Trimipramine in physical illness with depression

To assess whether tricyclic antidepressants are useful in patients with a serious physical disorder who develop symptoms of major depression, 42 medically ill outpatients who met RDC criteria for endogenous major depression and had a Raskin depression score of at least 7 were studied. The patients were randomly assigned to a 6-week trial of trimipramine or placebo under double-blind conditions. In the placebo group, depressive symptoms improved when the physical disorder improved; in the trimipramine group, improvement was seen in the depressive symptoms even when there was no concomitant improvement in physical condition.

The effect of illness behaviour on the apparent relationship between physical and mental disorders

Evidence for associations between organic disease and psychopathology is reviewed and it is concluded that some of this is determined by complaint and consultation behaviours. The concept of illness behaviour is described. The Self Care Assessment Schedule (SCAS) is a new measure of illness behaviour and has been used to provide an independent assessment of psychiatric day patients, gynaecology and surgical outpatients. Only weak positive correlations were found between SCAS scores and mental illness, measured using the General Health Questionnaire (GHQ). Subjects with organic pathology differed little from those without organic pathology, with regard to SCAS and GHQ scores. However SCAS and GHQ scores were more highly correlated in those without organic pathology. It is concluded that claimed associations between physical disease and psychopathology should be based on objective evidence rather than subjective complaints and that this should be found across the entire spectrum of illness behaviour.

Medical care in a geriatric psychiatry unit: impact on psychiatric outcome

The medical care of 49 randomly selected patients admitted to a geriatric psychiatry evaluation unit was assessed to determine the impact on psychiatric care and outcome. Medical factors were identified as directly causing psychiatric symptoms in 12 of the 49 cases, whereas psychiatric decompensation was precipitated by medical illness in 25. Previously undiagnosed significant medical problems were found in ten patients. In 25 cases concomitant medical illness had a major effect on psychiatric treatment, and in 23 the course of the medical illness affected psychiatric outcome. Seventy-nine per cent of the patients had at least moderately improved at the time of discharge, and most were able to return to their homes. Improvement in medical condition was correlated significantly with psychiatric improvement. Implications for the care of geriatric psychiatry patients are discussed.

Medical illness in psychiatric patients: barriers to diagnosis and treatment

We report a study of 102 consecutive admissions to the acute medical care unit of a large psychiatric hospital. The study was designed to investigate the epidemiology and the barriers to diagnosis and treatment of medical illness among female psychiatric inpatients. The majority of the patients were transferred to the unit because of nonspecific changes in physical condition or for behavioral differences. More than 70% of the patients were unable to communicate adequately with the physician. Ninety-two percent of the sample were found to have at least one with an average of three previously undiagnosed physical diseases not predicted by their symptoms on referral. We advocate a high index of suspicion of physical disease in the psychiatric population, and recommend an aggressive multidisciplinary diagnostic and therapeutic approach.

Relationship of depression to medical illness. A critical review

The relationship between medical illness and depression is critically reviewed. Evidence for an association exists but is based on relatively few studies of adequate research design. Data suggest the period prevalence of depressive syndrome in medically ill patients is around 18% for the severely medically ill. An etiologic relationship has not established. The incidence of diseases in the medical subspecialities of endocrinology, neurology, cardiology, gastroenterology, and rheumatology appears to be increased in patients with depression. A causal relationship has been suggested in the first four.

[Somatic disorders and depressive states]

Somatic disorders in depression can be separated into two main categories. The first comprises those which are true side effets of drug-therapy; the other includes somatic symptoms of the depression itself, which are subsequently considered as apparent side effects. Under the same treatment true side effects occur much more frequently in psychogenic depression, especially if the patient has a personality disorder. During the course of the treatment the disappearance of somatic complaints is noticed more easily by the physicians than the appearance of true side effects (schulterbrandt). The relative frequency of symptoms of depression as compared with all other symptoms seems to be higher in manic-depressive psychoses than in other varieties of depression (Watts). The other somatic disorders might either be symptoms of organic illness with secondary depression, the psycho-somatic equivalents of depression, or finaly the only symptoms of a masked depression.

[Spontaneous hemobilia in the differential diagnosis of upper gastrointestinal hemorrhages]

Hemobilia, biliary tree hemorrhage, is characterized by melana and/or haematemesis, biliary colic and clinical jaundice. The rare cause of gastrointestinal bleeding probably accounts for quite a large percentage of gastrointestinal hemorrhages of undetermined source. In the evaluation of gastrointestinal bleeding the hepato-biliary system is seldom examined unless trauma has occurred. However, 10-15% of cases with hemobilia are non-traumatic. Three cases are presented illustrating three different causes of non-traumatic hemobilia observed during the last three years. The diagnostic problems and the therapeutic possibilities are described.

Studies in a newborn infant with supraventricular tachycardia and Wolff-Parkinson-White syndrome

A neonatal patient with Wolff-Parkinson-White type A and supraventricular tachycardia is described. Demonstration of the mechanism of the tachycardia and its termination were achieved using intracardiac electrography and cardiac pacing. Quantitative left ventricular angiography and echocardiography showed impaired left ventricular function following the arrhythmia. Serial echocardiograms demonstrated the subsequent return to normal left ventricular performance.