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Biomedical subjects

C P Leeman

Publications and source records attributed to C P Leeman.

17 recordsLinked to original sources
PubMed1981

Should general hospitals accept involuntary psychiatric patients? A panel discussion.

The issue of whether involuntary patients can be treated safely and effectively on inpatient psychiatry units of general hospitals is addressed from several points of view. Parallels are drawn between contemporary reform efforts and 19th century hospital psychiatry, and the danger of repeating errors of the past is pointed out. An account follows, illustrating the recent planning process for mental health care in Massachusetts and recommending the active participation of psychiatrists in that process. Also discussed are the differences in the process of establishing a treatment alliance with voluntary and involuntary patients. The practical considerations in the development of a locked unit in a general hospital area explored, with respect to its effect on reimbursement, the private practice model, and the length and appropriateness of stay. In conclusion, the shared concern is stated that, in respect to making the transition from one system of care to another, safeguards be built in to protect and expand good treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

The "least restrictive environment": from rhetoric to practice.

During the past 10 years, more and more general hospitals have opened psychiatric units, many of which represent the best of modern hospital psychiatry. Therapeutic success on these units is based on control of admissions as well as on clinical programs. Pressure from the State to admit involuntary patients, recently justified by the doctrine of the "least restrictive environment," threatens to erode the quality of treatment now being provided. The concept of "least restrictive environment" is ambiguous and sometimes misleading. The treatment of involuntary psychiatric patients in general hospitals, in order to be safe and effective, requires the resolution of legal, clinical, financial, and architectural issues, as well as problems in the relationship between psychiatric units and other areas of the general hospital.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Involuntary admissions to general hospitals: progress or threat?

For a variety of reasons, general hospitals are being asked to accept both involuntary admissions and patients who are difficult to manage safely on an unlocked unit. The author considers some of the programmatic, legal, architectural, and economic issues that must be resolved if this challenge is to be met successfully. He also addresses the public relations issues and the impact on psychiatry's liaison to general medicine. He believes that if psychiatric services in general hospitals are broadened thoughtfully and deliberately, with careful attention to the clinical needs of all patients, the over-all quality of psychiatric care can be enhanced. Otherwise there is risk of destroying the best of modern hospital psychiatry.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

The Massachusetts Psychiatric Society's position paper on involuntary psychiatric admissions to general hospitals.

Believing that if general hospitals are pressured into admitting involuntary patients without adequate safeguards, care may deteriorate, the Massachusetts Psychiatric Society drafted a detailed position statement enumerating what resources and services would be required to provide the same high-quality care for involuntary as for voluntary patients. Among other points, treatment of involuntary patients should be considered "psychiatric intensive care," with attention given to the needs for special staffing, training, ancillary services, and funding. To provide high-quality care in the least restrictive environment, separate locked and unlocked units should be provided. Not all involuntary patients can be cared for within a general hospital, the statement says; some require specialized units more appropriately located elsewhere. The general hospital's willingness to accept involuntary patients should be contingent on its being able to control its admissions, and on the hospital's not being the provider of last resort.

Commitment of Persons with Psychiatric Disorders↗
PubMed1975

Diagnostic errors in emergency room medicine: physical illness in patients labeled "psychiatric" and vice versa.

Patients coming to general hospital emergency rooms often present mixed physical and psychological problems. An unfortunate tendency of physicians caring for these patients to "label" them as either "organic" or "psychiatric," based on initial impressions, may lead to inadequate diagnosis and improper treatment. Four case examples are discussed, in which diagnostic errors resulted either from ignoring psychological and social factors, or by focusing on emotional factors to the exclusion of organic disease. The provision of quality medical care in a hospital emergency room requires that attention be directed coordinately to both physical and emotional factors in each patient's illness.

Adult↗
PubMedDate not supplied

Risperidone-induced neuroleptic malignant syndrome.

OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995. DATA SYNTHESIS: We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management. CONCLUSIONS: Clinicians are cautioned about the possibility of NMS with risperidone.

Adolescent↗