Robert L. Frierson

AIDS: Psychological stresses on the family

Abstract Psychological repercussions of AIDS on family members were assessed and treated during psychiatric consultations over 4½ years with 50 relatives of 15 AIDS patients. The most frequent sources of stress were fears of contracting AIDS, the simultaneous revelations of homosexual or bisexual activity and what could prove to be a terminal disease, notoriety, a sense of helplessness, and grieving, especially among parents. Beneficial interventions for relatives include the provision of accurate information, a nonjudgmental approach, grief counseling, and peer-support groups, which in particular combat the sense of isolation felt by the family.

Heart transplant candidates rejected on psychiatric indications:Experience in developing criteria for proper patient selection

Abstract Heart transplantation necessarily involves allocation of a scarce resource. Seventy candidates for the operation were evaluated by a psychiatrist providing consultation for a transplantation team. Thirteen patients were determined to be unsuitable for the surgery owing to psychiatric factors. The psychiatric recommendation to the team for selection or nonselection was based on evaluation of the patients ability to overcome such challenges of transplantation as waiting for a donor, psychological incorporation of the new organ, and, especially, compliance with the medical regimen. Certain DSM-III diagnoses proved to be major impediments to patient selection. Based on their experience, the authors present specific recommendations for assessing candidates.

Psychiatric consultation for acute amputees: Report of a ten-year experience

Abstract Eighty-six patients receiving amputations (59 scheduled surgical amputations and 27 at the accident scene) were referred, usually after the amputation, to the psychiatric consultation service. Reasons for referral included assistance in coping, evaluation for depression, management of pain medication, behavioral problems, and suicidal ideation. Major reactions to amputation included flashbacks to the accident, body-image disturbances, a sense of helplessness, and grieving. Successful treatment interventions included psychotherapy, appropriate psychotropic or pain medication, grief counseling, and peer-group support. Psychiatric consultation also focused on improving the patients relationship with other caregivers, and it reduced the length of hospitalization somewhat.

Psychiatric Consultation for Patients With Self-Inflicted Gunshot Wounds

The study describes 260 persons referred over a 12-year period for psychiatric consultation after shooting themselves. The population consisted primarily of young, white men between the ages of 20 and 29. The abdomen was the most common site of injury for both sexes. Previous suicide attempts and past psychiatric histories were uncommon, but alcohol was involved in 25% of cases. Major depression and alcohol abuse were the most common psychiatric diagnoses. Tasks for the psychiatric consultant include dealing with reactions of hospital staff, instituting appropriate suicide precautions, determining future suicidality and psychiatric disposition, and helping patients cope with family reactions to the suicide attempt and with the psychological effects of disfiguring injuries.

Consultative psychiatry in both private and public general hospitals.

Most psychiatric patients obtain care in the nonpsychiatric units of general hospitals. Two groups of 100 psychiatric consultation patients in a private hospital setting and in a public hospital were compared. Significant differences were found. Patients in the public hospital were medically, psychiatrically, and socioeconomically more disabled. In the private setting, psychiatric consultants were usually seen as members of a treatment team. The public facility expected consultants to function as psychiatric triage officers. However, both patient groups had a similar frequency of psychiatric illness and had an equal need for psychiatric services.