Physician staffing for the practice of psychosomatic medicine in general hospitals: a pilot study.

Background: The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients.

Objective: The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services.

Epidemiologic trends and costs of fragmentation.

The data that were reviewed in this article documented that in health systems, which manage behavioral health disorders independently from general medical disorders, the estimated 10% to 30% of patients with behavioral health service needs can expect (1) poor access or barriers to medical or mental health care; (2) when services are available, most provided will not meet minimum standards for expected outcome change; and (3) as a consequence of (1) and (2), medical and behavioral disorders will be more persistent with increased complications, will be associated with greater disability, and will lead to higher total health care and disability costs than will treatment of patients who do not have behavioral health disorders. This article proposes that these health system deficiencies will persist unless behavioral health services become an integral part of medical care (ie, integrated). By doing so, it creates a win-win situation for virtually all parties involved.

Smoking and depression.

The relationship between smoking and depression is bidirectional. Recent research has focused on nicotine's neurobiologic impact on the brain as it relates to depression. Genetic factors are also important and may account for up to 67% of smoking initiation, maintenance, and dependence.

How do delirium and dementia increase length of stay of elderly general medical inpatients?

The purpose of this study was to identify the proximate causes through which dementia and delirium extend length of stay (LOS) in elderly general hospital patients. Among 93 patients age >/=65 years admitted to a tertiary-care teaching hospital through the emergency department, admission ratings of cognitive impairment, delirium, and dementia predicted the emergence of mental and behavioral manifestations of delirium and dementia in the hospital and greater LOS. Mental and behavioral manifestations also predicted greater LOS.

Two-year evaluation of the logic model for developing a psycho-oncology service.

Objective: The objective of this study was to test whether reorganizing a psycho-oncology service in a planned and focused manner would maximize the achievement of coherent developmental goals.

Methods: The logic model, a strategic program development tool, was used in the context of a public psychiatry fellowship to analyze and plan the organizational objectives of a psycho-oncology service. To assess the efficacy of the logic model, a two-year prospective evaluation of the model's outcome measures was performed.

Sickle cell disease -- when opioids and physicians fail.

An interview with a 32-year-old male with sickle cell anemia and multiple sequential admissions for vaso-occlusive crises, receiving high dose narcotic analgesics, is presented. The subsequent clinical discussion outlines psychiatric, psychosocial and treatment issues. Management of acute vaso-occlusive crisis is summarized along with a discussion of the value of comprehensive care for sickle cell disease patients.

Consultation-liaison psychiatry training and supervision results in fewer recommendations for constant observation.

In this study, we tested two hypotheses. First, that consultation-liaison (C-L)-trained psychiatry residents would order constant observation (CO) less frequently than psychiatry residents untrained in C-L. Second, we predicted that CO would be ordered less frequently under circumstances when experienced C-L psychiatry attending and fellows would be available to supervise psychiatry residents training in C-L.

Mental disorders in the primary care sector: a potential role for managed care.

Unlabelled: This activity is designed for leaders and managers of managed care organizations and for primary care physicians involved in evaluating, treating, and caring for patients with mental disorders.

Goal: To provide a better understanding of primary care patients' needs for mental health services and how managed care companies might best address these needs.

Objectives: 1.

Erythropoietin and visual hallucinations in patients on dialysis.

The authors encountered five patients who first had visual hallucinations while taking erythropoietin. Since this association had not previously been reported, the authors studied a convenience sample of dialysis patients at two institutions to determine the incidence of visual hallucinations in patients on erythropoietin and possible associated risk factors. Eleven percent of the patients had visual hallucinations at one institution with no other factor than erythropoietin as a probable cause and 2% at the other.

Psychiatric interventions in the medically ill. Outcome and effectiveness research.

This article reviews the current status and emerging trends of outcome data from research studies of psychiatric and psychosocial interventions for mental disorders in patients in the general medical sector. Although data from such studies have had limited success to date in influencing health policy, legislators and administrators are increasingly likely to turn to outcome data to inform their decisions. The impact of psychiatric disorders, the recognition and treatment or referral of psychiatric-disordered patients by general medical practitioners, and the outcome results of psychiatric intervention programs are examined for both the inpatient and outpatient general medical sectors.

Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization.

Objective: This study tested the hypothesis that psychiatric comorbidity measured in medical and surgical general hospital inpatients predicts increased readmissions and days spent rehospitalized at the same hospital up to 4 years after discharge.

Method: A convenience sample of 273 medical/surgical inpatients aged 18 years and older were given psychological tests during their third to fifth hospital days on medical and surgical units from June 1, 1985, through June 30, 1986. The main outcome measure was the number of medical/surgical readmissions and number of days rehospitalized during a 4-year follow-up at the same institution.

The attitudes of medical inpatients toward psychiatric consultation: a re-examination.

Objective: Several surveys from twenty to thirty years ago demonstrated that approximately 80 percent of patients were readily accepting of psychiatric consultation. The aim of this study was to re-examine whether medical inpatient attitudes toward psychiatric consultation have changed in the past twenty-five years and whether the type of psychiatric disorder affects the attitude toward consultation.

Method: Forty-eight medical inpatients seen in psychiatric consultation consented to answering a questionnaire pre- and post-consultation to assess their attitudes to this intervention.

Consultation-liaison psychiatry fellowship in primary care.

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program.

Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community.