Pilot study of current factors influencing the choice of psychiatry as a specialty.

Objective: This is a time of major shifts in the perception of medical specialties. The authors have attempted to assess current attitudes of potential applicants for a residency in psychiatry.

Method: Pilot interviews with fourth-year medical students at the University of California, San Francisco, led to the development of a questionnaire on factors influencing the choice of psychiatry as a specialty.

Student education and recruitment into psychiatry : a synergistic proposal.

The authors propose that the most effective recruitment strategy is a strong psychiatric curriculum positioned as a relevant and integral part of undergraduate education for primary care physicians. The necessary ingredients are educational leadership by the chair, a multifaceted curriculum, shared teaching with generalists, and an emphasis on gender and ethnic minority issues. In changing times, it is essential that psychiatric educators remain at the center of the educational stage and continue to attract medical students through sharing the excitement of the intellectual and clinical challenges in psychiatry.

The psychological impact of the Bay Area earthquake on health professionals.

An earthquake exemplifies a natural disaster in which the potential caregivers are experiencing their own emotional response to the event. A survey of 222 health care workers in San Francisco and Marin County in the first two weeks after the Loma Prieta earthquake found them to have a moderate level of psychological symptoms as measured by the Impact of Event Scale and to frequently endorse several earthquake specific stress items. Highly reliable gender differences existed on all of the dependent variables, with women reporting more symptoms.

A controlled trial of brief psychotherapy and mutual-help group treatment of conjugal bereavement.

Sixty-one women who sought treatment for unresolved grief reactions 4 months to 3 years after the death of their husbands were randomly assigned to either brief dynamic psychotherapy with experienced clinicians or mutual-help group treatment led by nonclinicians. Women in both groups experienced a reduction in stress-specific and general symptoms as well as improvement in social and work functioning. Women in the brief psychotherapy group showed a greater decline in one measure of general symptoms, and there was greater attrition in the group treatment condition.

Comprehensive analysis of change after brief dynamic psychotherapy.

This report provides data on symptom levels by using group means as well as categories of clinical relevance as they change over the course of treatment and also examines change "beyond symptoms" as levels of adaptive functioning. This approach allows a more comprehensive analysis of change in a series of patients with pathological grief reactions treated with brief dynamic psychotherapy. The different perspectives on outcome of the patient, the evaluating clinician, the treating clinician, and independent judges are compared.

A proposed method for measuring change beyond symptoms.

The initial report of the Patterns of Individual Change Scales battery presented the rationale, development, and conceptualization of this measurement package. Empirical data supported the reliability and validity of the scales as measures of patient characteristics that extended beyond the symptomatic domain. This article presents more extensive reliability and validity data.

Reactions to the death of a parent. Results from patients and field subjects.

The authors studied two groups of persons who had experienced either the death of a mother or father. One group consisted of patients who had sought treatment because of pathological aspects of bereavement. The other group consisted of volunteers selected from a review of hospital death records, which indicated the recent death of their parent.

Relationship testing after the loss of a parent.

In this study of adults presenting with symptoms of pathological grief after the death of a parent, there was a frequent pattern of strain on a current love relationship. The attempt to master negative views of the self, precipitated by loss of the parent, through reenactment with the significant other was prominent. Psychotherapy offered an opportunity to rework the feared representation of the self.

Judging change in psychotherapy. Reliability of clinical formulations.

Careful clinical formulation describing the dimensions of core neurotic conflicts is integral to the practice of psychodynamic psychotherapy. Therefore, a method for reliable and valid formulation is a necessary precursor for the empirical investigation of the impact of such therapy. Our study evaluated a method of outcome assessment based on clinical formulations.

Patterns of individual change scales.

Measurement of complex modifications in personal functioning is a necessary step to the relevant translation of psychotherapy research into clinical practice. Using an assessment strategy aimed toward decreasing subjective bias, we pursued an inductive clinical approach in constructing the Patterns of Individual Change Scales (PICS) battery. Designed for use with a bereaved population, each of the 13 scales has a unitary focus and hierarchy of functional levels across the domains of symptoms, social relations, and self-concept.

Initial psychological response to parental death.

A cohort of patients seeking help at a clinical research center providing time-limited brief therapy for posttraumatic stress disorders was assembled. The single life event experienced by each was death of a parent. A nonequivalent comparison group was gathered by review of hospital death records.

Signs and symptoms of posttraumatic stress disorder.

The new diagnostic nomenclature of the American Psychiatric Association (DSM-III) provides well-described categories of stress response syndromes that were not included in the previous nosology. The signs and symptoms of these syndromes used in the descriptive statements have been understood largely in terms of field studies of nonpatient populations and clinical descriptive and impressionistic studies of patient populations. We report quantitative data from the study of a population with post-traumatic stress disorder.

A field study of the stress response syndrome. Young women after hysterectomy.

The symptom pattern previously delineated as the stress response syndrome in a mental health setting was hypothesized to be useful in conceptualizing reactions to a traumatic event in a nonpsychiatric patient population. The experience of loss resulting from nonelective hysterectomy for benign disease in women of childbearing age was selected as a relevant field study model. Twenty-eight women were studied one year after hysterectomy, using extensive psychological interviewing by women clinicians and experiential rating scales.

The impact of midtrimester abortion techniques on patients and staff.

We studied 250 midtrimester abortions by dilatation and extraction (D and E) under general anesthesia and compared them with abortions by the intra-amniotic injection of prostaglandin (amnio) in order to assess the physical and emotional changes experienced by patients and staff under the different circumstances represented by each procedure. We found patients undergoing D and E abortions had fewer physical complications and described the procedure as minor surgery which went smoothly. The patients who had amnio abortions had more pain and reacted with more anger and depression afterward.

The response to stress.

The normal response to stress can be understood in terms of periods of outcry, denial, and intrusive thoughts leading to working-through to completion. The general physician who understands this pattern can assist the patient through the denial phase by encouraging ventilation and through the intrusive phase by providing structure, advice, and medication to temper the painful feelings. With such assistance, most patients can integrate the stress event into their lives, with the duration of response related to the severity of the stress.

Changing social-sexual patterns in gynecologic practice.

One hundred randomly selected patients from the outpatient Gynecology Unit of the University of California at San Francisco Medical Center were interviewed to determine current attitudes toward reproductive and sexual roles. Major areas of change apparent in the younger population were a substantial decrease in formal marriage, a reduction in the wish for children, a movement away from oral contraception back to mechanical barrier methods, and an attitudinal shift toward acceptance of a bisexual adaptation. It is important for the practicing physician to be responsive to the life-style pattern present in the new generation of women patients.

Childless by choice: a clinical study.

The authors report on a longitudinal study that involved the interviewing and testing of 33 young women volunteers who chose either contraception (N=18) or tubal ligation (N=15) to achieve infertility. They found that for these women the choice to be childless was multidetermined, persistent over time, and ego-syntonic. Comparison with other samples of women indicate that this is a distinct and nontraditional population.