Incidence of recurrent intussusception following barium versus air enema.

The aim of this study was to determine whether using air enema for acute intussusception is related to a higher rate of recurrence than other methods of treatment. A 10-y (1986-95) retrospective study was performed in a university-affiliated paediatric division. The overall recurrence rate for 97 patients with acute intussusception was 7.8% (10% of whom were treated non-surgically). There were no recurrences following the surgical treatment. In matched groups of patients, no risk factors were found for recurrence following air vs barium enema.

The psychiatrist in a rural CMHC.

Mental health professionals, including psychiatrists, working in rural areas face handicaps like distance, deficient support services, professional isolation, and lack of continuing education opportunities. Hence many rural community mental health centers, like some urban ones, have trouble attracting psychiatrists. In 1977 a rural CMHC in Arizona hired a part-time psychiatrist who visits the county six days a month to work with local therapists and nurses in the care of patients. The psychiatrist, affiliated with a university medical school, is also on call by telephone 24 hours a day. Thus some assessment and prescribing must be done over the telephone. The author describes the program and explains how the psychiatrist works to link various elements of the CMHC programs, and to link the CMHC with the community and with the medical school.

Psychopathology, treatment outcome and attitude toward mental illness in Mexican American and European patients.

Lower socio-economic European American and Mexican American psychiatric inpatients were compared on degree of psychopathology, response to treatment and attitude toward mental illness and hospitalization. The Mexican American patients were proportionately under-represented, but did not differ from the European Americans in degree of psychopathology at admission nor in response to treatment-both groups showing a high degree of improvement by both MMPI and clinical judgement. However, the Mexican American patients did have a significantly more negative view of hospitalization and treatment, viewing it as controlling and restrictive which may account for their lower proportion in the patient population.

Patient characteristics and clinician attitudes influencing the prescribing of benzodiazepines.

A questionnaire designed to evaluate the effect of patient characteristics and clinician attitudes on the prescribing of benzodiazepines was distributed to 86 members of the Departments of Psychiatry and Family Practice; the return rate was 87%. Of the respondents, 30% were consistently for, 20% were consistently against, and 50% were neither consistently for nor against the use of benzodiazepines. Prescribing decisions apparently depended on a complex interaction of patient's sex, employment, symptom severity and chronicity, and the respondent's attitude about the drugs. Plans are under way to revise the questionnaire, undertake in depth interviews, and compare questionnaire data with actual prescribing practices.

CMHC inpatient unit: private hospital for the poor?

An inpatient unit of a community mental health center located in a general hospital had ample beds and accepted all referrals from clinicians working an affiliated outpatient units. A study of the patients admitted to the CMHC unit showed that they more closely resembled the population of private psychiatric facilities in age, sex, and diagnosis, but in social class they were more like patients in public facilities. The author suggests that CMHC inpatient units may be filling a useful role by making brief hospitalization available to neurotic patients of the lower socioeconomic classes who previously were denied hospital care.

Factors associated with number of treatment interviews of patients from a barrio neighborhood mental health service: a cross-validation.

Demographic and treatment variables were, for a second time, found associated with number of treatment interviews completed by lower socioeconomic patients of a barrio area neighborhood mental health service. Of the eight variables that originally differentiated patients with respect to number of interviews, six remained significant on cross-validation. The longer staying patients were characterized by: young adult age range; disrupted marital status; self-referral; using psychotropic medication; major and secondary problems of anxiety and depression.

Staff conceptions of patients' attitudes toward mental disorder and hospitalization as compared to patients' and staff's actual attitudes.

Compared ward personnel's (N = 25) conceptions of their patients' attitudes toward mental disorder and hospital atmosphere to the patients' (N = 50) and the personnel's actual attitudes by use of the CPH Factor Scale. Personnel completed the scale as (1) they themselves viewed the hospital; and (2) as they thought their patients viewed it. Patients' views also were obtained. Personnel viewed the hospital in "positive mental health" terms and considered the patients to be significantly less so. In actually, patients were less positive than personnel, but significantly less extreme than they were considered to be by the personnel. This approach suggests a means to provide an index discrepancy in attitude between patient and personnel. Identifying these descrepancies can allow for correction and improved understanding empathy, and patient care.

Attitudinal issues in methadone maintenance programs.

When the addict fails to meet treatment goals, staff may split into "help" vs "shape up or be expelled" groups. To diminish this conflict, team meeting aid the staff to better understand the addict and their own intrapsychic and interpersonal attitudes, set reasonable treatment goals, and provide concrete help. General staff meetings clarify policy and increase awareness of various role stresses. Nondegree counselor subgroups help to define stresses in this unique role.

