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Biomedical subjects

S Fennig

Publications and source records attributed to S Fennig.

At least 55 records · Page 3Linked to original sources
PubMed1995

Factors influencing disposition decisions for patients seen in a psychiatric emergency service.

OBJECTIVE: The study examined factors influencing clinicians' decisions about disposition of patients seen in a psychiatric emergency service. METHODS: A stratified random unduplicated retrospective sample of 378 patient records was drawn from the records of 1,823 patients who visited the emergency service of an acute care psychiatric hospital in Israel during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N = 96), discharged after brief observation in the emergency service (N = 90), admitted to a open unit (N = 104), and admitted to a locked unit (N = 88). Data on demographic and clinical characteristics of patients and on some clinician and system variables were analyzed using univariate statistical techniques and stepwise logistic regression. RESULTS: Patients were more likely to be admitted if they were judged by clinicians to be suicidal, had more than three previous hospitalizations, were psychotic, had suicidal behavior as the presenting complaint, and were brought to the hospital involuntarily. Variables favoring assignment to a locked unit were age between 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. CONCLUSIONS: Patients' level of psychopathology and dangerousness were the primary factors influencing clinicians' decisions about disposition of patients from the emergency service.

Adult↗
PubMed1995

Medication treatment in first-admission patients with psychotic affective disorders: preliminary findings on research-facility diagnostic agreement and rehospitalization.

The discharge medications of 101 Suffolk County subjects with facility and/or research diagnoses of affective disorder were ascertained. Rehospitalization was recorded for a 6-month follow-up period. Twenty-three of 31 patients (74.2%) with a facility diagnosis of depressive disorder were prescribed antidepressants, and 21 of 36 patients with a facility diagnosis of bipolar disorder (58.3%) were prescribed lithium. When research and facility diagnoses concurred, 84.2% of depressed patients were prescribed antidepressants, and 66.7% of bipolars were given lithium. The percentages were lower when the two diagnoses were discrepant. The results for diagnostic congruence were independent of demographic variables, length of stay, and premorbid functioning. Patients prescribed diagnosis-specific medications had a lower rate of rehospitalization (7.3%) than those not prescribed such medications (22.2%). The findings suggest that such medications are prescribed in the more unambiguous cases of affective disorders and are important (with or without antipsychotic treatment) in preventing rehospitalization.

Adolescent↗
PubMed1995

Nonaffective acute remitting psychosis: historical and nosological aspects.

The present paper reviews the different approaches and evolution of the concept of nonaffective acute remitting psychoses (NARP) through a historical perspective. Although reports and clinical descriptions of nonaffective acute remitting psychoses were found as early as the middle of the 19th century there has been no consensus on their course and clinical characteristics, and this confusion and lack of clarity is expressed in the current major nosological systems. This selected review will focus on the main approaches to the definition of this group of psychoses and their expression in the current major nosologies.

Europe↗
PubMed1994

[Capgras' syndrome with right frontal meningioma].

We present a 43-year-old woman with a right frontal parasagittal meningioma of the brain who developed the delusion that her husband and children had been replaced by doubles (look-alikes). This type of delusion is typical for Capgras' syndrome. After removal of the tumor the delusion disappeared. The majority of such patients are diagnosed as paranoid schizophrenia. However, in the past decade there has been an increasing number of cases in which the etiology is suspected of being organic, involving mainly the right hemisphere. The case presented is unique because it is the first with meningioma as a possible pathogenic factor in the syndrome, as evidenced by the cessation of the delusion when the tumor was removed.

Adult↗
PubMed1994

Are diagnostic criteria, time of episode and occupational impairment important determinants of the female:male ratio for major depression?

This study addresses whether the female preponderance in the 1-year prevalence of major depressive disorder is associated with differences in reporting symptoms or underreporting remote episodes, or the inclusion of work impairment in the case definition. In a sample of 1870 professionals and managers, we find (1) a more restrictive cut-off point for women does not eliminate the differential; (2) males and females equally underreport symptoms for remote episodes; and (3) adding impairment to the case definition marginally affects the F:M ratio. Thus, the large F:M prevalence ratio is not an artifact of ascertainment method, case definition, or differential recall.

Adult↗
PubMed1994

The confusion between bipolar disorder and schizophrenia in youth: where does it stand in the 1990s?

