Search PubMed⌕ Search

Biomedical subjects

A L Callies

Publications and source records attributed to A L Callies.

31 records · Page 2Linked to original sources
PubMed1983

Clinical applications of DSM-III in consultation-liaison psychiatry.

The authors examine the clinical application of DSM-III from the perspective of the consultation-liaison psychiatrist. They discuss contributions of DSM-III that have refined psychiatric diagnosis in medical-surgical settings, including the multiaxial system, a broader approach to the organic mental disorders, introduction of the category of psychological factors affecting physical condition, and an improved classification of disorders that present with physical symptoms. However, some areas of continuing ambiguity remain, such as how much discretion a clinician has to discount somatic symptoms related to physical illness in the diagnosis of depression, the implications of exempting bereavement from diagnostic status, and uncertainty about what constitutes evidence of an etiological relationship.

Diagnosis, Differential↗
PubMed1982

Yield of psychiatric consultants' recommendations for diagnostic action.

The results of diagnostic measures proposed by psychiatric consultants were examined in a retrospective study of 793 medical records. Of 302 recommendations implemented by consultees, 137 yielded abnormal findings. Abnormalities were widely distributed among laboratory determinations, diagnostic procedures, and psychological tests. Highest yields were associated with EEGs, thyroid function studies, vitamin B12 and folate levels, and the Minnesota Multiphasic Personality Inventory. Two thirds of cases with one or more implemented recommendation were found to have an abnormal result. These findings suggest that consultees may curtail medical examinations of patients with psychiatric symptomatology. The outcomes demonstrate the merits of the diagnostic recommendations offered by psychiatric consultants and underscore the advantages conferred on patient and consultee by a consultant with a firm base on medical knowledge.

Electroencephalography↗
PubMed1981

An interdisciplinary comparison of consultation outcomes. Psychiatry vs cardiology.

Responses to cardiologists' and psychiatrists' recommendations for drugs and diagnostic actions were compared in a retrospective study of 788 consultations. Variables significantly related to outcome achieved by cardiologists and psychiatrists were identified; similarities among these variables were evident only for the drug recommendations. Cardiologists' recommendations achieved a higher rate of concordance than psychiatrists' for both drugs and diagnostic actions. For drug recommendations, the interservice discrepancy in concordance was directly related to differences in timing of the consultations and incidence of recommendations to start a drug. For diagnostic recommendations, however, the difference was directly related to the consultants' service. The following factors may explain the less favorable outcome for psychiatrists' diagnostic recommendations: (1) the reasons for seeking psychiatric consultation, (2) the consultees' expectations, and (3) the skill of the psychiatrists in offering these recommendations.

Cardiology↗
PubMed1981

Consultation-liaison outcome evaluation system, Part I. Teaching, applications.

Designed to assess clinical outcomes quantitatively, the Consultation-Liaison Outcome Evaluation System, Part I, includes methodologies to measure the frequency of and concordance with recommendations made by psychiatric consultants in three areas: recommendations for psychotropic medication, recommendations for diagnostic action, and representation of psychiatric diagnoses. Using these parameters, the performance of three psychiatric trainees was monitored for a 6-month period. The outcome obtained by the trainees were compared with normative rates achieved by a group of previous psychiatric consultants. The comparison provides a unique perspective on the trainees' progress with several teaching implications. First, it focuses clinical teaching on comprehensive and objective measures to trainee's performance, Second, it assists in curriculum design. Third, it emphasizes to trainees the necessity of altering one's clinical behavior based on results achieved. Finally, it suggest that clinical accountability can contribute to the teaching of clinical excellence.

Curriculum↗
PubMed1981

The effectiveness of cardiology consultation. Concordance with diagnostic and drug recommendations.

In an effort to characterize the effectiveness of cardiology consultation, the outcomes of consultants' recommendations for diagnostic actions and cardiac drugs were quantitatively examined in 394 cases. Drug recommendations were made more frequently (49 percent) than diagnostic recommendations (38 percent) and were associated with a higher rate of concordance (82 percent to 64 percent). Recommendations to start therapy with a drug, especially an antihypertensive or an antianginal, were associated with a lower concordance rate than recommendations to continue or discontinue drug therapy. Consultees' responses to recommendations for diagnostic action did not vary significantly according to the type of action suggested. Nonconcordance with diagnostic suggestions was particularly high when a service made a large number of consult requests. Concordance was increased if the consultant left a follow-up note. Consultees' responses to drug and diagnostic recommendations were independent of one another. The study represents the first systematic assessment of cardiology consultation activities and provides a methodology for subsequent studies.

