Laurens D. Young

Attitudinal and behavioral correlates of coronary heart disease

Abstract The recognition of an association between coronary heart disease (CHD) and coronary prone behavior (CPB) has raised the question of whether behavior may directly affect coronary atherosclerosis. The relationship of coronary occlusion measured by arteriography and angina pectoris to questionnaire responses selected as consistent with the attitudes and behavior of CPB were examined retrospectively in 2215 employed male patients. Nonbehavioral factors such as serum cholesterol and triglycerides were highly related to occlusion but not to angina. By comparison, most subjective attitudes and some quantitative behaviors consistent with CPB were overrepresented in angina but not in occlusion. Certain neurotic behaviors were also disproportionately represented in angina but not in occlusion. These results indicate that attitudinal and behavioral aspects of CPB contribute to angina pectoris and perhaps indirectly to atherosclerosis. This association was greatest in patients older than 50 years, but comparable to some standard risk factors in younger patients also.

Inpatient unit for combined physical and psychiatric disorders

Abstract The Behavior Evaluation and Treatment Unit of the Medical College of Wisconsin provides continuous care of patients with combined behavioral and physical problems. These patients differ from those seen in our consultation service by having higher rates of psychosis, approaching that of traditional psychiatric inpatient programs. The medical and surgical illnesses treated on this unit are not trival, are often found to aggravate the psychiatric problems, and are sometimes considered causative. The work-up and treatment of such patients can potentially be performed without major increases in length of stay. Inpatient programs for combined disorders hold the promise of enhancing quality and alternatives of care for a sizable group of patients.

Male genital self-mutilation combined surgical and psychiatric care.

Abstract Advances in plastic surgery require that consultation psychiatry respond with increasing sophistication. Self-mutilating patients may now undergo genital reimplantation, but few guidelines exist for their psychiatric management. We describe three contrasting cases of male genital self-mutilation, demonstrating the differential impact of psychiatric consultation, and offer guidelines for a consultative strategy to the surgical team, patient, and family. A general management plan for consulting psychiatrists is presented.

Length of stay on a psychiatry-medicine unit.

To assess the efficiency of a medical-psychiatric unit over 3 years, several studies were carried out on one combined psychiatry-medicine unit. On the Behavior Evaluation and Treatment Unit of the Medical College of Wisconsin, Division of General Hospital Psychiatry, average length of stay was calculated in successive cohorts of 28-31 consecutive patients (total 358 patients). Medical-surgical and psychiatric diagnoses were compared over a 2 1/2-year span; psychiatry diagnoses were compared to those on other units; and acuity of illness was measured comparatively by various methods. Length of stay decreased from more than 20 to less than 15 days. This effect did not appear to be directly related to diagnostic changes. Only minor increases in range of psychiatric diagnostic categories and changes in proportion of certain disorders were found. The acuity level was descriptively intermediate between that of a general medicine and that of a general psychiatry unit. Factors that could be related historically to these findings were discussed.

A profile of academic medical-psychiatric units

Medical-psychiatric inpatient programs are a relatively recent phenomenon. Although interest in these programs seems widespread, they are still found primarily at academic medical centers. The authors surveyed 11 such academic units. Variations found between their patient populations, milieu, and organization suggest that these programs, in general, are still in an early stage of evolution. It is hoped that these data will provide a descriptive base of how these programs have developed.

Reliability of a Brief Scale for Assessment of Coronary-Prone Behavior and Standard Measures of Type a Behavior

45 male volunteers were classified by the Structured Interview for Type A behavior and also by the Jenkins Activity Survey. Each subject also responded to a series of 10 questions taken from the Milwaukee Cardiovascular Life Quality Questionnaire. 10 items of the questionnaire were tested to form a scale, the Milwaukee questionnaire—10 for the classification of Type A and B coronary-prone behavior. Each response was rated as one if it was in the previously defined direction of Type A or as zero if in Type B direction. The mean response in this population was 3.56. Subjects scoring 0 to 3 were then classified as Type B and those scoring 4 and more as Type A. Subjects were also given two standard measures of Type A behavior, the Jenkins survey and the structured interview. Comparisons of Type A vs B classes were made between the Milwaukee questionnaire and the interview and the Jenkins survey. High agreement rating Type A behavior was found among instruments. The 10 items appear to provide a reliable and brief scale for rating Type A coronary-prone behavior.

Induction of mania by L-dopa in a nonbipolar patient.

The authors present a case of mania associated with the prolonged ingestion of large doses of L-dopa. Prior reports relating L-dopa therapy to mania in patients with bipolar disorders are discussed. The induction of a classic manic syndrome by catecholamine augmentation is possible in a nonbipolar individual.

Coronary-prone behavior attitudes in moderate to severe coronary artery occlusion.

This study was undertaken to clarify the relationship between coronary artery occlusion (CAO) and coronary-prone behavior attitudes (CPBA) in a large coronary arteriography population. A group of 2451 male patients responded to a questionnaire prior to coronary arteriography. Ten questions from the questionnaire, selected to form a scale measuring CPBA, were found to be reliably associated with standard measures of Type A behavior. No differences in CPBA were found when the group was divided into mild, moderate, and severe CAO, but angina pectoris (AP) tended to increase from mild to severe CAO. Multiple regression analysis confirmed that CPBA were independently associated with AP but were not associated with CAO. These findings suggest that angina pectoris is an important intervening variable between CPBA and CAO and that the relationship of AP in a population should be carefully considered before conclusions are drawn as to the relationship between CPBA and CAO.

Chest Pain and Behavior in Suspected Coronary Artery Disease

This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.

The psychiatric rotation: Traditional inpatient or consultation clerkship?

Abstract Thirty-nine medical students on a junior clinical clerkship in consultation psychiatry were compared with 21 students on a more traditional inpatient clerkship for changes in formal psychiatric knowledge, interest in psychiatry, self-rated psychiatry skills, and attitudes about psychiatry. Both groups showed comparable increases in objective knowledge and increased comfort with psychiatric patients. Minor but no fundamental differences between the two groups were ascertained by objective testing. The findings support the observation that students on a consultation clerkship can learn clinical psychiatry as well as those on traditional inpatient clerkships.