PubMed Health⌕ Search

Biomedical subjects

W R Procci

Publications and source records attributed to W R Procci.

At least 19 recordsLinked to original sources
PubMed1987

Mockery through caricature: a variant of introjection utilized by a masochistic woman.

This case study of a woman with moral masochism focuses upon her characteristic defenses. Particular attention is paid to her utilization of a variant of identification. This patient's mother was a strict, harsh disciplinarian who insisted upon total compliance as a condition for her approval and love. This roused considerable anger and resentment in this patient but also intense anxiety, lest she lose her mother's love. To deal with this, she adopted an ingenious strategy. She established a veneer of pseudocompliance, following her mother's dictates to the letter. She incorporated many of her severe attitudes. She took these to an extreme, in effect caricaturing her. Through this process of exaggerating these bits of maternal behavior she made herself miserable, i.e., she became anhedonic, anorectic, and anorgasmic except via painful anal intercourse. This was a most useful compromise formation that enabled her to appear as her mother's ideal child and, therefore, retain her love. At the same time, by achieving a state of misery through following her mother's orders, she exposed her as ridiculous, and thus covertly discharged considerable aggression.

Adult↗
PubMed1985

Effect of maintenance hemodialysis on male sexual performance.

Prior studies have suggested that male patients with uremia suffer from sexual dysfunction that worsens when they are placed on maintenance hemodialysis. The authors report a prospective study of the effect of maintenance hemodialysis on male sexual functioning using nocturnal penile tumescence (NPT) measures and detailed sexual histories. Twenty men already on maintenance hemodialysis and 23 men with advanced renal failure who began maintenance hemodialysis within 4 months of entering the study were followed at 4-month intervals for 1-year and 6-month intervals for the following 18 months. Sexual performance as assessed by NPT, frequency of intercourse, and complaints of erectile failure remained remarkably stable over time for both groups. When renal failure patients moved to maintenance hemodialysis, their frequency of intercourse increased significantly despite stability of NPT. These results suggest not only that maintenance hemodialysis does not worsen sexual functioning, but that adaptation to a sexual deficit is possible after starting hemodialysis.

Adult↗
PubMed1984

Preliminary observations of the utility of portable NPT.

Nocturnal penile tumescence (NPT) has been utilized as an aid in the differential diagnosis of male erectile failure. The development of portable NPT monitors will broaden its applicability. Surprisingly, there are few data correlating sexual history interviews with NPT. In this study, 50 normal controls, 25 chronically ill patients with normal renal functioning, and 48 men with end-stage renal disease (ESRD) provided both detailed sexual histories and NPT tracings from portable monitors. In general, the data obtained from these two different sources of information were congruent. The presence of a sexual partner who could verify the sexual history enhanced the congruity. Portable NPT is probably useful at the very least as a screening technique in the assessment of male erectile failure.

Adult↗
PubMed1983

Consecutive-night reliability of portable nocturnal penile tumescence monitor.

Consecutive-night reliability of nocturnal penile tumescence (NPT) was determined in 77 patients, including 47 normal controls (NC), 16 patients with end stage renal disease on maintenance hemodialysis (ESRD), and 14 patients with chronic illnesses but normal renal functioning (CI). A portable NPT monitor was used in a clinical research ward setting. Since there is not yet widespread agreement as to the clinically most relevant NPT response criteria, three were examined: the proportion of sleep time during which an erection of a given penile circumference change was maintained, the maximum penile circumference change obtained, and the number of erections per night of a given penile circumference change. For all three response criteria in each of the three populations the consecutive-night correlation of results was statistically significant, suggesting that portable NPT has consecutive-night reliability.

Erectile Dysfunction↗
PubMed1982

Sexual dysfunction associated with oral antihypertensive medication: a critical survey of the literature.

