Consultation-liaison psychiatry and funding: Why can't alice find wonderland?

Consultation-liaison psychiatry programs have long suffered from a lack of direct financial support. In this article, the authors report on the various mechanisms that the surveyed consultation-liaison programs use to obtain funding and present a review of research findings demonstrating the cost effectiveness of liaison psychiatry in offsetting more expensive medical expenditures.     

The referral and self-referral practices of behavior therapists: A comparative study

The referral and self-referral practices of 237 psychotherapists were examined in this study. They belonged to three groups: 62 clinicians who use behavior therapy techniques exclusively, 85 eclectic therapists using some behavior therapy techniques, and 90 therapists using no behavioral techniques. The data indicated that of “pure” behavior therapist 90.3 per cent would refer themselves or friends to other “pure” behavior therapists and 85.5 per cent would refer to them patients with whom they had failed. Of the eclectics using behavioral techniques, less than half would refer themselves or their friends to others of the same group. The non-behaviorists recommend treatment by their own ilk slightly less consistently than “pure” behaviorists.     

Adaptation of residents to consultation-liaison psychiatry: I. Working with the physically Ill

When working with hospitalized physically ill patients, psychiatry residents may impose a pseudoanalytic, rigidly biological, or overly sympathetic approach. These approaches often fail to address the special requirements and altered psychological state of the physically ill. To have a therapeutic impact on such patients, the psychiatrist needs to assume an engaging, more spontaneous “therapeutic stance” and deviate from anonymity, abstinence, and neutrality. In learning how these deviations are dictated by the therapeutic intent and by the patient's character style and psychodynamics, the resident acquires a mode of influence useful in other areas of psychiatry.     

The family in consultation-liaison psychiatry

This article calls attention to an underemphasized aspect of consultation-liaison psychiatry: the importance of the family in the management of illnes response. Recent trends in family dynamics have focused primarily on family therapy and less on the critical role family members play in the “coloration”, course, and outcome of acute episodes of illness. Case vignettes illustrate examples of intervention by liaison team members in the care of hospitalized medical-surgical patients. The authors suggest that a typology of family response to illness and hospitalization would offer a useful framework for diagnosis, evaluation, and management of the psychosocial aspects of illness. A coordinated approach by liaison team members is important to ensure comprehensive treatment.     

Sensory experience as a trigger in Gilles de la Tourette's syndrome

The case to be reported presented with multiple motor tics. During the course of therapy, directed along behavioural lines, a model of the nature of the movements emerged which was later found to be strikingly similar to that described by Bliss (1980). The patient (J) complained of a “horrible” sensation, similar to an “itch”, which always preceded the tic movements and which could be removed by movement. Occasionally, by supreme effort, the “itch” would be resisted and movement avoided. These sensations could thus be viewed as a trigger for the movements. The implications of such an analysis for current conceptualisations of, and intervention with, motor tics are discussed.     

Circannual variation in concentrations of endorphins in cerebrospinal fluid

In a series of 90 patients with chronic pain syndromes of psychogenic and organic etiology, the concentrations of fraction I endorphins in cerebrospinal fluid were investigated. A significant circannual variation in the concentrations of endorphins was found, with the highest concentrations in January–February and the lowest concentrations in July–August. There was no corresponding seasonal variation with regard to age, sex, bodylength, possible etiology of the pain syndrome, self-rated pain levels, or experimental pain measures.Circannual differences in the intensity of symptoms in chronic pain syndromes and in affective disorders have been described in the literature. The present results suggest an association between these observations, giving further support for functional importance of endorphins in chronic pain.     

Efficacy and safety of induced seizures (EST) in man

A review of the EST process finds its efficacy and safety in the treatment of psychotic depressive states and mania to be well-documented. In acute schizophrenia, EST is symptomatic and its usefulness is equivalent to psychotropic drugs. In chronic schizophrenia, the effects of EST and other therapies are equally poor; but the principal studies are faulted by inadequate numbers of EST treatments. In all other conditions, including the use in children and adolescents, the data are insecure and additional studies are needed.The principal risks of EST have been reduced by improved treatment methods. Fracture, panic, spontaneous seizures, and death are no longer prominent. Persistent deficits in memory and the psychologic stigma of having had “shock therapy” are the principal costs of therapy today. Suggestions to reduce these risks are made.For depression, mania, and acute schizophrenia, EST has a risk/benefit ratio equal to or better than other available treatments. Further study of the relative efficacy and safety of these treatments are needed; as are controlled studies for other conditions where its use has been recommended.     

Terminal care and survivorship in pediatric chronic illness

Childhood illnesses which were once acutely fatal have slowly yielded to progress in medical science. Some of these illnesses are today chronic life-threatening conditions which pose a new set of psychological challenges. Adaptation to loss and bereavement will still be required of some, but most of the children with these illnesses and their families will be forced to adjust to a new set of psychological realities including a high level of uncertainty. Delineation of the stresses confronting such patients and discussion of appropriate psychological intervention strategies are the heart of this paper. Additional discussion of psychological care during the terminal phase of such illnesses is also included.