ABSTRACT
This article describes management of two cases in a short-term medical/surgical setting developed by a crisis intervention service in a general community hospital. These patients have common links of suicidal threats, ambivalence about psychiatric hospitalization, and noncompliant character structures that lead to a manipulation of the mental health system. Cases selected are representative of a subset of patients who historically don't do well on a regular inpatient unit. We will examine the clinical change during short-term hospitalization, explore psychodynamic issues, and describe the integration within the overall mission of an acute care general hospital. The cost-saving implication for brief hospitalization in a medical/surgical setting for maintaining chronic mental patients in the community is also discussed.
Subject(s)
Crisis Intervention , Hospitalization , Length of Stay , Suicide Prevention , Adaptation, Psychological , Adolescent , Adult , Female , Humans , Male , Psychiatric Department, Hospital , Risk Factors , Suicide/psychologyABSTRACT
The authors compare a group of voluntary schizophrenics to another group of involuntary schizophrenic patients with regard to their various clinical and management aspects. Both groups had been treated on the same unit, by the same staff, and within the same approximate time period. The involuntary group needed a slightly longer stay, a significantly higher dosage of neuroleptics, and more staff supervision and intervention. The involuntary schizophrenic patients were more likely to be violent, with agitation and destructive behavior, and to require restraints or seclusion.
Subject(s)
Commitment of Mentally Ill , Schizophrenic Psychology , Adult , Antipsychotic Agents/administration & dosage , Hospitals, General , Humans , Length of Stay , Male , Psychiatric Department, Hospital , Restraint, Physical , Schizophrenia/therapy , Social IsolationABSTRACT
Psychosomatic intervention with patients who have suffered myocardial infarction is directed toward prevention of complications, development of realistic coping strategies, working through emotions, reduction of stress, and modification of coronary prone behavior.
Subject(s)
Myocardial Infarction/psychology , Adaptation, Psychological , Attitude to Health , Coronary Care Units , Denial, Psychological , Humans , Mood Disorders/complications , Myocardial Infarction/complications , Myocardial Infarction/therapy , Personnel, Hospital/psychology , Stress, PsychologicalABSTRACT
Three separate lithium chloride doses, calculated according to body weight, and a placebo were administered under double-blind conditions to 68 manic inpatients. The relationship of lithium chloride treatment dose to steady-state serum lithium levels (day 7 to 10 of treatment) and clinical response were examined. High (0.72 mEq/kg/day) and medium (0.5 mEq/kg/day) lithium chloride doses were more efficacious than placebo (P<.001 and P<.05, respectively), as determined by decrements in global mania ratings (day 7 to 10 of treatment). A low dose (0.24 mEq/kg/day) was not found to be more efficacious than placebo. The proportion of patients with improved manic ratings increased markedly as a function of increased steady-state serum lithium level(chi-squared for trend in proportions, 17.91; P<.001).
