The profile of cognitive impairment in elderly dyskinetic subjects.

Cognitive performance was assessed in 107 psychiatric patients whose age exceeded 59 years and who did not carry the diagnosis of organic mental syndrome. In this sample, tardive dyskinesia (TD) was associated with greater impairment in each of the seven cognitive domains assessed. These data do not address the etiology of TD but raise questions regarding the use of antipsychotics in young patients with cognitive impairment. Insofar as TD is an expression of basal ganglia dysfunction, these data also emphasize the critical role of relatively caudal brain structures in cognition and emotional expression.

Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients.

One hundred thirty-seven older alcoholic patients were randomly assigned to two different inpatient treatment programs at a Veterans Affairs medical center and followed for one year after discharge. The older alcoholic rehabilitation (OAR) program was operated by a tolerant staff that specialized in treating elderly alcoholics. Treatment included reminiscence therapy with goals of developing patient self-esteem and peer relationships. The traditional care program emphasized confrontation to focus on patients' past failures and present conflicts. Patient care costs were slightly lower (2.5 percent lower) in the OAR program than in the more traditional program, and OAR patients were 2.1 times more likely to report abstinence at one year. Response to the OAR program was best for patients over 60 years of age.

The national malaise concerning health-care costs in the DRG era.

This article considers cost, cost cutting, and cost efficacy issues, especially as they concern psychiatry. In this context, some signs and symptoms of a national malaise in these areas are discussed, and possible remedies recommended. Finally, some misgivings about outcome are also presented.

Earn-as-you-go pressures in academic psychiatry.

The future of academic psychiatry may be seriously jeopardized by recent funding cutbacks at federal and state levels. Hospitals and departments of psychiatry are having to function as businesses, and full-time faculty are increasingly concerned with profits, with less time for teaching. Shrinking departmental resources make it necessary for faculty to assume the new responsibility--in addition to their administrative, educational, and teaching roles--of generating large portions of their own salaries from private patient care revenues. Residents' opportunities to work with psychotherapy patients are being compromised by financial considerations. Other actual or potential consequences of the fiscal dilemma include decreased teaching of medical students and lessened scholarly productivity.

Psychiatric malpractice: a review of the national loss experience.

The authors examine the outcome of 217 malpractice actions against psychiatrists from 1974 to 1978. Claims against psychiatrists represented only 0.3% of the 71,788 claims against all physicians. Loss experience was developed as a function of procedure (ECT, psychotherapy), type of injury (suicide, diagnostic error), and the patient's psychiatric diagnosis. Over one-third of the claims were closed without payment; the average paid indemnity was $31,000. Diagnostic errors and suicide were the major sources of loss. Only a few cases went to trial. These data illustrate that psychiatry has one of the best malpractice claim records.

Compliance and the health belief model: a challenge for the liaison psychiatrist.

Noncompliance or nonadherence to prescribed medical regiments is a widespread problem. The behavior of noncompliance is complex, requiring an analysis based upon theoretical constructs. We review the Health Belief Model (HBM) as one such construct that may aid in understanding the problem. The four essential ingredients of the model include (1) a perception of susceptibility to disease, (2) a belief that the impact of this disease will affect him/her biologically and/or psychosocially, (3) a belief that the potential benefits of the regime outweigh the risks of the disease and its treatment, and (4) an ability to surmount barriers to treatment. The HBM has been shown to have construct validity and has provided a means of exploring practical and cost effective methods for reducing noncompliance and perhaps morbidity and mortality associated with failures to follow up on recommended medical procedures. Moreover, the general problem of noncompliance provides a unique opportunity for students of human behavior to interact constructively with their medical and surgical colleagues.

Contributions in teaching consultation-liaison psychiatry. The use of the medical team model on a consultation-liaison teaching service.

This paper describes a consultation-liaison (C/L) teaching service that uses a medical team rounding model; four teams cover distinct geographic areas of the hospital, each team consisting of an attending psychiatrist, a resident, two medical students, and a psychology graduate student. Daily attending rounds on the medical/surgical wards provide prompt and direct patient care supervision for the team members, allowing for coordination of their activities and communication with the attending physician, who serves as a role model. Psychological testing can be readily integrated into the clinical setting; neurology and family practice residents can also get their psychiatric training in this setting. The medical team model of rounding is different from other models used on C/L services; its pros and cons are discussed.

A marketplace model of consultation psychiatry in the general hospital.

The manner in which internists and surgeons view potential psychiatric consultations is analogous to the way in which consumers evalute a service or product in the marketplace. Factors that determine a purchase or a consultation request include 1) perception of need, 2) prior attitude and experience, 3) projected image, 4) availability, and 5) cost/benefit ratio. The author presents a model of psychiatric consultation, with similarities between research and development, manufacturing and merchandising phases on the one hand, and negotiation, investigation, and implementation phases on the other.

Basic considerations in the treatment of obesity.

The recognition and treatment of obesity has undergone marked changes in the past two decades. Along with the abandoning of the concept of exogenous obesity, the physician has discovered a variety of developmental, psychological, pharmacologic, socioeconomic, neurological, and genetic roots for the syndrome. The clinician has also found medical treatment modalities (fasting and behavior modification) that hold much more promise than traditional supportive relationships with dietary consultation and anorexogenic medications. Surgical treatment also, ileojejunal bypass, is gradually emerging as a treatment of choice for certain well-motivated, super-obese people for whom all other treatment modalities have failed. Future research into central serotonergic mechanisms offers hope that we can begin to know what it is that turns on hunger, turns off appetite, and regulates weight in such a stable manner over such a long period of time.

Peer counseling in a general hospital.

Self-help groups can aid an individual in coping with and adapting to catastrophic illness. The authors describe a therapeutic technique in which a member of a medical team serves as a catalyst in introducing a "veteran" patient to a newly disabled patient with the same disease or problem so that they can share feelings, experiences, and strategies. Two cases are presented in which patients who were severely depressed benefited from peer counseling. Short-term or "one-shot" encounters can be a valuable way to help some disabled patients deal with the anxiety and helplessness they feel in the acute states of serious disease or injury.