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Biomedical subjects

P B Lieberman

Publications and source records attributed to P B Lieberman.

16 recordsLinked to original sources
PubMed1998

The role of endogenous opioids in the luteinizing hormone surge in rats: studies with clocinnamox, a long-lasting opioid receptor antagonist.

Endogenous opioid peptides have been demonstrated to regulate luteinizing hormone (LH) secretion in a variety of species. Studies in rodents suggest a role of opioid peptide systems in controlling the timing of the LH surge, which is entrained to the circadian rhythm. The current studies utilize clocinnamox, a novel long-lasting opioid receptor antagonist that is capable of occupying mu-opioid receptors for periods of one week or more, to examine the role of endogenous opioid systems on the LH surge. Administration of clocinnamox [14b-(p-chlorocinamoylamino)-7,8-dihydro-N-cyclopropylmethyl normophineone mesylate]) on the morning of proestrus advanced the LH surge by several hours. Despite the blockade of opioid receptors and analgesia for more than one week, administration of clocinnamox on the evening of diestrus II had no effect on the timing of the LH surge but significantly increased plasma LH levels throughout the day of proestrus. These data suggest that removal of opioid tone is unlikely to be the critical signal controlling the initiation of the LH surge in rodents, although it does appear to be permissive for the surge. Furthermore, the mu-opioid receptor appears to be the receptor involved in the regulation of the LH surge.

Animals↗
PubMed1998

Decreasing length of stay: are there effects on outcomes of psychiatric hospitalization?

OBJECTIVE: The authors compared hospital outcomes for depressed patients hospitalized between 1988 and 1996. METHOD: Between 1988 and 1996, 206 depressed patients in three cohorts were evaluated at admission; of these, 161 (78.2%) were evaluated at discharge and 119 (78.3% of those followed [N = 152]) 1 month later. Evaluation consisted of measures of symptoms, global functioning, self-concept, ego defenses, work and social functioning, and readmission. RESULTS: Lengths of stay significantly declined over time (26.5 versus 19.5 versus 8.3 days). At discharge, the most recently hospitalized group showed higher residual depression and lower residual global functioning scores than the other groups. Other measures did not differ among the groups at discharge. One month after discharge, the shortest-stay group continued to show lower global functioning, as well as lower quantity of work functioning. Readmission rates were equal. Within the shortest-stay group, no differences in outcome were found between patients treated in a partial hospital and those not so treated. CONCLUSIONS: Improvement during very brief admission is comparable to that in longer stays on many aspects of functioning. However, depressed patients discharged more quickly show significantly higher residual levels of depressive symptoms and lower levels of global functioning, which may place them at greater risk for adverse outcomes in the immediate posthospital period.

Adult↗
PubMed1993

Dimensions and predictors of change during brief psychiatric hospitalization.

The effects of brief psychiatric hospitalization on patient functioning remain controversial and poorly defined. In this study, 217 subjects were evaluated for the changes they experienced during a brief admission (average length of stay 23.0 +/- 16.2 days). Significant improvements occurred in symptoms, global functioning, self-esteem, perceptions of others, and ego functioning. Better multidimensional outcome correlated with symptomatic improvement and preadmission functioning. No effects were found for age, gender, Axis I diagnosis, presence of an Axis II or Axis III disorder, prior hospitalization, severity of symptoms, length of stay, or payor group. During brief hospitalization, patients appear to improve in several areas of psychosocial functioning.

Adolescent↗
PubMed1989

"Objective" methods and "subjective" experiences.

Current psychiatric research and practice emphasize measurement of operationalized variables, quantification, and rigorous hypothesis testing. The fact that mental states can be subjectively experienced and that thoughts can refer to things and events outside the mind suggests that such objectifying methods alone may not provide a complete approach to mental life. Other complementary but systematic methods can be described which stress that (1) words are often natural expressions, not labels, of experiences; (2) usefulness, not agreement with observation, can sometimes validate psychological expressions; (3) some data can only be gathered by interactive involvement, not dispassionate observation; (4) a goal of inquiry can be interpretation, not hypothesis testing; and (5) understanding may require a holistic approach which expands rather than constricts the realm of relevant data.

Adaptation, Psychological↗
PubMed1989

Effect of patient gender on evaluation of intern performance.

To explore the effect of patient gender on the perceptions of intern performance, 366 patients were interviewed during hospitalization in acute medical services. Women reported being more satisfied with the care they received than did men. In particular, women were more satisfied than men with their intern's demonstration of personal concern. The women placed more importance on personal manner and concern, and their greater satisfaction with these behaviors may have contributed to higher ratings of overall satisfaction. In contrast, the men seemed less satisfied with their intern's personal concern; they also tended to weigh such concern less in determining overall satisfaction. Men considered the presentation of information by the physician and the establishment of dialogue with the physician as more important. The amount of such dialogue may have been inadequate to generate higher levels of overall satisfaction for the men patients.

Aged↗
PubMed1987

Evaluation of intern performance by medical inpatients.

