International journal of psychiatry in medicine
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Any one of a number of psychologic patterns may appear cardiotomy: (1) Some patients may be elated and confident after awakening from anesthesis and have no severe changes of affect or neurologic deficit. Denial seems to be for them an adequate defense against anxiety. (2) Others are disoriented and manifest neurologic disturbance immediately after awakening, without a lucid interval. The sensorium begins to clear five days after surgery. (3) Some patients go into delirium after being lucid for as long as a week and have hallucinations, illusions, and motor excitation for a few days-or over several weeks. ⋯ Delirium is fostered by sensory overload (or deprivation) in the recovery room and intensive care unit, and by staff tension. Modification of the intensive care unit environment, the administration of antipsychotic drugs, and metabolic correctives are recommended. Preoperative psychologic evaluation, with therapy as needed, preliminary familiarization with perioperative procedures, as well as collaboration between psychiatrist and surgeon, can do much to prevent post-cardiotomy delirium.
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Int J Psychiatry Med · Jan 1975
Teaching psychosomatic medicine to medical students, residents and postgraduate fellows.
The teaching objectives of a psychosomatic program are discussed--in particular, to teach skills and methods of observation; to help students to acquire information about mind-body relationships in health and disease; to help future practitioners develop the capacity for clinical reasoning which includes psychological and social considerations; to effect modifications in attitudes and behavior towards patients and their families; and to present to students the model of a physician who has a major interest and considerable competence in two areas of medicine--the psychosocial and the physical-physiologic-biochemical. A description of the general organization of the liaison service is presented, and the specific aspect of teaching programs for medical students, medical interns and residents, psychiatric residents, and liaison fellows are outlined. Implications for the future of liaison teaching are mentioned.