International medical graduates' attitudes toward substance abuse.

After developing a hypothesis that international medical graduates (IMGs)from different ethno-cultural backgrounds would have different attitudes toward substance abuse, we compared the attitudes of 79 IMG applicants to our psychiatry residency training program using Chappel's Substance Abuse Attitude Survey. Except for the finding that men were less moralistic about substance abuse than women, we found no significant attitudinal differences among these IMGs despite their diverse backgrounds.

Prevalence and characteristics of violent patients in a general hospital.

A survey was conducted in an inner city general hospital to determine the prevalence and characteristics of violent patients. The patients were evaluated by psychiatrists in the psychiatric emergency and psychiatric consultation services during a six-month period, and in the acquired immunodeficiency syndrome (AIDS) consultation service during a one-year period. Of 1,506 patients seen in the psychiatric emergency service, 103 (6.8%) exhibited violent behavior. The majority of these patients were diagnosed as having schizophrenic disorder or substance abuse disorder. Of 390 patients seen in the psychiatric consultation service, 17 (4.4%) were evaluated for violent behavior. The majority of these were diagnosed as having organic mental disorder or personality disorder. Of 256 patients seen by the AIDS consultation service, 11 (4.3%) were evaluated for violent behavior, of which seven patients were diagnosed as having organic mental disorder and four as having adjustment disorder. The authors conclude that violent behavior in their institution was not as prevalent as previously believed.

Attitudes of foreign medical graduates and u.s. Medical graduates toward mental illness.

One-hundred forty-nine applicants to two residency programs in psychiatry were surveyed with the Opinion About Mental Illness (OMI) scale. Stepwise regression analyses showed that the place where the applicant was raised was the best predictor. In comparison to those raised abroad, those raised in the United States tend to be less authoritarian-restrictive inclined, tend to report less adherence toward an unsophisticated benevolent approach, and less adherence toward an interpersonal-etiology approach. All subjects, whether raised in the United States or not, showed similar adherence to the concepts of the mental hygiene movement.

Inner-city substance abuse patterns: a study of psychiatric inpatients.

Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to use hallucinogens, and schizophrenics were less likely to use opioids. In all cases in which sex, age, and personality disorder were significant, males, the young adult group, and those with personality disorder were more likely to be abusers. These three variables were all strong predictors of both multiple and extensive substance abuse. Overall, our findings suggest that in the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse. The coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls attention for changes within the conventional psychiatric milieu.

Prospects for service sector employment growth in non-metropolitan America.

"This paper focuses on how successfully non-metropolitan areas [in the United States] can compete for service-producing industry. Data on wage and salary employment for the 1969-84 period are used to assess how well non-metropolitan areas have been keeping up with metropolitan areas in expanding service jobs. Changes in patterns of employment growth in non-metropolitan and metropolitan service industries between 1969-76 and 1976-84 are described and these changes related to the growth pattern in goods-producing industries. In addition, data are used to identify the types of service activities that have concentrated in non-metropolitan areas."

Discharging the violent psychiatric inpatient.

Since psychiatrists may be held legally accountable for their patients' violent acts against others, psychiatrists on inpatient wards are faced with the dilemma of deciding whether or not, and when, to discharge improved but still possibly dangerous patients. This paper presents a survey of an inner-city hospital's experience with violent patients admitted over a seven-month period and describes an interdisciplinary disposition committee, composed of a senior consulting psychiatrist and other mental health professionals, established by this hospital to help make these difficult decisions. The committee carefully evaluates all identified high-risk patients according to specific criteria before such patients are discharged. Two case studies illustrate this process of evaluation.

Pedophile types and treatment perspectives.

Pedophiles constitute a heterogeneous group of sex offenders. Direct physiological assessment of sexual arousal has significantly increased our diagnostic skill and capability of monitoring treatment response. Erectile response studies have indicated that the majority of pedophiles and incest offenders show arousal to other paraphilias and frequently to appropriate adult sexual stimuli. Many sexual offenders deny or minimize their problem during initial interviews, but when confronted with laboratory results indicating deviant sexual arousal, they often acknowledge and elaborate on the paraphilia(s). Complete data and diagnoses are crucial in integrating treatment in the cognitive-behavioral paradigm.

Drinking patterns of inner-city black Americans and Puerto Ricans.

