Psychologic and Psychosocial Aspects of Medical Practice
Authors: RUSSELL M. WILDER
Journal: Annals of Internal Medicine (1978)

The Literature of Medicine1 March 1978Psychologic and Psychosocial Aspects of Medical PracticeAn Annotated BibliographyRUSSELL M. WILDER, M.D., F.A.C.P.RUSSELL M. WILDER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-88-3-435 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn 1976Annals of Internal Medicinepublished a series of suggested readings for physicians reviewing medicine and its subspecialty fields, including neurology and dermatology, in preparation for certification or recertification examinations in internal medicine. The following list of suggested readings is drawn from the field of consultation-liaison medicine. This field has rapidly expanded in the past decade, partly to meet medical students' and medical house staff needs for instruction in psychosocial medicine. It has also expanded as a result of the new patient and family stresses that result from the consequences of technical advances in medical and surgical intensive care...Nephrology: Hemodialysis and Renal Transplantation Cardiology Hematology-Oncology Endocrinology and Metabolism Chemical Dependency Gastroenterology Neurology Sleep and Sleep Disorders Pain Factitious Illness Pharmacotherapy1. BALINT M: The Doctor, his Patient and the Illness, 2nd ed. New York, International Universities Press, 1972 A fascinating and classic description of the interactions between a group of English practitioners, their troubled patients (often not helped by the conventional wisdom of psychiatry), and the group leader and author. Google Scholar2. BOWDENBURSTEIN CA: Psychosocial Basis of Medical Practice. Baltimore, Williams and Wilkins, 1974 Designed as a basic text for medical undergraduates; provides a helpful review of human behaviors, including those of physicians, in illness settings. Google Scholar3. ENGEL G: Psychological Development in Health and Disease. Philadelphia, W. B. Saunders, 1962 Early chapters discuss growth and psychologic development through adulthood. This development is later related to psychologic and somatic responses to stress and conflict, including psychiatric disease and psychosomatic disorders. Google Scholar4. BIBRINGKAHARA GR: Lectures in Medical Psychology. New York, International Universities Press, 1968. A useful description of "normal" personality types and their characteristic responses to the threat of illness. A more concise version of much of the same material, also useful in the psychotherapy of the medical patient, is a chapter in Reference 5. Google Scholar5. ZINBERG N: Psychiatry and Medical Practice in the General Hospital. New York, International Universities Press, 1964 Google Scholar6. STRAINGROSSMAN JS: Psychological Care of the Medically Ill. New York, Appleton-Century-Crofts, 1975 Edward J. Sachar discusses the current status of psychosomatic medicine. Other important chapters deal with depression, hypochondriasis, pain, psychopharmacology, physicians, and death. Google Scholar7. LIPOWSKI Z: Psychiatry of somatic diseases: epidemiology, pathogenesis, classification. Compr Psychiatry 16:105-124, 1975 Psychologic decompensation complicating a physical illness or its therapy adds to suffering, interferes with treatment, adds to the overall course of illness, imposes additional burdens on physician, patient, and family. CrossrefMedlineGoogle Scholar8. WITTKOWERWARNES EH (eds): Psychosomatic Medicine: Its Clinical Applications. New York, Harper and Row, 1977 Represents a multiauthored combination of psychosomatic theory and practical applications in offering a generous variety of approaches to the psychologic dimensions and therapies of general medical and liaison practice. Google Scholar9. PASNAU R: Consultation-Liaison Psychiatry. New York, Grune and Stratton, New York, 1975 The editor and 23 other contributors attempt to bridge medical practice, psychosomatic medicine, psychiatric liaison, psychiatric consultation and medical education. We have found it particularly useful for the student or resident in the consultation field. Google Scholar10. MARKSSACHAR RE: Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med 78:173-181, 