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Biomedical subjects

E Leibenluft

Publications and source records attributed to E Leibenluft.

At least 37 records · Page 2Linked to original sources
PubMed1994

Sex differences in psychiatrists' practice patterns and incomes.

OBJECTIVE AND METHOD: Using data from the APA's 1988-1989 Professional Activities Survey, the authors compared male and female psychiatrists on demographic characteristics, training, practice patterns, and income. RESULTS: In keeping with previous studies' findings, female respondents on the average were younger than male respondents and more likely to have taken a residency or fellowship in child or adolescent psychiatry, worked fewer hours per week, allocated their working hours differently among types of activities, saw fewer patients per week, and worked in somewhat different settings. Multiple regression analysis showed that women had significantly lower mean net annual income than men after the effects of those predictors were statistically controlled. CONCLUSIONS: Differences in age, training, hours worked in specific settings, and numbers of patients do not completely account for the gender gap in psychiatrists' annual incomes.

Adolescent Psychiatry↗
PubMed1993

Sex differences in rank attainment and research activities among academic psychiatrists.

Data from a survey distributed to all full-time faculty in academic departments of psychiatry were used to examine possible sex differences in research activities and rank attainment among psychiatrists. A total of 1923 psychiatrists responded, 1564 men (81.3%) and 359 women (18.7%). Continuous dependent variables were analyzed by using analyses of covariance with the year graduated from medical school as a covariate. For categorical dependent variables, the sample was divided into four 10-year cohorts based on the year graduated from medical school, and differences between men and women were analyzed with chi 2 tests. Over the entire sample, men were more likely than women to have had research training, to have ever been principal investigators on peer-reviewed grants, to mentor research trainees, to be currently involved in research activities, and to meet defined criteria as a "researcher." Many gender differences remained significant after controlling for seniority and research training. In every cohort, the men had attained higher academic rank than the women. In general, differences in research activity and productivity were most marked in the youngest cohort. To ensure a rich talent pool for psychiatric research, efforts must be made to recruit and support researchers from among the increased number of women in psychiatry.

Age Distribution↗
PubMed1993

A clinical trial of sleep deprivation in combination with antidepressant medication.

The literature suggests that sleep deprivation can potentiate the effect of antidepressant medication in depressed patients. However, the clinical efficacy of sleep deprivation has not been demonstrated definitively, in part because it is difficult to design an adequate control condition. We conducted a trial of sleep deprivation in 26 depressed patients who remained symptomatic despite 3 months of treatment with antidepressant medication. Since the literature indicates that early sleep deprivation (ESD), carried out in the first half of the night, is a less effective antidepressant than late sleep deprivation (LSD), carried out in the second half of the night, we designed a study that attempted to use ESD as a control condition for LSD. Patients were randomly assigned to ESD or LSD, received a total of 4 nights of sleep deprivation over 2 weeks, and were followed in clinic for the 3 subsequent weeks. ESD proved to be as effective an antidepressant as LSD, with the overall sample showing a mild, but statistically significant, response. There was a significant correlation between patients' acute response at the time of the first course of sleep deprivation treatments and their improvement over the course of the study. There were significant changes in plasma levels of thyroid stimulating hormone, free triiodothyronine, prolactin, and cortisol measured at 8 a.m. before and after sleep deprivation, and in the followup period, but there were no significant correlations between changes in hormonal levels and either acute or chronic response to sleep deprivation.

Adult↗
PubMed1993

Depressive symptoms and the self-reported use of alcohol, caffeine, and carbohydrates in normal volunteers and four groups of psychiatric outpatients.

OBJECTIVE: The authors examined the relationship between depressive symptoms and the self-reported use of alcohol, carbohydrates, and caffeine in normal volunteers and four groups of psychiatric outpatients. METHOD: Outpatients and normal volunteers were given a questionnaire asking about their use of each of the three substances in response to each of the 14 depressive symptoms on the Hamilton Rating Scale for Depression. They also rated how much each substance improved each symptom. Twenty-six normal volunteers, 35 patients with major depression, 117 patients with seasonal affective disorder, 16 patients with alcohol dependence, and 24 patients with comorbid primary depression and secondary alcohol dependence completed the questionnaire. Test-retest reliability was established. Analysis of variance and stepwise multivariate discriminant function analyses were used to determine if diagnostic groups differed in the reported use and effect of each of the three substances. RESULTS: The responses concerning use and effect of alcohol of patients with alcohol dependence with or without depression were indistinguishable from each other. The responses of the patient groups regarding caffeine and carbohydrate use did not differ from each other, but all differed significantly from the responses of normal volunteers. Discriminant function analysis distinguished alcoholics from nonalcoholics in the relationship between drinking and the symptoms of anger and anhedonia. CONCLUSIONS: The relationship between symptoms and substance use varied depending on the substance. Alcoholics without depression were as likely to report drinking in response to depressive symptoms as were those who had had depression. Patients of all diagnostic groups were more likely than normal volunteers to report using caffeine and carbohydrates in response to depressive symptoms.

