Biomedical subjects
Publications and source records attributed to R Garb.
The evaluation of Post-Traumatic Stress Disorder (PTSD) following myocardial infarction in four patients is described. The authors outline principles of the therapeutic interventions performed to alter the disorder and alleviate patients' incapacitation. Also discussed are the reasons that may be at the root of the omission of the diagnosis of PTSD for this patient population.
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Twenty-five Israeli combat veterans fulfilling DSM-III criteria for posttraumatic stress disorder (PTSD) participated in an open, prospective trial of phenelzine sulfate administration (median daily dose, 60 mg; range, 30 to 90 mg); three patients withdrew early due to side effects. Treatment was continued for at least four weeks in 22 cases and thereafter for as long as it was felt to be of benefit. Therapeutic efficacy was rated using a new PTSD scale, the Hamilton Depression Scale, and the Hamilton Anxiety Scale administered at four weekly intervals. Six patients completed four to eight weeks of phenelzine treatment; seven patients, nine to 13 weeks; and nine patients, 14 to 18 weeks. Comparison of mean prediscontinuation scores with pretreatment ratings showed, at best, only small (23% to 38%) differences (on the PTSD and Hamilton Anxiety scales) in the group treated for nine to 13 weeks. Two patients with a concurrent diagnosis of panic disorder and two with a concurrent diagnosis of dysthymic disorder were the most improved symptomatically but fell short of clinically significant remission. Although statistically significant improvement was observed on seven of the 12 items of the PTSD scale, sleep disturbance was the only symptom showing a clinically impressive change. These results only partially support previous positive reports of phenelzine treatment of PTSD.
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The authors conducted an exploratory study of the nature and course of reactivation of combat-related posttraumatic stress disorder. Experienced psychiatrists, they each independently assessed 35 men with recurrent combat-related posttraumatic stress disorder. Two major types of reactivated posttraumatic stress disorder, each representing a different degree of pathology, were delineated: uncomplicated reactivation and heightened vulnerability. The second category was further subdivided into specific sensitivity, moderate generalized sensitivity, and severe generalized sensitivity. The authors conclude that reactivation of war-related trauma is a complex phenomenon that may take different forms.
The use of an immunological metaphor allows the incorporation of established theoretical ideas about trauma and stress in an integrative way which enables delineation and illustration of several varieties of combat stress reaction, including subtle forms of that condition which do not often appear in post-traumatic stress disorder literature.
Despite the obvious fact that loss and bereavement are an integral part of the war experience, surprisingly little has been written about bereavement and grief in combat. This article discusses reasons for the resistance to the concepts of loss and bereavement in military psychiatry, distinctive aspects of combat bereavement, factors that impede appropriate grieving in war, and, with the aid of case vignettes, the varieties of bereavement states seen in combat situations. The authors conclude that the clinical phenomena of grief run like a connecting thread through the various presentations of combat-related psychiatric syndromes, including post-traumatic stress disorders, and that more research in this area is called for.
The paper addresses the clinical entity of Combat Stress Reaction as it occurs in its immediate, undifferentiated form as well as its well-defined form - PTSD. Some aspects, such as the adaptive function of the syndrome and its relationship to physical injury, which may be of particular interest to the general military physician are touched upon.
In this article, we have described a subgroup of patients referred from a general medical setting and suffering from a cluster of similar physical and emotional symptoms, while presenting similar psychodynamics and personality traits. In contrast to a certain scepticism in the psychiatric community about the usefulness of psychotherapy with these people, our experience suggests that when a number of diverse psychotherapeutic techniques are drawn upon in an integrated fashion, psychotherapy can be an effective clinical tool. The coping-rest model, with its combination of physiological, behavioural and dynamic approaches, has been particularly helpful. We present 3 representative cases, which reflect the overall clinical and personality features of the subgroup and the integrated psychotherapeutic approach that was utilized.
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Post-traumatic stress disorder may follow combat stress or civilian psychological traumata. In 25 retrospectively studied patients, symptoms were severe in terms of number of DSM-III items fulfilled, chronicity, and severity of psychosocial disability. Antidepressants had good or moderate results in 67% of cases treated, but major tranquilisers were much less effective; response to drug treatment was not clearly related to somatisation symptoms, significant depression, or panic attacks. Pharmacotherapy appeared to have had a positive impact on psychotherapy in 70% of cases.
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A case of advanced, reversible renal failure due to psychogenic urinary retention occurring in a 17 year old female, is reported. The diagnosis of psychogenic urinary retention was made on the basis of existent florid psychopathology and the concomitant exclusion of an organic cause. Family psychodynamics are discussed. Psychosocial intervention led to a resumption of normal micturition, the disappearance of the urinary retention with resultant improvement of renal function.
Four cases of Peripheral Neurological Disorders (PND) are reviewed as models of misdiagnosis. Weaknesses in the logical process of diagnosis formation, combined with the dismissive function of the diagnosis, may lead to psychiatric misdiagnoses such as hysteria. The same logical and emotional factors can prevent correction of misdiagnosis and thus the misery of the patient may continue. Comments are made about the dangers of misusing the diagnosis of hysteria.