1973 Observations of a group of medical inpatients treated with narcotic analgesics and a questionnaire survey of physicians. Suggests both overcautious under-treatment with narcotics and misinformation regarding the pharmacologic and addictive effects of meperidine. LinkGoogle Scholar11. ENGEL G: Psychogenic pain and the pain-prone patient. AmJ Med 26:899-918, 1959 Observations on the total pain experience as a psychologic phenomenon with case illustrations to describe some of the features of the pain-prone individual. Highly recommended. CrossrefMedlineGoogle Scholar12. LIPOWSKI Z: Review of consultation psychiatry and psychosomatic medicine. Psychosom Med 29:153-171, 201-224, 30:395-422, 1967 Part I discusses the scope and function of consultation psychiatry. Part II surveys psychiatric problems common to nonpsychiatric wards. Part III looks at theoretical concepts and current hypotheses in psychosomatics. Part II may be of direct and practical value whereas Part III may help to give broader understanding of the field. CrossrefMedlineGoogle Scholar13. ENGELROMANO GJ: Delirium, a syndrome of. cerebral insufficiency. J Chron Dis 9:260-270, 1959 Although many newer references to the frequent problems of delirium and dementia are available this earlier paper combines clarity and psychologic elegance. Reliance on EEG accuracy is excessive. CrossrefMedlineGoogle Scholar14. THOMAS C: Precursors of premature disease and death: the predictive potential of habits and family attitudes. Ann Intern Med 85:653-658, 1976 A long-term study of groups of medical students later affected by suicide, cancer, hypertension, myocardial infarction, and mental illness who show significantly different personality characteristics in youth compared with their healthy classmates. LinkGoogle Scholar15. FLECK S: Unified health services and family-focused primary care. Int JPsychiatry Med 6:501-515, 1975 Fleck reminds us of the importance of a family as a clinical unit and urges that any comprehensive approach to patient care include beginning with the patient's family. CrossrefGoogle Scholar16. MINUCHIN S: Families and Family Therapy. Cambridge, Massachusetts, Harvard University Press, 1974 Presents a transactional approach to studying families with theory illustrated by segments of interviews. Fascinating reading even for those who never intend to work with families; especially valuable for relating "individual" problems to disturbed interactions. Google Scholar17. RAHE R: Epidemiological studies of life change and illness. Int JPsychiatry Med 6:133-146, 1975 A brief review of both retrospective and prospective investigations correlating life change and illness. CrossrefGoogle Scholar18. LIPOWSKI Z: Organic brain syndrome: overview and classification, in Psychiatric Aspects of Neurologic Disease, edited by BENSON FD, BLUMER D. New York, Grune and Stratton, 1975, pp. 11-35 A description of clinically useful concepts of "delirium," "subacute amnestic-confusional state," and "dementia". Google Scholar19. JEFFERSON J: A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom Med 37:160-179, 1975 A useful review of the effects, complications, contraindications, drug interactions, and so forth of a group of widely used and potent compounds. CrossrefMedlineGoogle Scholar20. LIPSITT D: Medical and psychological characteristics of "crocks." Int JPsychiatry Med 1:15-25, 1970 Recognizing and treating the long-suffering and depressed patient before chronicity and "the thick chart" occurs. Google Scholar21. HACKETTWEISMAN TA: Psychiatric management of operative syndromes. Psychosom Med 22:267-282, 1960 Psychological disorders commonly seen preceding surgical procedures and with postoperative and convalescent periods. The physician's role in management of anxiety, delirium, psychosis, and depression is discussed. CrossrefMedlineGoogle Scholar22. HACKETTWEISMAN TA: Psychiatric management of operative syndromes. Psychosom Med 22:356-372, 1960 Psychodynamics and noninterpretive therapeutic intervention in the management of preoperative, postoperative, and convalescent syndromes. CrossrefMedlineGoogle Scholar23. KELLNER R: Psychotherapy in psychosomatic disorders, a survey of controlled studies. Arch Gen