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Biomedical subjects

A L Callies

Publications and source records attributed to A L Callies.

At least 19 recordsLinked to original sources
PubMed1997

An instrument to evaluate the process of psychiatric care in ambulatory settings.

As part of an evaluation of the Utah Prepaid Mental Health Plan, the Process of Care Review Form was developed to assess the quality of the process of psychiatric care provided by Utah's community mental health centers (CMHCs) to clients with schizophrenia. This article briefly reviews issues in the measurement of quality of care and describes the development and implementation of the form. The 67-item form was designed for use by a trained abstracter to gather data from CMHC medical records in six areas: general management of the patient, medication management, medical management, social support, psychiatric hospitalization, and psychiatric assessment. A 59-item version of the form that omits the section on psychiatric assessment has been used in three waves of data collection to document data spanning five years (1990-1994) in the evaluation of the process of psychiatric care in the Utah plan. It is currently being used longitudinally to examine differences between Utah CMHCs receiving capitated payments and those paid on a fee-for-service basis by Medicaid.

Ambulatory Care↗
PubMed1991

Depressed mood and other variables related to bone marrow transplantation survival in acute leukemia.

Routine psychiatric evaluations of 100 adult patients undergoing allogeneic bone marrow transplantation for acute leukemia were reviewed to examine the possible relationship of psychiatric and psychosocial factors to duration of survival following the procedure. Three variables were found to independently affect outcome: illness status (first remission vs. other status), presence of depressed mood, and the extent of perceived social support. Patients transplanted while in their first remission had significantly improved survival; patients with depressed mood, regardless of specific psychiatric diagnosis, had poorer outcomes; and patients with a high level of perceived social support had improved survival. The possible mechanisms by which these variables affect outcome are discussed.

Adaptation, Psychological↗
PubMed1991

A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania.

OBJECTIVE: It has been proposed by some investigators that trichotillomania, a disorder of chronic hair pulling, is a variant of obsessive-compulsive disorder, and some studies have suggested that the antiobessional agents clomipramine and fluoxetine are useful in treating this disorder. The authors investigated the efficacy of fluoxetine in the treatment of trichotillomania. METHOD: Twenty-one adult chronic hair pullers were recruited into an 18-week placebo-controlled, double-blind crossover study of fluoxetine, in doses up to 80 mg/day. The fluoxetine and placebo treatment phases consisted of 6-week trials of each agent separated by a 5-week washout period. Fifteen subjects (14 female and one male) completed the study; an additional female subject dropped out at 16 weeks after developing a drug reaction. RESULTS: No significant Drug by Period interactions were found in weekly subject ratings of hair pulling, weekly subject ratings of the urge to pull hair, weekly assessments of the number of hair-pulling episodes, or the estimated amount of hair pulled per week. CONCLUSIONS: The short-term efficacy of fluoxetine in the treatment of trichotillomania was not demonstrated in this study.

Adult↗
PubMed1990

Adjustment disorders in medically ill inpatients referred for consultation in a university hospital.

The study examined medical records of 121 medical-surgical inpatients diagnosed with adjustment disorder by psychiatric consultants in a university hospital. Medical illness was the primary stressor, evoking the maladaptive reaction in 83 (68.6%) cases. These patients were largely free of preceding psychiatric problems, suffering protracted hospitalizations for advanced illnesses, particularly malignancy and diabetes; in contrast, the 38 (31.4%) patients whose adjustment disorder was precipitated by a stressor other than medical illness had established psychiatric histories and recurrent problems with relationships or finances. The data suggest that in the medically ill, identifying the primary stressor producing an adjustment disorder is more instructive than focusing upon "predominant" symptomatology and "subtypes."

Adaptation, Psychological↗
PubMed1988

Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus.

To examine the prevalence of psychiatric disorders in patients with long-standing type I diabetes mellitus, we assessed a series of candidates for pancreas transplantation. Using the Diagnostic Interview Schedule, six-month and lifetime prevalences of psychiatric disorders were established for the candidates and their potential donors (first-degree relatives). Excluding tobacco use disorder and psychosexual dysfunction, 38 diabetic subjects (51%) received one or more psychiatric diagnoses. The lifetime prevalence of major depression was comparable for female (11 of 48 [22.9%]) and male (seven of 27 [25.9%]) diabetics; both rates were significantly higher than rates in first-degree relatives and the general population. Among female diabetics, the six-month and lifetime prevalences of simple phobia were increased vs donors and the general population; among male diabetics, the lifetime prevalence of antisocial personality disorder was greater than that in the general population. None of these disorders was found to be related to the duration of diabetes or the presence of various complications. The data suggest that increased rates of psychiatric disorder in type I diabetics have both gender-independent and gender-related components.

Adolescent↗
PubMed1987

Antidepressant treatment of medical-surgical inpatients by nonpsychiatric physicians.

The prescribing of antidepressants by nonpsychiatric physicians on adult medical-surgical inpatient services of a university hospital was examined through the review of medical records of patients who received amitriptyline hydrochloride, doxepin hydrochloride, or imipramine hydrochloride during a one-year period. Reasons for antidepressant use were treatment of depression (56%), pain (30%), or other conditions (14%). Regardless of the reason for use, nonpsychiatric physicians were found to use relatively low dosages, rarely plan or effect dosage increases, and rarely discontinue medication.

Adult↗
PubMed1987

Psychiatric consultation to inpatients with 'early-onset' type I diabetes mellitus in a university hospital.

