Attitudes of psychiatrists toward elderly patients.

A group of 179 psychiatrists responded to a questionnaire requesting their opinions concerning four clinical vignettes. Analysis of their responses indicated that these psychiatrists, at a highly statistically significant level, regarded older patients as less ideal for their practices than younger patients with identical symptoms. The respondents viewed the older patients as having a poorer prognosis, and their treatment plans for them were less likely to emphasize psychotherapy. In general, there was a negative correlation between the age of the respondent psychiatrists and their estimate of the "idealness" of and favorable prognosis for older patients.

A psychiatric study of patients referred with a diagnosis of hypoglycemia.

Five-hour oral glucose tolerance tests (GTTs) differentiated 30 volunteer patients who considered themselves hypoglycemic into three major groups: those who had reactive hypoglycemia, those who were normal, and those who had diabetes. Clinical psychiatric evaluation and Minnesota Multiphasic Personality Inventory testing revealed that half of the 30 patients were experiencing a current psychiatric disorder, usually depression. Hysterical personality traits were also noted in many of the patients. The idea that reactive hypoglycemic patients have specific personality characteristics was not substantiated by the authors' data. They hypothesize that some patients with psychiatric illness may have their symptoms erroneously attributed to incidental GTT findings.

Lies and liars: psychiatric aspects of prevarication.

The authors discuss the phenomenon of lying, a common psychic process that has received remarkably little scrutiny. The ubiquity of lying and others forms of deception suggests that they have "normal" aspects, but lying which is persistent or destructive to the quality of a person's life becomes pathological. Lying has many determinants, including developmental, biological, social, and psychodynamic. Antisocial, histrionic, narcissistic, borderline, and compulsive personalities have been associated with lying. The treatment of lying needs to be individualized according to the overall symptom complex in which it is embedded.

Psychiatric aspects of dwarfism.

Sixteen adult dwarfs - 11 with achondroplasia and 5 with hypopituitarism - were studied by means of psychiatric interviews and psychological tests. There were no significant differences between the two groups; in general, the subjects had achieved a satisfactory life adjustment despite the stress of having bodies uniquely different from those of the general population. They had secure identities as "little people" and successfully used coping mechanisms such as a sense of humor and a pleasant interpersonal style. Male dwarfs tended to experience more emotional distress than female dwarfs.

A curriculum for education in geriatric psychiatry.

The authors present recommendations for educating medical students and psychiatric residents in geropsychiatry. They are primarily concerned with the objectives and methods rather than the content of training. Proposals are structured in terms of training objectives and educational settings in which such training takes place. The proposals are intended to be specific enough to be truly useful and at the same time sufficiently generalizable to adapt to geropsychiatric training in a variety of institutions. Priority is given to integrating knowledge of normal and abnormal aging with the clinical skills and empathy necessary to approach patients with competence and understanding.

Characteristics of general hospital patients referred for psychiatric consultation.

An analysis of 151 psychiatric consultations at a large publicly supported teaching hospital indicated that referral rates were greater from the medical services as compared with the surgical services. Minorities, elderly, and widowed persons were underrepresented. Depression and organic brain syndromes were the most common diagnoses and the presence of an organic brain syndrome had been frequently missed by the referring physician.

Anxiety and mitral valve prolapse syndrome.

The diagnosis of Mitral Valve Prolapse Syndrome (MVPS), even though symptomatically similar to anxiety neurosis, may prompt pharmacological treatment only, neglecting any underlying emotional problems. If only a dichotomy were considered, one diagnosis might be seen as mutually exclusive of the other. A case history is presented illustrating features of both clinical syndromes. We consider the interaction of both etiologies, as well as the possibility of both being unrelated and coincidental. As physiological factors are explored when the diagnosis of anxiety neurosis is considered, so should psychological factors be examined with MVPS.

Bipolar affective disorder in aged patients.

Bipolar affective illness may be a relatively common missed diagnosis in the elderly. Inaccurate historical data, atypical course of illness and atypical clinical presentation are all sources of diagnostic error. Lithium and tricyclic antidepressants are effective agents in this age group but require close monitoring, with particular attention to their interaction with illness and other medications. A high index of suspicion for bipolar illness is suggested when elderly patients present with depression.

Hospital treatment of elderly neuropsychiatric patients. II. Statistical profile of the first 122 patients in a new teaching ward.

Data are presented on the first 122 patients admitted to a geropsychiatric teaching ward in a university hospital. A high incidence of medical problems are reflected by abnormal laboratory findings complicated the management of these patients, most of whom had dementia or depression. In all diagnostic categories, the patients appeared to benefit from the intensive inpatient treatment. Difficulties in the areas of diagnosis, treatment, length of hospital stay, discharge placement and program evaluation are discussed.

