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Biomedical subjects

S J Eisendrath

Publications and source records attributed to S J Eisendrath.

At least 19 recordsLinked to original sources
PubMed1996

When Munchausen becomes malingering: factitious disorders that penetrate the legal system.

Psychiatrists and other physicians are usually familiar with factitious disorders, but attorneys and judges usually are not. Cases involving factitious disorders may enter the civil legal system in a number of ways and cause incorrect judgements, financial costs, and inappropriate medical care if these disorders are not identified. Psychiatric consultants may play a key role in identifying these cases and educating legal personnel about factitious disorders. This article describes three cases in which persons with factitious disorders entered the civil litigation system. The role of the psychiatrist in these cases is discussed. Clues to the identification of factitious disorders are described. The article also discusses the differentiation of factitious disorders from malingering and other forms of abnormal illness behavior, such as conversion, hypochondriasis, and somatization disorders. The concepts of primary and secondary gain in relationship to illness behaviors are elaborated.

Adult↗
PubMed1995

Psychiatric aspects of chronic pain.

Chronic pain complaints often reflect or are influenced by psychiatric factors. Physicians commonly encounter "illness-affirming behaviors" in which patient complaints or symptoms go beyond what should be expected from a specific disease process. In this paper, I describe common psychiatric conditions that often feature pain as part of the illness: somatization disorder, hypochondriasis, factitious physical disorders, pain associated with psychological factors (new DSM-IV nomenclature), and malingering. These conditions can be distinguished based on the conscious awareness (or lack of awareness) of both motivation and symptom production. Other psychiatric disorders may strongly influence chronic pain without directly causing it--depression, anxiety, panic, and post-traumatic stress disorders. Except for malingering and factitious pain, chronic pain should be regarded as genuine. Effective management requires psychiatric as well as biological considerations.

Adult↗
PubMed1994

Psychiatric predictors of pseudoepileptic seizures in patients with refractory seizures.

This study compared psychiatric factors and diagnoses in patients with pseudoepileptic seizures and genuine seizures. A semistructured interview identified psychiatric diagnosis and the presence of psychiatric factors associated with conversion phenomena. Twenty-five subjects with medically refractory seizures were interviewed and followed prospectively until a definitive diagnosis of pseudoepileptic or genuine seizures was made by neurologists using video-EEG telemetry. Four factors help to identify patients with pseudoepileptic seizures: a psychiatric diagnosis of either somatization disorder or personality disorder, the presence of a childhood loss, or the presence of a model for seizure symptoms. These findings can aid clinicians in identifying patients who would benefit from referral to a video-EEG telemetry diagnostic unit.

Adult↗
PubMed1993

Brief psychotherapy in medical practice. Keys to success.

For physicians faced with helping their patients cope with difficult medical problems, solution-oriented psychotherapeutic techniques provide brief, effective interventions. These approaches offer "skeleton keys" that can be used in a broad patient population. They include clarifying the meaning of the medical illness, therapeutic reframing, projection of the problem, role reversal, and face-saving techniques.

Adult↗
PubMed1991

Adverse neuropsychiatric effects of dopamine antagonist medications. Misdiagnosis in the medical setting.

Medications with central dopamine antagonist properties are in wide use in treating a variety of medical symptoms. Some of the most commonly used are metoclopramide (Reglan), prochlorperazine (Compazine), droperidol (Inapsine), and promethazine (Phenergan). The major adverse neuropsychiatric effects seen with these medications are acute dystonias, akathisia, parkinsonian symptoms, and neuroleptic malignant syndrome. These effects are often unrecognized or misdiagnosed by the primary physician as functional psychiatric disorders. The authors present four cases in which adverse neuropsychiatric effects from metoclopramide and prochlorperazine occurred with patients in the general hospital, and they discuss their initial misdiagnosis and subsequent identification and treatment by the consulting psychiatrist. The literature is reviewed on the adverse neuropsychiatric effects of metoclopramide and prochlorperazine, with attention to patient populations at risk. The authors believe that there is a key role in this area for the consulting psychiatrist, who can provide diagnostic clarity, advice on management, and ongoing staff education.

Adult↗
PubMed1990

Exogenous corticosteroid effects on mood and cognition: case presentations.

Eight patients who had undergone greater than five years of intermittent treatments with corticosteroids volunteered to be interviewed about their experiences. Seven patients stated they were not warned by their physicians of the possible psychiatric side effects. Five patients did not inform their physicians when symptoms did occur. The patients complained of insomnia, depression, hypomania or euphoria, confusion, and memory problems. Based on these reports, the frequency of affective and cognitive side effects of exogenous corticosteroids may be much higher than has been previously reported. The studies in the literature are discussed and recommendations are given for evaluating these side effects in patients who are treated with corticosteroids.

Adrenal Cortex Hormones↗
PubMed1989

Factitious physical disorders: treatment without confrontation.

Much of the psychiatric literature advocates vigorous confrontation of patients with factitious physical disorder. Believing that such a strategy often drives the patient to a new physician, the author developed alternatives to confrontation. These strategies include use of inexact interpretations of psychological defenses, therapeutic use of a double bind, and use of techniques that allow the patient to give up the factitious symptoms without losing face.

Adult↗
PubMed1987

Meperidine-induced delirium.

Despite the widespread use of meperidine as an analgesic, its potential for producing delirium has been overlooked. Six cases demonstrating meperidine-induced behavioral toxicity are reported. Toxicity was more likely when meperidine was combined with cimetidine or drugs having anticholinergic activity. Discontinuation of meperidine and substitution of morphine for analgesia were usually successful in treating the delirium. Physostigmine reversed the delirium in one patient. The authors suggest that the delirium results from the excessive anticholinergic activity of meperidine or its only active metabolite, normeperidine.

Adult↗
PubMed1986

Intensive care unit: how stressful for physicians?

The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians' ratings of stress in the ICU to other medical-surgical rotations. The 26 physicians in this study rated the ICU significantly less negatively than other rotations. There was also a trend to rate the ICU more positively. Prolonged care of patients with multisystem failure and a poor prognosis was the most frequently described source of stress. Humor, communication, and activities outside the ICU were the most frequently noted coping techniques.

Adult↗
PubMed1983

The living will. Help or hindrance?

The living will is a statement that directs physicians to act in certain ways during a patient's terminal phase of illness. The physician is instructed not to take measures that would prolong the life of the patient. The living will is designed to promote patient autonomy while removing onerous decision making from physicians and the patients' families. Experience with the living will indicates that it can either help or hinder clinical decision making. When appropriately implemented, the living will can perform its intended functions. When vague in terminology or applied to patients with uncertain prognoses, the living will can promote medical staff confusion. Adequate communication between patient and physician can improve the utility of the living will. Other considerations affecting the applications of the living will are discussed in detail.

Aged↗