Donald S. Kornfeld

Psychiatric outcome of heart transplantation.

The authors evaluated 73 cardiac transplant recipients 1 month to 6 years after transplantation to determine the prevalence of psychiatric disorders and psychosocial problems after cardiac transplantation. Affective illnesses had occurred in 51%, chiefly as a steroid-related syndrome, with mood lability, irritability, and grandiosity (22%). Major depressive episodes occurred in 11%. Postoperative delirium occurred in 4%. Anxiety symptoms were frequent (26%) but generally transient. Other frequent problems included cognitive, family, marital, and sexual dysfunction and inability to gain employment. Further effort is needed to reduce psychiatric morbidity and improve outcome for heart transplant recipients.

Type A behavior and blood pressure during coronary artery bypass surgery.

&NA; Systemic hypertension has been reported as common during coronary artery bypass surgery. The coronary‐prone Type A behavior pattern has been associated with heightened reactivity of the sympathetic nervous system. Therefore, the possible relationships between the two was explored. Significant correlations were found between systolic blood pressure rise during surgery and interview ratings of overall Type A (p < 0.05), aggressive content (p < 0.01), and job commitment (p < 0.001). A statistically association was also found between diastolic pressure rise and the job commitment rating (p < 0.01). Significant correlations were still present after controlling for the role of physical predictors of blood pressure rise by statistical multiple regression analysis. The data suggest that patients with Type A behavior characteristics manifest an autonomic hyperactivity which is present under general anesthesia. This hyperactivity may contribute to the association of Type A behavior pattern and coronary heart disease.

Psychiatric Evaluation of Mental Capacity in the General Hospital: A Significant Teaching Opportunity

Background Requests for evaluation of mental capacity in general hospitals have increased in frequency. Objective The authors sought to determine the interventions required to respond adequately and assess the initiating circumstances. Method Questionnaires completed by psychiatric consultants were analyzed, and chart reviews were completed. Results Capacity evaluation alone resolved 32% of the requests; 31% required an evaluation plus additional interventions; 37% did not require a capacity evaluation. Patients threatening to leave against advice, and/or refusing treatments or procedures represented 64% of requests. Consultants successfully resolved 88% of such cases. Conclusion A mental capacity evaluation alone was insufficient to resolve two-thirds of problems eliciting requests. Consultation–liaison psychiatrists can use these evaluations as teaching opportunities.

Psychological intervention in coronary heart disease: A review

Psychological intervention studies designed to reduce cardiac morbidity are reviewed. Preliminary findings suggest that various psychotherapeutic modalities may be effective. Such studies also provide an avenue through which the physical and psychological mechanisms involved in coronary heart disease and their interactions may be clarified. Implications for clinical interventions are also discussed.

Type A behavior and the thallium stress test

&NA; Several recent studies have examined the association between Type A personality and coronary artery disease (CAD) by coronary angiography. Most of these studies have reported a significant association. The present study is an attempt at further confirmation, using a new non‐invasive technique for measuring CAD. Subjects were 53 patients undergoing routine exercise stress tests with concomitant thallium‐201 myocardial perfusion studies. Five aspects of Type A behavior were assessed by the use of the Rosenman‐Friedman Semistructured Interview, and each was rated on a three‐point scale. Severity of CAD was independently estimated on a four‐point scale. Pearson correlation coefficients were separately computed for patients with and without reported history of myocardial infarction (MI). For 37 patients without reported MI, CAD severity was significantly correlated with Overall Type A (r = ‐0.53), Vocal Characteristics (r = ‐0.53), Job Involvement (r = ‐0.36) and Aggressiveness (r = ‐0.48), but not Time Urgency (r = ‐0.25). For 16 patients with reported MI, CAD severity was significantly correlated with Job Involvement only (r = +0.49). The data are consistent with the association of Type A personality and coronary atherogenesis, but may also reflect Type A psychological and physiological characteristics. Future studies may be able to examine these and other aspects of Type A behavior using this noninvasive technique in more diverse patient populations.

Type A behavior and blood pressure during general surgery.

&NA; The Type A behavior pattern (TABP) has been demonstrated as a risk factor for the development of coronary heart disease (CHD). Psychophysiologic studies suggest that the TABP may be associated with autonomic hyperreactivity to a variety of stressors. Recent studies report an association of TABP with autonomic hyperreactivity in patients under general anesthesia for coronary artery bypass surgery. The present study did not find a significant correlation between the TABP and intraoperative rise in blood pressure for 44 noncardiac patients undergoing anesthesia for elective general surgical procedures. Suggestive associations were found in sub‐samples with family history of CHD or age greater than 60 years. Thus, the TABP may be correlated with heightened physiologic response under anesthesia only in selected populations.

What Is the Role of a Clinical Ethics Consultant

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