ABSTRACT
The management literature of the past few decades was imbued with a humanistic, behavioral science orientation in which the formal use of power was down-played. But with the changing economic climate has come a reappraisal of concepts of power and leadership, and more than ever the clinician-executive must recognize his responsibility for the constructive use of power. The authors review definitions and classifications of power from the management literature and psychoanalytic theory related to the use of power in groups. They present a model, analogous to the doctor-patient relationship, for the use of power by the clinician-executive in both stable and unstable organizations.
Subject(s)
Leadership , Mental Health Services/organization & administration , Physician Executives , Psychiatry , Group Processes , Humans , Interprofessional Relations , Models, Theoretical , Psychoanalytic Theory , United StatesABSTRACT
Studies have documented the predeliction of New York hospitals to overdiagnose schizophrenia and to underdiagnose affective disorders. To further investigate that predeliction following the introduction of DSM-III diagnostic criteria, seven clinical experts at the Manhattan Psychiatric Center reevaluated the charts of 131 randomly selected patients and conducted clinical reviews of two subgroups of the sample. Rediagnosis essentially reversed the ratio of schizophrenia to affective disorder shown in the charts, indicated a lack of documented DSM-III criteria for the chart diagnoses, and revealed significant numbers of undiagnosed disorders. The diagnostic, prognostic, and treatment implications of the findings are discussed, especially the need for more precise differential diagnosis according to DSM-III criteria.
Subject(s)
Mental Disorders/diagnosis , Affective Disorders, Psychotic/diagnosis , Hospitals, Psychiatric , Hospitals, State , Humans , Intellectual Disability/diagnosis , Manuals as Topic , Neurocognitive Disorders/diagnosis , New York City , Personality Disorders/diagnosis , Schizophrenia/diagnosis , Substance-Related Disorders/diagnosisABSTRACT
The available historical information concerning Freud's subject Daniel Paul Schreber's life, family, and the phenomenology of his illness is reviewed. The author challenges the traditional diagnosis of paranoid schizophrenia in favor of a diagnosis of affective disorder.
Subject(s)
Depressive Disorder/history , Schizophrenia, Paranoid/history , Austria , Depressive Disorder/diagnosis , Germany , History, 19th Century , Humans , Psychoanalysis/history , Schizophrenia, Paranoid/diagnosisABSTRACT
In 1979 the commissioner of the New York State Office of Mental Health, after consulting with a committee of professionals, decided to adopt DSM-III as the psychiatric disorder classification system for state-run facilities; locally operated facilities were also encouraged to follow the new system. This report describes the processes administrative staff underwent in implementing the system. The authors discuss the problems encountered in winning acceptance of the new system, in adapting computer programs to the new coding, in encouraging its use by sister agencies, in training staff, in rediagnosing patients, and in reporting results to Medicaid and Medicare agencies.
