aspecte psihologice -heart desease

aspecte psihologice -heart desease - Psychological Aspects...

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Psychological Aspects of Cardiac Disease A Study of Patients Experiencing Mitral Commissurotomy STANLEY M. KAPLAN, M.D. As A RESULT of the use of the surgical procedure of mitral commissurotomy a num- ber of patients who were otherwise destined to progressive cardiac invalidism are now fairly normally functioning persons. Patients who have been benefited by this operation consti- tute a somewhat unique group, since cardiac patients seldom experience so dramatic an improvement of their cardiac function. Al- though patients with heart disease ordinarily are maintained in varying degrees of compen- sation by the use of medications and instruc- tions to live leisurely, even with this regimen they usually can anticipate progressive cardiac debility. The emotional problems of patients with heart disease have been discussed in the lit- erature. When individuals develop cardiac disease their concepts of themselves and their relationships to their environments change and, as a result, certain psychological adjust- ments are necessarily made. 6 ' 10 It is also quite likely that certain personality modifications will occur if the cardiac disorder is relieved. It would seem, then, that a further understand- ing of the emotional problems of patients with heart disease could be obtained if a group of From the Department of Psychiatry, University of Cincinnati College of Medicine, and from the Psy- chosomatic Service of the Cincinnati General Hos- pital, Cincinnati, Ohio. Public Health Service Special Research Fellow of the National Institute of Mental Health. The author is indebted to Drs. Leonard Gottes- man, James Helmsworth, Clarence Podore, and Bernard Schwartz for referring these patients and for their aid in evaluating them throughout the progress of this study. VOL. XVIII, NO. 3, 1956 patients who experienced physical improve- ment from the commissurotomy procedure was studied. In addition, such a study could provide additional information regarding the best ways to prepare these people psychologi- cally for the operation and to rehabilitate them optimally after the operation. Fox, Rizzo, and Gifford described their interesting study of a series of patients ad- mitted to the Peter Bent Brigham Hospital for mitral surgery. They investigated the emergency defenses these patients developed in the hospital situation both before and after the operation, which was considered to be an acute stress. They demonstrated in this study that an understanding of these patients' long- term adaptations to their progressive limita- tion of activities provided a necessary back- ground for the recognition of their emergency defenses. Their follow-up, however, was limited to the extent of the hospitalization except for brief written correspondence be- tween the patient and the surgeon. Moffett described her casework experience with a pa- tient who had ha4 mitral commissurotomy. She found that it was necessary to provide her
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aspecte psihologice -heart desease - Psychological Aspects...

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