Psychiatry 32:1021-1028, 1975 The authors suggest that the psychotherapeutic methods used in treating disorders such as peptic ulcer, ulcerative colitis, essential hypertension, bronchial asthma, migraine, and so forth depend for effectiveness not only on the particular disorder but also on the personality of the patient. CrossrefMedlineGoogle Scholar24. ENGEL G: Conversion symptoms, in Signs and Symptoms, 5th ed., edited by MACBRYDE CM, BLACKLOW RS. New York, J. B. Lipincott, 1970, pp. 650-668 Interesting and readable discussion includes psychodynamics behind conversion symptoms, suggestive and confirmatory diagnostic criteria, and a survey of commoner symptoms and complications. Differences between conversion, hypochondriasis, somatic delusions, malingering, and psychophysiologic symptoms are described. Google Scholar25. LEVY N: Living and Dying: Adaptation to Hemodialysis. Springfield, Illinois, Charles C Thomas, 1974 The report of a panel discussion by contributors to the study of nephrology at a recent American Psychiatric Association meeting. Deals with adaptation to hemodialysis, uncooperative patients, children, individual survival, personality in terms of coping, and sexual lives of patients on hemodialysis. Google Scholar26. REICHSMANLEVY FN: Problems and adaptation to maintenance hemodialysis. Arch Intern Med 130:859-865, 1972 The authors discuss three periods of adaptation: the "honeymoon"; "discouragement and disenchantment" (accompanied by shunt clotting) upon return to productive roles; and long-term adaptation. CrossrefMedlineGoogle Scholar27. MCKEGNEY F: The patient's role in beginning and continuing maintenance hemodialysis. Proc Int Cong Nephrol, 3:220-225, 1974 Describes home dialysis training in a renal transplant program in which patients and families have an opportunity to accept or reject hemodialysis. Google Scholar28. ABRAM H: Survival by machine: the psychological stress of chronic hemodialysis. Psychiatry Med 1:37-51, 1970 A comprehensive discussion of dialysis-imposed stresses, losses, restriction, and use of denial by patient, family, and physician. CrossrefMedlineGoogle Scholar29. SIMMONS R: Issues of informed consent, in book review of Catastrophic Diseases by KATZ J, CAPRON AM. Science 192:879-881, 1976 A discussion of legal and psychosocial problems created by organ transplantation in hemodialysis; the decision-making dilemma in which the physician investigator's self-interest may be opposed to the need to protect patients' dignity and right to medical care. CrossrefMedlineGoogle Scholar30. CALLAND C: Iatrogenic problems in end-stage renal failure. N Engl J Med 287:334-336, 1972 Written by a physician with chronic renal failure who explores his own experience of the social and psychological difficulties in coping with chronic dialysis and renal transplantation. CrossrefMedlineGoogle Scholar31. ABRAMMOOREWESTERVELT HGF: Suicidal behavior in chronic dialysis patients. Am J Psychiatry 127:1199-1204, 1971 Questionnaire overview of nearly 4000 patients showed the suicide incidence among chronic dialysis patients to be 100 times that of the general population. Paradigmatic case studies are presented. CrossrefMedlineGoogle Scholar32. MCKEGNEYLANGE FP: The decision to no longer live on chronic hemodialysis. Am J Psychiatry 128:267-274, 1971 An excellent discussion of the ethical dilemma in which staff and patient's care are caught when the possibility of discontinuing dialysis has not been discussed at its beginning. CrossrefMedlineGoogle Scholar33. FOSTERCOHNMCKEGNEY FGF: Psychobiologic factors and individual survival on chronic renal hemodialysis. A two-year followup. Part I. Psychosom Med 35:64-82, 1973 Twenty-one patients on dialysis studied prospectively in an attempt to correlate psychologic, social, and physiologic factors of survival. Roman Catholicism, at least one parent, low blood urea nitrogen, and marked indifference to fellow patients were associated with durability. CrossrefMedlineGoogle Scholar34. ABRAM H: Psychological dilemmas of medical progress. Psychiatry Med 3:51-58, 1972 Questions whether patient should be refused dialysis for psychologic reasons other than serious psychosis or mental deficiency. Abrams indicates the need