Factors associated with length of treatment in a barrio-neighbourhood mental health service.

Factors which discriminate between lower socio-economic largely Mexican-Americans who continue in treatment for few interviews, from those who continue longer were investigated. Demographic and treatment data were obtained from 356 consecutive cases. The factors which significantly differentiate short from long treatment contact patients were: self-referral, age, marital instability, and complaints of anxiety, depression, social or family incompatibilities. Non-self referral and financial or situation problems characterise the short treatment patient. While there were few Anglos in the sample they were disproportionately high in the long treatment group.

Cardiac toxicity with thioridazine-tricyclic antidepressant combination.

Thioridazine-tricyclic antidepressant combination is frequently used in clinical practice. One reason for the choice of this combination may be its anticipated effectiveness in depressions which show both retarded and anxious features. Because both of these drugs have an adverse effect on cardiac repolarization, this may be a particularly hazardous combination. Two cases are presented illustrating life-threatening ventricular arrythmia in patients who have ingested both thioridazine and tricyclic antidepressants.

Relationships between mental health treatment and medical utilization among low-income Mexican American patients: some preliminary findings.

The hypothesis that medical visits decrease as a function of mental health treatment was tested with a lower socioeconomic Mexican-American population. The number of medical and psychotherapy visits for all patients referred for mental health treatment during a specific period was obtained and analyzed in serveral ways to determine rate of medical visits as a function of psychiatric visits. Results indicated clear rejection of the hypothesis. Medical visits significantly increased rather than decreased. Factors which may account for these findings being opposite of previous studies are discussed and include previous poor medical service availability and socioeconomic differences in populations.

Mexican American and European Americal psychopathology and hospital course.

Demographic information, reason for admission, mental status on admission, hospital course variables, and discharge diagnosis were collected for 99 patients admitted consecutively to the psychiatric inpatient unit of a community mental health center serving a low-income population with a large proportion of Mexican-Americans; Patient ethnic distribution reflected that of the catchment area. Although ethnicity, sex, and social class each showed distinct characteristics, when any two of the factors were held constant, only three variables maintained significance, none of which indicated severe, flamboyant psychopathology. This study does not support earlier reports that hospitalized Mexican Americans are more severely disturbed than other ethnic groups.

Factors determining effective psychiatric outpatient treatment for Mexican-Americans.

A mental health center offering outpatient services to Mexican-Americans should be centrally located in the Mexican-American community, should have a bicultural and bilingual staff, and should have an informal atmosphere with a minimum number of bureaucratic procedures. The center's services must be publicized in a way that minimizes the stigmatization of mental illness, promotes preventive care, and indicates that staff understand Mexican-Americans' problems. La Frontera, a mental health outpatient clinic serving the Tucson area, operates under those guidelines. Clinic records in March 1973 showed that Mexican-Americans accounted for 61 per cent of the active cases.

Mental health patients in a Barrio health center.

Utilization by Mexican Americans of Mental Facilities of a Barrio area neighborhood health center, and demographic and symptom characteristics of this population were investigated. The findings suggest that contrary to other studies this program was able to reach a high risk Mexican American population frequently missed by mental health programs. The barrio location, the relationship to a neighborhood health clinic and a large proportion of Spanish speaking and local personnel, seemed to be factors in this result. The patients tended to be young adult women with marital problems, somatic complaints and depressive symptoms.

Transsexualism in Vietnam.

The case described is that of a man raised in the Vietnamese peasant countryside who clearly fits the transsexual syndrome. On physical examination he appears to be a normal male, yet he insists that he is a female. He dresses as a woman and is able to successfully "pass" in society. He relates that he felt he was a female from earliest childhood. He prefers nonhomosexual men, denies any heterosexual experience, and has an all-consuming desire for the sexual transformation operation. This paper focuses on the social aspect of transsexualism and the manner a society, particularly the Vietnamese, may handle transsexual behavior. These ways can be seen to fall into a continuum. On one end, sexual role reversal is institutionalized and transsexual-like behavior is carried on according to a prescribed cultural pattern. The Vietnamese "hermaphroditic witch" could be included in this category. In the middle of the continuum, the idiosyncratic transsexual is provided an acceptable cultural role, and he therefore should be visible when he occurs. The Vietnamese young person who cross-dresses could perhaps be in this category. On the other extreme, the transsexual role is not conceivable or, at best, is very marginal. Here, the transsexual remains hidden in the general culture and can only be detected, as the person described in this paper, by accident.