232 PSYCHOSOMATICS

Abstracted from the Medical Press

JULY-AUGUST

A CONSIDERATION OF MULTIPLE FACTORSIN THE ETIOLOGY OF UVEITIS. John K.Erbaugh, M.D., Survey of Ophthalmology, 5:260·263, June 1960.

This is a well written review of an excellentpsychosomatic approach to the problem of uvei­tis. Since it is a review it is difficult to abstract.An inflammatory disease such as uveitis can bebroken down into two interreacting components;an agent and a host. There is individual vulner­ability and tissue vulnerability. For examplethere are inheritable individual differences inthe ability to make antibodies. Our knowledgeof tissue or organ vulnerability is practicallynon-existent. To explain tissue vulnerability, inthis case ocular vulnerability, the psychologicapproach may yet prove the most fruitful. Atone unconscious level the eye has one meaning,while at another level it. may have an entirelydifferent significance. Probably the eye is onething to the hysterical amblyope and quite an­other to the uveitis patient. The hysteric merelyshuts off his vision, while the psychotic may re­move the eye.

T. F. Sch'laegel, Jr., M.D.Indianapolis, Indiana.

"HYPNOSIS," ANALGESIA, AND THE PLA·CEBO EFFECT. T. X. Barber, Ph.D., J.A.M.A.,Vol. 172, No.7, Feb. 13, 1960.

The author of this paper attempts to explainhow "mere words" spoken by one person to an­other are able to exert an analgesic effect.

Two factors are responsible. One of these isa placebo effect; the other resembles the modeof action of morphine.

The patient must have confidence in his physi­cian and believe that hypnotic procedures canrelieve his pain. The patient must also be ableto become inattentive to, not thinking about, andunresponsive to nocioceptive stimuli. The firstis the placebo effect; the second resembles re­lief of suffering achieved with morphine.

Emphasis should be placed on the character­istics of those few persons able to experience adeep hypnotic trance. As a result of previouslife experience, they are able qUickly and easilyto become relatively inattentive to, not thinkingabout and unresponsive to selected stimuli.

The patient believes that pain will be relieved(hypnosis acting as a placebo effect) and thepatient develops a contentment, freedom from

anxiety, and a "bemused state comparable todistraction." without altering the intensity ofpainfUl sensation or elevating pain threshold(morphine effect).

Joseph Joel Friedman, M.D.Brooklyn, N. Y.

PSYCHOLOGICAL FACTORS IN THE PRACTICEOF DENTISTRY. Alex H. Kaplan, M.D., J.A.D.A., 57:835, Dec. 1958.

The several topics that are developed withinthe dental frame of reference include such sub­jects as anXiety, psychosomatic versus neuroticreactions, emotional factors affecting dental dis­ease, psychophysiological reactions, psychologi­cal reactions to dental procedures, the dentist­patient relationship, bruxism and thumbsucking.

The author concluded that "Psychological fac­tors may, as a result of recurring emotionalstates and anxiety, cause physiological changesand dental disease. Conversely, dentofacial de­formities may have a significant effect on thegrowing personality. But in the majority ofpatients, emotional factors complicate ratherthan specifically cause dental disease. Further­more, the emotional factors influencing the doc­tor-patient relationship have a direct bearing onthe problem of the general treatment of dentaldisease. Patients may react to dental manipu­lations with tension or anxiety eqUivalents suchas avoidance, excessive reaction to pain, gaggingor irritability. This makes it essential for thedentist to treat the person as a whole, consider­ing his psychological reactions as well as his ob­vious dental disease. The importance of recog­nizing that the emotional reactions of patientsare usually directed at the oral attack, and notthe dentist himself, must be emphasized.

"Besides learning more about normal personal­ity development and its customary variations, thedentist must learn to guard himself carefullyagainst too many frustrations. He must havehis own normal emotional needs gratified as thefirst step in meeting his patients' emotionalneeds. In order to facilitate his understand­ing of personality traits and their effect on den­tal care, it is hoped that theoretical and prac­tical courses on the development of personalityand the science of psychodynamics will becomeprereqUisites in all dental schools."

Melvin Land, D.D.S.Dallas, Texas.

1960 PSYCHOSOMATICS 233

THE EFFECT OF EARLY SURGERY FOR STRA.BISMUS ON THE PSYCHOLOGY OF THECHILD. P. Vancea, M.D., P. P. Vancea, M.D.,and V. Vaighel, M.D., Ann. Ocul., 192:354·361,May 1959.