Hospital treatment of elderly neuropsychiatric patients. I. Initial clinical and administrative experience with a new teaching ward.

Program planning and the initial experience of a new teaching ward for geriatric psychiatry are described. Elderly psychiatric patients, with diagnoses predominantly of depression and dementia, demonstrate more self-centeredness and less group awareness than do younger patients. Ward staff members often experience frustration, sadness and anger in response to working with them. Major problems unique to a geriatric psychiatry service include the paucity of adequate resources for post-discharge care and the necessity to obtain excellent medical-surgical consultation and support.

Alexithymia in somatizing patients.

Aexithymia is a clinical concept referring to the difficulty some people have in verbalizing their feeling states. It is prevalent in patients suffering from a variety of psychosomatic illnesses. The authors conduced a controlled study to investigate the presence of this trait among patients attending a psychosomatic clinic and those attending a traditional outpatient psychiatric clinic in a county general hospital. The results indicate that, in this lower socioeconomic population, alexithymia is equally present in both clinics. The discrepancy between these results and those previously reported are discussed, as are the ramifications of the findings.

Phobic symptoms in an elderly woman: a multidisciplinary case conference.

A 67-year-old woman, previously self-sufficient, became housebound by phobic symptoms. During the patient's hospitalization for treatment of these disabling symptoms, a multidisciplinary case conference served to identify the underlying psychodynamic issues, which were related to separation anxiety. Treatment included helping the patient understand her relationships with her daughter and her own mother, and behavior modification to reduce the secondary gains of her symptoms. After treatment, the patient successfully returned to self-care.

Dimensions of somatization and hypochondriasis.

A significantly large group of patients who communicate their psychosocial distress in the form of physical symptoms are called somatizers. They tend to overuse medical services. The syndromes with which they present have indistinct boundaries, and there tends to be some fluidity of their symptomatic presentations. Underlying psychiatric disorders such as mood disorders, anxiety disorders (including obsessive compulsive disorder), and personality disorders are frequently present.

Illness as a lifestyle. The role of somatization in medical practice.

Persons with psychological problems who translate their distress into somatic symptoms (somatize) are frequent users of medical care. These patients often have underlying depression, anxiety, obsessive--compulsive symptoms, or personality disorders. Descriptions of the somatizing syndromes are provided in association with recommendations as how to recognize and manage the patient with somatization.

Somatization and fashionable diagnoses: illness as a way of life.

The history of "nondisease" dates back, at least 4000 years, to early descriptions of hysteria. More recently somatization became a part of the official diagnostic nomenclature by creation of the DSM III category, "somatoform disorders." Somatization can serve as a rationalization for psychosocial problems or as a coping mechanism, and for some illness, becomes a way of life. One variation of somatization can be the "fashionable diagnosis", for example, fibromyalgia, multiple chemical sensitivities, dysautonomia, and, in the past, "reactive hypoglycemia". These disorders are phenomenologically related to environmental or occupational syndromes and mass psychogenic illness. Fashionable illnesses are characterized by (i) vague, subjective multisystem complaints, (ii) a lack of objective laboratory findings, (iii) quasi-scientific explanations, (iv) overlap from one fashionable diagnosis to another, (v) symptoms consistent with depression or anxiety or both, (vi) denial of psychosocial distress or attribution of it to the illness. Fashionable diagnoses represent a heterogeneous collection of physical diseases, somatization, and anxiety or depression. They are final common symptomatic pathways for a variety of influences including environmental factors, intrapersonal distress and solutions to social problems. A fashionable diagnosis allows psychosocial distress to be comfortably hidden from both the patient and the physician, but premature labeling can also mask significant physical disease. Hysteria remains alive and well and one contemporary hiding place is fashionable illness.

Factitious disorders.

Reports of factitious disorders, Munchausen's syndrome, and self-induced illness exist throughout medical history. In practice, disease simulation represents a spectrum of behaviors that range from relatively common and benign (e.g., pleading illness to avoid an unwanted social obligation) to rare and malignant forms (e.g., Munchausen's syndrome and factitious disorder by proxy). Factitious disorders are differentiated from malingering by the goal that motivates the individual's behavior. The only apparent goal in factitious illness is to gain the sick role; the goal in malingering is to gain rewards, such as compensation, or to avoid the unwanted, such as military service or jail. This article summarizes clinically relevant information on factitious disorders for primary care physicians.