1/4. Psychological management of the myocardial infarction patient.The acute coronary experience is divided into three parts. In the first, the pre-hospital phase, attention is devoted to the widespread phenomenon of patient delay. Evidence is given to indicate that the source of delay is entirely psychological and centers around the inability to decide whether or not to seek help. The second part, or hospital phase, describes the response of the patient to the various aspects of the coronary care unit, including monitoring, false alarms, witnessing and sustaining a cardiac arrest. The third phase, the post-hospital convalescence, centers on the principal psychological problem of this period, depression. Its causes, manifestations, and methods of management are discussed.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
2/4. Leukocyte tubuloreticular inclusions in Reye's syndrome.Tubuloreticular inclusions (TRI) have been observed in the rough endoplasmic reticulum of blood lymphocytes and monocytes in two cases of Reye's syndrome initiated by influenza infections. Tubuloreticular inclusions are seen in these mononuclear leukocytes during the acute phase of illness, but not during convalescence. Since TRI have been demonstrated in peripheral mononuclear leukocytes in patients with acquired immunodeficiency syndrome, systemic lupus erythematosus, and certain viral infections including T-cell leukemia, it may be that the finding of TRI in Reye's syndrome reflects a viral infection and/or immune dysfunction, if such association is not proved to be fortuitous.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
3/4. Virologic, immunologic, and clinical observations on a patient during the incubation, acute, and convalescent phases of infectious mononucleosis.One patient with infectious mononucleosis (IM) was studied from the probable time of Epstein-Barr virus (EBV) infection (38 days before the onset of clinically overt disease), during the incubation and acute phases, until 6 months after clinical remission. Analysis of spontaneous outgrowth of EBV-carrying lymphoblastoid cells, by limiting dilution on feeder layer cultures, showed that virus containing B lymphocytes are already present early during the incubation period. Also low interferon serum levels were detected early after infection, and only before the onset of clinical disease. All other studied clinical laboratory and virus-associated variables were within normal range during the incubation phase, but changed to a pattern characteristic of IM in parallel to the clinical symptoms. During the acute disease EBV-associated nuclear antigen (EBNA)-positive cells could be directly detected among the lymphocytes, and antibodies to EBV antigens appeared. lymphocytes stained by monoclonal antibodies, detecting Ia-like determinants (activated cells) and suppressor cells, increased dramatically, in parallel to a strong increase of functional suppressor cell activity, measured by inhibition of blastogenesis and PWM-induced immunoglobulin production. During the acute phase there was also a decrease of spontaneous cytotoxicity against the NK-sensitive cell line K562, while cytotoxicity (spontaneous) against an autologous EBV-positive lymphoblastoid cell line (LCL) was detected only during this phase. These reactions correlated to the presence of blasts, and the autologous reaction was exerted mainly by Fc-receptor-negative cells. Lymphokine production in response to EBV antigens was also initiated during the acute phase. During the convalescence period the serological and cellular immune parameters adjusted to the pattern of a normal EBV-seropositive person.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
4/4. Denial and rehabilitation of the post-infarction patient.The use of denial has been widely accepted as an adaptive and protective coping mechanism in the acute phase of myocardial infarction. Although instrumental in lowering anxiety and mortality in the acute phase of coronary care, the use of denial creates hazards for the patient in convalescence. These hazards, not well known to intensive care personnel but all too apparent to the liaison psychiatrist working in cardiovascular rehabilitation, include a high vulnerability to disruptive anxiety and even psychosis at times of transition from greater to lesser intensity nursing care and a maladaptive resistance to rehabilitation efforts in convalescence. Failure of denial under the stress of transition may produce a transient paranoid psychosis with a clear sensorium, a variant of Abram's "cardiac psychosis." maintenance of the defense in convalescence leads to noncompliance with medical advice and rejection of rehabilitation efforts, increasing the risk of reinfarction. A case report is presented illustrating both hazards. Recommendations for management include early recognition, supportive psychotherapy, education and mobilization in the acute phase of coronary care. Cardiovascular conditioning and reshaping of risk factors follow in convalescence. The physical and psychological benefits of this approach are reviewed. The adaptive value of denial in coronary patients is challenged from the long-term perspective of rehabilitation.- - - - - - - - - - ranking = 4keywords = convalescence (Clic here for more details about this article) |