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PubMed1975

Dimensional diagnosis and the medical student's grasp of psychiatry.

Two problems that interfere with the student's understanding and acceptance of psychiatric knowledge result largely from the use of a categorical model for psychiatric diagnosis. These two problems are: (1) the apparent inapplicability of the standard system of psychiatric diagnosis to real patients; and (2) the apparent irrelevance for general medical practice of psychiatric diagnosis and theory. Both problems may be avoided by presenting psychiatry in the framework of a multidimensional diagnostic schema that used familiar terms but treats them as dimensions with severe, moderate, and mild degrees of impairment rather than as categories of mutually exclusive psychiatric diseases. A teaching program is described in which detailed review of student interviews with psychiatric and especially nonpsychiatric patients is employed to demonstrate the usefulness of multidimensional psychiatric diagnosis.

Affective Symptoms↗
PubMed1975

Good patients and bad. Therapeutic assets and liabilities.

This is an extension of an earlier article that identified three utilization styles at an urban mental health center where, apart from a minority of intensive users, casual users, and pseudousers predominate and, combined, characterize the therapeutically passive user. The present article compares center data to added data from the private sector, where the intensive user predominates. Center/private differences are examined, and correlates of differing utilization styles are identified, such as sex, diagnosis, marital/living arrangements, referral source, and social engagement factor. The later is associated with differences not attributable to diagnostic severity of social impairment. The growing division of labor, wherein the privates sector is engaged in intensive psychiatric treatment while the center increasingly operates an emergency/crisis/maintenance service, is shown to reflect a gross public/private maldistribution of therapeutic assets and liabilities.

Alcoholism↗
PubMed1976

The disturbed and the disturbing psychiatric resident.

Two hundred psychiatric residents who were in training during a 25-year period were retrospectively studied. We found that residents could be meaningfully divided into the four following categories: (1) neither disturbed nor disturbing; (2) disturbed and disturbing; (3) disturbed but not disturbing; and (4) disturbing but not disturbed. There is a need for early recognition of disturbed residents in order to guide them into appropriate treatment, supervision, and career choice. Some very disturbed residents make a satisfactory adjustment to residency and psychiatric practice. Certain disturbing residents are not at all disturbed but are mislabeled as such by faculty. These residents often make outstanding psychiatrists. Personal psychotherapy is an important factor in the eventual outcome of the lives and careers of disturbed residents.

Adult↗
PubMed1977

Consistency of Kurt Schneider-oriented diagnosis over 40 years.

Diagnostic rates of routine hospital first and total admissions in various categories of functional mental illness in three strongly Schneider-oriented German psychiatric clinics over 40 years were examined. No matter how centers and categories were compared, statistically significant inconsistency was almost always found. Only first admissions for schizophrenia and mania in Munich and Heidelberg, as well as total schizophrenic admissions in Munich and Homburg/Saar, showed no significant diagnostic differences. However, from a practical point of view, actual percentage differences found in schizophrenia and mania were really not that great; indeed, rather similar diagnostic rates were apparent. This was in contrast to actual large percentage discrepancies shown between Munich on the one hand and Heidelberg and Homburg/Saar on the other with respect to manic-depressive illness and psychotic depression.

Adjustment Disorders↗
PubMed1977

Decision to admit. Criteria for admission and readmission to a Veterans Administration hospital.

Factors related to the decision to hospitalize applicants for psychiatric treatment at a Veterans Administration hospital were explored. For a three-week period, decision makers completed questionnaires following interviews with applicants. It was found that 79% of applicants were "revolving door" patients. These patients were much less likely to be married, and more likely to be homeless and diagnosed as schizophrenic, than patients without previous hospitalizations. A small number of patients were admitted because of characteristics of their illness regardless of their social situations. Patients were not hospitalized on the basis of social or nonpsychiatric criteria alone. A large number were admitted because of a combination of factors, some social in nature and others related to their psychopathology. A social process taking place in the screening interview appeared to have some influence in the decision to admit.

Decision Making↗
PubMed1977

Alternatives to the mental hospital: use of residential facilities for long-term psychiatric care.

We examine the use of the mental hospital and alternative residential facilities by 149 chronic psychiatric patients in Ontario. All major movements of patients since the time of first admission were recorded, including the number of episodes and duration of hospitalization and placement in alternative facilities and in the community. Clinical and social variables thought likely to influence use were correlated with duration, placement, and mobility. In spite of the lack of formal criteria for placement, relatively discrete and homogeneous populations were found in each facility and clear patterns of use could be distinguished. For many patients, their present placement represents their most typical setting and implies a particular route through the psychiatric services. We describe factors relating to different types of movements, and emphasize the continuing importance of the mental hospital in long-term psychiatric care.

Adult↗
PubMed1978

Reliability of the Group for Advancement of Psychiatry Diagnostic Categories in Child Psychiatry.

A total of 403 multiple diagnoses were independently assigned to 41 patient protocols by 73 psychiatrists, psychologists, and social workers to determine the levels of interrater reliability of the Group for the Advancement of Psychiatry (GAP) diagnostic categories. With the exception of the psychotic disorders category, these diagnostic categories were found to have low levels of interdiagnostician reliability. Differences in the reliabilities across disciplines and levels of training were found. It is noted, however, that neither years of experience, kind of training, nor direct contact with the patient can be regarded as a substitute for improvements in the classification system itself. The importance of a reliable classification system for child psychiatry is emphasized and suggestions for improvements in the present GAP system are made.

Child↗