Adult↗
PubMed1980

Consultees' concordance with consultants' psychotropic drug recommendations. Related variables.

In an attempt to identify variables critical to consultees' concordance with the recommendations of psychiatric consultants for the use of psychotropic medications in a general hospital, the medical records from 394 psychiatric consultations were reviewed. Using quantitative concordance criteria, consultee response was examined as a function of 29 variables. These characterized the patient, the consultee, the consultant, and the consultation. Seven variables were found to be significantly related to concordance. Among these were the patient's history of exposure to psychotropic medications, the presence of multiple recommendations, specification of starting dosage, the category of psychotropic drug recommendation, and the timing of the consultation. The latter two variables emerged as most noteworthy. This work extends the investigation of consultees' responses to consultants' recommendations and anticipates the development of specific consultation strategies derived from quantitative outcome studies.

Attitude of Health Personnel↗
PubMed1980

Consultees' concordance with consultants' recommendations for diagnostic action.

Consultees' concordance with psychiatric consultants' recommendations for diagnostic action was studied retrospectively. Of 381 initial consultations reviewd, 110 (29 per cent) contained one or more recommendations for diagnostic action. Consultees' responses were rated concordant in only 53 per cent of these cases. This disturbing outcome, reflecting broad resistance to consultants' practice of making recommendations for diagnostic action, is attributed to consultees' use of a functional vs. organic dichotomy regarding psychiatric disorder. The functional category is argued to be perceived by consultees as a nonmedical entity. As the psychiatrist is invoked to deal with this nonmedical entity, he is seen in other than the medical mode and inconsistently afforded medical privilege. The work implies how wide the gap to medical credibility may be for psychiatric consultants and the need for new consultation strategies incorporating this cognizance.

Adolescent↗
PubMed1980

Consultees' representations of consultants' psychiatric diagnoses.

In an attempt to characterize consultees' representations of consultants' psychiatric dagnoses, the authors reviewd the medical records from 190 psychiatric consultations in a general hopsital. Using specific outcome criteria, they rated 50% of representations as concordant and 39% as nonconcordant. Five variable,s icluding the primary medical diagnosis at discharge and the referring service, were significantly related to concordance. Surprisinlgy, concordance was independent of the psychiatric diagnosis, indicating theat consultees did not respond differentially to varying magnitudes and implications of the different disorders. This work raises the question of possible strategies to improve receptivity to psychiatric diagnoses in the consultation setting.

Attitude of Health Personnel↗
PubMedDate not supplied

Lifetime prevalence of psychiatric disorders in patients with alopecia areata.

Thirty-one patients with alopecia areata were administered a structured psychiatric interview (the Diagnostic Interview Schedule; DIS). Overall, 74% had one or more lifetime psychiatric diagnoses. Particularly noteworthy were the high lifetime prevalence rates of major depression (39%) and generalized anxiety disorder (39%). In addition, patients reported increased rates of psychiatric disorders in first-degree relatives: anxiety disorders (58%), affective disorders (35%), and substance use disorders (35%). Patients with patchy alopecia areata were more likely to have a diagnosis of generalized anxiety disorder. No relationships were found between major depression and any variable characterizing alopecia areata history. Possible interrelationships between psychiatric disorders and alopecia areata are discussed. The study suggests that patients with alopecia areata are at increased risk for psychiatric disorders, and calls attention to the need for psychiatric assessment in this population.

Adolescent↗
PubMedDate not supplied

Psychiatric diagnosis and the surgical outcome of pancreas transplantation in patients with type I diabetes mellitus.

To examine the role of psychiatric diagnosis in the surgical outcome of pancreas transplantation, we studied candidates with type I diabetes mellitus. Eighty of 140 candidates underwent transplantation. Survival analysis found the extent of human leukocyte antigen-DR (HLA-DR) matching, two diagnoses, and patients' perceived support from first-degree relatives to be related to duration of full-graft function. Lifetime diagnoses of tobacco use disorder (P = 0.029) and alcohol abuse/dependence (P = 0.006) were associated with less favorable outcomes; perceived support was associated with positive outcomes (P = 0.048). Subsequent analysis suggested that the four variables independently and directly affect outcome.

Adaptation, Psychological↗