Patient ethnicity and diagnosis of emotional disorders in women.

BACKGROUND AND OBJECTIVES: Ethnic background and family resources have not been sufficiently examined in relation to emotional disorders and their treatment in primary care settings. This study examined the diagnosis and management of psychological disorders in family practice patients to explore how ethnicity may affect the diagnosis and treatment of emotional disorders. METHODS: A random sample of family practice patients was selected from 1 year of office visits. The charts of 100 African-American and 100 Caucasian women were audited for primary and secondary diagnoses, presenting symptoms, prescriptions, psychotherapy referrals, history of domestic violence and substance use, and family and demographic characteristics. Chi-square tests of association and multiple regression were used to analyze the data. RESULTS: Ethnic background was significantly associated with a diagnosis of a psychiatric disorder; 44% of Caucasian patients were diagnosed with an emotional disorder, compared with 24% of African-Americans. Proportionately more Caucasian patients with psychiatric diagnoses were treated with psychotropic medications. Patient race, marital status, and insurance status explained 15% of the variance in psychiatric diagnoses. CONCLUSIONS: Women's ethnicity is significantly associated with the diagnosis of emotional disorders and their treatment.

Evaluation and treatment of impotence: a pragmatic approach addressing organic and psychogenic components.

Twelve patient referrals for evaluation of impotence comprise the subjects of a pilot study examining psychogenic and biogenic factors of erectile dysfunction. A structured interview format (KCII) was developed which allowed the clinician to estimate the likelihood of the presence of three organic factors (hormonal, neurological, cardiovascular) and three psychogenic factors (intrapsychic, relational, and behavioral) as well as the presence of relevant lifestyle factors (alcohol, smoking, exercise patterns). The results demonstrated a good ability of the KCII to accurately identify impotent patients (on the basis of history) who would have positive or negative signs of hormonal factor or neurological factor confirmed by laboratory results or physical examination. The sample of patients who had significant vascular findings did not allow for adequate comparison with interview findings. The majority of patients had significant psychogenic components to their impotence and might have been incorrectly classified as "solely psychogenic" if they had not been simultaneously evaluated for organic factors. The most important finding was that impotence, in most cases, involved multifactorial etiological components and required a comprehensive evaluation and treatment program.

Medical students and comprehensive patient care: attitudes, perceived competence and demonstrated ability.

The importance of medical training which emphasizes comprehensive, biopsychosocial medical care is increasingly recognized. Research has focused on characteristics affecting attitudes toward psychosocial information, inferring that such attitudes are acceptable surrogates for demonstrated ability. The current study evaluates the accuracy of information elicited during medical interviews conducted by medical students. Information regarding patient compliance, patient income and patient reliance on social support was correlated with student characteristics, attitudes toward psychosocial information and self-perceived competence in eliciting such data. For 36 third-year medical students on a 4-week family medicine rotation, results showed that measures of psychosocial attitudes were not an acceptable substitute for demonstrated ability. Exposing medical students to the importance of psychosocial data is valuable, but additional attention must be given to their eliciting such information accurately and efficiently.

Multiple versus individual therapy: are two better than one?

Individual and cotherapy sessions were compared via questionnaires and tape recordings to assess differences in attitudes and therapy process. Results showed that therapists view multiple therapy more positively, do not observe differences in process in the counseling situations, and offer lower levels of facilitative conditions on Carkhuff scales in the multiple than the individual situation.

Essential areas for behavioral science training: a needs assessment approach.

The design of effective behavioral science curricula for graduate medical education is an important link in the delivery of high quality medical care. Despite the work that has gone into developing methods of teaching and evaluating behavioral science training, as shown by numerous published articles, practicing primary care physicians still show deficits in handling patients' psychosocial problems. In this study, the authors propose the use of a behavioral science needs assessment questionnaire to ascertain the needs of residents for content areas based on the residents' medical school backgrounds and preferences for training. The questionnaire can also be used to monitor the effectiveness of existing curricula. The questionnaire was administered to 40 family practice residents in four programs to determine essential content areas. It was then used for curriculum planning in one program with 19 residents. Results from this program identified areas not covered in medical school and reflected the resident's comfort/confidence in practice in areas emphasized in the residency curriculum.