OBJECTIVE: To determine whether the bias against diagnosing bipolar disorder in youth continues, and if so, why. METHOD: Subjects are bipolar and schizophrenic patients taken from a county-wide sample of first admissions for psychosis. Patients are given structured interviews and consensus diagnoses at intake and 6 months. Age of onset of psychosis, gender, and 6-month consensus diagnosis between both groups are compared. To assess diagnostic bias, diagnostic stability and facility discharge diagnoses are examined in young (aged 15 through 20 years) versus adult (aged 30 through 40 years) patients. RESULTS: Bipolar disorder and schizophrenia are diagnosed at similar rates in younger age groups by 6-month consensus. However, bipolar disorder was underdiagnosed by Suffolk County's psychiatric hospitals in the youth. The stability of both disorders in both age groups was similar and excellent. Schizophrenia had a slightly older age at first psychosis than bipolar disorder and an equal gender representation. Bipolar disorder in males was rare after age 30. CONCLUSION: Community psychiatrists no longer call young bipolar patients schizophrenic, but they underdiagnose bipolar disorder. The more complicated nature of early-onset bipolar disorder may be a contributing factor.

Adolescent↗
PubMed1994

Eliciting psychotic symptoms using a semi-structured diagnostic interview. The importance of collateral sources of information in a first-admission sample.

This study addressed the importance of medical record information in determining the presence of psychotic symptoms in first-admission patients. A sample of 232 first-admission inpatients screened for psychotic symptoms by facility personnel was administered the Structured Clinical Interview for DSM-III-R (SCID) followed by a medical record review and interview with a significant other. Medical records were unavailable for sixteen patients. These patients were more often female, married, and more suspicious than patients whose records were reviewed. Of those having interviews and record reviews, 49 showed no clear evidence of psychosis. The remainder were divided into three groups: 97 subjects who revealed all of their psychotic symptoms during the interview (SCID-ALL); 61 who revealed only some of their delusions or hallucinations during the interview (SCID-PART); and 25 who revealed none of this information during the interview but whose records clearly described psychosis (SCID-NONE). The three groups were reasonably similar demographically and with respect to clinical history. Clinically, at the time of interview, SCID-NONE subjects were less often still psychotic, were rated on the Brief Psychiatric Rating Scale as less depressed, more withdrawn, less cooperative and less severely ill, and had poorer insight ratings on the Hamilton Depression Scale.

Adult↗
PubMed1994

Comparison of facility and research diagnoses in first-admission psychotic patients.

OBJECTIVE: The present study investigated the concordance of clinical and research-based DSM-III-R diagnoses in community, public, and university hospital first-admission patients. In addition to demographic characteristics, information and criterion variance were assessed as explanations for the diagnostic disagreements. METHOD: As part of the Suffolk County (New York) Mental Health Project, 223 first-admission subjects with a psychotic disorder were interviewed with the Structured Clinical Interview for DSM-III-R, and consensus diagnosis was made by two project psychiatrists. Clinical diagnoses were abstracted from discharge summaries obtained subsequent to the research diagnoses, and reasons for disagreement between the two diagnoses were determined. RESULTS: Moderate overall agreement between facility and research diagnoses was found, with highest agreement with the university facility, lowest with the public facilities, and intermediate agreement with the community facilities. Demographic variables were not significantly associated with diagnostic discordance. Apparent reasons for diagnostic disagreement included evidence of variability in information available to clinicians and research psychiatrists (N = 39 or 48% of cases with disagreement), as well as in clinical judgment in the application of DSM-III-R criteria (N = 42 or 52% of cases with disagreement). CONCLUSIONS: Considerable differences between facility and research diagnoses remain, especially in the public and community sectors; these differences can be attributed to information and criterion variance. Longitudinal follow-up is necessary to establish the predictive validity of the initial clinical and research diagnoses. Future research should also address other possible reasons for these discrepancies.

Adult↗
PubMed1994

Six-month stability of psychiatric diagnoses in first-admission patients with psychosis.

OBJECTIVE: The short-term diagnostic stability of schizophrenic and other psychotic disorders was examined in first-admission patients, with attention to the principal reasons for diagnostic change. METHOD: Hospitalized first-admission patients (N = 278) participating in an epidemiologic study were interviewed at baseline and after 6 months with the Structured Clinical Interview for DSM-III-R. A best estimate diagnosis was made at both time points with the use of all available sources of information. Reasons for changes in diagnosis were determined by two psychiatrists. RESULTS: Affective psychosis and schizophrenic disorders were relatively stable broad diagnostic categories over the 6-month period, with 86.5%-88.9% of the patients remaining in the same category, although findings for specific diagnoses within these categories ranged from 61.5% to 85.7%. The groups with unknown and nonspecific diagnoses showed less stability; the diagnoses of more than one-third of these patients remained unknown or nonspecific at the 6-month evaluation. If the 6-month diagnoses are used as the research standard, somewhat lower percentages of patients received the same diagnoses at baseline. Forty-three percent of the changes in diagnosis were attributed to the clinical course of illness; the rest were attributed to the diagnostic process itself. CONCLUSIONS: A longitudinal diagnostic assessment based on multiple sources of information is crucial for categorizing first-admission psychotic patients, particularly those who do not initially fit into a DSM-III-R category. The short-term stability of a diagnosis is a function of multiple factors, including the changing clinical picture, additional sources of information, and new interpretations of original data.

