Guidelines for xenotransplantation.
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Animal Care Committees↗
Biomedical subjects
D S Kornfeld
Publications and source records attributed to D S Kornfeld.
Role of emotional factors in adults with atopic dermatitis.
BACKGROUND: The role of anger in the onset or perpetuation of episodes of atopic dermatitis in adults has long been considered an important factor. The objective was to investigate whether atopic patients feel ineffective in dealing with anger and assertiveness when compared with psoriasis patients and control patients. METHODS: Thirty-four adult patients with atopic dermatitis were compared to 28 patients with psoriasis and 32 controls, dental patients without major skin disease. Standard measures of anxiety, anger, assertion, depression, and locus of control as well as a measure of anger effectiveness, designed for this study, were used. RESULTS: There were significant differences between atopic dermatitis patients and controls in that atopics felt angry more readily but were less likely to express it, were more anxious and less assertive, and felt less effective in expressing anger. The only difference between psoriasis patients and controls was less ability to express anger. Atopic patients were more chronically anxious than those with psoriasis. CONCLUSIONS: Adult atopic dermatitis patients are often chronically anxious and feel ineffective in handling anger which suggests that psychological interventions may prove helpful.
Adolescent↗
Group psychotherapy during radiotherapy: effects on emotional and physical distress.
OBJECTIVE: The purpose of this study was to ascertain whether group psychotherapy during radiotherapy for cancer significantly decreases patients' emotional and physical distress. METHOD: Twenty-four patients receiving radiotherapy were randomly selected for group psychotherapy (six patients per group, 90-minute weekly sessions for 10 weeks). Another 24 patients served as control subjects. Each patient was given the Schedule for Affective Disorders and Schizophrenia (SADS) at the onset of radiotherapy, midway through radiotherapy, at the end of radiotherapy, and 4 and 8 weeks after radiotherapy ended. RESULTS: The combined SADS items for depression, pessimism and hopelessness, somatic preoccupation and worry, social isolation and withdrawal, insomnia, and anxiety and agitation were used as a measure of emotional distress. The combined SADS items for anorexia, nausea and vomiting, and fatigue were used as a measure of physical distress. By 4 weeks after the end of radiotherapy, the patients who received group psychotherapy showed significant decreases in both emotional and physical symptoms, and the decreases were greater than those for the control patients. The subjects who initially seemed unaware of their cancer diagnoses had the lowest baseline levels of emotional and physical distress, but 4 weeks after the end of radiotherapy they had high distress levels. CONCLUSIONS: Group therapy may enhance quality of life for cancer patients undergoing radiotherapy by reducing their emotional and physical distress. The degree to which patients acknowledge the diagnosis of malignancy may be a factor in their initial distress level and their response to radiotherapy and group therapy.
Adult↗
Relation of psychosocial and stress reactivity variables to ventricular arrhythmias in the Cardiac Arrhythmia Pilot Study (CAPS).
Both animal and human data implicate psychosocial distress and cardiovascular reactivity in response to challenge in the etiology of sudden cardiac death. In this study, the relation of these biobehaviorial factors to frequency of ventricular premature complexes, a predictor of sudden death was investigated. The study population was made up of patients enrolled in the National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Pilot Study (CAPS). Ventricular premature complexes (VPCs) were assessed by multiple, 24-hour ambulatory electrocardiographic recordings. Patients completed trait psychosocial measures assessed at baseline and state psychosocial measures assessed periodically during a 1-year follow-up period. Psychosocial measures included self-reports of depression, anxiety, anger and type A behavior pattern. A competitive challenge using a video game was used as a stressor to elicit cardiovascular reactivity and was administered at baseline and during follow-up sessions. Cardiovascular reactivity was defined as peak level during stressor exposure minus the mean of resting levels for systolic and diastolic blood pressure and pulse rate. Results indicated that biobehavioral factors were not associated with diurnal VPC rates. Furthermore, biobehavioral factors did not predict response to antiarrhythmic therapy. Based upon the results of this study, it is speculated that the established relation between behavioral factors and sudden death may not be mediated by VPC rates.
