Integrating general health care in private community psychiatry practice

Patients with chronic mental illness have multiple health care needs. These patients, particularly those with schizophrenia, have higher incidences of heart disease and metabolic syndrome than the general population and show increased risks of infectious disease, pulmonary disease, and substance abuse. In order to effectively monitor and treat these patients, psychiatric and general health care should be integrated as much as possible. This presentation describes the role of the psychiatrist in helping to maintain the physical health of his or her patients, including monitoring for weight gain and other cardiac risk factors that may be increased by psychotropic medications, and explains the importance of communication between psychiatrists and primary care physicians.     

Alternate level of care patients in public general hospital psychiatry

Little has been written on the relationship between psychiatric services in public general hospitals and in other institutional settings. The authors analyze the interaction between them and its effects on quality of care. They suggest that clinicians and administrators are biased in favor of institutional care. Several recommendations for further research on the subject are made.Luis R. Marcos, M.D., is Vice-President, Mental Hygiene Services, New York City Health and Hospitals Corporation, and Associate Professor of Psychiatry, New York University School of Medicine. Rosa M. Gil, D.S.W., is Assistant Vice President and Assistant Professor of Social Work at Columbia University. The authors thank Dr. Reuben Margolis for his comments. Assistance in data analysis was provided by Beverly Carroll, Sara Craig, Edith Cresmer, Margaret Escoe, Jacqueline Huey, Fred Johnson, Simon Levin, William Mates, Eleanor Rothenberg, and Kathleen Vazquez. Views expressed in this paper are those of the authors and do not necessarily reflect the opinions or policies of the New York City Health and Hospitals Corporation. Requests for reprints should be directed to Dr. Marcos at the New York City Health and Hospitals Corporation, 125 Worth Street, New York, NY 10013, Telephone (212) 566-7113.     

综合医院精神科会诊患者谵妄的临床特点

目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的58例谵妄患者(会诊组)与同期在精神病院的54例患者(非会诊组)的临床资料进行对照分析,并使用谵妄评分量表中文修订版(CAM-CR)测评。结果:会诊组中的谵妄患者年龄偏大,病因复杂,内科疾病以呼吸系统感染、脑卒中、心血管疾患多见,外科疾病以脑外伤、手术后、骨折多见,其中多系统疾病引起谵妄的几率最高,CAM-CR精神运动性抑制因子分显著高于非会诊组;非会诊组相对年龄偏小,病因简单,以精神活性物质依赖戒断、老年痴呆、抗精神病药应用不当多见,CAM-CR总分及意识水平的改变、知觉障碍、精神运动性兴奋因子分均显著高于会诊组。结论:综合性医院中的谵妄患者年龄大,病因症状复杂,误诊率高,预后差。会诊联络亟待加强。     

Inpatient psychiatry: perspectives from the general, the private, and the state hospital

Although it is widely recognized that inpatient psychiatry is different as it is practiced in the general, private, and state hospital, why and how it is different have not been clearly articulated. In this paper, the directors of inpatient units in a general hospital, a private hospital, and a state hospital first provide an analysis of how the history and the organizational structures of these units have shaped their identity. The authors then specifically detail the different patient populations, referral sources, financial bases, leadership arrangements, milieu philosophies, research and training activities, and lengths of stay on these units. Finally, on the basis of the reality and the value of different inpatient settings, a view toward the future of inpatient psychiatry is offered.     

Training general psychiatry residents in child and adolescent psychiatry

The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.     

Education and training in public psychiatry

The Public Psychiatry Training Program offers an education in the unique knowledge, attitudes, and skills essential for working with persons with severe and chronic illness in both hospital and community settings.     

Comparing clinic and private practice of psychiatry

The author compared data on 2,020 cases treated by private psychiatrists with those on 2,052 cases treated by clinic psychiatrists in California. He also compared data on private treatment in California with those from a national survey of private psychiatrists. Private psychiatrists in California treated as many psychotic patients and used relatively brief psychotherapy about as often as clinic psychiatrists and were more likely to use hospitalization and to see patients individually. In comparison with the national sample, private psychiatrists in California treated more children and patients with situational disturbances and were more likely to receive payment from government sources.     

Forensic psychiatry and public protection

The prominence of risk in UK social and criminal justice policy creates opportunities, challenges and dangers for forensic psychiatry. The future standing of the specialty will depend not only on the practical utility of its responses to those opportunities and challenges, but also the ethical integrity of those responses.