Biomedical subjects
Publications and source records attributed to A E Slaby.
This chapter addresses the acute treatment of alcohol and cocaine. Because of the widespread use of both these drugs, health professionals must recognize the medical complications of alcohol and cocaine abuse and addiction. The biochemistry will be briefly reviewed as an avenue to understand the different treatment targets and modalities.
The relationship between suicide and creativity has long been a subject of considerable concern. The author presents evidence indicating that in fact depression, suicide, and creativity are related. Several hypotheses for the relationship are posited. It is suggested that the same changes in the serotonergic system that are associated with depression in general and with impulsive suicides and homicides in the extreme may also be responsible for an element of risk taking that characterizes creativity and innovation in a person psychodynamically predisposed to being creative.
De Clérambault's syndrome is said to usually occur in heterosexual women with little overt sexual experience. The authors present five cases of women with considerable sexual experience including, in some instances, homosexual activity and discuss their diagnosis of De Clérambault's syndrome in the context of what has been reported in the literature.
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Approaching individuals in the emergency situation presenting with medical illness and depression requires an understanding of psychologic, biologic, social, and existential factors that converge to create alterations in mood, thought, and behavior. Clinicians must understand how these same factors may be used in managing patient response to treatment of both the depression associated with an illness and the physical illness itself. Whenever a physical illness is present, it is imperative to ascertain the degree to which physical illness and concomitant treatment may be responsible for the psychiatric symptoms.
The advantages and disadvantages of a cross-hospital consultation-liaison service are discussed. Factors in support of such a service tend to be primarily administrative and economic. The disadvantages tend to be psychosocial and affect how clinicians perceive themselves and the quality of their work within the social system.
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Prospective payment represents a major economic challenge to inpatient psychiatric units. For a unit to survive, increased efficiency of treatment will be crucial but will probably not be enough. Most units will need to alter the percentages of high-cost and low-cost patients they treat (case mix) and set less ambitious treatment goals. When altering case mix, ethical and political concerns must be considered first, followed by careful evaluation of which patients will benefit most from high-cost treatment. The authors recommend several measures for improving efficiency of treatment, including decreasing time to make dispositions, using electroconvulsive therapy when indicated, and strengthening aftercare services. They also recommend negotiating with hospital administrators to redeploy conserved resources within the psychiatry department rather than elsewhere.
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The pattern of use of psychiatry over a 12-month period in a university-based primary care center is reported. Interest in pursuing careers in family practice and amount of time spent in the center were related to seeking consultation. All nurse practitioners and social workers sought psychiatric consultations. The majority of patients received care for their psychiatric problems by their primary care clinicians after consultation rather than being referred to a traditional psychiatric clinic.
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This paper attempts to determine the extent to which the growing acceptance of deviant behaviors (sexual, sumptuary, and regarding abortion and euthanasia) is related to economic considerations and to draw out some of the attendant implications for health policy in light of notions of social justice. The analysis suggests that economic factors are very influential if not determining variables in this relationship and that they may conflict with "higher-order values" such as human dignity and respect for human life as bases for policy formulation, particularly with respect to the care of the elderly.
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