Arrhythmias, Cardiac↗
Psychiatric outcome of heart transplantation.
The authors evaluated 73 cardiac transplant recipients 1 month to 6 years after transplantation to determine the prevalence of psychiatric disorders and psychosocial problems after cardiac transplantation. Affective illnesses had occurred in 51%, chiefly as a steroid-related syndrome, with mood lability, irritability, and grandiosity (22%). Major depressive episodes occurred in 11%. Postoperative delirium occurred in 4%. Anxiety symptoms were frequent (26%) but generally transient. Other frequent problems included cognitive, family, marital, and sexual dysfunction and inability to gain employment. Further effort is needed to reduce psychiatric morbidity and improve outcome for heart transplant recipients.
Adaptation, Psychological↗
Psychiatric aspects of head and neck cancer surgery.
Psychiatric problems of patients with head and neck cancer include reactions to disfiguring illness and treatment; adjustment to alterations of speech, eating, and other functions, including sex; changes in body image; alcohol and tobacco addiction; pain; organic brain syndromes; and dealing with terminal illness. Although speech is often compromised, head and neck patients can communicate and psychiatric work is possible. The consultation-liaison psychiatrist can provide considerable assistance by utilizing psychodynamic, behavioral, and pharmacologic modes of treatment and by working with family members and staff.
Adult↗
A "new" drug for treating agitation and psychosis in the general hospital: chlorpromazine.
Psychiatric residents on a consultation-liaison service consistently avoid chlorpromazine in favor of haloperidol for the treatment of psychotic, agitated patients. The residents' fears of chlorpromazine as a dangerous medication are presented and the literature about chlorpromazine's side effects is reviewed. Evidence was not found to support the contention that chlorpromazine is too dangerous to use in the medical setting. Case material illustrating the benefits of chlorpromazine is presented. A theoretical explanation for the observed prescribing practices is suggested.
Adolescent↗
Psychotherapy during radiotherapy: effects on emotional and physical distress.
The authors determined the effects of ongoing weekly individual psychotherapy on the symptoms of patients undergoing a 6-week course of radiotherapy for cancer. Forty-eight patients were given weekly psychotherapy sessions for 10 weeks; another 52 patients served as control subjects. A statistically significant reduction was found in both emotional and "physical" manifestations of distress in the patients receiving psychotherapy compared with the control group. This was true regardless of gender, ward or private patient status, or knowledge of diagnosis. Patient gender and knowledge of diagnosis did affect the pattern and magnitude of the response to psychotherapy.
Adult↗
Type A behavior and the thallium stress test.
Several recent studies have examined the association between Type A personality and coronary artery disease (CAD) by coronary angiography. Most of these studies have reported a significant association. The present study is an attempt at further confirmation, using a new non-invasive technique for measuring CAD. Subjects were 53 patients undergoing routine exercise stress tests with concomitant thallium-201 myocardial perfusion studies. Five aspects of Type A behavior were assessed by the use of the Rosenman-Friedman Semistructured Interview, and each was rated on a three-point scale. Severity of CAD was independently estimated on a four-point scale. Pearson correlation coefficients were separately computed for patients with and without reported history of myocardial infarction (MI). For 37 patients without reported MI, CAD severity was significantly correlated with Overall Type A (r = -0.53), Vocal Characteristics (r = -0.53), Job Involvement (r = -0.36) and Aggressiveness (r = -0.48), but not Time Urgency (r = -0.25). For 16 patients with reported MI, CAD severity was significantly correlated with Job Involvement only (r = +0.49). The data are consistent with the association of Type A personality and coronary atherogenesis, but may also reflect Type A psychological and physiological characteristics. Future studies may be able to examine these and other aspects of Type A behavior using this noninvasive technique in more diverse patient populations.
Adult↗
Psychological and behavioral responses after coronary artery bypass surgery.