for further psychologic study of kidney-donor motivation. In what situations does the prolonged life afforded by dialysis become a "living death"? CrossrefMedlineGoogle Scholar35. ALEXANDER L: The double-bind theory and hemodialysis. Arch Gen Psychiatry 33:1353-1356, 1976 Discusses such primary directives for patients as: "be independent," "be normal," "be grateful," and a group of secondary injunctions that paradoxically neutralize the care-taker-to-patient injunctions. CrossrefMedlineGoogle Scholar36. STONEDELEO RJ: Psychotherapeutic control of hypertension. N Engl J Med 294:80-84, 1976 Subjects taught a relaxation technique had lower mean arterial blood pressures than a group of five controls after 6 months. Peripheral adrenergic activity reduction and decrease in stimulated renin activity both may contribute to response. CrossrefMedlineGoogle Scholar37. JENKINS C: Recent evidence supporting psychologic and social risk factors for coronary disease. N Engl J Med 294:987-994, 1033-1038, 1976 Reviews 88 references between 1970 and 1975. High-risk coronary disease factors include disturbing anxiety and depression, interference with sleep, type A behavior pattern, exaggerated blood pressure response to cold pressure test. CrossrefMedlineGoogle Scholar38. LOWNTEMTEREICHGAUGHANREGESTEINHA BJPCQH: Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management. N Engl J Med 294:623-629, 1976 Possible relations between psychologic stresses and ventricular arrhythmias in a previously healthy 39-year-old man without clinical evidence of organic heart disease. CrossrefMedlineGoogle Scholar39. HACKETTCASSEMWISHNIE TNH: The CCU: an appraisal of its psychological hazards. N Engl J Med 279:1365-1370, 1968 A survey of 50 coronary care patients serves to show attitudes, fears, and reactions of a person subjected to such an environment. The question investigated was whether all intensive care units produce an increased incidence of psychologic difficulties. CrossrefMedlineGoogle Scholar40. ROSENMANBRANDJENKINSFRIEDMANSTRAUSWURM RRCMRW: Coronary heart disease in the Western Collaborative Group Study; final followup experience of 8½ years. JAMA 233:872-877, 1975 These investigators report impressive evidence that the "type A behavior pattern" must be considered along with smoking habits, serum cholesterol, and hypertension as critical risk factors in heart disease. CrossrefMedlineGoogle Scholar41. CASSEMHACKETT NT: Psychiatric consultation in a coronary care unit. Ann Intern Med 75:9-14, 1971 Consultations from liaison psychiatry were requested directly by coronary care unit nursing staff, and 145 of 411 (32.7%) of patients were seen. Anxiety, depression, and management behavior were the most common problems identified. Referred patients showed reduced mortality. LinkGoogle Scholar42. RAHEROMOBENNETTSILTANEN RMLP: Recent life changes, myocardial infarction, and abrupt coronary death. Studies in Helsinki. Arch Intern Med 133:221-228, 1974 Recent life-change data, based on the schedule of recent experience (SRE) indicate that a significant increase in life-change units occurs in the 6 months before documented myocardial infarcts and abrupt coronary death. CrossrefMedlineGoogle Scholar43. HENDRIX G: Proceedings of the National Conference on Emotional Stress and Heart Disease. J SC Med Assoc 72:1-95, 1976 Report of a symposium on such factors as exercise, stress and anxiety, intervention, personality factors (Rosenman), relaxation response (Benson) social stresses. MedlineGoogle Scholar44. REISERBAKST MH: Psychophysiological and psychodynamic problems of the patient with structural heart disease, in American Handbook of Psychiatry, 2nd ed., Vol. 4, edited by ARIETI S, REISER MF. New York, Basic Books, 1975, pp. 618-652 A comprehensive review of such processes as congestive heart failure, essential hypertension, diagnosis and treatment (catheterization, implantation of pacemaker, intensive care units and cardiac surgery). Contains a final brief section on conditioning techniques. Google Scholar45. CASSEMHACKETTBASCOMWISHNIE NTCH: Reactions of coronary patients to the CCU nurse. Am J Nurs 70:319-325, 1970 In 100 patients psychosis was rare and delirum uncommon. Psychologic recovery lags