Persistent Nausea without organic cause.

The onset of functional nausea among 77 patients was frequently related to an organic disease or to a psychophysiologic response to stress. Later, the nausea had obvious features of conversion, hypochondriasis, or an hallucination. The patients had significant psychiatric disorders as assessed by the Minnesota Multiphasic Personality Inventory (MMPI) and by clinical examination. While in the hospital most patients experienced symptomatic improvement but they did not accept a psychologic explanation for their nausea.

Regulation of electrolyte transport by nitric oxide in the mouse cecum.

The effect and role of nitric oxide (NO) in the regulation of ion transport in the mouse cecum were investigated. L-arginine, used to increase NO production, increased short-circuit current (Isc), a measure of ion transport, in a concentration-dependent manner with a maximal increase of 193.8+/-65.5 microA/cm2. This increase was not changed in Cl-- or HCO3--free buffers, but was significantly decreased in Na+-free buffer. Using immunohistochemistry, the constitutive form of nitric oxide synthase was found not to be different in the inflamed cecum. The inducible form of the enzyme, however, which was absent in the cecum of normal mice, was present in high levels in the cecum of the colitic mouse. These results suggest that NO causes an increase in Na+ absorption. The increased levels of inducible NO synthase in the inflamed cecum suggest a role for NO in the pathophysiology of inflammatory bowel disease.

Unresolved bereavement: medical reenactment of a loved one's terminal illness.

In our psychiatric practice in Seattle, we have found several cases of complicated bereavement in which the patient has been unable to accept the death of her mother for an unusually long time and, consequently, continues to complain of physical symptoms similar to those of her mother. These patients initially sought medical care from primary care physicians, who tried to treat the symptoms without considering the cause. In some instances, needless medical and even surgical procedures were pursued to no avail. We believe that such patients usually require only referral for psychiatric care, which unfortunately often is palliative but not curative.

Short-term group psychotherapy. A successful approach to functional complaints.

The term "functional illness" describes a large group of patients who have psychologically determined physical symptoms for which they repeatedly seek medical treatment to little or no avail. At the Mason Clinic, Seattle, we in the section of behavioral medicine have devised a psychotherapeutic format for treating these chronically disabled patients. With short-term intensive group psychotherapy, patients with functional complaints are removed from the discouraging isolation of their home environment for three or four weeks, yet are spared the expense and stigma of psychiatric hospitalization. Group support is coupled with intensive self-inquiry in daily psychodynamic treatment. This immersion in a variety of therapeutic modalities helps foster new adaptations to past and present psychological conflicts. In addition to symptomatic relief, some degree of constructive and enduring personality change takes place.