Depressive symptoms and abnormal illness behavior in general hospital patients

There have been many accounts of depression and abnormal illness behavior in medical inpatients, but systematic studies of their prevalence and features in a general hospital are lacking. Occurrence and characteristics of depression and illness behavior were studied in 325 inpatients of a general hospital in the northern part of Italy. Patients were surveyed in six separate wards (medicine, surgery, dermatology, OB-GYN, orthopedics, and opthalmology) and represented about 90% of their actual population during a one-week period. Two self-report scales were used for screening: the CES-D (scale devised by the Center for Epidemiologic Studies of Depression at NIMH) for measuring depression and the Illness Behavior Questionnaire (IBQ), developed by Pilowsky and Spence. Both scales were administered in their validated Italian translations. The customary cut-off point of 16 in the CES-D score revealed about 58% of the patients as depressed. A more conservative cut-off point of 23 still showed 33.5% of the patients as depressed. The IBQ scores of the depressed patients showed significantly (p < 0.001) higher levels of general hypochondriasis, disease conviction, dysphoria, and irritability than the nondepressed patients. No relevant differences existed between wards in the amount of depression and IBQ scores, even when differences were adjusted for age, sex, marital status, and social class. Implications for psychosomatic research (sociodemographic characteristics of depression and illness behavior, bias in comparing hospital patients and controls in the general population, and so on) and treatment (consultation-liaison psychiatry) are discussed.     

Deliberate self-harm and substance dependence: the management of patients seen in the general hospital

The aim of this study was to examine management decisions made at the time of assessment of an episode of deliberate self-harm seen in the general hospital and examine the extent of referral to a specialized addiction unit. Factors involved in making a clinical decision regarding the appropriate management of self-harm cases when alcohol factors were identified are reviewed. Simply referring to a specialized addiction unit was found to be an unsatisfactory method of providing a comprehensive response to the problem of substance misuse and deliberate self-harm. It is suggested that services should be developed using active posthospital discharge community follow-up. Motivational interviewing used in such a setting may increase the number of patients who will go on to accept specialist care.     

Intensive treatment of characterologically difficult patients. A general hospital perspective

This article describes the development of a long-term inpatient treatment program in a general hospital setting for severely disturbed patients with personality disorder. A treatment model is outlined, with case vignettes included, that illustrates pertinent clinical issues. Also, the issue of regression in therapy, the role of consultation in a teaching unit, and research perspectives are discussed.     

Teaching liaison psychiatry and clinical practice of psychosomatic medicine in the general hospital.

One of the recent trends in the general hospital is the increase of psychiatric units and the number of psychiatrists working therein. Thus the psychiatrist has had greater opportunities to participate as a member of a clinical team in the care of patients of other units. Accordingly, daily cooperation with other specialties casts him into new roles which transcend those of the traditional psychiatric consultant. The role of liasion psychiatrist involves the complex relations of doctor--nurse--patient--family, interdepartmental relations, communications and so on. By improving these relationships he tries to bring about a more holistic approach in the general hospital.     

精神病院中谵妄病人的临床分析

目的：探讨谵妄的病因和临床特点。方法：对符合ＣＣＭＤ－２－Ｒ意识障碍和ＤＳＭ－Ⅳ谵妄诊断标准１２１例患者的临床资料进行回顾性分析。结果：引起谵妄的病因很多,以颅脑疾病为最常见,其次是综合因素。临床表现以意识障碍伴有思维不连贯,遗忘,视幼觉和行为紊乱等为主。结论：引起谵妄的病因很多,往往是多种原因作用的结果。谵妄的临床特点是急性起病,以意识障碍伴全面认识功能障碍,症状节律变化为主的临床症状群。     

A general systems approach to severe family pathology.

The author proposes a general systems approach to the examination and understanding of family functioning. Scrutinizing the family as an open system with 1) evolutionary goals and tangible tasks, 2) a need for "semipermeable" boundaries, 3) cultural and subcultural communication modes, 4) leadership effectiveness, and 5) the nature and age-appropriateness of the affective bonds will enable clinical judgements about family functioning that indicate general system competencies and defects. Such a framework may also lead to a typology of family process because the major functions of the family as a system (creation, nurturance, enculturation, and guidance of the young into adulthood) can be evaluated regardless of symptoms or diagnoses.     

Seasonal variations in mood and behavior in the general population: a factor-analytic approach.

In a mailed survey conducted at four centers--Nashua, NH; New York, NY; Washington, DC; and Sarasota, FL--1,671 respondents provided information on monthly variations in 10 behavioral categories representing extremes in the areas of mood, socializing, appetite, weight gain/loss, and sleep length. A 10-factor solution revealed the following factors: (1) a winter weight gain factor; (2) a winter depression factor; (3) a winter hypersomnia factor; (4) a summer weight gain factor; (5) a summer hypersomnia factor; (6) a summer depression factor; (7) a winter socializing factor; (8) a winter weight loss factor; (9) a fall depression factor; and (10) a possibly mixed factor. Factors consistent with winter seasonal affective disorder were positively correlated with latitude, while those consistent with summer seasonal affective disorder were negatively correlated with latitude.     

A marketplace model of consultation psychiatry in the general hospital.

The manner in which internists and surgeons view potential psychiatric consultations is analogous to the way in which consumers evalute a service or product in the marketplace. Factors that determine a purchase or a consultation request include 1) perception of need, 2) prior attitude and experience, 3) projected image, 4) availability, and 5) cost/benefit ratio. The author presents a model of psychiatric consultation, with similarities between research and development, manufacturing and merchandising phases on the one hand, and negotiation, investigation, and implementation phases on the other.     

Effects of proprietary management in general hospital psychiatric units

The rapid increase in the number of proprietary psychiatric hospitals during the last 15 years has drawn criticism from those concerned about the impact of the profit motive on the quality of patient care. This study assessed changes in the structure and quality of care on 13 acute care psychiatric units before and after a single outside proprietary firm was hired to manage the units. The study found significant improvements in many areas after the change; they included higher occupancy rates, higher staffing levels, more hours of staff inservice training, higher collections-to-billings ratios, and improved program structure and process as measured by Joint Commission on Accreditation of Hospitals criteria. No changes were found in the length of stay or diagnostic mix of patients. The findings indicate that program quality and profit are not necessarily incompatible, but the author cautions against making generalizations to other situations based on the small study sample.     

Motivation to change drinking behavior: comparison of alcohol-dependent individuals in a general hospital and a general population sample

The general hospital would be especially suited to initiate interventions if hospitalized alcohol-dependent individuals were particularly motivated to change their drinking behavior. This study compares the readiness to change of alcohol-dependent persons in the general hospital and the general population. Stages of change according to the model of Prochaska and DiClemente [6] are assessed using the Readiness to Change Questionnaire (RCQ) in two representative samples: 118 alcohol-dependent subjects admitted to a general hospital (sample 1) and 50 alcohol-dependent individuals in the general population (sample 2). In sample 1, alcohol-dependent persons were identified in 1167 consecutive admissions using screening questionnaires and a diagnostic interview (SCAN). In sample 2, alcohol dependence was assessed in 4075 individuals using a German version of CIDI. The distribution of stages of change differed significantly (p < 0.0001) between the groups, revealing a shift towards higher stages in the hospital subjects. Logistic regression analysis revealed that the stages of readiness to change and age contributed in predicting whether subjects belonged to the general hospital or the general population sample. Findings suggest that the general hospital is a suitable site to initiate interventions for alcohol-dependent individuals.