No abstract

Three groups of patients were identified during a study of men who had recently suffered an acute myocardial infarction: those with psychiatric morbidity antedating the infarction and those with no significant psychopathology. Compared to the other two groups, patients with psychiatric morbidity before the infarction were more likely to be unmarried, unemployed and to have received previous psychiatric treatment. They also obtained higher scores for neuroticism and psychoticism on personality assessment. Patients whose symptoms have been precipitated by the infarction resembled the psychologically healthy group with regard to their demographic characteristics and personality. Their symptoms tended to be transient, improving without special psychiatric treatment.

Summary and conclusionsOne week after a first myocardial infarction 35 out of 100 consecutive men patients aged under 65 were found by standardised clinical interview to have psychiatric morbidity. In 16 the morbidity had been evident before the infarct, and these patients showed a wider range of psychopathology than those whose symptoms had been precipitated by the infarct.The results suggest that psychiatric morbidity in patients with heart disease is not necessarily a result of the disease process. Thus characterising psychiatric morbidity and identifying the patients' individual needs are important if rehabilitation is to be effective.

Ninety three patients took part in a two centre double blind controlled clinical trial designed to assess the efficacy of dothiepin (Prothiaden) as compared with placebo and a soft biteguard in the treatment of psychogenic facial pain. The results showed the superiority of dothiepin over placebo in achieving pain relief; 71% of patients were pain free in the dothiepin group at nine weeks compared with 47% in the placebo group. The biteguard conferred no benefit and compliance in its use was poor. Out of 84 patients followed up for 12 months, 68 (81%) became pain free. An adverse life event before development of pain, minimal previous surgical treatment, and freedom from pain at nine weeks were strong prognostic indicators for successful treatment.These results are clear evidence of the efficacy of dothiepin in psychogenic facial pain, though the drug may be needed for up to a year.