Alcoholic patients--183 Black Americans (62 women) and 132 Puerto Ricans (18 women)--at an inner-city alcoholism treatment program were surveyed using the Drinking History Questionnaire. Significantly more Puerto Rican men than Black men reported drinking distilled spirits, daily drinking, drinking in the morning to relieve a hangover, shakes when sobering up, blackouts when drinking, convulsions after a bout, psychoperceptual withdrawal symptoms and alcohol-related marital difficulties. Puerto Rican women were significantly older at the first time of drunkenness than the other groups. These women tended to drink at home daily and they reported a surprisingly high mean alcohol consumption. Significantly more Black women reported drinking to make friends. The tendency for Blacks to drink with their spouse, and to encourage their spouse to drink, was a major finding. This finding may have clinical implications for treatment and suggests that in lower class Black alcoholics a careful history of the drinking patterns of the spouse or living companion should be taken to determine the proper treatment approach.

Cultural influences and alcoholism: a study of Puerto Ricans.

Some reports in the literature suggest a correlation between acceptance of traditional Latin American family values and alcoholism in Hispanic males. To examine the effects of traditional values on alcoholism, the authors surveyed 151 lower-class Puerto Rican alcoholics (126 males and 25 females), using a scale to measure Hispanic-American family values. The scores of these patients were compared with those of 116 lower-class Puerto Rican nonalcoholics (45 males and 71 females). A path model was constructed with alcoholism as the dependent variable, the Traditional Scale scores as an intervening variable, and demographic variables which may also influence alcoholism (such as sex, age, years of residence in the United States, education, and English ability) as independent variables. Overall, the findings show that traditionalism is a significant predictor of alcoholism, both directly and as an intervening variable in the relation between sex and alcoholism, and education and alcoholism. However, sex and years of residence in the United States were both stronger direct predictors of alcoholism than was traditionalism. These results support the hypothesis that the manifestations of alcoholism in lower-class Puerto Ricans are influenced by cultural attitudes.

Pedophilia: an update on theory and practice.

The number of sexual attacks on children is staggering, yet it is extremely difficult to understand what effective treatments are available for the pedophile by reviewing the literature. Therefore, the authors present an update of the changing conceptualizations regarding the offenders and their victims. An overview of the currently used modalities to treat the pedophile is presented with emphasis on the promising cognitive-behavioral approach. A brief description of this approach is given with two case illustrations.

Nonemergency forensic psychiatric house calls.

Recent literature on medical house calls in general is not extensive, and that on nonemergency forensic psychiatric calls in particular is nearly nonexistent. Two cases of nonemergency forensic psychiatric house calls are described in this communication; it is our contention that they led the psychiatrist to a better appraisal of the person's capacity to perform than would have been expected from office visits. One situation involved testamentary capacity; the other, possible abrogation of parental rights. In our estimation the individual, as well as the legal system, would benefit if this type of house call were promoted.

The psychiatrist as a "presence": possible effects on emergency room staff attitudes.

In this preliminary study, the experimental presence of a consulting psychiatrist at medical rounds was instituted in a busy city hospital emergency room. The psychiatrist was instructed only to respond to questions on psychiatric topics. Students were asked to record data from the discussions which occurred both with and without the presence of the psychiatrist. Our results suggest that the passive, supportive presence of a psychiatrist during medical rounds in the E.R. had a significant impact upon medical staff sensitivity to psychological topics as measured by the time spent discussing issues of a related nature. Since the study is limited to the time of the recording, no long-term conclusions can be drawn. Our work does raise significant questions, however, about medical staff sensitization to psychosocial issues and the facilitating effect of the psychiatrist in the E.R. setting.

Effects of the urban crisis on the community general hospital.

The contemporary urban crisis has necessitated a drastic transformation of the community general hospital. The Bronx-Lebanon Hospital Center, in New York, has struggled through this crisis by adapting to the changing needs of the patients it serves. The authors describe the hospital's new emphasis on conditions such as alcoholism, drug abuse, traumatic injuries, high infant-mortality rate, and teen-age pregnancy, and discuss the critical need for community-oriented psychiatric services. Over the past 15 years the patient population has changed, as has the type of service provided, marked by a major shift toward use of the emergency room. Psychiatric services have been expanded at the expense of a more traditional hospital program. One of the few remaining institutions in the decaying inner city, the hospital also becomes the sole provider of medical care as private-practice physicians leave. The problems of recruiting and retaining high-level professional staff are discussed, along with the need for the urban general hospital to take a leading part in meeting the enormous demands caused by the continuing urban crisis.