One hundred consecutive patients who underwent coronary artery bypass surgery at the Columbia-Presbyterian Medical Center from December 1972 through February 1975 were evaluated at surgery and then followed for as long as 4 1/2 years to study their postoperative psychosocial and behavioral course. One patient died during the first 30 days. At 4 1/2 years, 23 patients were reported as deceased, 15 from cardiac causes. The majority of the long-term survivors had substantially less angina and greater exercise capacity; surgery did not increase the number of patients who were employed, but led to substantial improvements in the quality of life, including general pleasure, reduction of anxiety and depression and subjective improvement in job and family roles. Sexual adjustment improved the least; the frequency of sexual relations tended to decrease. Compliance with the medical regimen was relatively good for smoking and exercise, but not for diet or type A behavior, suggesting a need for psychological intervention.
Adult↗
Clinical and cost benefits of liaison psychiatry.
A liaison psychiatrist participated in the postoperative care of a group of elderly patients who underwent surgery for fractured femurs. Clinical outcomes for this group were compared with a control group of patients who were not treated by a liaison psychiatrist. Length of stay for the treatment group was 12 days shorter than for the control group, and twice as many patients in the treatment group returned home rather than being discharged to a nursing home or other health-related institution; therefore, a substantial reduction in the cost of their medical care was effected. The authors suggest that psychiatric liaison services should be viewed as a potential cost containment mechanism for general medical care.
Aged↗
Type A behavior and blood pressure during coronary artery bypass surgery.
Systemic hypertension has been reported as common during coronary artery bypass surgery. The coronary-prone Type A behavior pattern has been associated with heightened reactivity of the sympathetic nervous system. Therefore, the possible relationships between the two was explored. Significant correlations were found between systolic blood pressure rise during surgery and interview ratings of overall Type A (p < 0.05), aggressive content (p < 0.01), and job commitment (p < 0.001). A statistically association was also found between diastolic pressure rise and the job commitment rating (p < 0.01). Significant correlations were still present after controlling for the role of physical predictors of blood pressure rise by statistical multiple regression analysis. The data suggest that patients with Type A behavior characteristics manifest an autonomic hyperactivity which is present under general anesthesia. This hyperactivity may contribute to the association of Type A behavior pattern and coronary heart disease.
Aggression↗
The intensive care unit in adults: coronary care and general medical/surgical.
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Adult↗
Psychological intervention in coronary heart disease: a review.
Psychological intervention studies designed to reduce cardiac morbidity are reviewed. Preliminary findings suggest that various psychotherapeutic modalities may be effective. Such studies also provide an avenue through which the physical and psychological mechanisms involved in coronary heart disease and their interactions may be clarified. Implications for clinical interventions are also discussed.
Adaptation, Psychological↗
Postcardiotomy delirium and cardiac output.
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Adult↗
Type A behavior pattern and coronary angiographic findings.
One hundred forty-seven consecutive patients scheduled to undergo coronary angiography were classified according to the type-A behavior pattern. Statistically significant correlations were found between diseases severity and the physical risk factors cholesterol, smoking, hypertension, sex, and age. The correlation of the behavior pattern with angiographic disease severity was of the same magnitude as that of the other risk factors except cholesterol, which was greater. The association between the behavior pattern and severity persisted after adjustments had been made for the effects of five other major risk factors.
Adult↗
Psychiatric aspects of radiotherapy.
The authors evaluated 200 cancer patients, half of whom received betatron therapy and half linear accelerator therapy. The incidence and severity of anxiety and depression were high in both groups; as radiotherapy continued these symptoms tended to decrease in intensity among the patients treated with the linear accelerator and to increase among the betatron patients. Patients who denied knowledge of their diagnosis were initially less depressed and remained less depressed than those who knew or suspected that they had cancer.
Anxiety↗
Delirium after coronary artery bypass surgery.
The incidence of postoperative delirium following coronary artery bypass surgery was 28%. This rate is comparable to that after open-heart surgery. However, of those variables which were previously found to correlate with delirium in the open-heart group, only severity of postoperative illness in the recovery room significantly correlated with delirium in patients having bypass. The relationship between personality type and delirium, previously found to be signficant, was suggestively associated in these patients. A history of myocardial infarction prior to surgery was significantly associated with delirium.
Adult↗