Administrative psychiatry.
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Biomedical subjects
Publications and source records attributed to M Greenblatt.
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This study was designed to gather data on psychotic symptoms in a sample of homeless adolescents. The sample included adolescents who were located in street sites as well as adolescents who were currently using shelter services. Ninety-six adolescents participated in this study (mean age = 16.1 years). The results indicated that 29% of the sample reported the experience of four or more psychotic symptoms on the Diagnostic Interview Schedule psychotic symptom index. These results suggested that the endorsement of psychotic symptoms is a relatively prominent feature of the self-report of psychopathology among homeless adolescents. These symptoms did not only include reports of paranoid ideation, which may be generally elevated as part of the stress of street life, but also included reports of ideas of reference and auditory hallucinations. Moreover, these symptoms were correlated with reports of affective disturbance, abusive life experience, and a particular type of substance use.
In an effort to define better the indications for renovascular repair, risk factors for renal loss, and eventual patient outcome, records of 36 patients with 37 renovascular injuries were reviewed. The renal artery alone was injured in nine kidneys, the renal vein alone in 12, and both the main renal vein and artery in six. Segmental vessel injuries alone were noted in ten kidneys. Two patients died before repair could be attempted. Eleven nephrectomies were performed. Vascular repair was attempted in the remaining 24 renal units either as isolated procedures or combined with renal parenchymal repair. Compared to 78 patients with only parenchymal injuries, those with renovascular injuries were more severely injured as assessed by nephrectomy rate, Injury Severity Score, transfusion requirement, number of major complications, and death. Fifteen patients sustained main renal artery injuries of whom six underwent immediate nephrectomy. Nine attempts at repair were performed. Six patients had either persistent thrombosis or preservation of only marginal function. One patient died in the immediate postoperative period of associated injuries. Complete renal preservation was achieved in only two kidneys (14%). Nephrectomy was required for the management of three of 12 main renal vein injuries, but in none of ten patients with segmental vascular injuries.
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The case records of 225 randomly selected adolescent psychiatric inpatients were reviewed to determine prevalence of residential instability. The study also examined the demographic, family composition, life event, and behavior characteristics associated with residential instability. Approximately 30% of the sample had experienced a high rate of residential instability (i.e., from 5 to 20 domicile moves). Analyses indicated that residential instability was associated with a set of characteristics that included caregiver neglect, caregiver abuse, parental separation, multiple hospitalizations, lower IQ, indices of poor impulse control, and antisocial behavior. The possible contribution of residential instability to treatment resistance and the development of antisocial behaviors in some adolescents is discussed.
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Two hundred fifty ex-fellowship psychiatrists answered a questionnaire on their administrative and other professional experiences during and after residency as part of a study to determine the relationship between psychiatric training experiences and interest in administration. A large majority of subjects had had role models during training. The subjects' interest in administration had grown significantly during residency in the direction of their role models' interest. Postresidency interest in administration was significantly correlated with supervision by a psychiatrist administrator and with the number of hours subjects spent on administrative work.
Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.