W.E. Fann – författare

This is the sixth in a series of volumes sponsored by the Department of Psychiatry of Baylor College of Medicine, each reviewing one broad category of psychiatric disorders. Earlier conferences have focused on well-established psychiatric categories such as depression, schizophrenia, and alcoholism. Psychosexual disorders are usually considered as a subgroup of psychiatric dis­ orders, and form one of the major categories of the DSM -III Classification of Mental Disorders. However, psychosexual disorders are also of concern to all physicians and clinicians, working in virtually every field of medicine. The whole area of human sexuality has been characterized by rapid advances during the last few decades. Notable contributions have been from psychoan­ alysis, from the work of Kinsey and associates, and particularly from the work of Masters and Johnson, which has led to new stress on psychosexual dysfunc­ tions, in addition to the earlier interest in paraphilias, gender identity disorders, etc. Still later there has been increasing emphasis on disorders of sexual desire.

The "aging" of the world population is by now a well-recognized phenomenon. It has become a matter of concern to the social planner and deliverer of services, as weil as to the clinician. On aper capita basis, the aged-that is those 65 and older-appear in outpatient health care facilities at a rate wh ich is approximately fifty percent greater than their adult peers, stay about three times as long in general medical and surgical facilities, and represent more than 90 percent of the long-term-care beds in the United States. In addition, at a time when they represented approximately 10 percent of the total population, the aged were the recipients of 25 percent of all prescriptions for medication. Thus, an understanding of the drug use consequences, misuse and abuse of drugs among older persons, has become a salient issue for the scientist, clinical physician, and other health care professionals. The aged are a group at heightened risk for a number of disorders and often present with clinical problems not usually encountered in an aging population. Many such problems are the direct consequence of multiple, concurrent, and complicating disorders; drug/drug interactions, com­ pliance with physician prescription, the use of concurrent non-prescribed substances such as alcohol or over-the-counter medication, and a variety of other behaviors. There is also a growing interest in the well recognized, but poorly understood, pattern of organic changes which occur in later maturity.

The interrelationships between somatic and psychiatric complaints involve virtually every major organ system and every psychiatric diagnostic category. Psychiatric distress frequently finds expression in physical ailment or pain, and chronic physical illness or disability is a common exacerbant of psychiatric symptoms. The complexity of the interplay between psychological and physiological disease is profound, and many of the mechanisms involved remain undefined or imperfectly understood. Our intention in assembling this volume, the fifth in the Baylor Psychiatry Series, has been to consolidate the most recent medical and psychiatric opinion on the description and treatment of psychophysiological disorders. We have included reviews and new material on disorders long understood to be in the psychophysiological realm, such as gastrointestinal disease, pulmonary reactions, headache, and hypertension. Additionally, there are contributions on conditions less frequently, but no less clearly, recognized as psychophysiological or psychosomatic, including immune response deficits, epilepsy, stuttering, and sleep disorders. Chapters on Couvade syndrome, menstrually related mood disturbance, obesity, keratoconus, and anorexia nervosa examine the degree to which psychological and physical events interact in conditions usually considered attributable essentially to a single system. Drs. Dowling and Gaitz have written excellent reviews of developmental elements in psychophysiological events, and examine such disorders as they are specific to the very young or the very old. Treatment approaches to the variety of disorders are discussed in chapters by Dr. Decker, who describes multifaceted modalities, Dr. Lomax, who examines psychotherapeutic techniques, and in a final chapter on psychopharmacological mitigation of psychophysiological syndromes.

The interrelationships between somatic and psychiatric complaints involve virtually every major organ system and every psychiatric diagnostic category. Psychiatric distress frequently finds expression in physical ailment or pain, and chronic physical illness or disability is a common exacerbant of psychiatric symptoms. The complexity of the interplay between psychological and physiological disease is profound, and many of the mechanisms involved remain undefined or imperfectly understood. Our intention in assembling this volume, the fifth in the Baylor Psychiatry Series, has been to consolidate the most recent medical and psychiatric opinion on the description and treatment of psychophysiological disorders. We have included reviews and new material on disorders long understood to be in the psychophysiological realm, such as gastrointestinal disease, pulmonary reactions, headache, and hypertension. Additionally, there are contributions on conditions less frequently, but no less clearly, recognized as psychophysiological or psychosomatic, including immune response deficits, epilepsy, stuttering, and sleep disorders. Chapters on Couvade syndrome, menstrually related mood disturbance, obesity, keratoconus, and anorexia nervosa examine the degree to which psychological and physical events interact in conditions usually considered attributable essentially to a single system. Drs. Dowling and Gaitz have written excellent reviews of developmental elements in psychophysiological events, and examine such disorders as they are specific to the very young or the very old. Treatment approaches to the variety of disorders are discussed in chapters by Dr. Decker, who describes multifaceted modalities, Dr. Lomax, who examines psychotherapeutic techniques, and in a final chapter on psychopharmacological mitigation of psychophysiological syndromes.

Phenomenology and Treatment of Alcoholism is the fourth in a series of texts on the major psychiatric disorders developed by the Department of Psychiatry at Baylor College of Medicine in Houston. Like the previous three volumes on depression, schizophrenia, and anxiety, this text the proceedings of a two day symposium conducted by Baylor. represents Psychiatrists and other physicians and scientists who have made major contributions to the field of study were invited to discuss important aspects of their work with a large group of other medical professionals. Questions of definition, diagnosis, and clinical management were addressed with a degree of specificity and detail not normally found in general psychiatric texts nor in books presenting an individual outlook or treatment approach. More than most other psychiatric ailments, alcoholism generates considerable interest among the general medical profession. Psychosis and affective disorders are clearly and specifically within the province of the psychiatrist. Neurotic disorders are often treated by the primary care practitioner in their more moderate manifestations, but by psychiatrists when they reach their most malignant stages. Alcoholism, on the other hand, is confronted by virtually every medical practitioner, whether generalist or specialist. Alcoholism is among the most prevalent and difficult disorders afflicting human beings. It may exist discretely, as a precipitant, or as a complication of other major diseases, intruding upon virtually every physiological and psychological symptom complex.

psychiatric treatment approaches there are opportunities for trial and error, exploration and reconsideration, revision of treatment approach, and correc­ tion of errors. Revisions and corrections are based on observations of pro­ gress and on response from patients about the impact of treatment efforts. But emergency interventions usually are one time efforts involving a sequence of evaluation, therapeutic intervention, and referral out. Response is limited or absent and there are no opportunities for corrections over time. Therefore, interventions and referrals must be made on the basis of first evaluations, with positive conviction related to current best effort and despite the lack of guidance derived from tracking the patient''s progress over time. The staff must tolerate the risk-taking required, and must also be prepared to forego the gratification of seeing the beneficial results of the work done. Even in pro­ grams structured to allow return visits, and despite the occasional information provided by other agencies after referrals, the majority of patients are lost to follow up. The usefulness of specific interventions is hard to evaluate and the satisfaction of seeing a task completed is rarely available. The emergency program staff must tolerate a considerable amount of stress in the environment. Emergency care centers are collection points for an extraordinary volume of human suffering. The anxieties and strains asso­ ciated with persistent urgency of need, alarm related to unexpected difficul­ ties, fearfulness about outcome, closeness of death, and presence of pain pervade the atmosphere.