Psychiatric Medicine
Authors: NED H. CASSEM
Journal: Annals of Internal Medicine (1980)

The Literature of Medicine1 March 1980Psychiatric MedicineAn Annotated Bibliography of Recent LiteratureNED H. CASSEM, M.D., GEORGE B. MURRAY, M.D., JERROLD F. ROSENBAUM, M.D.NED H. CASSEM, M.D.Search for more papers by this author, GEORGE B. MURRAY, M.D.Search for more papers by this author, JERROLD F. ROSENBAUM, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-92-3-444 SectionsAbout ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail General Alcoholism Depression Cardiovascular Disease Drug Abuse Eating Disorders Endocrinology Factitious Illness Gastroenterology Genitourinary Disorders Infectious Disease Immunology Life Stress Neuropsychiatry Oncology Nephrology Pain Health of Physicians Psychopharmacology Pulmonary Sleep Other Sources1. BARSKY A. Patients who amplify bodily sensations Ann Intern Med. 1979;91:63-70. Patients amplify symptoms as a result of various psychological and sociocultural forces. Suggestions are made for better management of such patients. LinkGoogle Scholar2. ENGEL G. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-36. The author argues that the dominant model of disease today is biomedical and leaves little room for social, psychological, and behavioral dimensions of illness. He proposes a biopsychosocial model that would include these dimensions. CrossrefMedlineGoogle Scholar3. FANNSUSSEX WJ. Late effects of early dependency need deprivation: the meal ticket syndrome. Br J Psychiatry. 1976;128:262-8. A psychiatric condition disabling persons in the fifth and sixth decades is described. This group is characterized by inability to continue gainful employment and differs significantly from psychotic applicants only in commencement of full-time employment before age 16 years and level of education. Apparently, being thrust earlier than their peers into the responsibilities of adulthood contributed to the disability. CrossrefMedlineGoogle Scholar4. GELENBERG A. The catatonic syndrome. Lancet. 1976;1:1339-41. Catatonia is often automatically assumed to be a subtype of schizophrenia. This paper proposes that it be considered a syndrome with various possible causes and advises physicians to be aware of potentially serious organic illness that may underlie the syndrome. CrossrefMedlineGoogle Scholar5. GROVES J. Taking care of the hateful patient. N Engl J Med. 1978;298:883-7. Now classic paper with helpful advice to physicians on dealing with dependent clingers, entitled demanders, manipulative help rejectors, and self-destructive deniers. All these patients evoke negative feelings in the physicians who care for them. CrossrefMedlineGoogle Scholar6. HALLPOPKINDEVAULFAILLACESTICKNEY RMRLS. Physical illness presenting as psychiatric disease. Arch Gen Psychiatry. 1978;35:1315-20. Full evaluation of 658 consecutive psychiatric outpatients showed an incidence of medical disorders productive of psychiatric symptoms in 9.1% of cases. The most frequent presentations were of depression, confusion, anxiety, and speech or memory disorders. Visual hallucinations were believed to indicate medical cause until proved otherwise. Major illnesses presenting psychiatric symptoms, in order of frequency, were infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic, and central nervous system diseases. CrossrefMedlineGoogle Scholar7. HILL O. The psychological management of psychosomatic diseases. Br J Psychiatry. 1977;131:113-26. Thorough, practical review of psychologic factors helpful in treating physical diseases with concise reviews of functional somatic disorders: hyperventilation syndrome, asthma, epilepsy, ulcerative colitis, peptic ulcer, anorexia nervosa, obesity, hypertension, and ischemic heart disease. CrossrefMedlineGoogle Scholar8. KENYON F. Hypochondriacal states. Br J Psychiatry. 