Narcissistic personalities in DSM III

Although DSM III designates narcissistic personality disorder as one of the eleven personality types, the author places that category within a cluster of narcissistic personality types. Others in that cluster are paranoid, antisocial, dependent and avoidant personalities. All these personality types share basic features of intense narcissism and a cohesive sense of self. The specific personality types within this cluster differ from one another by their intersections with other types of personality groupings.     

An emergency psychiatry update

A review of trends in emergency psychiatry since 1981 indicates that the scope and complexity of the field have greatly increased. Clinicians have found it useful to identify patient groups with special assessment and treatment needs, including adolescents, the elderly, victims of rape and of domestic violence, and repeat visitors to the emergency service. The spread of AIDS requires greater medical attentiveness by psychiatric emergency clinicians, and two recreational substances of abuse, cocaine and inhalants, have become increasingly popular. The use of psychotropic drugs in the emergency room has received more attention, and new trends in rapid tranquilization are apparent. Also reviewed are current medicolegal controversies related to emergency room practice, findings on prediction and control of violence, and the use of the psychiatric emergency service as a training site.     

Two year follow-up study of an outreach program in geriatric psychiatry

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives. A number of community outreach programs are available. From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24% who had been admitted were compared with the 75.9% who remained in the community. While patients' relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter three considered less mentally ill because of the criteria for admission to the hospital.     

Redesigning emergency room psychiatry in New York

Significant changes in the characteristics of persons using psychiatric emergency services have resulted in increased demands beyond the needs emergency services traditionally have been expected to meet. In New York City, these changes caused a crisis in psychiatric emergency services. The authors report a state statute that gave the New York State Office of Mental Health the authority to license a specialized psychiatric emergency service, a comprehensive psychiatric emergency program, within general hospitals designed to provide specialized assessment, stabilization, and referral services.At the time this article was written, he was Counsel and Deputy Commissioner of the New York State Office of Mental Health.     

Substance abuse and emergency psychiatry.

Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other Axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.     

Mood and anxiety syndromes in emergency psychiatry.

Mood and anxiety disorders are common in the general population and in the emergency setting. As psychiatric emergency care moves from the realm of triage and referral to a more definitive initiation of treatment, clinicians must approach the assessment and initial management of patients with mood and anxiety disorder in a rational and safe way. In the ED, the next step in assessing patients with mood or anxiety symptoms, after any immediate safety concerns are addressed, is to rule out medical or substance-induced causes. Treatment of these patients is directed at the underlying condition. When a primary psychiatric diagnosis is made, initial management, including definitive pharmacologic or psychotherapeutic intervention, can be started in the ED.     

Somatic presentation of DSM III psychiatric disorders in primary care

This paper describes a study assessing the correlates and possible determinants of ‘somatisation’ by patients consulting their family doctor with a new illness. Operational criteria of ‘somatisation’ are given and the relationship between DSM III psychiatric disorders and physical illness are described. The epidemiological findings that are presented illustrate that ‘somatisation’ is a common phenomenon and accounts for a substantial proportion of ‘hidden psychiatric morbidity’ in primary care.