Filling the need for emergency psychiatrists: is better education the answer?

Although the need for specialists in emergency psychiatry is increasing, little attention is given to this field by American psychiatric residency programs, and few psychiatrists choose emergency psychiatry as a career. Like their American counterparts, few Canadian psychiatric residents also choose this specialty. To determine Canadian patterns of emergency education and Canadian residents' opinions of their emergency psychiatry experience, the authors distributed a 41-item questionnaire to 190 psychiatric residents across Canada. The results showed that most residents worked long hours alone, with little complementary education or evaluation. Residents in programs with formal education and evaluation components and on-call assignments no more than once a week found the emergency psychiatry experience most rewarding. The authors make a series of recommendations to strengthen the educational aspects of the emergency psychiatry experience.

A comparison of AMA and non-AMA patients on a short-term crisis unit.

Nineteen patients who left a short-term psychiatric crisis unit against medical advice were compared with 109 patients who received a regular discharge during a six-month period. Demographic, historic, assessment, and diagnostic variables of both groups were examined. Results indicated that patients diagnosed as having personality or substance use disorders and patients judges abnormal on a mental status examination were more likely to be AMA patients. However, AMA patients indicated fewer social problems as rated on Linn's Social Dysfunction Scale. It was concluded that diagnostic variables best differentiated patients leaving the treatment unit against medical advice from those who completed treatment.

Physiologic observations in a controlled clinical trial of the antiemetic effectiveness of 5, 10, and 15 mg of delta 9-tetrahydrocannabinol in cancer chemotherapy. Ophthalmologic implications.

One hundred twenty patients about to receive their first treatment with potentially nauseant cancer chemotherapy were randomized to one of six antiemetic treatments: (1) no treatment; (2) placebo; (3) prochlorperazine (PCPZ), 10 mg; (4) delta 9-tetrahydrocannabinol (THC), 5 mg; (5) THC, 10 mg; (6) THC, 15 mg. Four doses of each medication were given orally at 4-hour intervals starting 2 hours before chemotherapy. A study nurse was responsible for both objective (nurse) and subjective (patient) symptom questionnaires. Serum levels were obtained at intervals for cross-reacting cannabinoids. Physiologic measurements including intraocular pressure (IOP), blood pressure, and pulmonary function were also recorded. In summary, the patients were remarkably free of adverse physiologic effects. All intraocular pressures before and after treatment were within the normal range, although a surprising statistically significant increase in IOP occurred in the group receiving 5 mg THC.