1976;129:1-14. Clear, concise review of hypochondriasis focusing on differential diagnosis. An estimated 85% of such patients have some other primary condition, particularly psychiatric illnesses, responsible for their hypochondriacal traits. Treatment and prognosis are discussed. CrossrefMedlineGoogle Scholar9. KORANVAN NATTASTEPHENSPASCUALY LJJR. Patients' reactions to psychiatric consultation. JAMA. 1979;241:1603-5. Sixty patients undergoing psychiatric consultation at a general hospital were interviewed 24 h later. Nearly two thirds believed the consultation was beneficial, patients with long-term illnesses more often having positive attitudes than those with short-term illnesses. Those initially hostile or ambivalent usually had positive attitudes 24 h later. Patients' positive attitudes were attributed largely to preparation for psychiatric consultation by referring physicians. CrossrefMedlineGoogle Scholar10. KRAUTHAMMERKLERMAN CG. Secondary mania: manic syndromes associated with antecedent physical illness or drugs. Arch Gen Psychiatry. 1978;35:1333-9. Although mania usually occurs as a phase of manic depressive disease, it can occur in association with organic dysfunction in patients with no history of affective disorder. Literature is reviewed that describes mania occurring secondary to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. CrossrefMedlineGoogle Scholar11. LUTZ E. Restless legs, anxiety and caffeinism. J Clin Psychiatry. 1978;39:693-8. A clinical study of 62 patients with restless leg syndrome and associated anxious-depressed and other clinical states seems to indicate that caffeine is the major etiologic factor. MedlineGoogle Scholar12. MANSCHRECKPETRI TM. The paranoid syndrome. Lancet. 1978;2:251-3. Paranoid characteristics often prompt the diagnosis of schizophrenia. These investigators advise the cautious diagnostic approach with increased awareness of the many and potentially serious illnesses that may present with paranoid features. CrossrefMedlineGoogle Scholar13. REICHKELLY PM. Suicide attempts by hospitalized medical and surgical patients. N Engl J Med. 1976;294:298-301. All suicide attempts in Peter Bent Brigham Hospital were surveyed for 7 years: 17 attempts occurred; none fatal. Only four patients were seriously ill, two with neoplasia. All attempts were impulsive and associated with stress and disturbance of impulse control, with anger, not depression, seen most often before the attempt. In all cases precipitating stress was the felt loss of emotional support from staff. However, patients' vulnerability to suicide seems to be the key determinant. Fifteen patients had mental disorders. CrossrefMedlineGoogle Scholar14. SCHLAUCHREICHKELLY RPM. Leaving the hospital against medical advice. N Engl J Med. 1979;300:22-4. Survey at Peter Bent Brigham Hospital for January 1974 and 1975 showed 0.8% of patients leaving against advice (171). A disproportionate number were poor, single, and black; most were anxious or agitated, or both; leaving was often related to addiction to alcohol or drugs or both and tended to be repetitive behavior. Forty-seven left under unsafe circumstances; psychiatric consultation was requested in 27 cases. CrossrefMedlineGoogle Scholar15. THOMAS C. Precursors of premature disease and death: the predictive potential of habits and family. Ann Intern Med. 1976;85:653-8. Johns Hopkins Precursor Study of a cohort of medical students in 17 successive classes compares family habits and attitudes of medical students who later developed or died from one of five disease states compared to healthy classmate controls. The disorder group had significantly more nervous tension, anxiety and anger under stress, insomnia; smoked more cigarettes; and drank more alcohol. LinkGoogle Scholar16. CLARRENSMITH SD. The fetal alcohol syndrome. N Engl J Med. 1978;298:1063-7. Maternal abuse of ethanol during gestation produces a readily identifiable dysmorphic condition and appears to be the most frequent known teratogenic cause of mental deficiency in the western world. CrossrefMedlineGoogle Scholar17. EDWARDSORFORDEGERT GJS. Alcoholism: a controlled trial of 'treatment' and advice. J Stud Alcohol. 1977;38:1004-31. Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the groups. Careful Maudsley study highlights questions of economics and patient responsibility and takes a closer look at treatments less intensive than previously thought necessary. CrossrefMedlineGoogle Scholar18. STINSONSMITHAMIDJAYAKAPLAN DWIJ. Systems of care and treatment outcomes for alcoholic patients. Arch Gen Psychiatry. 