Patients, as the recipients of medical care, have a unique and crucial perspective from which to judge the performance of physicians. In this study, 27 interns (postgraduate year 1 residents) were evaluated by a sample of 212 medical inpatients at two university-affiliated hospitals using a previously validated questionnaire constructed from patients' comments. Patients were generally very satisfied with the performance of their interns and valued traditional clinical skills and interpersonal skills equally. The most important and characteristic attributes of the interns as rated by patients were demonstrating personal concern, skill in treating disease, providing information about findings, preparation for impending events, availability, manner of communication, trust, and comforting and listening skills. Encouraging mutuality by the interns was not often done and was not believed to be particularly important by patients. Older patients and whites were more satisfied with their interns, whereas college-educated, employed, and male patients were less satisfied. Implications of the findings for understanding and teaching about the physician-patient relationship are discussed.

Clinical Competence↗
PubMed1987

Conceptual and methodological issues in the comparison of inpatient psychiatric facilities.

The authors compared the length of stay of acute admission patients at a mental health center and a nearby state hospital. The two facilities had significantly different length of stay distributions; the mean was not an adequate index to describe these patterns. Despite careful matching, patients at the state hospital were more disabled. Different patient characteristics were associated with length of stay at the two facilities, and these were also characteristics on which the patient populations differed at admission. The authors conclude that comparisons of hospitals, for example, on mean or median length of stay can be misleading unless the different functions, policies, and constraints of the facilities are taken into account.

Community Mental Health Centers↗
PubMed1987

Bereavement and its complications in medical patients: a guide for consultation-liaison psychiatrists.

Bereaved individuals consult their physicians, including psychiatrists, at an increased frequency for the many symptoms of normal or pathological grief as well as related medical and psychiatric disorders. As many as 25 percent of patients seen by a consultation-liaison service may be suffering from recent unresolved grief. The consultation-liaison psychiatrist needs to be sensitive to the manifestations and course of bereavement in both its uncomplicated and pathological forms. This report provides an overview of these issues as a guide for the accurate assessment and treatment of this often unconsidered condition.

Affective Symptoms↗
PubMed1987

Work and mental illness. I. Toward an integration of the rehabilitation process.

For centuries, philosophers and physicians have noted the beneficial impact of work for the restoration and maintenance of mental health. This paper reports the findings from a survey in which all the principal components (both providers and consumers in one catchment area) contributed data about the degree to which vocational rehabilitation was integrated into systems of care for the mentally ill. The major repetitive themes found at the interface of each participating sector were: rigidity, isolation, compensatory ad hoc operations, and narrow frames of reference. Vocational and other forms of rehabilitation were accomplished by persistent, energetic personnel inventing ingenious solutions to the roadblocks set up at system interfaces. Their problem-solving techniques pointed to ingredients that might help to integrate treatment and rehabilitation efforts. These key elements were flexibility, collaboration, data-based training, and a unified theoretical framework.

Adolescent↗
PubMed1986

Brief psychiatric hospitalization: what are its effects?

This exploratory study was undertaken to begin to identify what clinically significant changes besides symptom diminution may occur during brief psychiatric hospitalization. Intensive interviews with 20 patients at the beginning and end of a 1-month inpatient stay revealed that their cognitive abilities, self-esteem, and perceptions of the availability of other people frequently improved. The patients attributed these changes to forming relationships with others, having the opportunity to reflect, and making the decision to change. The improvements seemed to affect the patients' attitudes toward themselves and their lives, and 12 patients underwent significant life changes after discharge.

Adult↗
PubMed1985

The reliability of psychiatric diagnosis in the emergency room.

The authors compared the diagnoses made for 50 patients in an emergency room with those made during a subsequent inpatient hospitalization. They found an acceptable level of reliability for broad diagnostic categories, such as psychosis, depression, and alcoholism. The authors believe such diagnostic reliability is sufficient for emergency assessment and triage. However, the diagnosis of more specific subtypes of mental illness, such as schizophrenia and bipolar disorder, were not made reliably in the emergency room. The authors point out the risk of diagnostic labeling, and suggest that the tendency to overlook nonalcoholic substance abuse deserves special attention.

Adjustment Disorders↗
PubMed1984

The recurrence of mania: environmental factors and medical treatment.

Three patients experienced recurrent manic episodes while taking lithium at levels that previously had been effective. In each case, the patient's decompensation followed a life stress. These stresses, which had a striking similarity, involved conflictual situations in which the patient felt impelled to pursue activities contrary to his or her own interests and aspirations. The activities, often involving the patient's family, seemed impossible to avoid. These clinical examples, together with several reports from the literature, suggest that pharmacological, psychodynamic, and situational forces may need to be considered together to allow more accurate conceptualization and to prevent recurrence of mania.

Adult↗
PubMed1984

The JCAH and psychiatry: current issues and implications for practice.

The Joint Commission on Accreditation of Hospitals recently revised its Accreditation Manual for Hospitals (AMH), used to assess the quality of care at health institutions. The authors briefly examine the history of accreditation of hospital-based psychiatric services. They then provide background on factors that influenced the revision of AMH standards such as third-party pressure for cost containment and consumer demands for high-quality health care. The authors also explore such issues as clinical privileges for nonphysician health professionals and the interdependence of the medical staff and the hospital administration in monitoring quality of care.

Accreditation↗