Donald L. Dudley

Long-term adjustment, prognosis, and death in irreversible diffuse obstructive pulmonary syndromes.

&NA; Forty subjects with severe debilitating irreversible diffuse obstructive pulmonary syndrome were studied over a 4‐year period. They were found to utilize denial, repression, and isolation to protect their failing respiratory systems from environmental inputs. Failure of these defenses led to physiologic and psychologic deterioration. Psychosocial assets were found to be as important as the physiologic assets in the treatment of these patients. Patients with high psychosocial assets were found to be more effective in protecting themselves from dangerous symptoms or behaviors and were more likely to proceed with realistic, appropriate treatment programs. The probability of dying was increased in the presence of both low psychosocial and low physiologic assets. Dying was found to be a specific goal‐directed adaptive behavior which was reported as being comfortable and relatively devoid of threat. Emotional upsets accompanying death were largely related to problems with family, friends, and hospital staff.

Emergency use of intravenous haloperidol

Experience is reviewed with intravenous haloperidol in 20 cases in which the mental state was gravely impaired, prohibiting necessary investigation and treatment of physical disabilities. This use of haloperidol was efficacious and uncomplicated, although not specifically FDA approved.

Heroin vs alcohol addiction--quantifiable psychosocial similarities and differences.

Abstract A pilot study of 50 heroin addicts and 66 alcohol addicts utilizing the recently developed quantitative methods for measuring life change and seriousness of illness. Alcohol addicts were found to have significant attenuation of perception of life change and seriousness of illness as compared to heroin addicts and current “normative” data. The heroin addicts were found to have a mild but significant augmentation of perception of life change and seriousness of illness as compared to the “normative” data. In addition both the heroin addicts and alcohol addicts were found to maintain very high levels of life change. The documented differences in perception and the maintenance of high levels of life change were felt to have potential significance in the treatment and evaluation of both groups of addicts.

Cigarette smoking in a chest clinic population —Psychophysiologic variables

Abstract This is a cross-sectional study of the relationship of psychosocial, physiologic and epidemiologic data to the ability to stop cigarette smoking in a private chest clinic population of 240 patients. The separation of ever and never smoked categories showed the expected differences in physiologic variables. The separation of those who stopped smoking from those who continued to smoke was significant. The primary variables associated with the capacity to stop are good psychosocial assets, psychologic stability and the ability to express depression openly. The study is consistent with the hypothesis that patients with high psychosocial assets have several behaviors to substitute for that of smoking. These patients are psychologically stable and their psychologic comfort is not seriously threatened if they need to stop smoking. Smoking may be a learned behavior associated with an increase in comfort and capacity to deal with the problems of living. To some patients who have difficulty in adapting, the dangers of smoking may not outweigh the certain loss in ability to deal with the immediate environment if they stop.

Psychosocial assets and severity of chronic asthma

Abstract A quantitative evaluation of psychosocial assets and environmental change was made in a group of 36 asthmatic patients in whom corticosteroids were part of comprehensive, long-term treatment. There were 15 men and 21 women, ranging in age from 19 to 74 years. All patients were maintained at the lowest possible dosage, but only 5 were not on steroids continuously. Psychosocial assets (coping abilities) were evaluated with the Berle Index (BI). This instrument provides quantitative values for psychologic and social items such as social status, medical history other than asthma, factors related to patients family, interpersonal relationships, past performance, attitudes, and personality structure. The mean amount of daily prednisone or its equivalent was calculated for the year following the psychosocial testing. Patients with low psychosocial assets (BI s = −0.564, p

COPD: Psychosocial and Psychophysiological Issues

Abstract The treatment of the patient with chronic obstructive pulmonary disease (COPD) described here is one in which psychosocial assets are increased, the effect of life change is minimized, and the emotional defenses are utilized to cope with the disease process. Problems in the patients environment are surmounted when the patient maintains a therapy program that allows him or her to meet the requirements of daily living.

Post-detoxification drug treatment of anxiety and depression in alcohol addicts.

A study was undertaken to assess the effectiveness of treating alcoholics after detoxification for the very commonly observed syndrome of anxiety, depression, and somatic complaints. Previous studies had indicated that these patients generally respond quite well to drug treatment with the phenothiazine class of drugs. However, a double blind placebo-controlled study of adequate size had not been undertaken. Forty-five comparably addicted male alcoholics with anxiety or mixed anxiety-depression from an inpatient alcohol treatment ward comprised the treatment group. Twenty-three patients received thioridazine treatment and 22 received placebo treatment in a double blind fashion after acute withdrawal from alcohol. Progress over a 4-week period was measured with standard rating instruments—the Hamilton Rating Scale for Depression (by physician) and the Zung and Lipman Self-Rating Scales. Both placebo and active medication groups improved symptomatically during the 4-week program. The thioridazine group had significantly better improvement in sleep disturbance (early, middle, and late insomnia) than the placebo group. There was also significantly better improvement in anxiety with thioridazine as compared with placebo. Interestingly, the placebo group had significantly better work and activity (as appraised by the ward physician) than the thioridazine group. The authors note that active drug effect might actually hamper some patients in their rehabilitative effort, especially if phenothiazines of the more sedating variety are used. Since alcohol rehabilitation generally utilizes a wide range of activities (such as didactic sessions, occupation therapy, group therapy), alertness and performance ability appear to be important factors in the rehabilitation program. Although thioridazine treatment for some patients with anxiety and insomnia would appear to be quite helpful, its blanket use for the post-detoxification anxiety-depression of the alcoholic might be detrimental for others and cannot be recommended as a routine treatment strategy in an alcohol rehabilitation program.

Intravenous chlorimipramine and refractory depression

A total of 252 infusions of chlorimipramine were performed on 12 patients with refractory depression. It is suggested that the intravenous route of administration is safe and effective. It may, in fact, be the preferred route when the oral route of administration is not available.

Quantification of Psychosocial Variables in Intrinsic Asthma Relationship to Physiologic Variability

This was a pilot study of 36 patients with intrinsic asthma which indicates that routine testing of psychosocial assets and life change would be of value in clinical management. Therapeutic attention