1979;36:535-9. Four hundred sixty-six diagnosed alcoholics were randomly assigned to either an intensive in-hospital care program with high staff/high inpatient ratio or to a peer-oriented in-hospital program with low staff density. The peer-oriented in-care system was superior to the intensive incare treatment approach in outcome criteria measured 3, 6, 12, and 18 months after admission. CrossrefMedlineGoogle Scholar19. KETAI R. Family practitioners' knowledge about treatment of depressive illness. JAMA. 1976;235:2600-03. Failure of patients with endogenous depression to respond to antidepressant chemotherapy may result from prescribing inadequate doses for too short a period, and relapse may be attributed to an insufficient maintenance period after remission. CrossrefMedlineGoogle Scholar20. MAAS J. Clinical and biochemical heterogeneity of depressive disorders. Ann Intern Med. 1978;88:556-63. Concise, graphic review of biochemical and pharmacologic evidence in depressive illness of at least two subtypes, one a norepinephrine-deficient and the other a serotonin-deficient state. LinkGoogle Scholar21. WEISSMAN M. The myth of involutional melancholia. JAMA. 1979;242:742-44. Depressions in the menopausal years do not fit the diagnostic descriptions of the American Psychiatric Association's Diagnostic and Statistical Manual, edition II. Such patients do not have a distinct symptom pattern, an absence of previous episodes, or an absence of life stress precipitants. Evidence indicates that postmenopausal depression is no different from any other kind and supports the decision to exclude involutional melancholia, as currently defined, from a third edition of the Manual. CrossrefMedlineGoogle Scholar22. AVERYWINOKUR DG. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry. 1976;33:1029-37. Treatments of 519 depressed patients hospitalized in 1959-1969 were compared in a 3-year follow-up study. The electroconvulsive therapy-treated group had a significantly lower mortality than the inadequate antidepressant treatment group (P < 0.05) and the group that received neither treatment (P < 0.025). Nonsuicidal deaths (P < 0.005), particularly myocardial infarctions (P < 0.01), were significantly more frequent in the inadequately treated group than in the adequately treated group. The superiority of adequate treatment was particularly striking among older persons, especially men. CrossrefMedlineGoogle Scholar23. BLANCHARDMILLER ES. Psychological treatment of cardiovascular disease. Arch Gen Psychiatry. 1977;34:1402-13. Review focusing on hypertension, cardiac arrhythmias, coronary artery disease, and peripheral circulatory disease treated with such modalities as biofeedback and relaxation training. Preliminary data indicate sufficient success to warrant more systematic and controlled investigations in these areas. CrossrefMedlineGoogle Scholar24. BROUGHTONBARON RR. Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction. Electroencephalogr Clin Neurophysiol. 1978;45:348-60. Twelve patients (mean age 49.5 years) underwent EEG recordings in the intensive care unit and subsequently on the ward after an acute myocardial infarction. Significant differences from control patients in nocturnal sleep patterns included greater wakefulness, low percentage of rapid-eye-movement sleep, long rapid-eye-movement latency, fewer rapid-eye-movement periods, more awakenings, more stage shifts, and decreased sleep efficiency. The altered sleep patterns appeared mainly attributable to infarction itself. CrossrefMedlineGoogle Scholar25. DIMSDALEHACKETTHUTTERBLOCKCATANZANO JTAPD. Type A personality and extent of coronary atherosclerosis. Am J Cardiol. 1978;42:583-6. In a study of 109 patients undergoing selective coronary angiography, type A personality did not appear to correlate with the extent of coronary artery disease. This is the only study to date With negative results. CrossrefMedlineGoogle Scholar26. DOHNOPASKEWITZLYNCHGIMBELTHOMAS SDJKS. Some aspects of sleep disturbance in coronary patients. Percept Mot Skills. 