The Patient: Biological, Psychological, and Social Dimensions of Medical Practice.
Authors: Hoyle Leigh
Journal: Annals of Internal Medicine (1986)

I. On Becoming a Patient: Psychosocial Considerations.- 1. Illness and Help-Seeking Behavior.- Concepts and Definitions: Help-Seeking Behavior and Illness Behavior.- Factors Influencing Help-Seeking Behavior.- Factors Affecting Perception of a Symptom.- Demographic Factors.- The Role of Stress.- The Role of Previous Experience (Priming Factors).- Taxonomy of Medical Help-Seeking Behavior.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 2. The    Role Expectations.-  Role Performance by Patients.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 3. Expectations in the Consulting Room.- Relief from Distress.- Communication of Information.- Effect of Priming Factors on Expectations.- The Physician's Covert Expectations.- Society's Expectations about the Physician-The Doctor Role.- Technical Competence.- Universalism of the Medical  Functional Specificity.- Affective Neutrality.- The Physician's Collectivity Orientation.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- II. On Being a Patient: Psychophysiologic Considerations.- 4. Anxiety.- Phenomenology of Anxiety.- Theories of Anxiety and Emotions.- Learning Theory Model.- Psychoanalytic Signal Theory of Anxiety.- Physiology of Anxiety.- Brain Mechanisms of Anxiety.- Central Neurochemistry of Anxiety.- Function of Anxiety.- Disregulation of Anxiety.- Fainting.- Hyperventilation Syndrome.- Stress-Related Disorders.- Classification of Anxiety Disregulation Syndromes.- Evaluation of Anxiety.- Contexts of Anxiety.- Differential Diagnosis of Anxiety States.- Management of Anxiety.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 5. Psychological Defense Mechanisms.- Distress, Anxiety, and Defense Mechanisms.- Classification of Defense Mechanisms.- Defenses Listed According to Their Main Subsystem Effects.- Illustrations of Defense Mechanisms as They May Be Encountered in Medical Practice.- Defense Mechanisms That Manifest Their Main Effects in the Input Subsystem.- Defense Mechanisms That Manifest Their Main Effects in the Internal Processing Subsystem.- Defense Mechanisms That Manifest Their Main Effects in the Output (Action) Subsystem.- Defense Mechanisms Whose Main Effects Are More Evenly Distributed in All the Subsystems by Affecting the Decider or Executive Subsystem Itself.- Defense Mechanisms, Anxiety, Character, and Coping Styles.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 6. Depression.- Affect, Mood, and Depression.- Phenomenology of Depression and the Depressive and Manic Syndromes.- Separation, Bereavement, and Grief.- Phenomenology.- Course.- Pathological Grief Reactions.- Separation in Children.- Separation in Infant Monkeys.- Significance of Bereavement and Depression.- Function of Depression.- Brain Mechanisms of Depression.- Biogenic Amines.- Acetylcholine.- Other Putative Neurotransmitters and Neuromodulators.- Intracellular Sodium.- Psychological Aspects.- A Hypothetical Integrated Model.- Physiology and Endocrinology of Depression.- Neuroendocrinology.- Physiologic Signs of Depression (Depressive Syndrome).- Evaluation of Depression.- Physical Symptoms in Depressive Syndrome Associated with Major Affective Disorders.- Evaluation of Suicidal Potential.- Risk Factors.- Suicidal Attempt.- Evaluation of Suicidal Attempt.- Management of Depression.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 7. Pain.- Definitions and Functions of Pain.- Qualities of Pain.- Nature of Pain.- Neurophysiology of Pain.- Historical Neurophysiologic Theories of Pain Perception.- Descending Influences from the Brain.- Role of Endorphins in Pain Mechanism.- Central Neuropharmacology of Pain.- Psychosocial Factors Influencing Pain Experience.- Placebo Effect.- Use of Placebos in Medical Practice.- Psychological Meanings of Pain.- Psychogenic Pain.- Management of Pain.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 8. Sleep and Dreaming.- Stages of Sleep.- NREM Sleep.- REM Sleep.- Basic Rest-Activity Cycle.- Biological Rhythms.- Brain Mechanisms of Sleep.- Dreams.- Functions of Sleep and Dreaming.- Sleep Needs.- Environmental Factors Affecting Sleep.- Sleep Disorders.- Insomnia.- Hypersomnia.- Narcolepsy.- Somnambulism (Sleepwalking).- Enuresis (Bed-Wetting).- Night Terrors.- Nightmares.- Sleep Apnea.- Medical Conditions Affected by REM Sleep.- Hyperthyroidism and Hypothyroidism.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- III. On Assessing a Patient: A Clinical Systems Approach.- 9. Approach to Patients: The Systems-Contextual Framework and the Patient Evaluation Grid.- The Patient, His Components, and the Environment.- Disease, Illness, and Distress.- The Systems- Contextual Approach.- The Patient Evaluation Grid (PEG).- What Goes into the PEG.- The Significance of Contexts.- The Significance of Dimensions.- Rational Patient Management.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 10. The Current Context of Help-Seeking Behavior.- The Current Context in the Biological Dimension.- The Current Context in the Personal Dimension.- Outline of the Mental-Status Examination.- The Current Context in the Environmental Dimension.- Interaction among the Current Context Dimensions.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 11. The Recent Context of Help-Seeking Behavior.- The Recent Context in the Biological Dimension.- The Recent Context in the Personal Dimension.- The Recent Context in the Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 12. The Background Context of Help-Seeking Behavior.- The Background Context in the Biological Dimension.- The Background Context in the Personal Dimension.- Personality as a Factor in Pathogenesis of Disease.- The Background Context in the Environmental Dimension.- Intersystems Interaction in the Background Context-Development.- Freud.- Erikson.- Piaget.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- IV. On Managing a Patient.- 13. The Case of the Sick Tarzan: A Challenging Case History.- 14. The Doctor-Patient Relationship.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 15. The Patient's Personality.- Personality and Character.- The Concept of Personality Types in Patients.- Personality Types and the   Dependent, Demanding Patients.- Orderly, Controlling Patients.- Dramatizing, Emotional Patients.- Long-Suffering, Self-Sacrificing Patients.- Guarded, Suspicious Patients.- Superior and Special Patients.- Seclusive, Aloof (Schizoid) Patients.- Impulsive Patients with a Tendency to Act Out.- Patients with Mood Swings.- Patients with Chronic Memory Deficits and a Tendency to Confusion (Chronic Organic Brain Syndrome).- From Types to Individuals.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 16. The Hospitalized Patient.- The Hospital as a Social System.- Kinds of Hospitals.- The People in a Hospital.- The Organization of an Inpatient Unit.- The Hospital and Outside Organizations.- The Hospital Environment.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 17. Therapeutic Dimensions.- Approaches in the Biological Dimension.- Approaches in the Personal Dimension.- Psychotherapy in Medical Settings.- Formal Psychotherapy.- Approaches in the Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 18. Drugs Affecting Behavior.- Drugs Affect All Dimensions of the Patient.- Psychotropic Drugs.- Antianxiety Drugs (Minor Tranquilizers).- Drugs Affecting Mood.- Antipsychotic Drugs (Major Tranquilizers, Neuroleptics).- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and Health Care System.- Recommended Reading.- References.- 19. Some Illustrative Patients.- The Management of the  Tarzan.- Biological Dimension.- Personal Dimension.- Environmental- Interpersonal Dimension.- The Case of the Catatonic Patient with Enlarged Ventricles.- History and Course.- Comments.- The Case of the Suicidal Terminal Cancer Patient.- History.- Evaluation.- Course of Management.- Comments.- 20. Summary and Perspectives.