The use of the medical team model on a consultation-liaison teaching service

This paper describes a consultation-liaison (C/L) teaching service that uses a medical team rounding model; four teams cover distinct geographic areas of the hospital, each team consisting of an attending psychiatrist, a resident, two medical students, and a psychology graduate student. Daily attending rounds on the medical/surgical wards provide prompt and direct patient care supervision for the team members, allowing for coordination of their activities and communication with the attending physician, who serves as a role model. Psychological testing can be readily integrated into the clinical setting; neurology and family practice residents can also get their psychiatric training in this setting. The medical team model of rounding is different from other models used on C/L services; its pros and cons are discussed.     

The diagnosis of hysterical personality disorder: A study of attitudes

The concept of personality disorder must, as other psychiatric diagnoses, be evaluated in terms of reliability, utility, and validity. In recent years, there has been growing interest in such issues for personality diagnoses in general^1,2 and for obsessive-compulsive,^3–6 antisocial,⁷ and hysterical personality disorders in particular. Since these diagnoses rest on the judgment that an individual is deviant in respect of traits shared to a greater or lesser degree by everyone, the diagnostic process itself, the exercise whereby that judgment is made, should receive particular study. In this way, we might learn which clinical features can be reliably recognized and, thus, used to form the basis for operational definitions of personality disorders. As an initial step in such research, a group of psychiatrists was asked to comment on several factors important in the diagnosis of hysterical personality disorder.     

Bilateral skin conductance activity, clinical symptoms and CSF monoamine metabolite levels in unmedicated schizophrenics, differing in rate of habituation

Bilateral skin conductance (SC) and heart rate (HR) were recorded for 18 RDC-diagnosed unmedicated recently admitted psychotic patients (13 schizophrenic and 5 paranoid) and for age- and sex-matched controls, during rest and tone stimulation (85 dBA, 1000 Hz, 1 sec duration and 0.25 msec rise time). Schizophrenics had more SC spontaneous fluctuations and faster HR, indicating higher arousal. SC spontaneous fluctuations were more frequent in left hand and showed an increasing trend over the session. Several SC measures indicated higher responsivity and a more irregular responding pattern in schizophrenics. These patients had higher levels of the noradrenaline metabolite (MHPG). Paranoid psychotic patients had a more stable SC habituation course than controls, and higher levels of the dopamine (HVA) and serotonin metabolites (5-HIAA). Schizophrenic nonhabituators had fewer positive psychotic symptoms than habituators, suggesting that poor habituation is not due to interference by symptoms. It may be related to higher arousal, or to deficient information processing.     

Psychiatric diagnostic predispositions to alcoholism

Various authors have described pre-alcoholic psychopathology in female problem drinkers;¹ however, actual studies of rigorously defined antecedent and concurrent psychiatric disorders have been few. More recently, several authors have reported that both affective disorder and antisocial personality are quite prevalent as primary diagnoses in hospitalized alcoholic women,^2,3,4 but the risk of subsequent alcoholism in women with these and other psychiatric syndromes needs to be clarified. In this study we investigate the prevalence of alcoholism in three populations of women with serious psychopathology. The first is a sample of psychiatrically hospitalized women with a history of depression at some time in their lives (hospitalized sample); second is a felon sample of women on probation and parole (felon sample); and third is a sample of female narcotics addicts admitted to the United States Public Health Service facility at Lexington, Kentucky for detoxification and treatment (Lexington sample). Our data set is unique in that despite being collected at different times and at different locations, uniform diagnostic criteria and uniform interview schedules were employed.^5,6     

Psychiatric consultation among hospitalized arthritis patients

Fifty consecutive psychiatric consultations on 48 patients over an 18-month period in an arthritis hospital are analyzed. The range of psychiatric disorders and their relationship to characteristics of the patient population, such as age, sex, and medical diagnosis, are described. Approximately 2% of patients admitted to the hospital during this period elicited psychiatric consultation. This rate is one-third of the consultation rate of an acute medical and surgical hospital serviced by the same consultants. The relative distribution of psychiatric diagnoses—depression 59%, personality disorders and drug abuse 15%, psychosis 10%, conversion reaction 10%, and “other” 6%—was similar to that encountered in an acute general hospital setting. Although depression was the most prevalent psychiatric problem, it was severe enough to elicit consultation only in 1% of the total hospitalized population; its severity did not correlate directly with the severity of rheumatoid arthritis, the most common medical diagnosis encountered. Neither a particular medical illness nor sex accounted for a disproportionate share of the psychiatric consultations.     

The elimination of a severe long term facial tic and vocal distortion with multi-facet behavior therapy

A multifaceted behavioral program was designed for a 52-year-old female who had a severe facial tic and vocal distortion for six years. The program included extensive relaxation training combined with an unsuccessful use of massed practice, followed by a habit reversal procedure. This was followed by a continuation of relaxation training, in vivo metronomeinduced desensitization and a prosthetic response prevention and feedback device which restricted the client's spasmodic jaw movements. Also, audio and video feedback equipment was used in some sessions. This study supports the value of on-going behavioral analysis in developing a successful therapeutic intervention. During a 24-month follow-up period the client remained completely free of the tic and of the related speech distortion.     

Assessment of behavior therapy training

Structured assessment should be used to evaluate training programs in behavior therapy. This study evaluates the 7th Annual Behavior Therapy Institute at Temple University Medical School, using a questionnaire which provides orderly feedback of trainee evaluations, one important aspect of assessment. Findings concerning organization, content, method of presentation, and supervision are discussed, and suggestions are made as to what should be included in training programs. It is urged that they should teach the fundamentals thoroughly rather than attempt to cover the whole range of techniques and research issues.