Folie à deux.

A review of folie à deux or induced psychotic disorder (DSM-III-R) is provided. The author believes it to be a more frequent phenomenon than usually thought, especially when hospitalized patients are evaluated with their families. An argument is made for viewing it as a description of a relationship and possible influence between individuals who may have very different disease processes. This includes, in the secondary partner, a continuum from being very "impressionable" to having an autonomous and independent delusional disorder. A case report and suggestions for treatment are given.

Applicants' choice of a residency training program.

The authors present results from a survey of senior medical students in the class of 1981 concerning their selection of residency training programs in psychiatry. Generally, students were more influenced by clinical training opportunities and quality of life factors and not much influenced by the philosophy of the program. The implications of the findings are discussed from the perspectives of both advising and recruiting medical students.

Medical students' learning as primary therapists or as participant/observers in a psychiatric clerkship.

The authors assessed two different inpatient models of clinical clerkships in psychiatry on the basis of both an examination assessing amount of learning and a survey of student attitudes. One clerkship model placed the third-year medical student in the role of primary therapist; the other model assigned each student to join a psychiatrist as a participant/observer. No overall difference in objective assessment of learning was found between the two groups of students, and student attitudes generally favored the participant/observer model. These findings suggest that the widespread bias favoring the primary therapist model may not be justified.

The medical student's perspective of psychiatry residency selection procedures.

To determine what factors influence medical students' perception of the application and selection procedures of psychiatric residency programs, the authors sent a questionnaire to 100 medical students interviewed for the residency program at a major psychiatric facility; 43 returned the forms. There was general concordance between the respondents' perception of the institution's selection criteria and their convictions regarding what those criteria ought to be, with the exception that applicants tended to downgrade the dean's letter. Factors important in the residents' evaluation were the warmth, enthusiasm, and interviewing skills of the faculty and residents. They did not object to psychologically probing interviews if the interviews were skillfully conducted. It was important to them that they met the chairman and program director, and if the applicant was a woman, she wanted to have at least one woman interviewer.

From supervisee to supervisor: an unexplored aspect of the psychiatrist's education.

The authors describe several problems that are unique to the beginning supervisor of psychiatry residents. These difficulties can be divided into four general areas: inexperience, competition, identity, and administration. The authors provide examples to illustrate the types of situations that the new supervisor may encounter and make recommendations for dealing effectively with them.

Psychiatric problems in third-year medical students.

Each year as many as one of four medical students experience sufficient emotional pain to seek psychiatric consultation. In many cases the precipitating stress relates to specific stresses associated with the phase of training. In the third year increased clinical responsibility may evoke feelings centered on caretaking, sexuality, and aggression that cannot be contained by an as yet fragile emerging professional identification. The authors present four case histories of third-year medical students to illustrate the complex interaction between family background, motivations to enter medicine, and the specific patient experience that resulted in sufficient distress to require psychiatric consultation.

Seclusion: uses and complications.

A total of 7.2% of the patients in a private psychiatric hospital were placed in seclusion during a one-year study. These 63 patients had a more frequent diagnosis of schizophrenia and manic-depressive illness, manic type, than a comparison group. Significant intergroup differences in age and length of hospitalization became insignificant when the seclusion patients under 20 were excluded. Although seclusion was often used to protect patients, others, and property, the most frequent reason was to maintain a therapeutic environment. This study pointed toward a staff tendency to see the "problem" of the patient's behavior as being solved by seclusion rather than viewing seclusion as an intensive care environment in which the patient's behavior and treatment could be morec arefully monitored.

Evaluating signs and symptoms: comparison of structured interview ans clinical approaches.

Are research interview techniques adequate in assessing signs and symptoms? This question is investigated by obtaining two sets of interview schedule ratings on 49 patients, one by a research psychiatrist applying the interview and one by the patient's psychiatrist using all available information. The latter was considered a clinical standard with which a cross-sectional research interview could be contrasted. These two data sets were subjected to several types of analysis commonly undertaken with research interview ratings. Results indicated that the research interview adequately represents symptom data, but is seriously lacking in the assessment of observed behaviour. The effect of this difference depends on the goals of the study and the nature of the data analysis. If overall group findings are desired, or if analysis relies primarily on symptom data, results with a research interview may be similar to results based on a far more extensive evaluation. On the other hand, if conclusions are to be drawn on individual patients, or if data analysis relies heavily on observed behaviour, then data derived from research interviews are questionable.