The authors point out that the relation be­tween strabismus and the psyche may be con­sidered two ways: (1) psychic troubles as etio­logic factors in strabismus; (2) strabismus as agenerator of psychic troubles. They stress thefact that strabismus should be corrected beforeit can produce psychic upsets, that is, beforefamily and school surroundings arouse in thepatient the consciousness of his infirmity. Theyreport on a series of 17 children operated be­fore the age of four with excellent results in allcases.

T. F. Schlaegel, Jr., M.D.Indianapolis, Indiana.

A REHABILITATION PROGRAM FOR GERIAT·RIC PATIENTS. H. Blustein, J. Amer. Geriat.S., 8:204, March 1960.

This article was presented before the SixthAnnual Meeting of the National Geriatric So­ciety, Chicago, April 19, 1959.

A plan for the rehabilitation of elderly menon the Geriatric Service of a Veterans Adminis­tration hospital had as ils objective the remoti­vation of patients showing mental regressionand antisocial behavior to get them to attainthe fullest life possible in view of their abilitiesand disabilities. A team approach was usedand internal medicine, neurology, psychiatry,nursing care, physical, corrective, occupationaland recreational therapy all contributed to theprogram. The men responded well to the attemptat total rehabilitation by showing an improve­ment in physical condition and mental status.

Anthony R. Tortora, M.D.Brooklyn, N. Y.

PSYCHOPHYSIOLOGY OF HYPNOSIS. Louis J.West, M.D., J.A.M.A., Vol. 172, No.7, Feb. 13,1960.Dr. West broadens the concept of dissociative

reaction. Data cO:1ccrning the physiology ofawareness indicate a mechanism capable ofscanning and screening incoming information andregulating the 8phere of awareness moment bymoment. Only a minute amount of the tolalavailable information (from the external envi­ronment and from within the brain itself) canbe held in awareness at any given time.

Scanning and screening is constantly neces­sary to focus on selected material and to keepeverything else out of awareness. This makes

possible concentration and a "dissociation ofawareness from the majority of sensory andeven strictly neural events that are takingplace." This quote is Weitzenhoffer's recent defi­nition of hypnosis and implies an appreciation ofthe combined functions of focus and exclusion;between excitation and inhibition.

The brain system which permits integrationof incoming stimuli and awareness to them isthe ascending reticular activating system andthe thalamocortical projection system. Stimula­tion, inhibition, arousal and depression are allmanaged in the reticular formation. This areasubserves the reality-testing functions of the ego.Focus of awareness may be narrowed down toone particular aspect of reality (as in the initia­tion of the hypnotic trance), and sensory data(verbal suggestion) becomes more effective.

The reticular activating system may act in twoways: The first in which attention is fixed by anarrow range of stimUli, monotonously presented;the second in the non-acceptance of nearly alladditional incoming information in the presenceof an input-overload.

Deliberate exclusion of external stimuli maybe achieved through intense concentration. Thisis possible through the focusing and inhibitingability of the reticular system. It is probably inthis way that the trained subject quickly entersthe trance state on receiving his learned signal.

Phenothiazines render the chronically 'anxiouspatient more accessible to hypnosis; phenobar­bital will not.

Joseph Joel Friedman, M.D.Brooklyn, N. Y.

USE OF PROTAMIDE IN THE TREATMENT OFHERPES ZOSTER. A. G. Baker, PennsylvaniaMed. J., 63:697, May 1960.A variety of remedies have been used in the

treatment of herpes zoster ("shingles"), includ­ing antibiotics, vitamin B complex, cyanocobala­mine (Vitamin BI), corticosteroids, vasodila­tors, sulfonamides, immunoglobulin, and symp­tomatic drugs such as analgesics and antipruri­tics. They prOVide only limited benefit and manymay induce undesirable reactions. The reportpresents observations concerning the incidenceof postherpetic neuralgia and the duration ofpain, disability, and skin lesions in 34 cases ofherpes zoster treated with Protamide, a dena­tured proteolytic enzyme, and compared with 10patients of the same age groups treated withcyanocobalamine (vitamin BIz)'

Protamide injections (1.3 ml.) were adminis­tered intramuscularly at 12 to 24 hour intervalson the first two days and thereafter one injectionon alternate days. Treatment was continued

284 PSYCHOSOMATICS JULY-AUGUST

from 5 to 16 days depending upon severity ofsymptoms.