Adolescent↗
PubMed1993

Pseudopregnancy and postpartum psychosis: a case study.

We report on an uncommon case of a woman who presents with pseudopregnancy. In the past she suffered from postpartum psychosis and an episode characterized by pseudohallucinations. No such association was reported in the literature survey we have made. We discuss the distinction between the overvalued idea as presented in pseudopregnancy and delusion as presented in the postpartum psychosis and suggest that the two phenomena can be viewed as a continuum rather than dichotomized, especially in cases like the one reported here.

Adult↗
PubMed1993

Gender differences in clinical characteristics of first-admission psychotic depression.

The authors explored differences in the clinical characteristics of 17 male and 13 female patients experiencing their first admission for psychotic depression. Few differences were observed for most depressive and psychotic features, but fewer male than female patients reported fatigue, psychomotor agitation, and systematized and mood-incongruent delusions and more male patients reported feelings of worthlessness. Overall, the findings were consistent with those derived from samples of patients with chronic, nonpsychotic mental illness.

Adolescent↗
PubMed1993

The psychiatrist as a psychotherapist: the problem of identity.

Becoming a psychotherapist is a complicated process for individuals from any discipline but for physicians the process is even more difficult. We consider the identity issue to be central to the integration of psychotherapy into the training of psychiatrists. Residents can be taught that seemingly contradictory aspects of identity can coexist successfully. It is important to address this issue early in the training of residents and to provide a setting in which a positive professional identity can develop. Failure to do so can lead to frustration, anger, demoralization, and devaluation, inhibiting optimal development of skills.

Combined Modality Therapy↗
PubMed1993

Body image of achondroplastic children before and after leg elongation.

Body image disturbance was studied in 6 achondroplastic children before and after surgical leg elongation (Wagner's procedure) using Fisher's Draw-a-Person Test and the Body Cathexis Test, as well as on another group of 6 achondroplastic children who had undergone the same procedure several years earlier. These groups were compared with 12 healthy control children. Gross disturbance of body image was present before the operation with a substantial improvement after the procedure. However, even years after the surgical procedure there still exists a difference in body image between the control-normal group and achondroplastic adolescents.

Achondroplasia↗
PubMed1992

The epidemiology of psychosis: the Suffolk County Mental Health Project.

This article describes the rationale, aims, and methodology of an epidemiological study of psychosis being conducted in Suffolk County, New York. A sample of first-admission patients is drawn from 10 inpatient and 25 outpatient facilities. Diagnostic psychosocial interviews are conducted shortly after admission to treatment, and at 6- and 24-month followup. Consensus diagnoses are made after each interview. Demographic and clinical background characteristics of the first 250 subjects enrolled over a 2-year period are presented here. The response rate was 76 percent. Based on the initial interview, 75 percent of subjects received a diagnosis involving psychosis. The three most common diagnoses were schizophrenia, bipolar disorder with psychotic features, and major depression with psychotic features. Among subjects with psychosis, 58 percent of males and 29 percent of females had a history of substance abuse/dependence. Gender differences were found on several background and clinical characteristics. Males were somewhat younger, less likely to have ever married, and had less education. Although the median length of hospitalization was the same for females and males (27 days), females were more likely to be hospitalized within 1 month of the occurrence of their first psychotic symptom (60% of females compared to 37% of males). Subjects with schizophrenia-related disorders were significantly more impaired on an assessment of negative symptoms than were affectively ill subjects, but clinical ratings of depression were not significantly different across diagnostic groups.

Adolescent↗
PubMed1992

The Arab nurse and the Jewish psychotic patient in the closed psychiatric ward.

The ongoing Israeli-Arab conflict has its impact on the mental health system. This issue is investigated from the point of view of the interactional process in the locked unit mainly between the Arab nurse and the Jewish psychotic patient. The unique experience of being treated by the formal enemy during one of the most vulnerable periods seems to be sometimes even therapeutic for the patient. Aspects concerning psychopathology, psychodynamics and social interaction are evaluated through observation and interviews with patients and staff members. Ways of dealing with the complicated issues are discussed.

Adolescent↗