Mental health treatment teams and leadership: a systems model.

Mental health treatment teams are living systems at the group level and comprise key productive subsystems of organizations providing mental health care. Effective treatment teams, like effective organizations, are anticipatory systems that contain subsystems that model and predict future system and environmental conditions and enable responses that increase system viability. A systems analysis of treatment teams highlights their potential instability due to their tendencies to regress toward dysfunctional partial systems and their active maintenance in nonequilibrium steady states with their organizational and external environments.

General systems approaches in mental health administration : developing state-university collaboration programs.

Developing state-university collaboration is the process of creating mechanisms to couple two systems for mutual benefit. Collaboration requires setting new organizational boundaries for both the state agency and the university and developing new patterns of information flow within and between the organizations. Each organization's homeostatic properties resist change; this resistance must be balanced by leaders' attention to the organization's developmental needs.

Virginia's experience with state-university collaboration.

The development of an active collaboration between the department of behavioral medicine and psychiatry of the University of Virginia School of Medicine and Western State Hospital is described. The collaboration includes clinical research and opportunities for training residents and medical students. University faculty provide clinical and administrative leadership at all levels of the hospital's organization.

Correlation of parameters of urinary excretion with serum osmolality among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Nine patients (seven men and two women, mean age 36.3 +/- SD 6.7 years), six of whom had schizophrenic disorders, two of whom had bipolar disorder (manic-depressive illness), and one of whom had schizoaffective disorder, manifested psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Treatment of psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) using lithium and phenytoin.

Six patients [5 men and 1 woman, mean age 37.3 +/- 8.2 (SD) years] with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent a sequence of treatments in an effort to normalize basal serum sodium levels and thereby protect the patients against complications, including hyponatremic seizures and coma.

The use of demeclocycline in the treatment of patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Eight patients (7 men and 1 woman, mean age 43.1 +/- 8.9 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent treatment with demeclocycline in an effort to normalize serum sodium levels and thereby protect the PIP patients against complications including hyponatremic seizures and coma.

Absence of carbamazepine-induced hyponatremia among patients also given lithium.

Of 33 chronically psychotic patients in a state hospital, 17 received carbamazepine, 13 received carbamazepine and lithium, and three received carbamazepine and then the combination. There was a significant difference in serum sodium level between the patients receiving carbamazepine alone (mean +/- SD = 138.4 +/- 4.

Diurnal variation of urinary excretion for patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Ten patients [8 men and 2 women, mean age (SD) 37.6 +/- 6.5 years] with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent serial determinations at 6:00 AM, 12 noon, 6:00 PM, and 12 midnight of levels of urinary creatinine concentration (UCR), urinary specific gravity (SPGR), and urinary osmolality (UOSM) on 8 consecutive Thursdays.

Correlation of cigarette-induced increase in serum nicotine levels with arginine vasopressin concentrations in the syndrome of self-induced water intoxication and psychosis (SIWIP).

Ten patients [9 men and 1 woman; mean age 42.4 +/- 8.5 (+/- SD) years] who were smokers and who suffered the complications of self-induced water intoxication and psychosis (SIWIP) (8 patients with schizophrenic disorders, 1 patient with manic-depressive illness, 1 patient with dementia) are reported.

Polyuria among patients with psychosis.

Using the criterion of early morning urinary specific gravity (SPGR) of 1.008 or less to define the presence of polyuria, we identified 26 of 72 male (36 percent) and 14 of 31 female (45 percent) institutionalized chronically psychotic patients as polyuric during a comprehensive survey of one of the chronic care units at a State mental hospital. Factors including diagnosis, sex, age, weight, and serum sodium did not distinguish the polyuric from the nonpolyuric patients.

Psychogenic polydipsia and water intoxication--concepts that have failed.

Ten patients (8 men, 2 women; mean age 38.7 +/- 8.1 years), 7 of whom had schizophrenic disorders and 3 of whom had bipolar disorder (manic-depressive illness), manifested psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Patterns of urinary excretion among patients with self-induced water intoxication and psychosis.

Parameters of water metabolism were measured serially in nine patients with the syndrome of self-induced water intoxication and psychosis (SIWIP). Clinical and laboratory findings indicated that SIWIP patients are type A of the syndrome of inappropriate antidiuresis. Estimated 24-hour urinary excretion of creatinine and early morning urinary creatinine concentration measurements were used to calculate 24-hour urine volumes.

Death from self-induced water intoxication among patients with schizophrenic disorders.

Review of 60 consecutive records of patients who died before the age of 53 years in a state mental hospital revealed that 27 of those patients (45%) had a schizophrenic disorder. Of those 27 patients, five (18.5%) died of the complications of self-induced water intoxication and schizophrenic disorders (SIWIS).

Oral sodium chloride in the management of schizophrenic patients with self-induced water intoxication.

Hyponatremia is always present in patients with water intoxication and accounts for many of the life-threatening symptoms and signs found in this population. In schizophrenic patients, water restriction, a cornerstone in the treatment of water intoxication, may be impossible to implement over the course of long-term management. The use of oral sodium chloride administration in such patients and its short-term efficacy in preventing major motor seizures are described.

Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders.

Four patients with the syndrome of self-induced water intoxication and schizophrenic disorders, as well as inappropriate antidiuresis, are described. In each case, severe hyposthenuria preceded the clinical symptoms by 1 to 7 years. Hyposthenuria may be a marker for this syndrome.

Evaluation of patients with self-induced water intoxication and schizophrenic disorders (SIWIS).

The complications of water intoxication are well documented in the medical literature. Less well appreciated is the frequent appearance of self-induced water intoxication in patients with schizophrenic disorders. Six such patients are described and compared with the findings in the literature.

A conjoint psychiatry-internal medicine program: development of a teaching and clinical model.

At a time when psychiatry's repertoire of successful treatment strategies is burgeoning and the public is seeking primary medical care with greater emphasis on humanistic issues, psychiatry has been paradoxically losing status and trainees, partly because it has failed to make its expertise integratable by nonpsychiatric physicians. In response to the educational and patient care deficiencies that result, two universities developed a teaching and clinical program that leads to partial integration of their departments of psychiatry and internal medicine. This collaborative approach includes a conjoint internal medicine-behavioral medicine inpatient unit and a residency program leading to Board eligibility in both specialties.

Psychiatry as an internal medicine subspecialty: an educational model.

Psychiatry has been integrated into the Department of Internal Medicine at the West Virginia University School of Medicine as a means of ameliorating the educational and patient care deficiencies engendered by the traditional mind-body dichotomy in medical education. A major project derived from this merger of clinical and teaching activities has been the transformation of the university hospital psychiatric ward in to the Conjoint Medicine Service. This service, to which patients with a variety of emotional and medical problems are admitted, is staffed by medical house officers and a general internist in a close collaborative relationship with the Department of Psychiatry.