Emergency psychiatric evaluation of "organic" mental disorders.

The emergency psychiatrist must first differentiate abnormal behavior with a medical etiology from that caused by so-called functional processes. Delays in diagnosis can be catastrophic and make a compelling argument for physician involvement in emergency mental health care.

Monitoring the quality of psychiatric care.

Modern medical quality assurance depends on the identification and continual monitoring of important parameters or indicators of care. Indicators are defined as measurable clinical variables, often related to high volume, high risk, or problem-prone areas of medical care. Although the identification and monitoring of indicators is often a complex task, there are several areas in psychiatry where effective indicators can be developed.

The new information technologies and psychiatry.

The author reviews the history and technology of the microcomputer and discusses the various classes of software that are presently available. Three major categories of software are described: numeric data processing, text processing, and communications. The application of this software to psychiatric education and practice is briefly discussed.

Quality assurance monitoring in psychiatry.

The implementation of quality assurance monitoring is an important response to public demands for accountability in medicine as well as a requirement for institutional accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The author examines the somewhat elusive definition of quality as it is applied to medical care. He reviews the history, terminology, and reasons for quality assurance monitoring and presents the JCAHO-defined concepts of indicators and thresholds.

Psychiatric components of medical and surgical practice, II: Referral and treatment of psychiatric disorders.

In response to a questionnaire regarding the frequency and type of psychiatric disorders among their patients, internists and surgeons in private practice estimated that 21.1% of their patients had psychiatric problems, that 14.6% would benefit from psychiatric treatment, and that they spent an average of 17.

Psychiatric components of medical and surgical practice: a survey of general hospital physicians.

A questionnaire was sent to 206 internists and surgeons asking them to estimate the following: the frequency of psychiatric disorders and behavioral problems among their patients, the type and frequency of psychiatric medication they prescribed, the psychiatric consultation services they most valued, and the type of psychiatric problems they considered emergencies. These physicians estimated that 14% of their patients had significant psychiatric problems; the most frequently mentioned was depression. More than 25% of the physicians prescribed minor tranquilizers, sedatives, and antidepressants at least once a week.

Treatment of the agitated patient with an organic brain disorder.

Agitated patients with organic brain disorders represent relatively common diagnostic and management problems. Therapeutic failures usually result from a failure to understand the patient's disturbed behavior, the staff's emotional response to the patient's behavior, or neglect of the biological cause and ineffective use of medication. Effective management depends on continued monitoring of the patient's mental status and physical condition.

Recognition and management of drug abuse emergencies.

As with any medical emergency, the initial approach to the management of the drug abuse emergency is to attend to the potential threat to life. Establish and maintain an adequate airway, with respiratory support if necessary: secure a reliable intravenous route: administer appropriate drugs and antidotes; and perform the necessary diagnostic procedures to identify the cause of the problem. Always make an assessment of the psychological threat of self-destruction before discharging a patient who has taken an overdose.

A diagnostic system for organic brain disorders: critique and suggestion.

Organic brain disorders (OBD) are among the most complex psychiatric diagnostic problems. A critique of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM II) and the proposed DSM III suggests that the diagnostic outline for organic brain disorders contained in these publications (Organic Brain Syndromes in the DSM II; Organic Mental Syndromes in the proposed DSM III) is inadequate to describe the potential range of organic-based behavioral disorders and their possible organic etiologies. A new diagnostic system is proposed, with examples, of its use, which should fit in with the DSM II and the proposed DSM III and be flexible enough to overcome the problems of the present diagnostic system.

Psychiatric sequelae of phencyclidine abuse.

Phencyclidine use has been noted to produce a psychosis of several week's duration in a small fraction of users. Descriptions of the premorbid personalities of those who became psychotic resemble descriptions of LSD and marijuana users who experienced prolonged psychiatric difficulty. In addition, the psychosis produced can often be recognized as a "hallucinogen" psychosis.