With the use of medical records and the Consultation-Liaison Outcome Evaluation System, we studied psychiatric consultation to 52 hospitalized patients with type I diabetes mellitus having onset of disease by age 25 years. The distribution of psychiatric diagnoses assigned to this sample of patients with "early-onset" diabetes did not differ from those of patients with other medical and surgical illnesses. Three features did distinguish consultation to patients having type I diabetes: the diabetics were referred unusually early in the hospital course; psychotropics were seldom utilized; and consultants' recommendations for diagnostic studies were not followed in more than 90% of cases. The study indicates that the primary medical diagnosis is a critical variable governing consultees' use of and responses to psychiatric consultation.

Adult↗
PubMed1985

The outcome of antidepressant use in the medically ill.

To examine the feasibility of using antidepressant medication to treat major depressive syndromes in the hospitalized medically ill, we reviewed a series of psychiatric consultations meeting the following criteria: the consultant diagnosed a major depressive syndrome, treatment with an antidepressant was advised, the consultee initiated the antidepressant, and hospitalization had been prompted by a major medical illness. The final sample of 50 consultations, representing less than 5% of the case reviewed, was assessed by retrospective study of entries in the medical record. Judgments regarding response were thus a function of routine clinical observation and care. Drugs were not randomly assigned; rather, the choices represented ongoing clinical usage patterns. Two major points emerge from the data of the study. First, 32% of the trials were terminated due to side effects judged to be unacceptable by the physicians or consultants. Delirium accounted for half of such side effects; cardiotoxicity, however, was not evident. Second, only 40% of patients with medical illnesses, including malignant neoplasm, insulin-dependent diabetes, and epilepsy, responded to treatment. The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder.

Adult↗
PubMed1985

Data-based psychiatric consultation: applying mainframe computer capability to consultation.

Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.

Computers↗
PubMed1985

Pedagogic applications of a computerized data base.

The educational experience of medical students taking a 6-week clerkship in consultation psychiatry was augmented by clinical simulations. Using a microcomputer program and a video-display terminal the students are confronted with an actual case and asked to make specific recommendations. The program records their answers and then indicates what the consultant actually did. This method broadens the student's clinical exposure, provides prompt feedback, frees staff to supervise live patient contact, and offers the possibility of sharing clinical problems with other centers.

Aged↗
PubMed1984

Psychiatric consultation to geriatric medically ill inpatients in a university hospital.

Using hospital admissions data, medical records, and the Consultation-Liaison Outcome Evaluation System, we studied psychiatric consultation to hospitalized medical-surgical patients who were aged 60 years or older. In comparison with younger patients, the geriatric population was less often referred for psychiatric consultation. Those referred had less prior psychiatric history than the group aged less than 60 years. They received a different distribution of psychiatric diagnoses. Consultants recommended psychotropic medication and diagnostic actions more often for the elderly; the former was related to the presence of organic mental disorder. Concordance with consultants' recommendations and diagnoses did not vary with patients' age. Certain aspects of the consultation process are thus modified when geriatric patients are involved, and specific features of "geriatric consultation" are unique.

Age Factors↗
PubMed1984

Difficulties in the physician-patient dyad: invoking the psychiatric consultant.

Drawing upon their studies of physicians' responses to the recommendations and diagnosis of psychiatric consultants, the authors propose that the psychiatric consultant is most often invoked when the primary physician experiences an inappropriate interpersonal distance in the relationship with the patient. Sensing the threat or the reality of the patient as too close or too distant, the physician seeks the presence of the consultant. In the subsequent triadic constellation, the psychiatric consultant is suggested to function principally as buffer between the physician and the patient, restoring, or effecting a more optimal interpersonal distance in the original dyad. This construct helps to explain the consultees' "selectivity" in requesting consultation and the marked disparity between reported prevalence of psychiatric disorders in the medically ill and referral rates. It also calls attention to the role of the psychiatric consultant in assuring that the medical care of the patient with psychiatric features is not compromised or abbreviated.

Humans↗
PubMed1983

Consultation-Liaison outcome evaluation system. I. Consultant-consultee interaction.

The Consultation-Liaison Outcome Evaluation System characterizes the effectiveness of consultative activities. The initial phase of the system identifies consultees' responses to psychiatric consultants' recommendations and diagnoses and the variables critical to concordance with the use of quantitative measures. The observed incidence and concordance rates of the consultant-consultee interaction were integrated (1) to establish a concordance hierarchy clarifying consultees' priorities in seeking psychiatric consultation, (2) to provide reference points to guide psychiatric consultants' clinical actions, (3) to establish tentative standards with which to evaluate the effectiveness of psychiatric consultation, and (4) to signal the need for further outcome studies and the development of data-based consultation practices.

Clinical Competence↗
PubMed1983

Consultation outcomes. The psychiatrist as consultee.

The frequent coexistence of psychiatric and medical illness supports the need for excellent medical care on inpatient psychiatric services. Effective use of consultation is an important element in ensuring this care. In our study of medical-surgical consultation to an inpatient psychiatric service during a two-year period, outcome variables, such as frequency of and concordance with drug and diagnostic action recommendations, were determined and compared with similar data for psychiatric consultations to medical-surgical services. Thirty-eight percent of cases received a consultation. Patients seen by a consultant had a longer hospital stay. Twenty-seven and forty-six percent of consultantions contained a drug or a diagnostic action recommendation, respectively. The concordance of psychiatric consultees was 79% for drugs and 75% for diagnostic action recommendations. Comparison with medical-surgical consultations done by psychiatric consultants revealed important important differences and similarities.

Adult↗