Gary W. Small
The well-known risks of internship and residency--depression, marital problems, alcohol abuse, and the like--actually may represent features of a house officer stress syndrome. Merklin and Little have described a "beginning psychiatry training syndrome" characterized by anxiety, depression, and psychosomatic disturbances. Seven features characterize the house officer stress syndrome: (1) episodic cognitive impairment, (2) chronic anger, (3) pervasive cynicism, (4) family discord, (5) depression, (6) suicidal ideation and suicide, and (7) substance abuse. Although usually benign, the first four features of the syndrome--cognitive impairment, anger, cynicism, and family discord--occur in nearly all house officers. Those severely affected may also suffer from the more malignant features-- depression, suicidal ideation, and substance abuse.
Cognition, the mental process of comprehension, judgment, memory, and reasoning, is a prerequisite to adequate performance by a house officer. Episodic impairment in cognition, however, occurs among house officers. Friedman and associates3,4 tested cognition in 14 interns who had each remained awake for approximately 30 hours. In comparison with their performance when rested, the interns deprived of sleep showed significant impairment in their