Alcohol Drinking↗
PubMed1992

Diurnal variation: reliability of measurement and relationship to typical and atypical symptoms of depression.

We used three rating scales to study diurnal variation of mood in 37 patients with major depressive disorder (17 drug-free patients and 20 treatment refractory patients on stable regimens of antidepressant medication). The three rating scales included global self-ratings administered twice a day; an itemized, prospective, observer-rated scale administered twice a day; and the retrospective item on the Hamilton Depression Rating Scale. Z scores and Intraclass Correlation Coefficients demonstrated a poor level of agreement between the itemized, prospective scale and the self-ratings. In addition, stepwise multiple regression analysis and point bi-serial correlation showed no systematic relationship between atypical diurnal variation (i.e., mood worsening in the evening) and atypical depressive symptoms (weight gain, hypersomnia, etc.), or between typical diurnal variation (i.e., mood worsening in the morning) and typical depressive symptoms (weight loss, insomnia, etc.). This lack of relationship was observed in both drug-free and medicated patients using each of the three rating scales. We discuss possible explanations for these negative findings.

Adult↗
PubMed1992

Is sleep deprivation useful in the treatment of depression?

OBJECTIVE: The authors critically reviewed the literature on clinical applications of sleep deprivation in the treatment of depression. DATA COLLECTION: They included all studies using sleep deprivation for clinical purposes, with the exception of treatment studies that did not provide follow-up beyond a night of recovery sleep. They focused on six uses of sleep deprivation: 1) to potentiate response to antidepressant medication (13 studies), 2) to hasten the onset of action of antidepressant medication or lithium (five studies), 3) to prevent recurrent mood cycles (four studies), 4) as an alternative to antidepressant medication (five studies), 5) as a diagnostic probe (two studies), and 6) to predict response to antidepressant medication (nine studies). FINDINGS: Although the literature appears to demonstrate the efficacy of sleep deprivation as a potentiation strategy, these treatment studies have substantial methodological shortcomings. Well-designed pilot studies indicate that sleep deprivation may hasten the onset of action of thymoleptic medications. Sleep deprivation may prevent premenstrual mood swings, and response to sleep deprivation may differentiate depressive pseudodementia from primary degenerative dementia with depression. Studies attempting to use sleep deprivation to predict response to antidepressant medication have yielded inconsistent results. CONCLUSIONS: Given the noninvasive nature of sleep deprivation, it would be useful to determine if even a small subset of refractory patients respond to it. The authors suggest future research directions to determine the usefulness of this potential treatment.

Depressive Disorder↗
PubMed1991

Self-ratings of anger and hostility in borderline personality disorder.

Forty-six patients with borderline personality disorder with and without major depression and 27 normal volunteers completed the Buss-Durkee Hostility Inventory, a self-rating scale of anger and hostility. The patients with borderline personality had significantly higher scores than the normal volunteers. The scores of the patients with borderline personality disorders were not related to gender, treatment or research setting, the degree of acute distress, or the presence of major depression. These findings suggest that a proneness to anger and hostility are enduring characteristics of borderline personality disorder and that anger and depression may represent independent clinical conditions with independent biological mechanisms regulating these two affective states.

Adult↗
PubMed1991

Mood variability: a study of four groups.

OBJECTIVE: The authors' goal was to determine whether self-rated patterns of mood regulation differed among patients with major depression, patients with borderline personality disorder, patients with premenstrual syndrome (PMS), and normal subjects. METHOD: Fourteen days of morning and evening mood self-ratings on a visual analog scale were analyzed for 65 female subjects (10 with major depression, 16 with borderline personality disorder, 15 with PMS, and 24 without psychiatric diagnoses). For each individual, the mean and standard deviation of morning and evening ratings, the mean absolute change in mood from one day to the next, and the change from morning to evening were determined. RESULTS: The four groups differed significantly on every measure of mood and mood variability except diurnal variation. As expected, the group with major depression had the lowest global ratings and a low degree of variability. The group with borderline personality disorder was less depressed than the group with major depression and showed a high degree of mood variability. Autocorrelation analysis suggested that mood ratings in borderline personality disorder vary randomly from one day to the next. The mood variability over the 14 days of the patients with PMS was significantly greater than that of normal subjects. CONCLUSIONS: The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.

Adolescent↗
PubMed1990

The effect of borderline personality disorder on the hospital course of affective illness.