1979;48:199-205. Forty-two coronary patients were studied during 10 h of polygraphrecorded sleep, 28 in an open-ward coronary care unit and 14 on a semiprivate telemetry unit. Sleep disturbances were not a function of type of unit, length of hospitalization, sex, or medications. Sleep was significantly less fragmented in less severely ill patients. These results indicate that sleep disturbances occur routinely in the coronary care environments, even without disturbing environmental stimuli. CrossrefMedlineGoogle Scholar27. ENGEL G. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med. 1978;89:403-12. Risk for conduction disturbances, dangerous arrhythmias, and sudden death is increased under conditions of emotional arousal and psychic uncertainty. LinkGoogle Scholar28. FRANKHELLERKORNFELDSPORNWEISS KSDAM. Type A behavior pattern in coronary angiographic finding. JAMA. 1978;240:761-3. In 147 consecutive patients undergoing coronary angiography significant correlations were found between disease severity and the physical risk factors, cholesterol, smoking, hypertension, sex, and age, and behavior pattern. The association of behavior pattern was as great as that of the other risk factors except cholesterol, which was greater, and persisted after adjustments had been made for the effects of the physical risk factors. CrossrefMedlineGoogle Scholar29. JENKINS C. Recent evidence supporting psychologic and social risk factors for coronary disease. N Engl J Med. 1976;294:987-94, 1033-8. Comprehensive review of psychosocial risk factors for coronary heart disease covering sociologic indexes, social mobility and status incongruity, anxiety and neuroticism, life dissatisfaction, stress and life change, and coronaryprone (type A) behavior pattern, with in-depth discussion. CrossrefMedlineGoogle Scholar30. KAVANAGHSHEPHARD TR. Sexual activity after myocardial infarction. Can Med Assoc J. 1977;116:1250-3. Most of 161 patients in a rehabilitation program after myocardial infarction were functioning well sexually. Those with decreased sexual activity were more neurotic and depressed and had a poorer response to training in other areas. Because the frequency of angina and ventricular premature beats was less during intercourse than during standard laboratory exercise, it was concluded that normal sexual relations carry no special risk for the average postcoronary patient. MedlineGoogle Scholar31. LOWNVERRIERRABINOWITZ BRS. Neural and psychologic mechanisms and the problem of sudden cardiac death. Am J Cardiol. 1977;39:890-902. Increased sympathetic activity, whether induced by neural or neurohumoral action, predisposes the heart to ventricular fibrillation. Environmental stresses can injure the heart, lower the threshold of cardiac vulnerability to ventricular fibrillation and, in the animal with coronary occlusion, provoke potentially malignant ventricular arrhythmias. In humans, administration of catecholamines can induce ventricular arrhythmia, whereas vagal activity exerts an opposite effect. Further, in certain subjects diverse stresses in various psychologic states provoke ventricular ectopic activity. CrossrefMedlineGoogle Scholar32. LYNCHPASKEWITZGIMBELTHOMAS JDKS. Psychological aspects of cardiac arrhythmias. Am Heart J. 1977;93:645-57. Reviews the relations between emotional stress and cardiac arrhythmia, changes in rhythm through suggestion and autosuggestion, classical conditioning and arrhythmia, and operant conditioning and cardiac arrhythmia. Psychological-emotional factors can influence and alter the frequency of cardiac arrhythmia. CrossrefMedlineGoogle Scholar33. MARMOTSYME MS. Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol. 1976;104:225-47. Three thousand eight hundred nine Japanese-Americans were classified according to the degree in which they retain the traditional Japanese culture. The most traditional group had a coronary heart disease prevalence as low as that observed in Japan. The group mostly acculturated to the West had a three- to fivefold higher prevalence. This difference could not be accounted for by differences in the major coronary risk factors. CrossrefMedlineGoogle Scholar34. RAHEWARDHAYES RHV. Brief group therapy in myocardial infarction rehabilitation: three- to four-year follow-up of a controlled trial. Psychosom Med. 1979;41:229-42. Forty-four patients surviving their first myocardial infarction were randomly allocated to either group therapy or control group status and followed up over 4 years. Those who received group therapy had significantly less follow-up coronary morbidity and mortality, and a significantly higher number returned to work than control patients. CrossrefMedlineGoogle Scholar35. ROSENMANBRANDSHOLTZFRIEDMAN RRRM. Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. Am J Cardiol. 1976;37:903-10. Prospective study of 3154 employed men age 39 to 59,257 with ischemic heart disease. Follow-up for 8.5 years showed coronary heart disease to be highly significantly associated with serum cholesterol level, behavior pattern, cigarette smoking, and systolic blood pressure. Type A behavior pattern was strongly related to the prevalence of coronary disease, independent of interrelations and behavior patterns with any other risk factor. CrossrefMedlineGoogle Scholar36. SCHROEDERLAMBHU JIM. The prehospital course of patients with chest pain: analysis of the prodromal, symptomatic, decision-making, transportation and emergency room periods. Am J Med. 1978;64:742-8. Most recent analysis of delay period in precoronary course in 211 consecutive patients with suspected myocardial infarction. Authors conclude that prodromas are not helpful in differentiating infarction from non-infarction and that the delay (mean over 6 hours, median 3½ hours) is the most immediate problem to be solved to decrease out-of-hospital mortality. CrossrefMedlineGoogle Scholar37. SHAPIROSCHWARTZFERGUSONREDMONDWEISS AGDDS. Behavioral methods in the treatment of hypertension: a review of their clinical status. Ann Intern Med. 1977;86:626-36. Comparing behavioral methods (biofeedback, relaxation, psychotherapy, and suggestion plus suggestion and environmental modification) to the phases of drug studies, the authors conclude that widespread application of non-pharmacologic methods cannot currently be recommended. LinkGoogle Scholar38. STERNPASCALEACKERMAN MLA. Life adjustment postmyocardial infarction: determining predictive variables. Arch Intern Med. 1977;137:1680-5. Sixty-eight patients with diagnosed myocardial infarctions were followed up for 1 year to assess psychosocial adjustment. Of those who were depressed, 70% remained so throughout the follow-up, failed to remain at work or function sexually or both, and had a higher hospital readmission rate. Women accounted for 80% of the deaths and 50% of the depressed group. CrossrefMedlineGoogle Scholar39. WEINBLATTRUBERMANGOLDBERGFRANKSHAPIROCHAUDHARY EWJCSB. Relation of education to sudden death after myocardial infarction. N Engl J Med. 1978;299:60-5. Over a 3-year period 7939 male survivors of myocardial infarction were monitored for 1 h at a standard examination. Those with complex ventricular premature beats in the monitoring hour and with little education (8 years or less) had over three times the risk of sudden coronary death found among better-educated men with the same arrhythmia (33% versus 9% cumulative mortality, respectively). CrossrefMedlineGoogle Scholar40. ZYZANSKIJENKINSRYANFLESSASEVERIST SCTAM. Psychological correlates of coronary angiographic findings. Arch Intern Med. 1976;136:1234-7. Of 94 patients those with greater coronary artery obstructions scored significantly higher than those with lesser disease on all four scales of the test for the type A coronary-prone behavior pattern, higher on anxiety/depression scales, and lower on the denial scale. Men with more frequent and intense angina scored higher on hypochondriasis, depression, and admission of symptoms than men less subject to ischemic pain. CrossrefMedlineGoogle Scholar41. ARONOWDONE RA. Phencyclidine overdose: an emerging concept of management. J Am Coll of Emerg Physicians. 