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At least 127 records · Page 7Linked to original sources
PubMed1986

First do no harm: short-term inpatient psychotherapy of the borderline patient.

Patients with borderline personality disorder typically are hospitalized in the midst of a crisis and in a state of acute regression. After a few days in which the patient is provided with containment and support, the therapist can assess whether the patient has the capacity for exploratory psychotherapy that may help in ego development or whether such psychotherapy may prompt further regression and dangerous acting out. For exploratory therapy certain conditions, such as an observing ego, a therapeutic alliance, and the therapist's ability to contain countertransference feelings and deal with the patient's projections, are essential. The therapist must be alert to common treatment errors that can undermine the patient's capacity to recompensate; they are likely to occur in the areas of empathy, confrontation, transference, interpretation and management, and the patient's attachment to pain.

Adult↗
PubMed1986

Inpatient psychosocial treatment of chronic schizophrenia: negative effects and current guidelines.

In the inpatient psychosocial treatment of schizophrenia, therapies that are intense and overstimulating often promote or prolong regression and negatively affect long-term adjustment. These approaches fail to take into account the chronicity of the disorder, the special vulnerabilities of the schizophrenic patient, and the appropriate goals of an inpatient admission. Based on a review of these problems, the authors offer several prescriptions for inpatient psychotherapy of schizophrenia: modest, well-defined goals; gentle, supportive, educational interactions with the patient; inclusion of the patient's support system and outpatient caregivers in the treatment; and attention to long-term adjustment as well as to short-term symptom removal.

Chronic Disease↗
PubMed1987

Psychiatric expertise in clinical decision making for psychiatric inpatients.

Hospital boards and medical staffs are faced with difficult decisions about whether nonphysician mental health professionals should be given admitting privileges to psychiatric hospitals or treatment units. The authors describe the special medical expertise of the psychiatrist and define 11 indicators, such as a patient's need for new psychotropic medication or the presence of symptoms requiring medical or laboratory procedures, that can be used to determine whether psychiatric expertise is needed. The indicators were applied to a group of ten patients who constituted all admissions to a treatment unit in a private, nonprofit psychiatric hospital in a one-month period. At least half of the indicators were relevant to all the patients studied, suggesting the need for management by a psychiatrist.

Clinical Competence↗
PubMed1992

Case-based reimbursement for psychiatric hospital care.

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

Adolescent↗
PubMed1995

False allegations of sexual misconduct: clinical and institutional considerations.

That some therapists engage in sexual misconduct with patients has been unequivocally established. In recent years, however, some patients' allegations of sexual misconduct have been determined to be false. This paper describes four cases in which hospitalized psychiatric patients made false allegations. Such allegations may result from patients' seeking to gain monetarily or in other ways or from a desire for retaliation or revenge against a clinician who they believe has scorned, abandoned, or otherwise mistreated them. In other cases, especially among patients with a history of severe trauma, a patient's psychopathology may be inadvertently stimulated by diagnostic, treatment, or milieu activities. The authors recommend specific institutional responses to allegations of sexual misconduct, such as forming a clinical investigative team, conducting a physical examination, and reporting the charge to outside agencies or investigators when appropriate. Because false claims can have disastrous effects on all involved, clinicians should understand the presentations of such claims and the motivations behind them, and institutions should carefully develop a set of procedures for responding to them.

Ethics, Professional↗
PubMed1998

Guidelines for prescribing psychiatrists in consultative, collaborative, and supervisory relationships.

Most psychiatrists enter into a variety of professional relationships with other clinicians in which they prescribe medications or make recommendations about pharmacotherapy. This paper describes a set of guidelines for prescribing psychiatrists involved in consultation, collaboration, and supervision with other clinicians. The guidelines were developed by psychiatrists for the Harvard Risk Management Foundation. The terms consultation, collaboration, and supervision are defined, and the psychiatrist's roles and responsibilities in each type of arrangement are described. The guidelines limit consultation and collaboration to relationships with professionals who are licensed or credentialed. Based on the definitions, the paper describes a structure for working with other clinicians, which begins with a thorough assessment of the context and circumstances of the clinical situation. The guidelines strongly encourage structured communication among clinicians and with the patient and significant others, as well as clarification by clinicians of their respective responsibilities for treatment and follow-up.

Clinical Competence↗
PubMed1995

The imperative of outcome assessment in psychiatry.

This report describes the current conceptualization of outcome assessment in psychiatry and focuses on how assessment instruments can be built into psychiatric facility-based practice. First, the domains of clinical assessment are outlined, with an emphasis on three elements: level of psychiatric symptoms, clinical functioning, and patient satisfaction. Examples of outcome instruments then are provided as well as the elements of their successful implementation. Finally, the value of linking outcome assessment to data on patient characteristics and service utilization are discussed in order to gain insight into the relationship between treatment and outcome. The clinical, fiscal, and regulatory imperatives emerging for outcome assessment call for its demystification and widespread application.

Hospitals, Psychiatric↗
PubMed1986

Pleural effusion after plasmapheresis in Waldenström's macroglobulinemia.

Transudative pleural effusion developed after plasmapheresis in a patient with Waldenström's macroglobulinemia and hyperviscosity. When albumin was added to the apheresis, the effusion resolved. We therefore suspect that rapid removal of high-molecular-weight IgM led to an abrupt decrease in intravascular colloid oncotic pressure and transudation of fluid into the pleural space. Plasmapheresis can cause pleural effusions in patients who were previously hemodynamically compensated at high levels of colloid oncotic pressure.