behind physiologic repair. The coronary care unit nurse, minimizing the psychologic hazards of the coronary care unit, makes a first and basic contribution to psychologic recovery. MedlineGoogle Scholar46. KUBLER-ROSS E: On Death and Dying. New York, Macmillan Company, 1969 Kubler-Ross opened an area of widened understanding of ourselves, our dying patients, and their families; has helped in sensitizing us to their messages. Google Scholar47. AGLERATNOFFSPRING DOG: The anti-coagulant malingerer. Psychiatric studies of three patients. Ann Intern Med 73:67-72, 1970 Case histories of three patients who used anticoagulants, all familiar with the pharmacology of the coumarins, are contrasted with a patient who ingested medication in apparent accidental overdose. LinkGoogle Scholar48. AGLERATNOFFWASMAN DOM: Conversion reactions and autoerythrocyte sensitization; their relationship to the production of ecchymoses. Arch Gen Psychiatry 20:438-447, 1969 The authors present six patients who produce spontaneous painful ecchymoses. All six seem to fulfill the current criteria for a diagnosis of hysterical conversion reaction. CrossrefMedlineGoogle Scholar49. MATTSONGROSS AS: Adaptation of defensive behavior in young hemophiliacs and their parents. Am J Psychiatry 122:1349-1356, 1966 A group of 35 young hemophiliacs is presented in terms of coping mechanisms and defenses. A discussion of their parents' adaptation and early adjustment to hemophilia is explored. CrossrefMedlineGoogle Scholar50. WILKES F: Some problems in cancer management. Proc R Soc Med 67:1001-1005, 1974 Summarizes two years' experience in caring for dying cancer patients in a special 25-bed unit. Valuable suggestions, applicable to other patient care facilities, concern analgesia, personal care, diet, and acute paranoid reactions, among others. MedlineGoogle Scholar51. STRAUSS A: Family and staff during last weeks and days of terminal illness. Ann NY Acad Sci 164:687-695, 1969 A discussion of common problems surrounding the presence of family members at the bedside of the dying patient, preparation of the family for the patient's death, and helpful means for coping with family interferences. CrossrefMedlineGoogle Scholar52. RATNOFFAGLE OD: Psychogenic purpura; a reevalu-evaluationof the syndrome of autoerythrocyte sensitization. Medicine (Baltimore) 47:475-500, 1968 The authors discuss clinical features, onset, exacerbations, and the manifestations and psychologic characteristics of a group of patients with autoerythrocyte sensitization and propose a term "psychogenic purpura" as being aptly descriptive of the condition. CrossrefMedlineGoogle Scholar53. HOLLAND J: Cancer Medicine. Psychologic aspects of cancer. Philadelphia, Lea & Febiger, 1973 A comprehensive description of people with cancer-phobia, responses to cancer (physical and psychologic), openness in discussing cancer with patients, and so forth. It could have been entitled "What the informed physician needs to know about cancer." Google Scholar54. WARRENVAN DE WIELE MR: Clinical and metabolic features of anorexia nervosa. Am J Obstet Gynecol 117:435-449, 1973 Study of 42 patients with the clinical symptom complex of anorexia nervosa, easily differentiated from other causes of cachexia "except pure starvation." The authors note the change of temperature control and deficient gonadotropic release; they postulate hypothalamic disorder. CrossrefMedlineGoogle Scholar55. BOYARKATZFINKELSTEINKAPENWEINERWEITZMANHELLMAN RJJSHEH: Anorexia nervosa. Immaturity of a 24-hour luteinizing hormone secretory pattern. N Engl J Med 291:861-865, 1974 In young women (17 to 23 years) with anorexia nervosa 24-h secretory patterns of luteinizing hormone were age-inappropriate.In two women normal patterns recurred with remission of illness and weight gain. CrossrefMedlineGoogle Scholar56. KATZWEINER JH: A functional, anterior hypothalamic defect in primary anorexia nervosa? (editorial). Psychosom Med 37:103-105, 1975 A review of the confusing reports of anterior hypothalamic defect in anorexia nervosa, raising the question of whether the deficiency coincides with or is the result of the illness. They consider the possibility that the manifest illness and its functional defect