The impact of political process on hospital psychiatry.

Political forces motivated the New York State Department of Health to withhold payment for Medicaid-financed inpatients on therapeutic passes. The elimination of therapeutic passes had many negative effects on patient care. The authors believe this experience demonstrates that political factors can overwhelm standard clinical practice and reasoned health planning to force irrational change on health care delivery.     

The impact of contact with psychiatry on senior medical students' attitudes toward psychiatry

OBJECTIVE: To investigate the attitudes of Danish medical students as to the attractiveness of psychiatry as a career possibility and to asses the impact on such attitudes of actual contact with psychiatry. METHOD: A base-line survey included 222 senior medical students, of whom 160 were also surveyed subsequent to a 4-week psychiatric affiliation. RESULTS: The base-line survey shows that psychiatry is rated as less attractive than other specialization groups, and that working as health assistants in psychiatric wards contributes to the problematic image. However, a 4-week psychiatric affiliation resolves a number of image issues, and following such an affiliation more medical students were considering specializing in psychiatry. CONCLUSION: The findings of this study suggest that psychiatric affiliations can influence students' attitudes to psychiatry. The observed changes in attitudes lead to the presumption that some aspects of the image problem of psychiatry stem from inadequate knowledge of psychiatry as a specialty and the actual work psychiatrists perform.     

Intensive early exposure to geriatric psychiatry in residency training: impact on career choice and practice.

The authors examined the impact of intensive early exposure to geriatric psychiatry on the career choice of trainees. All psychiatrists who had completed a six month inpatient rotation on a general hospital psychogeriatric unit as part of their first year of residency were interviewed three to 12 years later with a questionnaire designed to elicit practice patterns, prior interest in geriatrics, and the major influences of the rotation. Nine of 16 trainees had spent more than 50% of their time since graduation treating elderly patients. Those surveyed who were not practicing geriatrics spontaneously reported positive influences of the rotation on psychiatry training in general. The nature of geriatric psychiatry and the clinical issues, as well as the supervisors and educational activities were rated as the most important influences of the rotation. Early experience in psychogeriatrics seems valuable for subspecialty recruitment as well as general psychiatry training.     

Cultural perspectives on the impact of women's changing roles on psychiatry.

The author examines sex role stereotypes in the United States and their impact on the self-concept of women. She suggests that the fact that women's roles are changing may have a positive impact on general mental health because both men and women will profit from increased flexibility ingender role specifications. She emphasizes the fact that therapists as well as their patients have been socialized into accepting the values and assumptions of our society; there is thus a high probability that not only the presenting complaints but also the treatment goals for women in therapy are culturally determined.     

The impact of classification on psychopharmacology and biological psychiatry

Nosological classification in psychiatry, as it is currently applied, does not facilitate biological and psychopharmacological research.• Syndromal acuity has disappeared. Consequently, it is impossible to determine: (i) vi/hether a particular drug affects a particular symptom configuration; (ii) what exactly the behavioral correlate of a particular biological disturbance is. The problem of unfocused diagnoses is greatly magnified by the phenomenon called comorbidity.• The boundary between distress and disorder is illdefined.• Symptom configuration and certain nonsymptomatological variables such as duration and severity are prematurely linked, so as to conceptualize categorical entities. The validity of those constructs has not been sufficiently demonstrated. This undermines the validity of biological studies and leads to “nosologomania,” ie, an ever-growing series of undervalidated psychiatric “disorders.”• Symptoms are grouped horizontally as if they all had the same diagnostic “valence.” This, however, is highly unlikely.• The nosological disease model is unconditionally and uncritically accepted. Alternative models are ignored, particularly the reaction-form model, though it has substantial heuristic value, and deserves to be thoroughly scrutinized.(Research) strategies to remedy this situation are pointed out.     

The theory and practice of movie psychiatry

The depiction of psychiatry in the movies has been a source of concern over the years to many in the profession who feel that a false picture of psychiatrists' work has been presented to the public. In fact, psychiatry in the movies has developed its own characteristics, which only occasionally intersect with those of the real-life profession. This paper outlines the methods and theories of the invented profession of movie psychiatry.     

Child psychiatry practice patterns in Ontario.

OBJECTIVES: To examine the demographics, training, distribution, venues of practice, remuneration patterns, and professional affiliations of child psychiatrists in Ontario. METHOD: In July 1997, questionnaires were sent to 229 Ontario psychiatrists. A second mailing was sent to nonresponders in the fall of 1997. The overall response rate was 66.8%. RESULTS: Compared with other research regarding the ratio of child psychiatrists to children with mental health problems, Ontario fares relatively well (1:6148). Generally, Ontario child psychiatrists report having received formalized training in the speciality. Child psychiatrists are disproportionately concentrated in Toronto and in midsize cities with medical schools compared with rural regions. Out-reach services to smaller communities are provided by 30% of child psychiatrists, but it is not clear whether the services are sufficient and equitably available. Approximately 50% of current psychiatrists will be aged 65 years or older in 15 years, and it is unclear whether sufficient numbers will replace them. The profession appears to be reaching an equitable gender representation. Most child psychiatrists belong to the professional organizations that support the profession; however, they are least likely to belong to the Ontario Psychiatric Association (OPA). CONCLUSIONS: An optimal ratio of child psychiatrists per population served still needs to be determined, with special consideration given to the needs of rural communities. The small ratio of child psychiatrists to the population of children with mental health needs highlights the importance of collaborating with other medical and mental health professionals. Recruiting and retaining child psychiatrists will need to be monitored. Child psychiatrists in Ontario need a unified voice to address these issues.     

Irregular practice of psychiatry

Psychiatric Quarterly -