Aged↗
PubMed2001

Hemifacial microsomia. Etiology, diagnosis and treatment.

BACKGROUND: Three percent of all newborns have significant structural anomalies. Hemifacial microsomia, or HFM, is the second most common facial anomaly, second only to cleft lip and palate. New therapeutic and clinical management techniques offer promising interventions that can allow many patients to have more normal childhoods at earlier ages. DESCRIPTION: Due to a unilateral deficiency of the mandible and lower face, patients who have HFM have specific dental needs that require restorative, orthodontic and surgical correction. CLINICAL IMPLICATIONS: Oral and maxillofacial malformations present diagnostic and treatment challenges unique to the dental profession. The etiology, diagnosis and treatment modalities discussed in this article can be used to help effectively rehabilitate patients who have HFM.

Child↗
PubMed1981

Detecting and localizing peripheral arterial disease: assessment of 201Tl scintigraphy.

Detection and localization of peripheral arterial disease was evaluated by intravenous injection of 201Tl at peak exercise in 22 subjects. Images of the gluteals (G), thighs (T), knees (K), and calves (C) were obtained at exercise and after a 3 hr delay, and stored in a computer, interextremity (T/T and C/C) and intraextremity (G/T, T/C, T/K) counts ratios were calculated. Normal values were defined in 11 control subjects and compared with those obtained in 11 patients with angiographically proven peripheral arterial disease. Bilateral disease was detected scintigraphically in all patients. T/T and G/T ratios correctly predicted proximal disease in nine of 12 limbs, while C/C, T/C, T/K ratios correctly predicted distal disease in 21 of 21 involved limbs. Delay images 3 hr after stress generally reverted towards the norm. Objective systematic evaluation of limb isotope uptake permits accurate detection and localization of peripheral arterial disease. Method accuracy compares favorably with physical signs and with other noninvasive methods of detection of peripheral vascular disease. Scintigraphy presents advantages which indicate great clinical potential.

Adult↗
PubMed2001

Sagittal plane analysis of head, neck, and trunk kinematics and electromyographic activity during locomotion.

STUDY DESIGN: Descriptive study examining kinematic and electromyographic (EMG) patterns of the upper body during walking. OBJECTIVE: To examine trunk, neck, and head movements to determine a mechanism for upper body stabilization during walking. BACKGROUND: Dynamic balance of the upper body during walking provides a stable base for function of sensory systems. Prior investigations of upper body motion during walking were limited to examination of isolated segments, or examination of the upper body as a single unit. In our study, the upper body is examined as 3 segments: the trunk, neck, and head. METHODS AND MEASURES: Sagittal plane walking patterns were examined in 8 unimpaired young adults. Markers placed on the trunk, neck, and head segments were recorded on videotape. Angles were calculated with respect to an external horizontal reference to determine segment position relative to space. EMG measures were obtained from erector spinae, rectus abdominus, semispinalis capitis, and sternocleidomastoid muscles. RESULTS: Results showed dynamic stability was accomplished through maintenance of a posture where the trunk was flexed, the neck was extended and the head was flexed. The trunk segment demonstrated greatest stability with the neck being the least stable of the 3 segments. Movements of upper body segments showed a tendency for the head and neck to move opposite to the trunk. EMG data demonstrated erector spinae muscle activity occurring near heel contact of each limb followed by trunk extension. The remaining muscles exhibited variable patterns of activity. CONCLUSIONS: These data indicate that movements of the upper body help to maintain a posture that promotes stability of these segments during walking. The trunk was the most stable of the three segments thereby, providing a stable platform for head and neck movement. Erector spinae muscle activity contributed to upper body movements by extending the trunk to maintain balance at heel contact. These results provide a basis for studying changes in dynamic stability that occur with age.

Adult↗
PubMed2000

The role of CD4+ T cell help and CD40 ligand in the in vitro expansion of HIV-1-specific memory cytotoxic CD8+ T cell responses.

CD4(+) T cells have been shown to play a critical role in the maintenance of an effective anti-viral CD8(+) CTL response in murine models. Recent studies have demonstrated that CD4(+) T cells provide help to CTLs through ligation of the CD40 receptor on dendritic cells. The role of CD4(+) T cell help in the expansion of virus-specific CD8(+) memory T cell responses was examined in normal volunteers recently vaccinated to influenza and in HIV-1 infected individuals. In recently vaccinated normal volunteers, CD4(+) T cell help was required for optimal in vitro expansion of influenza-specific CTL responses. Also, CD40 ligand trimer (CD40LT) enhanced CTL responses and was able to completely substitute for CD4(+) T cell help in PBMCs from normal volunteers. In HIV-1 infection, CD4(+) T cell help was required for optimal expansion of HIV-1-specific memory CTL in vitro in 9 of 10 patients. CD40LT could enhance CTL in the absence of CD4(+) T cell help in the majority of patients; however, the degree of enhancement of CTL responses was variable such that, in some patients, CD40LT could not completely substitute for CD4(+) T cell help. In those HIV-1-infected patients who demonstrated poor responses to CD40LT, a dysfunction in circulating CD8(+) memory T cells was demonstrated, which was reversed by the addition of cytokines including IL-2. Finally, it was demonstrated that IL-15 produced by CD40LT-stimulated dendritic cells may be an additional mechanism by which CD40LT induces the expansion of memory CTL in CD4(+) T cell-depleted conditions, where IL-2 is lacking.

Adjuvants, Immunologic↗