The concept of denial is important for the psychosomatic understanding of cardiovascular disease and treatment. This study evaluated denial using several psychometric assessment scales in patients referred for psychiatric evaluations prior to heart transplantation. Surviving patients who had a mean survival of more than 38 months had less denial than nonsurviving patients who had a mean survival of 4 months. These findings are very preliminary, but interesting, and would encourage further investigation of denial in these patients. Denial is a complex psychological variable, only part of which may be applicable to surgery patients.

To assess the efficiency of a medical-psychiatric unit over 3 years, several studies were carried out on one combined psychiatry-medicine unit. On the Behavior Evaluation and Treatment Unit of the Medical College of Wisconsin, Division of General Hospital Psychiatry, average length of stay was calculated in successive cohorts of 28-31 consecutive patients (total 358 patients). Medical-surgical and psychiatric diagnoses were compared over a 2 1/2-year span; psychiatry diagnoses were compared to those on other units; and acuity of illness was measured comparatively by various methods. Length of stay decreased from more than 20 to less than 15 days. This effect did not appear to be directly related to diagnostic changes. Only minor increases in range of psychiatric diagnostic categories and changes in proportion of certain disorders were found. The acuity level was descriptively intermediate between that of a general medicine and that of a general psychiatry unit. Factors that could be related historically to these findings were discussed.

The clinical clerkship has been suggested as a significant factor in a medical student’s decision to enter psychiatry. Sixty-seven junior students were surveyed with regards to career interest in psychiatry, attitudes toward psychiatry, formal psychiatric knowledge and self-rated psychiatric skills preand post-rotation. The overall influence of the psychiatric clerkship on career interest appears limited. Interest in a psychiatric career correlated with interest in psychiatric knowledge, attitudes concerning curability of patients, comfort with psychiatric patients and the view of psychiatry as a scientific specialty. Students who reported a significant change in career interest could not be identified by any of the measured variables. The findings are discussed in relation to prior studies dealing with the influence of the clerkship on students’ career choice.

This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.

High rates of tranquilizer use in coronary disease have been previously reported. In patients being evaluated for coronary disease, tranquilizer use has been related to myocardial infarction, angina pectoris, neurotic traits, employment and the use of cardioactive and other medications. In this study, responses of 1046 male patients to a questionnaire assessing biological, psychological and social variables before and after coronary bypass surgery were related to tranquilizer use. The effect of CABG was to decrease tranquilizer use. Tranquilizer use prior to coronary bypass operations was related to neuroticism, myocardial infarction and taking cardiac and analgesic medication. Similar findings were noted after coronary bypass operations except that angina pectoris was added as a contributor to tranquilizer use. The multivariate analysis tended to confirm the univariate findings, except that neurotic traits did not make an independent contribution. These results indicate that in patients undergoing coronary evaluations, cardiac disease variables other than coronary atherosclerosis determine tranquilizer use. Neurotic traits play a secondary role. Relief of angina pectoris appears to be particularly important in reducing tranquilizer use. The finding of angina pectoris after coronary bypass operation may have special significance for the continuation of tranquilizer use.

Responses from 45 volunteers to the Milwaukee Neurotic Trait Scale (NT) and to the Hopkins Symptom Check List (SCL-90R) were compared. The NT scale was significantly correlated with the subscales of the SCL-90R. Second, agreement for high, middle, and low scores was found between the NT Scale and the SCL-90R Global Severity Index and Positive Symptom Total. These limited findings, based on a small sample of students, are promising and warrant replication with different and larger groups of adults.

At coronary arteriography, a large proportion of patients (10–30%) have normal or minimal coronary artery disease1. These trends continue despite the highly technical approaches to the diagnosis of coronary artery disease2. Previous studies have demonstrated that a disproportionate number, although not all, of these patients have psychologic or social disturbance3,4. However, psychopathology is not always useful to separate patients without coronary disease from those with coronary disease because a significant proportion of patients with atypical pain have coronary disease without psychological or social disturbance. Conversely, typical anginal patients with moderate to severe coronary disease can have increased psychosocial disturbance.

The Behavior Evaluation and Treatment Unit of the Medical College of Wisconsin provides continuous care of patients with combined behavioral and physical problems. These patients differ from those seen in our consultation service by having higher rates of psychosis, approaching that of traditional psychiatric inpatient programs. The medical and surgical illnesses treated on this unit are not trival, are often found to aggravate the psychiatric problems, and are sometimes considered causative. The work-up and treatment of such patients can potentially be performed without major increases in length of stay. Inpatient programs for combined disorders hold the promise of enhancing quality and alternatives of care for a sizable group of patients.

This study was undertaken to clarify the relationship between coronary artery occlusion (CAO) and coronary-prone behavior attitudes (CPBA) in a large coronary arteriography population. A group of 2451 male patients responded to a questionnaire prior to coronary arteriography. Ten questions from the questionnaire, selected to form a scale measuring CPBA, were found to be reliably associated with standard measures of Type A behavior. No differences in CPBA were found when the group was divided into mild, moderate, and severe CAO, but angina pectoris (AP) tended to increase from mild to severe CAO. Multiple regression analysis confirmed that CPBA were independently associated with AP but were not associated with CAO. These findings suggest that angina pectoris is an important intervening variable between CPBA and CAO and that the relationship of AP in a population should be carefully considered before conclusions are drawn as to the relationship between CPBA and CAO.

The recognition of an association between coronary heart disease (CHD) and coronary prone behavior (CPB) has raised the question of whether behavior may directly affect coronary atherosclerosis. The relationship of coronary occlusion measured by arteriography and angina pectoris to questionnaire responses selected as consistent with the attitudes and behavior of CPB were examined retrospectively in 2215 employed male patients.

Journal Article Alcohol State Dependent Effects in Humans: A REVIEW AND STUDY OF DIFFERENT TASK RESPONSES Get access LAURENS D. YOUNG, MD LAURENS D. YOUNG, MD Department of Psychiatry and Mental Health Science Medical College of WisconsinWauwatosa, WI 53226 Chief of Psychosomatic Service, Wood V A HospitalWood, WI 53193, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Alcohol and Alcoholism, Volume 14, Issue 2, Summer 1979, Pages 100–105, https://doi.org/10.1093/oxfordjournals.alcalc.a044145 Published: 01 July 1979