It is commonly held clinical belief that antihypertensive agents affect sexual performance. The authors survey the English language literature concerning oral antihypertensive agents and critically review studies examining sexual side effects. Surprisingly, few studies support much of the conventional clinical wisdom. Evidence is strong for the pathogenicity of guanethidine upon ejaculatory mechanisms. Contrary to expectation, strong evidence also exists for the ability of propranolol, especially in high doses, to inhibit erectile functioning. Only equivocal support was found for the pathogenicity of methyldopa, reserpine, and clonidine upon sexual functioning. The authors suggest that this may be in part due to underdeveloped methodology for assessing the sexual side effects of hypertensive medications. Suggestions are offered for future studies as well as for the clinical evaluation of sexual dysfunction in the hypertensive patient.

Antihypertensive Agents↗
PubMed1982

Autonomic nervous system dysfunction and impotence in uremia.

The relationship between abnormalities in nocturnal penile tumescence (NPT) and autonomic function, measured by the Valsalva maneuver, was evaluated in 25 uremic patients and 22 normal subjects. NPT in uremic patients (45 +/- 6.8 min/night) was lower (p less than 0.01) than in normals (85 +/- 10.4 min/night). Valsalva ratio in uremics (1.58 +/- 0.07) was also lower (p less than 0.01) than in normal subjects (2.05 +/- 0.11). NPT and Valsalva ratio were significantly correlated in uremic patients (r = 0.62, p less than 0.01). The 12 uremic patients with abnormal Valsalva maneuver had NPT of 22 +/- 5.2 min/night, a value lower (p less than 0.01) than that (67 +/- 8.7 min/night) observed in the 13 uremic patients with normal Valsalva maneuver. There was also a significant correlation (r = 0.56, p less than 0.05) between the Valsalva ratio and the frequency of intercourse per month in the uremic patients, who had steady and active sexual partners. The data suggest that a dysfunction of the autonomic nervous system may be an important factor in the genesis of erectile abnormalities in patients with uremia.

Adult↗
PubMed1981

Psychosocial disability during maintenance hemodialysis.

Overall psychosocial functioning was assessed in 21 maintenance hemodialysis patients. The Ruesch Social Disability Scale, which provides an overall Social Disability (DS) score as well as subscores for Physical Impairment (PI), Behavioral Impairment (BI), and Social Modifiers (MS), was utilized. A majority of the patients (13) experienced Major Social Disability and the mean DS score of this sample was in the Major Social Disability range (mean = 52.1 +/- 10.9). There were no differences between the mean DS score of men and women. Married patients had DS scores significantly lower than those who were divorced or never married (P less than .05). Patients with more than five years of maintenance hemodialysis had a mean DS score significantly higher than those with less then five years of maintenance hemodialysis (P less than .03). In those patients with more than five years of hemodialysis, the MS scale was significantly elevated (P less than .01) in comparison with their counterparts, whereas the BI and PI scores were not different. The data suggest that serious psychosocial impairment is a common sequela of maintenance hemodialysis, especially for long-term patients and those who are not married. Therapeutic approaches directed toward improved social functioning are indicated.

Disability Evaluation↗
PubMed1981

Psychological factors associated with severe abuse of the Hemodialysis diet.

Thirty-one maintenance hemodialysis patients were observed for a six-month period. Seven of these patients (22.6%) were severe and persistent abusers of the hemodialysis diet. Because there are serious, even lethal, consequences of the sequelae of hemodialysis diet abuse such as fluid overload and/or hyperkalemia, this finding demands explanation. All seven severe abusers were men and, as a group, their current life situation was devoid of typical adult male gratifications. Their developmental histories indicated major difficulties with resolution of dependency/independency conflicts. Statistical analysis of demographic data and extensive psychiatric interviews support this. The author postulates that severe abuse of the hemodialysis diet results in part from the combination of unresolved dependency conflict, unfavorable current environmental circumstances, and a dependency-provoking treatment regimen. Severe abuse of the hemodialysis diet may serve an adaptive function by allowing at least some gratification in one area of the lives of these patients who suffers severe deprivation.

Adaptation, Psychological↗
PubMed1981

Sexual dysfunction in the male patient with uremia: a reappraisal.