are a consequence of some third, as yet undetermined, variable. CrossrefMedlineGoogle Scholar57. STUNKARD A: Presidential Address—-1974. From explanation to action in psychosomatic medicine: the case of obesity. Psychosom Med 37:195-236, 1975 A comprehensive discussion of the relation of social factors to obesity and the use of social intervention (particularly behavior modification) in treatment. CrossrefMedlineGoogle Scholar58. BRUCH H: Anorexia nervosa. See Reference 44, p. 787-809 Description of the results of 30 years' experience in the diagnosis and treatment of what has been described as a paradigm of psychosomatic illness. Treatment, the author declares, involves not only restitution of normal nutrition but also resolution of psychologic needs for thinness. Google Scholar59. GARNERGARFINKELSTANCERMALDOFSKY BPHH: Body image disturbances in anorexia nervosa and obesity. Psychosom Med 38:327-335, 1976 Eighty-two female subjects, 18 with primary anorexia nervosa, 16 with juvenile onset obesity, 16 "thin normals," and several additional control groups were confronted with an adjustable distorting photograph apparatus. The anorectics and the obese showed similar distortion in self-perception. CrossrefMedlineGoogle Scholar60. KIELYADRIANLEENICOLOFF WAJJ: Therapeutic failure of oral thyrotropin-releasing hormone in depression. Psychosom Med 38:233-241, 1976 The results of this study showed no therapeutic benefits from thyrotropin-releasing hormone, in dosage of 200 to 300 mg per day. Three of six patients showed dysphoric effects. CrossrefMedlineGoogle Scholar61. MASON J: Clinical psychophysiology. Psychoendocrine mechanisms. See Reference 44, p. 553-582 A comprehensive review of 20 years of research on the effects of psychologic influences on the psychoendocrine system, psychoendocrine reflections of emotional states, psychologic defenses, neurotic and psychotic processes, depressions, and so forth. Google Scholar62. JACKSON J: The adjustment of the family to the crisis of alcoholism. Q J Stud Alcohol 15:562-586, 1954 Explains family system components of alcohol dependency and aids in understanding the alternating anger, helplessness, and apathy of the family often apparent to the physician who deals with the addicted family member. CrossrefMedlineGoogle Scholar63. CURLEE J: How a therapist can use Alcoholics Anonymous. Ann NY Acad Sci 233:137-143, 1974 Comments on effective interfacing among the doctor, his alcoholic patient, and the self-help group (Alcoholics Anonymous). CrossrefMedlineGoogle Scholar64. GOODWINSCHULSINGERMOLLERHERMANSENWINOKURGUSE DFNLGS: Alcohol problems in adoptees raised apart from alcoholic biologic parents. Arch Gen Psychiatry 28:238-243, 1973 Classic research methodology attempting to clarify "nature" and "nuture" issues in this highly familial disease. CrossrefMedlineGoogle Scholar65. LUDWIG A: The first drink; psychologic aspects of craving. Arch Gen Psychiatry 30:539-547, 1974 Carefully detailed psychophysiologic research on the phenomena of craving and the hypothesis (adage) "one drink is too many and a thousand are not enough." CrossrefMedlineGoogle Scholar66. MIRSKY I: Physiologic, psychologic, and social determinants in the etiology of duodenal ulcer. Am J Dig Dis 31:285-314, 1958 A classic discussion of the development of duodenal ulcer in an individual with sustained rate of gastric hypersecretion who is exposed to a situation mobilizing unconscious incorporative wishes or threatening dependent relationships. CrossrefGoogle Scholar67. NEMIAH J: The psychological management and treatment of patients with peptic ulcer. Adv Psychosom Med 6:169-185, 1971 A comprehensive review of psychotherapeutic approaches to people with peptic ulcer disease. It rather discouragingly points out the paucity of information available about the value of psychologic treatment. CrossrefMedlineGoogle Scholar68. SCHUSTERIBER MF: Psychosis with pancreatitis. Arch Intern Med 116:228-233, 1965 An acute toxic psychosis frequently accompanies relapsing pancreatitis. Transient hallucinations are its major manifestation and are reported to be more common than diabetes, pancreatic insufficiency, or pancreatic calcifications. CrossrefMedlineGoogle Scholar69. SOLOWSILBERFARBSWIFT