, and cognitive function, showed a statistically significant difference in the cognitive performance of the elderly as shown by lower scores on the Mini Mental State examination (chi-square, P less than .025). Our findings support future efforts to address the clinical relevance of cognitive dysfunction in older coronary bypass patients.

Age Factors↗
PubMed1986

Quality of life six months after coronary artery bypass surgery: a preliminary report.

Ninety-six patients who had coronary artery bypass grafting showed improvement on the Psychosocial Adjustment to Illness Scale at six months postoperatively. Findings of improved sexual function and vocational status were unexpected in light of previous studies. Older patients showed less psychologic distress than younger ones after coronary artery bypass surgery.

Adaptation, Psychological↗
PubMed1986

Alprazolam treatment of postcoronary bypass anxiety and depression.

The effectiveness of alprazolam in treating symptoms of anxiety and depression in 60 patients undergoing coronary bypass surgery was assessed in a double-blind, placebo-controlled study. The results indicate that alprazolam treatment for anxiety following coronary bypass surgery, particularly symptoms occurring in the immediate postoperative period, can significantly affect patient outcome. Specifically, only modest but statistically significant improvement was observed in the alprazolam-treated groups at 1-month follow-up; however, alprazolam-treated patients were significantly more likely to experience a very rapid anxiolytic effect by postoperative day 8. The implications of this study are discussed with respect to patient management and models for future studies of anxiety in postoperative patient populations.

Adult↗
PubMed1986

Lithium treatment of hyperthyroidism and mania.

A case of a man who was admitted to the hospital with both mania and hyperthyroidism is presented to illustrate the interactions between affective disorder and thyroid function. In addition, the methods in which lithium carbonate affects thyroid function, thus making diagnosis more difficult, are discussed. The authors suggest guidelines for evaluation and management of similar patients.

Acute Disease↗
PubMed1985

Psychiatric disorders in geriatric medical/surgical patients. Part I: Report of 195 consecutive consultations.

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.

Age Factors↗
PubMed1985

Psychiatric disorders in geriatric medical/surgical patients. Part II: Review of clinical experience in consultation.

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.

Age Factors↗
PubMed1985

Münchausen's syndrome and other factitious illness.

Current perspectives on Münchausen's syndrome and other factitious illnesses are presented in this article. Self-destructive behavior manifested by the artificial production of illness remains a puzzling but fascinating clinical entity. A distinction between the clinical features of those cases that are more treatable suggests an optimistic rationale for approaching these difficult patients.

Adolescent↗