Stephen C. Scheiber

Dementia dialytica: A new psychotic organic brain syndrome

Abstract This paper describes the clinical manifestations of dementia dialytica, a new psychotic organic brain syndrome. The anxiety and depression that are prevalent in patients undergoing dialysis, 8–11 and evident in this patient, must not mislead the psychiatrist in suspecting dementia dialytica. In addition to the progressive dementia, paranoid ideation and psychotic behaviors are noted accompanying the neurologic findings. The latter include dysarthria, dysnomia, dyspraxia, and seizures. 3 All of these signs and symptoms are aggravated during and immediately following dialysis. Serial observations of the patient by the consulting psychiatrist during dialysis, immediately following dialysis, and between dialyses will help to confirm the diagnosis early in its course. Most patients die within 6 months of the onset of dementia dialytica. Early identification of the syndrome will help the dialysis team, the patient, and his family make informed plans regarding continuing treatment.

Clinical and psychological test findings in cerebral dyspraxia associated with hemodialysis.

Cerebral dyspraxia associated with hemodialysis is a progressive, fatal syndrome. Patients suffer from a combination of psychiatric and neurological signs and symptoms. Psychiatric manifestations include anxiety, depression, paranoid ideation, and a progressive dementia with impaired concentration, decreased memory, personality changes, and hallucinations. Neurological findings include deliberate speech, stuttering, dysarthria, dyspraxia of speech and movement, tremulousness, myoclonic activity, asterixis, and seizures. These symptoms are aggravated during and immediately following dialysis. Patients usually die within 6 months of its onset. The etiology is unknown. Treatment efforts have failed to reverse its course. Recognition of this syndrome is highlighted so that informed, critical decisions can be made as to whether to continue dialysis therapy.

Why Psychiatry is Recruiting Fewer Residents: The Opinions of Medical School Deans and Psychiatric Department Chairmen

In response to a survey of medical school deans and chairmen of departments of psychiatry about factors contributing to reduced recruitment of medical students into psychiatry, opinions were obtained from 82 American medical schools, with 50 deans’ and 59 chairmen’s responses returned. Factors most often cited include decreased federal support for psychiatric training, the push toward increasing the numbers of primary care physicians, role diffusion in mental health care, and poor teaching in some departments of psychiatry. Suggestions are offered for enhancing recruitment of students to psychiatry.

Why should dialysis benefit schizophrenia

If dialysis is successful for the treatment of schizophrenia, the artificial kidney must be removing something which the human kidney cannot, unless other nonspecific factors are involved. Either there is an abnormal compound present which is retained by normal renal tubular transport processes, or the kidney of a schizophrenic must be abnormal in that it fails to excrete a normally present compound. Since the latter explanation is less probable, biochemical research should focus on classes of compounds which are known to be handled differently by the artificial kidney than by the human kidney. A dialyzable “schizophrenic toxin” might be a nonprotein, nonprotein-bound compound of molecular weight below 500 daltons such as an organic acid or base. Proteins, peptides, amino acids, and trace elements are less likely possibilities.

Emotional Problems of Physicians

The life of a physician can be personally rewarding and professionally fulfilling. The physician is in a position to earn the respect of his peers, the admiration of his patients, and the love of his family. Frequently leaders in their community, physicians have a potential for personal and professional growth that is enormous. Most physicians prosper and live a rich, emotionally satisfying life. A minority of physicians, however, are emotionally troubled. This chapter discusses these emotional problems of physicians.

The Medical School Admissions Committee

Many medical students who sought psychiatric help had personality problems before entering medical school and the major cause of maladaptation was “the personality they brought with them,” according to Hunter et al.1 The study of psychiatric illness in medical students by Pitts et al. demonstrated a high correlation with family histories positive for psychiatric illness.2 Modlin and Montes, in their study of physician addicts, and Vaillant et al., in their work on psychological vulnerabilities, point to early childhood factors that influence the need for psychiatric care.3,4 Blachly et al. describe the physician at risk for suicide as “competitive, compulsive, individualistic, ambitious, a graduate of a high prestige school, one who had mood swings, had problems with drugs, or alcohol, a non-lethal annoying physical illness, and one who may feel a lack of restraint by society.”5 These risk factors are discussed in Chapter 1, Emotional Problems of Physicians: Nature and Extent of Problems.

The Restoration of a Fourth Year of Graduate Training in Psychiatry: Guidelines to Anticipated Problems

The new requirements for psychiatric training beginning in July, 1977, extend the training period from three to four years. A minimum of four months of the four years must be spent on primary care medical services. These changes are likely to present problems for psychiatric residency training programs. Guidelines for anticipated problems such as program funding, expanding institutional affiliations, stipend and fringe supports, rotations on primary care services, and filling traditional first-year residency positions in 1977 are offered.