Cyanocobalamine was administered 1000 mi­crograms daily by hypodermic injection andtreatment continued one to two weeks.

Good to excellent results were seen in 32 of 34cases treated with Protamide. Patients treatedwith cyanocobalamine showed eqUivocal results.

B. Z Haidri, Ph.D.Detroit, Mich.

PSYCHOSOMATIC ASPECTS OF INFERTILITY.Theodore E. Mandy, M.D., and Arthur J. Mandy,M.D., Sinai Hosp. J., 8:28-35, 1959 (Baltimore).

In cases of infertility, emotional factors shouldbe assessed if no organic disease is apparent. In­vestigation should include the following ques­tions: 1) Why does she want a child? 2) Whatwill having a child mean to her? 3) What wasthe relationship of the patient to her mother inchildhood and what is it at the present time? 4)What was her relationship to her brothers andsisters, and 5) What is her marital history?

A woman with functional infertility may de­sire pregnancy to satisfy her husband's demands,to try to correct a shaky marriage, to have achild so that someone would love her, or to showher own mother how to raise a child.

Ambivalent feelings about having a baby, anda conscious or unconscious rejection of mother­hood may be present. When rejection is uncon­scious, shifting from one physician to anotheris common, as are the symptoms of menstrualirregularity. Most of these patients are imma­ture and dependent; the dependency may bemarked by aggressiveness.

MENTAL DISORDERS IN CEREBRAL CYSTI·CERCOSIS. R. Jeri, Rev. psiq. peruana, 1:211­227, 1958.

A total of 28 of 32 patients with cerebral cys­ticercosis showed mental disturbances. All pa­tients showed symptoms pointing to a cerebrallesion (headache, convulsions, visual disorders,paresis, etc.). Mental symptoms consisted of per­sonality changes, acute delirium and psychoticreactions. In some the diagnosis of schizophreniaor manic-depressive psychosis had been madeprior to neuropsychiatric observation.

ULCERATIVE COLITIS AND PREGNANCY. Ed­ward L. Krawitt, Obs. and Gyn., 14:354-61.

A review of the literature revealed that morethan one third of qUiescent ulcerative colitis pa­tients are activated by pregnancy and half of

the active cases are aggravated. Approximatelyone fourth will improve with pregnancy.

The interrelationship of the two conditions isthought to be psychogenic. The course of thecolitis is determined by the expectant mother'sattitude towards her pregnancy. She usually isemotionally immature, cannot tolerate frustra­tion or ~sume responsibility; pregnancy there­fore constitutes a stressful situation threateningher dependent status.

(Quoted in World-Wide Abstracts, Vol. 3, No.2, Feb. 1960.)

THERAPY OF HYPERTENSION WITH ORALLYGIVEN SYROSINGOPINE. G. R. Herrmann, etaI., J.A.M.A., 169:1609·1612, April 4, 1959.

Syrosingopine (Singoserp, Ciba) is a syntheticcompound derived from reserpine. It was pre­pared with the hope of removing undesirable sidereactions. The stUdy considered 77 patients withessential hypertension. Of 38 patients who hadno previous therapy for hypertension, 16 (42%)responded with a clinically significant drop inblood pressure. Thirty-four patients who hadpreviously received reserpine were changed tosyrosingopine and were controlled without sideeffects. In five patients who had severe mentaldepression or severe nasal congestion on otherRauwolfia products, a hypotensive effect was nowseen without these side effects on a dose of 3 mg.per day.

ACUTE BRAIN SYNDROME. I. J. Farber, Dis.Nerv. System, 20:296·299, 1959.

The most common manifestations of the acutebrain syndrome are delirium and defects in thesensorium, but delusions and behavior changesmay be seen. The most common causes, exclud­ing alcoholic hallucinosis and delirium tremens,include convulsive disorders, drug intOXication,circulatory disturbances, systemic infections andhead trauma.

Disorientation is frequent, more often in rela­tion to time than to place. Memory disturbancesmay be diffuse or isolated and may be for recentor remote facts. Auditory hallucinations aremore common than visual ones. Ideas of perse­cution may be present as well as depression orsigns of increased anxiety and irritability.

In patients where the delirium is of unknownetiology, autopsy may reveal one of the follow­ing: Wernicke's encephalopathy, frontal lobe ab­scess, tuberculous meningitis, or a cerebrovascu­lar accident.

W.D.