State-university collaboration in psychiatry: the Pew Memorial Trust Program.

This contribution summarizes the background leading up to the goals of and the experience gained from a major national initiative to expand and improve collaborative activities between state departments of mental health and university departments of psychiatry through regional conferences, national workshops, ongoing consultations, and awards. It details the problems of the public system and how successful collaborative efforts have improved the situation, cites the role of one such a program (in Maryland), recounts the process of holding a national invitational conference and the subsequent "Call to Action," and summarizes what the Pew Project is intended to do and how the project is progressing.

The current status of psychiatric education in alcoholism and drug abuse.

The authors conducted a survey of psychiatric education in alcoholism and drug abuse in the United States. Ninety-seven percent of 106 undergraduate training programs and 91% of 169 residency programs offered curriculum units in this field. Most of these programs also provided supervised clinical care. Areas of reported faculty dissatisfaction included problems with attitude and interest of psychiatric faculty and with the amount of curriculum time allotted. The authors conclude that although the amount of curriculum time devoted to training in alcoholism and drug abuse is growing, further investment in developing faculty and fellowships is warranted to increase the quality of teaching commitment.

Informed consent--mandating the consultation.

This article illustrates how a mandatory consult procedure identified treatable psychiatric problems. Using a computerized data-based format, 372 (37.4%) patients (the "judgment" group) of 996 psychiatric consultations were identified as referred to assess the patient's capacity to execute a consent form for a medical or surgical procedure. One hundred twenty-nine (35%) of the 372 patients thus referred by hospital mandate were given psychiatric diagnoses (DSM-II) by the consultant and received recommendations for primary psychiatric treatment. The "judgment" group had significantly more organic brain syndrome and psychoses associated with CNS conditions (p less than 0.001), whereas the "nonjudgment" group was diagnosed as exhibiting significantly more neurosis, alcoholism, psychophysiologic disorders, transient situational reactions, and personality disorders (p less than 0.001). Without a required psychiatric consultation sanctioned by administrative hospital mandate, the majority of the "judgment" cases with major psychopathology would not have been identified. The use of the mandated psychiatric consultation in the general hospital is discussed.

Models of mental health training for primary care physicians.

Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysiologic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs.

Emotional problems in psychiatric residency training: recommendations for their reduction.

Working from an initial study, which attempted to quantify the number of serious mental disorders among psychiatric residents, the authors focused on the relationship of these problems to the exigencies of the training experience. Under the auspices of the American Association of Directors of Psychiatric Residency Training's Task Force on Emotional Problems of Residents, a questionnaire was distributed to all residents who completed training in 1975. Respondents in this national survey had an opportunity to rate the stressfulness and the impact on personal and professional growth for many specific aspects of residency training. These ratings, plus the considerable demographic data obtained, suggest high stress levels for many aspects of residency training, but also illustrate the growth promoting effects of most of these experiences. Much of this important data was included in an article recently published in this journal. As a follow-up to this initial report, this article provides a further review of the data and offers guidelines for improving the emotional status of our colleagues in training.

Stress and growth factors in psychiatric residency training.

Previous studies of emotional stress in psychiatric residency training have been impressionistic, focused on suicide or severe emotional disorder, or derived from small samples. There have been no reports of what large groups of "average" residents consider stressful, and no reports of the relationship of stress factors to personal and professional growth. The authors, working with a Task Force of the American Association of Directors of Psychiatric Residency Training, developed a questionnaire that was distributed to all residents who completed their training in 1975. Summarized in this paper are many of the more significant results obtained from this very detailed survey. The 148 variables examined include considerable demographic data. This is analyzed and correlated with the impact on stressfulness and impact of personal and professional growth rated for many specific aspects of residency training. Concrete data and recommendations that might prove useful to all psychiatry programs are provided. It is hoped that this may stimulate similar research in other areas of postgraduate medical education.

Recording psychiatric consultations: a preliminary report.

Two new forms, specifically designed for computer processing of data from a contemporary consultation-liaison service, are described. The need for such data and their immediate applicability to problems currently facing this psychiatric subspecialty are discussed. Clinical, administrative, and evaluation uses are reviewed. It is hoped that this work will provide a stimulus to consultation-liason practitioners to use this system or to develop similar systems that will permit documentation, exploration, and enhancement of the consultation-liaison effort.

Heroin addicts with a history of glue sniffing: a deviant group within a deviant group.

Sociodemographic, drug-taking history and psychological test data were collected from 133 male heroin addicts in treatment programs. Those addicts who had ever sniffed glue (26.4%) were characterized by a unique orientation toward death. Not only were they significantly more likely to have attempted suicide, but also they more often fantasized about death both while on heroin and when clean, and they acknowledged less fear of the pain/deterioration involved in dying as measured by the Collett-Lester Scales. In addition, they had on the average abused more than twice as many different substances as addicts without a glue use history.