Partial or complete impotence is common in uremia. It is not clear whether the impotence is organic or psychogenic in nature and whether uremia itself or the state of chronic illness is responsible for it. We examined these questions, by psychiatric interviews and nocturnal penile tumescence (NPT), in 50 normal subjects, 48 patients with chronic uremia, including 23 patients treated with maintenance dialysis, and 22 patients with chronic illness and normal renal function. About 40 to 50% of patients with uremia, but not those with chronic illness and normal renal function, complained of erectile dysfunction and reported a significant decrease in frequency of intercourse. There were no significant differences between patients with uremia prior to initiation of therapy and those treated with maintenance hemodialysis. NPT declines after 40 years of age. In all age groups, NPT was significantly (P less than 0.01) lower in uremics than in normals or those with chronic illness. There was no correlation between erectile complaints, frequency of intercourse or NPT, and the presence or absence of depression. The frequency of intercourse correlated significantly (r = 0.68, P less than 0.01) with NPT in patients with uremia. Data indicate that 50% of male patients with uremia have partial or complete impotence, which is most probably organic in nature and is related to uremia or its metabolic or hormonal consequences rather than to the state of chronic illness.

Adolescent↗
PubMed1981

Anger, anxiety, guilt and increased basal and stress-induced neurogenic tone: causes or effects in primary hypertension?

1. Basal plasma and spinal fluid noradrenaline were increased in patients with primary hypertension and phaeochromocytoma compared with normotensive patients (P less than 0.01). 2. Patients with primary hypertension had more anger (P less than 0.01), anxiety (P less than 0.01) and guilt (P less than 0.05) than normotensive patients or patients with phaeochromocytoma. 3. The responses of noradrenaline and adrenaline concentrations were similar after mental and isometric stress in primary hypertensive and normotensive subjects. 4. However, after mental stress and isometric exercise there were increased responses of plasma noradrenaline and systolic blood pressure respectively, in patients with high anxiety and anger compared with those below the 50th percentile (P less than 0.05). 5. Increased central and peripheral neurogenic tone at rest and after stress in association with increased anxiety and suppressed anger appear to be pathogenic factors in some patients with primary hypertension and may not be a result of the blood pressure elevation.

Adrenal Gland Neoplasms↗
PubMed1980

Anorexia nervosa: a group case conference.

Four patients with primary anorexia nervosa were interviewed in order to demonstrate some of the characteristic features of this disorder. Although this disorder occurs only rarely in males, one of these four patients was a young man. Primary anorexia nervosa is discussed from a variety of perspectives, including descriptive, psychodynamic, and hormonal. A brief review of the theoretical rationale underlying a variety of psychotherapeutic approaches is offered, and reports of their effectiveness are considered. Primary anorexia nervosa is probably best conceptualized as a complicated disorder with an admixture of serious psychological and somatic components, including the characteristic approach-avoidance conflict over eating. The authors speculate on the possibility of an underlying disorder of central catecholamine metabolism, particularly in relationship to dopamine transmission.

Adolescent↗
PubMed1980

A comparison of psychosocial disability in males undergoing maintenance hemodialysis or following cadaver transplantation.

Sixteen males undergoing maintenance hemodialysis were evaluated for social disability through the use of the Ruesch Social Disability Rating Scale and were compared with a group of 16 cadaver renal transplant recipients, matched for age and marital status. All 16 had excellent functioning of their transplanted kidney. In both groups most patients experienced a major degree of social disability, indicating significant interference with life-style. Patients who were married had lower social disability scores (DS) than those who were divorced or single (P less than 0.01). Contrary to expectation, no differences were noted between these two groups with regard to the overall degree of social disability. The DS data are corroborated by other clinical indices, such as employment status, financial stability, degree of depression and sexual functioning, which indicated similar degrees of impairment in both groups. New approaches, aimed at the preservation and enhancement of social and avocational skills, are mandatory of a comprehensive effort seriously geared towards rehabilitation is to be implemented in the overall treatment of these patients. The expertise of the mental health professional, especially the liaison psychiatrist, is critical for this task.

Adult↗
PubMed1980

The role of expectation in treatment for psychotic patients.

Four patients, originally diagnosed as schizophrenic and treated as though they had no hope for recovery, were later reassessed and given more optimistic expectations. The ensuing positive treatment results underscore the danger of equating diagnosis with prognosis, the danger of inaccurate or premature diagnosis, and the danger of neglecting psychotherapy for such patients.

Adult↗