1978;7:56-59. One of the best papers on the management of phencyclidine overdose, based on ion-trapping by continuous gastric suctioning and acidification of the urine. CrossrefGoogle Scholar42. BIGGSSPIKERPETITZIEGLER JDJV. Tricyclic antidepressant overdose: incidence of symptoms. JAMA. 1977;238:135-8. Review of 40 hospitalized patients who had taken overdoses of tricyclic antidepressants. A QRS duration of 100 ms or more on a routine ECG within the first 24 hours is an indicator of overdose patients at high risk. Plasma levels correlated with severe medical complications (which are relatively rare) and may remain elevated for 4 to 6 days after overdose. CrossrefMedlineGoogle Scholar43. GOLDREDMONDKLEBER MDH. Clonidine blocks acute opiate-withdrawal symptoms. Lancet. 1978;2:599-601. In a double-blind placebo-controlled crossover trial, clonidine eliminated objective signs and subjective symptoms of opiate withdrawal for 4 to 6 hours in 11 addicts. The same patients did well while taking clonidine for a week. Clonidine is a promising agent in opiate withdrawal. CrossrefMedlineGoogle Scholar44. KHANTZIANMCKENNA EG. Acute toxic and withdrawal reactions associated with drug use and abuse. Ann Intern Med. 1979;90:361-72. Diagnosis and management of common acute problems related to use, intoxication, overdose, and withdrawal of opiates, barbiturates (and other sedative hypnotic agents including alcohol and benzodiazepines), cocaine, amphetamines, phencyclidine, hallucinogens, inhalants, and marijuana. LinkGoogle Scholar45. CRISPPALMERKALUSY ARR. How common is anorexia nervosa? A prevalence study. Br J Psychiatry. 1976;128:549-54. Nine schools in England with an overall population of 12 391 girls were surveyed between 1972 and 1974 to determine the prevalence of anorexia nervosa. Overall prevalence was 4.6 per thousand, that is, approximately one girl in every 200. Authors, like others, conclude that the prevalence of anorexia nervosa is increasing. CrossrefMedlineGoogle Scholar46. HALMIGOLDBERGCASPERECKERTDAVIS KSREJ. Pre-treatment predictors of outcome in anorexia nervosa. Br J Psychiatry. 1979;134:71-8. In a study of 81 female anorexia nervosa patients increased number of prior hospitalizations was associated with a lower weight gain, greater overactivity during pretreatment was associated with greater weight gain during treatment, denial of illness correlated negatively with weight gain, and increased insight did not increase weight gain. CrossrefMedlineGoogle Scholar47. STUNKARDPENICK AS. Behavior modification in the treatment of obesity: the problem of maintaining weight loss. Arch Gen Psychiatry. 1979;36:801-6. Excellent review of all follow-up studies of behavior modification for obesity. A new method of data analysis shows that weight losses are only modestly maintained. CrossrefMedlineGoogle Scholar48. FORDBRAGSWERDLOFF CGR. A psychiatric study of patients referred with a diagnosis of hypoglycemia. Am J Psychiatry. 1976;133:290-4. Five-hour oral glucose tolerance test differentiated 30 volunteers who considered themselves hypoglycemic into three major groups: hypoglycemic patients, normal persons, and those who had diabetes. Half were experiencing a current psychiatric disorder, usually depression, and hysterical personality traits were also noted in many. The idea that reactive hypoglycemic patients have specific personality characteristics was not substantiated. CrossrefMedlineGoogle Scholar49. GROSSDUNNERLAFLEURMELTZERMUHLBAUERFIEVE HDDHHR. Prostaglandins: a review of neurophysiology and psychiatric implications. Arch Gen Psychiatry. 1977;34:1189-96. Reviews the functions of prostaglandins in the nervous system, discussing the possible alterations in their metabolism relating to mental illness, their role in psychiatric conditions, and their interaction with psychoactive drugs. CrossrefMedlineGoogle Scholar50. MACCRIMONWALLACEGOLDBERGSTREINER DJWD. Emotional disturbance and cognitive deficits in hyperthyroidism. Psychosomat Med. 1979;41:331-40. Cognitive and emotional variables in 19 women with hyperthyroidism were assessed pretreatment, at 3 weeks, and after euthyroidism was established. Cognitive deficits and symptoms of emotional disorder were associated with the severity of thyroid toxicity before treatment, and measures of these moved towards control group values as euthyroidism was established. CrossrefMedlineGoogle Scholar51. ROSENBAUMROTHMANMURRAY JJG. Psychosis and water intoxication. J Clin Psychiatry. 