Residents' treatment of clinic patients beyond graduation.

Twenty-one of 24 psychiatrists surveyed report that 51% (n=56) of their clinic patient panel entered their private care after they completed residency training. Patients with a DSM-III personality or depressive disorder were more likely than those with schizophrenia to continue in private treatment (p<.001). The practice of continued treatment of clinic patients beyond residency is reported to aid the professional development of the psychiatrist and the quality of patient care. Residency program directors may consider recommending this practice, if it is appropriate in their institution, to facilitate the psychiatrist's transition from training to career.

Lymphocyte function in major depressive disorder.

Lymphocyte stimulation by phytohemagglutinin, concanavalin A, and pokeweed mitogen was significantly lower in a group of hospitalized depressed patients than in matched controls. The absolute number of T and B cells was lower in the depressed group, but the percentage of these cell types did not differ between the groups. These findings may be related to the altered neuroendocrine function found in patients with depressive disorders.

What's new in aftercare? A review of recent literature.

With the deinstitutionalization movement has come the need to develop effective aftercare systems for chronic mental patients in the community. To assess the progress that has been made in aftercare, the authors conducted a review of the journal literature published since 1977. They summarize the major findings related to studies of aftercare in its various dimensions and conclude that, although numerous studies have reported more positive outcomes for patients involved in aftercare programs, none of the approaches used have been subjected to the kind of rigorous scientific investigation that would justify recommending their widespread application. They emphasize the need for further studies that attempt to define which type of treatment works for which type of patient.

The use of psychoanalytic concepts in crisis intervention.

Crises have a dynamic structure. Repressed neurotic conflicts and defects in ego organization determine vulnerability to specific stresses. Selection of focus in crisis intervention follows from the recognition of those rigid defensive patterns and adaptive incapacities which have either partially failed or been overwhelmed by the current stress. Aiming at the old problem in the new situation allows crisis work to go beyond symptom relief to improved conflict resolution and coping abilities. Therapeutic activity, rather than passivity, is the hallmark of crisis intervention and involves suggestion, abreaction, manipulation, clarification, and dynamic interpretation. Individuals in crisis are characteristically in a partially regressed state of transference readiness and availability, particularly as this involves intensified dependence wishes. Management of the transference requires recognition of negative, as well as positive, responses and the limitation of further regression that might lead to continual adaptive failure. A variety of specific countertransference responses are commonly evoked in crisis work. These must be recognized for effective treatment to proceed.

Influence of experience on major clinical decisions. Training implications.

We studied 779 walk-in psychiatric patients presenting to 32 first- or second-year residents and 772 patients presenting to 25 third-year residents or attending physicians as to the decision to admit to the hospital or to administer medication to those not admitted. There were no significant demographic or clinical differences between patients presenting to the two groups. The more experienced staff admitted half as many patients and treated serious depression with tricyclics twice as frequently. Inexperienced psychiatrists used hospitalization more frequently when these patients suffered from suicidal ideation, hallucinations, delusions, and inability to cope. When the training procedure was modified and second-year residents were introduced into a more structured setting, their decision-making quickly approached that of third-year residents and attending physicians. We suggest that specific training can modify decision-making, where general clinical experience may not. Implications for resident and medical student training are discussed.

Evaluation of a psychiatric clerkship by videotape.

The authors used a videotape-based objective examination ingeneral psychiatry to assess the clinical competence of medical students who had completed their third-year clerkship. The test has been shown to be a reliable, valid measure of clinical competence. Subjective faculty grading related positively to test scores. Students on one ward had significantly lower overall test scores, with particularly low scores on clinical judgement questions. However, faculty grades for these students were not significantly different. This suggests that the faculty was unable to assess the relative efficacy of its own teaching. The test can provide objective assessment of student clinical competence and is a means of program evaluation.

The psychoanalytic treatment center as a transference object.

Three Treatment Center cases are presented. They reveal resistances and technical difficulties having to do with a split in the transference-the analyst viewed as the depriving mother and the Institute viewed as the nurturant grandmother. Possible implications for the conduct of student analyses are described.