Two groups of patients with affective disorders, one group with a coexistent axis II diagnosis of borderline personality disorder and one group without, were compared to determine if the presence of borderline personality disorder affects the hospital course of patients with affective illness. Response to hospital treatment was assessed using standard psychiatric rating scales administered at admission, after one week of hospitalization, and before discharge. Although the patients with borderline personality disorder were more severely impaired than the comparison group, they were as likely as patients without the disorder to improve over the course of hospitalization.

Adult↗
PubMed1989

Isolated versus visible seclusion rooms: attitudes of psychiatric patients.

This study compares the attitudes of nonsecluded patients hospitalized on psychiatric units with either isolated or visible seclusion rooms. It was found that there were minimal differences between units. Patients at the hospital with visible seclusion rooms more often indicate that patients are often cured in such rooms, in contrast to the patients on the other unit who endorsed more stereotypical perceptions of the quiet room.

Attitude↗
PubMed1989

When is enough enough: the administrative discharge.

This paper has described the process of administrative discharge. Indications for its implementation and obstacles to recognizing its appropriateness have been reported. Administrative discharge is a process that has profound effects on the treatment milieu. It deserves further study to document more fully the patients who are subject to it and their eventual clinical outcome.

Adult↗
PubMed1989

Who gets treated where. A study of patients transferred and not transferred from a consultation-liaison service to a general hospital psychiatry unit.

The decision to transfer a patient from a general hospital unit to a psychiatric unit is multifactorial. The most salient patient characteristics include the degree of dysfunctional behavior, the absence of social supports, and the presence of Axis II pathology. Severity of medical illness does not discriminate between the two groups. Awareness of these characteristics could aid physicians in formulating transfer decisions.

Age Factors↗
PubMed1989

The academic dilemma of the inpatient unit director.

Inpatient units in academic departments are typically directed by junior faculty members, who quickly abandon these positions for less demanding, more rewarding jobs. These frequent turnovers in the directorship compromise the clinical, research, and educational functions of the inpatient unit. The authors believe that the average inpatient director's truncated term can be traced to two causes: an exacerbation of the junior faculty member's developmental crisis by factors intrinsic to the inpatient unit and a disparity between the expectations for academic productivity and the opportunities for scholarly activity. These conflicts are elaborated and pragmatic ways of relieving this situation are suggested.

Burnout, Professional↗
PubMed1988

Reimbursement for partial hospitalization: a survey and policy implications.

Lack of third-party reimbursement is frequently cited as a cause of underutilization of partial hospitalization. The authors contacted a sample of health maintenance organizations (HMOs) and public and private payers to obtain information about their payment policies. They conclude that in the private sector, reimbursement barriers are diminishing but that clinicians frequently must obtain an extracontractual agreement for coverage. Partial hospitalization is particularly attractive to HMOs and others that pay on a capitated basis and can strictly control utilization. A recent clarification of Medicare guidelines may facilitate reimbursement for hospital-based programs, but there remain significant disincentives under the Medicare statute for widespread utilization of partial hospitalization.

Ambulatory Care↗
PubMed1988

Mourning and milieu: staff reaction to the death of an inpatient.

The staff reaction to the death from natural causes of a patient hospitalized on a psychiatric unit is described. The staff's response is conceptualized in terms of the stages of normal bereavement: denial, anger, depression, and resolution. Each stage is described and suggestions are given for its management. As with a suicide, a psychological autopsy can be conducted after a death from natural causes; an outline for such an autopsy is provided.

Attitude of Health Personnel↗
PubMed1987

Guidelines for short-term inpatient psychotherapy.

The authors propose guidelines for conducting psychotherapy in short-term general hospitals. They divide short-term psychiatric hospitalization into three phases, each of which presents different therapeutic tasks and calls for different therapeutic interventions and techniques. In phase one, when the patient is typically most distressed, the therapist and the patient must establish a therapeutic alliance and agree on the goals of therapy, a treatment contract, and limits on acting-out behavior. In phase two, the period of greatest comfort for the patient, the therapist must encourage the patient to focus on his goals while keeping the issue of discharge in the forefront of therapy. In phase three, the therapist helps the patient cope with separation issues that arise as he prepares for discharge.

Adult↗
PubMed1987

Special considerations in integrating elderly patients into a general hospital psychiatric unit.

Geriatric patients with psychiatric disorders are highly treatable in an acute general hospital setting, but they require special attention in assessment, treatment, and discharge planning. Assessment must include the active involvement of a broad multidisciplinary team led by the psychiatrist. In the treatment process, staff must stay aware of the psychiatric symptoms, which may be obscured by medical problems, and should take therapeutic advantage of the transference issues that an age-mixed population can generate. Discharge planning must attend to resistances and the realistic dilemmas that are unique to the geriatric population. In discussing these issues, the authors describe how a university hospital inpatient unit with a full age range of adult patients adapted its milieu and staffing to treat a larger proportion of geriatric patients.

Aged↗