Developmental histories of borderline patients.
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Adolescent↗
Biomedical subjects
P H Soloff
Publications and source records attributed to P H Soloff.
The liaison psychiatrist in cardiovascular rehabilitation: an overview.
Depression, anxiety and fear of recurrence following myocardial infarction often lead to disability in excess of actual cardiac impairment in a large number of patients. The high social, economic and emotional cost of psychogenic cardiac invalidism has stimulated the development of cardiovascular rehabilitation programs throughout the country. The liaison psychiatrist can play a critical role in the rehabilitation effort. This paper describes the psychological impact of the rehabilitation process in combating psychogenic cardiac disability. The conflicts of the post-infarction patient and their management by the rehabilitation team are presented from the perspective of the team psychiatrist. Cardiovascular rehabilitation as described is a productive area for psychiatric liaison, through individual consultation, group therapy sessions and team meetings which address the psychosocial issues of convalescence.
Anxiety↗
Denial and rehabilitation of the post-infarction patient.
The use of denial has been widely accepted as an adaptive and protective coping mechanism in the acute phase of myocardial infarction. Although instrumental in lowering anxiety and mortality in the acute phase of coronary care, the use of denial creates hazards for the patient in convalescence. These hazards, not well known to intensive care personnel but all too apparent to the liaison psychiatrist working in cardiovascular rehabilitation, include a high vulnerability to disruptive anxiety and even psychosis at times of transition from greater to lesser intensity nursing care and a maladaptive resistance to rehabilitation efforts in convalescence. Failure of denial under the stress of transition may produce a transient paranoid psychosis with a clear sensorium, a variant of Abram's "cardiac psychosis." Maintenance of the defense in convalescence leads to noncompliance with medical advice and rejection of rehabilitation efforts, increasing the risk of reinfarction. A case report is presented illustrating both hazards. Recommendations for management include early recognition, supportive psychotherapy, education and mobilization in the acute phase of coronary care. Cardiovascular conditioning and reshaping of risk factors follow in convalescence. The physical and psychological benefits of this approach are reviewed. The adaptive value of denial in coronary patients is challenged from the long-term perspective of rehabilitation.
Anxiety↗
Medically and surgically treated coronary patients in cardiovascular rehabilitation: a comparative study.
Mood and physical performance were assessed in medically and surgically treated patients with coronary artery disease referred to a cardiovascular rehabilitation program early in convalescence. Surgically treated patients reported less mood disturbance prior to training and demonstrated greater gains in exercise tolerance. Medically managed patients had more mood disturbance prior to training and greater mood improvement in the six week rehabilitation program. Improvements in mood were independent of improvement in exercise tolerance. Group differences in mood state could not be attributed to the use of defensive denial, time from discharge, severity of coronary disease, or age of patient. The psychological and physical impact of bypass surgery contributes to the mood and physical performance of postoperative patients.
Adjustment Disorders↗