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BROWNING, JAMES S.; HOUSEWORTH, JOHN H.
doi: N/Apmid: N/A
The purpose of the present investigation was to test the hypothesis that removal of duodenal ulcer symptoms by medical or surgical treatment may result in the development of new symptoms. The experimental group consisted of 30 patients who had been treated for duodenal ulcer by means of gastrectomy, a procedure which abolished the ulcer symptoms completely in 57 per cent of these patients. The control group consisted of 30 patients with duodenal ulcer who had been treated by conservative medical measures, and in whom complete remission of ulcer symptoms did not occur. Both groups were subjected to a follow‐up study which consisted of: (1) A detailed interview by one of the investigators; (2) an interview by a psychiatric social worker with complete social case study; and (3) medical, laboratory, and x‐ray follow‐up examinations. An attempt was made to determine the incidence and severity of symptoms of all types that were present before and after treatment. The surgically treated group revealed a significant decrease in ulcer symptoms following gastrectomy, but this was compensated for by a significant parallel increase in other psychosomatic and psychoneurotic symptoms. The medically treated control group, in which ulcer symptoms were not significantly reduced in incidence or severity, revealed no such redistribution of symptoms following treatment. These findings support the hypothesis that successful removal of duodenal ulcer symptoms by gastrectomy, without resolution of the associated psychopathogenic conflicts may result in the development of new symptoms.
doi: N/Apmid: N/A
Twelve psychotic reactions are reported in 11 patients with various somatic illnesses treated with ACTH and/or cortisone. Two major patterns occurred: (a) A primarily affective disorder, either manic or depressive; and, more frequently, (b) an organic reaction (toxic psychosis) with associated paranoid‐hallucinatory and/or affective (usually depressive) components. No consistent correlation could be obtained with regard to drug dosage and onset, duration, or type of psychosis. Suicidal tendencies were present in several cases. After the ACTH or cortisone was discontinued, termination of the psychosis occurred spontaneously in the organic reactions. The affective disorders required electroconvulsive therapy. A comparison is made between these states and psychoses appearing in naturally occurring hyperadrenalism or Cushing's syndrome. The following factors involved in the production of these psychotic reactions are considered significant: The physiological effects of the hyperadrenal state on the central nervous system. The influence of the underlying disease process. The premorbid personality. Only in a few cases were recognizable psychotic trends present before treatment. It is felt that in most instances the previous personality pattern determined the psychological content of the psychosis, but not its onset. A complete understanding of the interrelationships of all of these physiological and psychological mechanisms is not possible at the present time.
DOUST, JOHN W. LOVETT; LEIGH, DENIS
doi: N/Apmid: N/A
Thirty selected patients suffering from undisputed attacks of bronchial asthma were investigated medically, by clinical examination and a number of pathological and radiological techniques, and psychiatrically by a series of interviews during the course of psychotherapy. Twenty‐five of these patients were also examined by a technique of spectroscopic oximetry, readings being taken frequently during the course of a psychiatric interview. Medically, it was found that a past history of pertussis or other severe chest infection had occurred in some 60 per cent of the patients, other "allergic" affections in 20 per cent, and a family history of such affections in 50 per cent. Psychiatrically, 75 per cent of the patients showed evidence of an affective disorder (depression) and 50 per cent of their near relatives also had some mental instability. Physiologically, oximetric measurements showed the basal, resting arterial oxygen saturation levels of the blood of asthmatic patients to lie in the low normal range of 94.5 per cent. Their efficiency scores similarly were low, approaching but not reaching those of other physically or neurotically ill patients. Evidence is presented which suggests the following conclusions regarding the nature and mechanisms underlying the asthma attack: (a) Pent‐up emotional tension is accompanied by anoxemia. This may be present as such or may be inhibited in suitably predisposed subjects by the homeostatic production of asthmatic dyspnea. (b) Simulated asthmatoid breathing actually increases arterial oxygen saturation levels. (c) The anoxemia accompanying emotional tension can be overcome by means of the motor expression of the emotion, i.e., by weeping, laughing, the acting out of anger, confession‐or by asthma, (d) A condition resembling neurogenic shock exists as an alternate of the asthma attack under conditions of intense emotion, (e) Depression and rage predominate as the affects associated with asthmogenic patients. Their evocation at psychiatric interview produces quantifiable intensities of anoxemia equivalent to those induced when significant interpersonal relationships are discussed, (f) Bronchial asthma may alternate with clinical depression when stress is brought to bear on predisposed subjects. The interrelationships between these findings and the known psychophysiology of bronchial asthma are discussed.
MAHL, GEORGE F.; KARPE, RICHARD
doi: N/Apmid: N/A
This paper illustrates a crude first approximation of what appears to be a fruitful method for investigating differential relationships between anxiety, oral‐dependency needs, and hostility and hydrochloric acid secretion during psychoanalytical and psychotherapeutic hours. In one patient studied systematically, hydrochloric acid secretion increased with anxiety regardless of its origin‐sexual, hostile, or passive‐dependent wishes, ideation, or motives. These results are compatible with those of studies on dogs, monkeys, and humans when more traditional experimental procedures are followed. The results are not compatible with an oral‐dependency hypothesis of peptic ulcer etiology. Possible improvements in the method are noted.
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