CPK: Psychosocial effects of intestinal bypass surgery for severe obesity. N Engl J Med 290:300-304, 1974 A thoughtful report of the generally favorable psychosocial outcomes observed after bypass surgery. CrossrefMedlineGoogle Scholar70. ENGEL G: Studies of ulcerative colitis: the nature of the psychologic process. Am J Med 19:231-256, 1955 A presentation of a composite of psychologic data on patients with ulcerative colitis. Describes the personality structure of people with the illness and the environmental circumstances preceding or accompanying exacerbations. CrossrefMedlineGoogle Scholar71. SHEFFIELDCARNEY BM: Crohn's disease: a psychosomatic illness? Br J Psychiatry 128:446-450, 1976 A report suggesting that patients with Crohn's disease are more anxious, neurotic, and introverted than "nonpsychosomatic" medical outpatients with other "psychosomatic" illnesses. CrossrefMedlineGoogle Scholar72. HISLOP I: Onset setting in inflammatory bowel disease. Med J Aust 1:981-984, 1974 Emphasizes the particular environmental setting at the onset of illness in patients with ulcerative colitis, granulomacolitis, and regional enteritis. Reports greater frequency of serious life crises in those with illness compared with control subjects. CrossrefMedlineGoogle Scholar73. MENDELOFFMONKSIEGELLILIENFELD AMCA: Illness experience and life stresses in patients with irritable colon and with ulcerative colitis. N Engl J Med 282:14-17, 1970 A review of life stresses as related to illness onset, which reports that patients with irritable colon have higher life-change scores than do patients with ulcerative colitis or the general population. CrossrefMedlineGoogle Scholar74. THOMPSON W: The irritable colon. Can Med Assoc J 111:1236-1244, 1974 An excellent review with 75 references. In part it describes the many psychogenic factors implicated in this illness. MedlineGoogle Scholar75. LissALPERSWOODRUFF JDR: The irritable colon syndrome and psychiatric illness. Dis Nerv Syst 34:151-157, 1973 Specific psychiatric illness is cited as present in a majority of individuals with the irritable colon. Hysteria, anxiety neurosis, and primary affective disorder, depressed type, are the major diagnoses. MedlineGoogle Scholar76. YOUNGALPERSNORLANDWOODRUFF SDCR: Psychiatric illness and the irritable colon syndrome: practical implications for the primary physician. Gastroenterology 70:162-166, 1976 The article confirms earlier work by the same groups, finding psychiatric illnesses present and in higher frequency than in control subjects. In only 20% of subjects did the primary physician accurately describe emotional illness. CrossrefMedlineGoogle Scholar77. ALMY T: Experimental studies on the irritable colon. Am J Med 10:60-67, 1951 A classic report of heightened colonic activity related to unusual stresses. Attempts to accurately differentiate those individuals with diarrhea from those with spastic constipation. CrossrefMedlineGoogle Scholar78. HISLOP I: Psychological significance of the irritable colon syndrome. Gut 12:452-457, 1971 According to these observations, stresses in patients with irritable colon occur with no greater frequency or specificity than in a comparison population. Depressive symptoms are reported as a frequent accompaniment of bowel distress. CrossrefMedlineGoogle Scholar79. DALY D (ed): Ictal clinical manifestations of complex partial seizures, in Advances in Neurology, vol. 11, edited by PENNEY JK, DALY DD. New York, Raven Press, 1975, pp. 57-73 Discusses seizures associated with confusion, automatisms, delusions, hallucinations, illusions, memory, and affective changes. Google Scholar80. RODIN E: Psychomotor epilepsy and aggressive behavior. Arch Gen Psychiatry 28:210-213, 1973 A careful study of 150 seizure patients indicates to this author that though both psychomotor seizures and the elaboration of aggressive acting out are involved with limbic system structures, there is no evidence that the underlying mechanisms are identical. CrossrefMedlineGoogle Scholar81. BENSONBLUMER DD (eds): Psychiatric Aspects of Neurologic Disease. New York, Grune and Stratton, 1975 Thoughtfully considers the evaluation and treatment of that borderline between neurology and psychiat