If partial-hospital programs come of age: some caveats.

The potential role of partial-hospital programs in solving both clinical and fiscal problems is acknowledged. The development of one partial-hospital program in the context of an inpatient-oriented hospital is reviewed in some detail. Lessons learned are identified, and anticipatory strategies are noted to facilitate the development of new programs should the funding become available.

Neuropsychological deficits in chronic schizophrenics. Relationship with symptoms and behavior.

Thirty-nine hospitalized chronic schizophrenics were administered the Luria-Nebraska Neuropsychological Battery (LNNB) and the Weschler Adult Intelligence Scale-Revised when they were clinically stable. Test variables were related to Brief Psychiatric Rating Scale ratings and two behavioral measures of ward functioning, points and activities. Spearman correlations of test variables with the symptom and behavioral measures were entered into a series of median polish analyses.

ROUNDS, a new time-sampling methodology for the quantitative behavioral assessment of schizophrenic withdrawal. Reliability and validity.

Negative symptoms in schizophrenia have been the subject of much research interest. However, there has been a need for a way to measure withdrawal behavior quantitatively over time. We have developed a behavioral time-sampling methodology performed by nursing staff on a schizophrenia inpatient unit.

Rational psychopharmacology in the treatment of multiple personality disorder.

The current state of the data concerned with psychopharmacologic interventions for multiple personality disorder (MPD) is reviewed. Common sense guidelines are provided for drug treatment of MPD. An overview is given for use of medications for specific symptoms commonly found in MPD patients, such as affective, posttraumatic stress disorder, and sleep disorder symptoms.

An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder.

Chronic complex dissociative symptoms can be readily inquired about in the diagnostic interview leading to a clinical diagnosis of MPD in many cases. It is most useful to begin with inquiry about amnesia, autohypnotic, posttraumatic, pseudopsychotic, and passive-influence symptoms, and childhood abuse or traumatization. As this proceeds, overt dissociation is commonly noted including spontaneous trances, age-regression, blending or overlap of states, or frank switching.

Prospective cost allocations for the chronic schizophrenic patient.

Schizophrenia affects from 0.5 percent to 1.0 percent of the population and is often a chronic relapsing illness with high morbidity.

Managed care and the discharge dilemma.

Efforts at cost containment in medicine and psychiatry are ubiquitous. The escalating costs of health care have led to a variety of initiatives to manage the use of expensive settings and treatments. Cost containment aims to be cost efficient.

Frequency and correlates of childhood sexual and physical abuse histories in adult female borderline inpatients.

Suspected complex partial seizure disorder, eating disorders, and drug abuse disorders were overrepresented among the 40% (N = 16) of female borderline inpatients who reported a history of sexual abuse. Early family disruption, more frequent hospital admissions, and concomitant antisocial personality disorder were overrepresented among those who reported past physical abuse.

DSM-III-R personality disorders in patients with eating disorders.

The authors conducted a systematic examination of DSM-III-R personality disorders among 35 patients with eating disorders. Fifty-seven percent of the patients met the criteria for at least one axis II diagnosis; borderline, self-defeating, and avoidant were the most frequently assigned personality disorders. Forty percent of the patients were given two or more diagnoses, and 17% of the patients met criteria for five to seven diagnoses.

The borderline/schizoid marriage: the holding environment as an essential treatment construct.

The borderline/schizoid marital constellation is the prominent constellation among borderline patients on a long-term inpatient unit. Treatment of this marital constellation, in which each spouse has a severe personality disorder, requires application of the concept of the holding environment as an essential treatment construct, with the therapist as manager of the holding environment. This paper explicates the means of management.

The catastrophic case. A special problem for general hospital psychiatry in the era of managed care.

In the quest for cost containment, case-managed care can harm some patients who are catastrophically ill and treatment resistant. One such case is presented and the "catch-22" situation described where the case manager determined that the chronicity and severity of the case deemed the patient "custodial" and discharge planning was ordered despite the fact that the patient had excellent continued inpatient benefits. The consequences of premature discharge or transfer to a state facility should be studied carefully as we move to more case-managed care.

Financing the medical management of mental disorders.

In 1987 Medicare benefits for the mentally ill were expanded for the first time in 22 years. A major change was the removal of limits and copayments for the "medical management of psychopharmacologic agents." Payment for medical management recognizes the trend toward the remedicalization of psychiatry; however, medical management can be defined either broadly or narrowly.

How to survive in the private practice of psychiatry.

The private practice of psychiatry is being transformed by the new economics of medical care. Patients are paying more out-of-pocket for necessary care (demand-side cost sharing), and health care providers are being asked to assume part of the risk of treatment through prospective payment (supply-side cost sharing). Specific survival strategies for psychiatrists in private practice include development of a balanced practice, expansion of referral networks, participation in alternative delivery systems such as health maintenance organizations and preferred provider organizations, active involvement in utilization and claims review, participation in outcome studies, and expansion of patient care advocacy and community involvement.

The psychiatric uses of cold wet sheet packs.

The cold wet sheet pack is a treatment that is seldom discussed anymore. The authors present results of a national survey which demonstrated that this treatment is rarely used in modern American psychiatry. They retrospectively review its recent use for 46 hospitalized psychiatric patients and conclude that the treatment is safe and has interesting and useful effects that go beyond the concept of simple restraint.

Long-term effects of unresolved sexual trauma.

Rape and child sexual abuse are common in our society, and the incidence is increasing. A variety of presenting complaints in adults may be signals of unresolved, remote sexual trauma. These include memory problems, confusion, impulsive or self-injurious behavior, unexplained somatic complaints and many others.