1979;40:287-91. Cases of psychosis, polydipsia, and water intoxication are presented as examples of a syndrome that is potentially unrecognized in psychiatric settings. Diagnostic and etiologic considerations, with attention to the syndrome of inappropriate antidiuretic hormone secretion are discussed with a review of literature. MedlineGoogle Scholar52. ADUANFAUCIDALEHERZBERGWOLFF RADJS. Factitious fever and self-induced infection: a report of 32 cases and review of the literature. Ann Intern Med. 1979;90:230-42. Fascinating case material and thorough review of the literature. Practical guidelines for management of these patients, many of whom suffer borderline personality syndrome, are presented. LinkGoogle Scholar53. SWANSONSWENSENHUIZENGAMELSON DWKS. Persistent nausea without organic cause. Mayo Clin Proc. 1976;51:257-62. The onset of functional nausea among 77 patients was frequently related to an organic disease or to a psychophysiologic response to stress. Later, there were obvious features of conversion, hypochondriasis, or an hallucination. The patients had significant psychiatric disorders, and while in hospital most experienced symptomatic improvement but would not accept a psychologic explanation for their nausea. MedlineGoogle Scholar54. YOUNGALPERSNORLANDWOODRUFF SDCR. Psychiatric illness and irritable bowel syndrome: practical implications for the primary physician. Gastroenterology. 1976;70:162-6. Twenty-nine consecutive outpatients with irritable bowel syndrome and 33 control subjects were given structured psychiatric interviews. Seventy-two percent of irritable bowel syndrome subjects, compared to 18% of control subjects, had psychiatric illness, with hysteria and depression the most prevalent syndromes. Primary physicians made an accurate psychiatric assessment in only 28% of the subjects. CrossrefMedlineGoogle Scholar55. ADATTODOEBLEGALLANDGRANOWETTER KKLL. Behavioral factors in urinary tract infection. JAMA. 1979;241:2525-6. Eighty-four female university students with a history of recurrent urinary infection were compared to a control group. Sixty-one percent of the patients but only 11% of the controls gave a history of regular voluntary deferral of micturition for periods of 1 hour or longer than 6 hours. Behavioral regimen stressing regular, complete bladder emptying was shown effective in preventing reinfection. CrossrefMedlineGoogle Scholar56. BARRETT D. Psychogenic urinary retention in women. Mayo Clin Proc. 1976;51:351-6. A spectrum of psychogenic urinary retention is seen mostly in women. Some patients may have one acute episode temporally related to psychologic trauma; others have problems related to large residual volume, such as recurrent urinary tract infection or incontinence. All need neurologic, urologic, and psychiatric evaluation. MedlineGoogle Scholar57. BINDELGLASDEE PG. Enuresis treatment with imipramine hydrochloride: a ten year follow-up study. Am J Psychiatry. 1978;135:1549-52. Twenty-nine young adults treated for enuresis with imipramine were followed for 10 years. They generally were active, well-motivated, and sociable and showed no significant psychiatric symptoms. One patient still wetted, but only occasionally. Enuresis is more urologic than psychologic in origin. CrossrefMedlineGoogle Scholar58. FRANKANDERSONRUBINSTEIN ECD. Frequency of sexual dysfunction in "normal" couples. N Engl J Med. 1978;299:111-5. Results of a self-report questionnaire to 100 predominantly white, well-educated, and happily married couples. Although 80% of the couples reported that their marital and sexual relations were happy and satisfying, 40% of the men reported erectile or ejaculatory dysfunction and 63% of the women reported arousal or orgasmic dysfunction. CrossrefMedlineGoogle Scholar59. LEVINE S. Marital sexual dysfunction: erectile dysfunction. Ann Intern Med. 1976;85:342-50. LinkGoogle Scholar60. LEVINE S. Marital sexual dysfunction: ejaculation disturbances. Ann Intern Med. 1976;84:575-9. LinkGoogle Scholar61. LEVINEROSENTHAL SM. Marital sexual dysfunction: female dysfunctions. Ann Intern Med. 1977;86:588-97. Three papers pointing up sexual dysfunction. Basic questions important in the diagnosis are considered, and newer ther