Search PubMed⌕ Search

Biomedical subjects

B M Astrachan

Publications and source records attributed to B M Astrachan.

At least 37 records · Page 2Linked to original sources
PubMed1980

Regulation, adaptation, and leadership in psychiatric facilities.

The public policies of the sixties led to new organizational forms, expansion, significantly increased services, and inflation. The policies of the seventies, characterized by cost containment and regulation, have dramatically modified health care institutions. The impact of changing public policy and regulation is mediated by the effectiveness of executive groups, whose members must have the skills to ensure that institutional values are preserved during organizational changes. The author maintains that the future of health care organizations lies primarily in their members' clinical competency and commitment to excellent practice, but is also dependent on their knowledge of such administrative tasks as planning and budgeting and the management of the physical plant and its employees.

Community Mental Health Centers↗
PubMed1979

Treatment of secondary depression in schizophrenia. A double-blind, placebo-controlled trial of amitriptyline added to perphenazine.

The combination of antidepressants and neuroleptics has been widely recommended and commonly used clinically for the schizophrenic patient who becomes depressed. However, the value of the combination for these patients has not been clearly demonstrated. This report presents results of a double-blind, randomized, placebo-controlled clinical trial designed to evaluate the combination of perphenazine and amitriptyline hydrochloride with that of perphenazine alone in the treatment of 35 ambulatory chronic schizophrenic patients in whom depressive symptoms developed. Results showed that the addition of amitriptyline to perphenazine, when compared with perphenazine alone, was more effective in reducing symptoms of depression after four months of treatment, but less effective in reducing thought disorder. The study concludes that the value of adding an antidepressant to the usual neuroleptic in the treatment of secondary depression in schizophrenia should be reviewed.

Adolescent↗
PubMed1978

The concept of prevention in psychiatry: a reexamination.

We examine current concepts of prevention and offer a new approach. Prevention has different meanings and functions in the four major task areas of psychiatry: (1) medical tasks, (2) rehabilitative tasks, (3) social control tasks, and (4) humanistic tasks. Constructs of primary and secondary prevention are most useful in the medical task area. However, efforts at primary prevention of mental illness can have only limited effectiveness when we know so little about etiology. Secondary prevention is central to the medical caring tasks, where early diagnosis and treatment may lead to successful outcome. Tertiary prevention of disease and primary prevention of developmental defect are the work of the rehabilitative task area. The application of models of prevention in the social control and humanistic task areas has led to serious confusion.

Adult↗
PubMed1976

The impact of national health insurance on the tasks and practice of psychiatry.

Psychiatry, like all professions, is strongly affected by changes in societal expectations and economic forces. Changes in professional priorities and patterns of patient care will undoubtedly be brought about by national health insurance. Two major types of national health insurance have been proposed: comprehensive health insurance and catastrophic insurance. We do not anticipate major impact on psychiatric tasks from some form of catastrophic insurance. Comprehensive health insurance would shape and change psychiatric practice. An examination of psychiatric tasks provides a framework for anticipating alterations in practice. We identify four major task areas in psychiatry: (1) medical tasks, (2) reparative tasks, (3) social control tasks, and (4) humanistic tasks. These tasks would be differentially influenced. Psychiatry's medical tasks will be stressed, while funding for many reparative tasks may be limited. The care of the severely ill patient may be fragmented because of problems in integrating medical and rehabilitative services.

Humans↗
PubMed1976

The development and validation of a measure of the psychiatrist's authoritative domain.

In order to examine issues relevant to the authority which patients bestow upon psychiatrists the present authors constructed the Psychiatrist's Sphere of Influence Scale (PSIS). The PSIS is a 68-item Likert-type questionnaire which asks patients to specify the skills which they believe belong to the psychiatrist's authoritative domain. Patients being treated in day hospital (N=82), inpatient (N=113), and outpatient (N=121) settings were individually administered the PSIS along with various discriminant and construct validity measures. The findings indicated that the PSIS is an internally consistent, factorially complex, relatively stable measure of the roles which are ascribed to psychiatrists. Neither the social desirability nor the agreement response set represents important contaminants of the PSIS. Moreover, individual differences on the PSIS appear to be predictable, within broad limits, from patients' positions in the social structure, their preferred styles of help seeking in hospital and therapy settings, and their generalized orientations toward power and authority. A tendency to blur the boundaries between "psychiatric" and "nonpsychiatric" roles appears to be concentrated among patients who are middle-aged or older, minimally educated, of lower socioeconomic status, inclined toward an authoritarian conception of the good patient and the good hospital, and who endorse traditional family role relationships. The implications of these findings for the manner in which psychiatrists exercise their authority were discussed.

Adult↗
PubMed1975

Concordance of multiple assessments of the outcome of schizophrenia. On defining the dependent variable in outcome studies.

Concordance of multiple assessments of the outcome of schizophrenia are examined from (1) concordance of three different assessments of mental status, and (2) concordance of four different dimensions of outcome. Findings are related to the methodological issue of defining the dependent variable in outcome studies. When the assessment instruments were compared, discordance in overall assessment happened because each instrument taps varying aspects of symptomatology, suggesting that outcome is somewhat instrument-related. Although adjustment in mental status is correlated with social adjustment and role performance, a patient's status at follow-up bears little relationship to rate of rehospitalization or to consumer satisfaction with treatment. A differential impact of the same predictor variables on four dimensions of outcome underscores the discordance in multiple assessments. Since treatment outcome is multifaceted and multidertermined, multiple assessments must continue as vital procedures.

Adult↗
PubMed1973

Values and treatment.

Explore the source record for details and available documents.

Community Mental Health Services↗