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Biomedical subjects

E B Fink

Publications and source records attributed to E B Fink.

16 recordsLinked to original sources
PubMed1985

Effectiveness of alcoholism treatment in partial versus inpatient settings: twenty-four month outcomes.

The authors examined the effectiveness of the partial hospital setting, in contrast to the inpatient setting, for the rehabilitation of alcohol abusers and alcoholics. Outcomes after 24 months in five life health areas indicated marked improvement from baseline for the entire follow-up period on almost all measures. There also was a strong relationship between drinking outcomes and outcomes in the other health areas. Although there were few between group differences on the clinical outcome measures, differences which were found favored the partial hospital setting. Furthermore, cost of treatment over two years clearly favored the partial hospital.

Activities of Daily Living↗
PubMed1984

Adherence in a behavioral alcohol treatment program.

This report examines the correlates of early treatment termination by patients being treated for alcohol abuse or dependence. All of the study subjects were participants in a controlled experimental investigation of the differences in clinical outcome and treatment cost of extended inpatient and partial hospital treatment. A large number of clinical variables demonstrated no difference between groups, except for the greater likelihood of a DSM III Axis I diagnosis of alcohol abuse or dependence in the treatment completers. In contrast, three of four system variables differentiated completers from noncompleters. Patients treated by hospital-employed psychiatrists, in contrast to private psychiatrists, were more likely to complete the program; 4 sequential months in the middle phase of the study were associated with noncompletion of treatment; and patients who were detoxified on the preferentially designated unit were more likely to receive some specialized alcohol treatment. The authors interpret these data to indicate that treatment adherence is influenced by factors affecting the cohesiveness of the treatment delivery system. The failure of patient characteristic variables to predict treatment adherence may well be a result of their comparative insignificance in relation to system variables.

Adult↗
PubMed1982

Lithium and chlorpromazine in psychotic inpatients.

A sample of recently hospitalized psychotic patients was assigned to treatment with lithium or chlorpromazine in a double-blind drug trial. Several diagnostic systems were used to characterize the patients. No relationship was found, regardless of criterion system used, between diagnosis and differences in drug effectiveness; specifically, the presence of "schizophrenic" symptoms did not predict a poor response to lithium. Among patients with physical overactivity, those treated with lithium terminated earlier and had poorer outcome than those treated with chlorpromazine. In patients who were not overactive, the two drugs were equally effective, and chronically psychotic patients had poorer outcomes regardless of drug. Lithium may be an effective treatment for acutely psychotic patients who are not overactive. The use of a lithium trial as a diagnostic tool may be unwarranted.

Adult↗
PubMed1982

Encouraging third-party coverage of partial hospitals.

Despite the proven clinical effectiveness and cost-effectiveness of partial hospitals programs, any third-party insurers still refuse to offer coverage of their services. A number of clinical, administrative, and fiscal issues involving current partial hospital programming and the health care system in general have led to this difficulty. The author outlines these barriers, which include concerns about lack of cost accountability, lack of financial incentive to third parties, and lack of consumer interest, and makes specific recommendations on pursuing coverage of partial hospital programs. He urges a redefinition of the scope of partial hospital services and the development of detailed standards of treatment as prerequisites to pursuing third-party coverage.

Day Care, Medical↗
PubMed1982

Psychiatry's role in the dehumanization of health care.

Contemporary health care systems have been criticized as being insensitive to patients' affective needs. Although the mental health care disciplines have assumed the guardianship of medical humanism, psychiatrists and behavioral scientists have unintentionally played a role in the development of this insensitivity. Preclinical psychiatric curricula and the role models presented by clinician-teachers often neglect the technologic aspects of humanistic medicine. This has encouraged a schism between the affective and cognitive components of medical practice. Alterations of psychiatric teaching and practice that may foster humanistic medical practice are suggested.

Curriculum↗
PubMed1982

Predicting pharmacotherapy outcome by subjective response.

Subjective response to the initial 24-hour dosage of psychoactive medication was evaluated as a predictor of clinical outcome in 33 drug-free patients with DSM-III diagnoses of functional psychoses. Pretreatment evaluation included measures of symptom severity, role functioning and attitude towards treatment. Clinical improvement after 8-21 days was significantly correlated with subjective response. The author suggests that inquiry regarding a patient's early subjective response to prescribe chemotherapy can help to identify ultimate drug refusal and clinical unresponsiveness.

Adult↗
PubMed1980

Diagnosing mania: the use of family informants.

The contribution of a history taken from the family was evaluated in a series of acutely psychotic patients diagnosed using DSM-III criteria. Families often describe manic symptoms not reported by the patient; this is especially so for excessive or inappropriate activities. The traditional reliance on current mental state may lead to underdiagnosis of mania and overdiagnosis of schizophrenia.

Adolescent↗
PubMed1978

The paradoxical underutilization of partial hospitalization.

Partial hospitalization continues to be underutilized even though its clinical effectiveness for a variety of psychiatric patients has been demonstrated. The authors investigated the potential economic advantage of partial hospitalization by comparing matched groups of day hospital patients and inpatients who had comparable symptoms and prognoses on admission. They present one-year follow-up data documenting the comparability of the study groups on clinical outcome measures and the cost advantages favorable the partial hospitalization group. They discuss possible causes of the paradoxical underutilization of the clinically effective and lower-cost partial hospitalization, which include institutional factors, patients' clinical characteristics, family resistance, and clinician bias.

Adolescent↗
PubMed1978

Unexpected and prolonged akinesia: a case report.

This report describes a male college student who experienced akinesia lasting almost 3 weeks following withdrawal from relatively brief, low-dose neuroleptic treatment. The literature is reviewed and the case is discussed with special focus upon the duration of extrapyramidal side effects. These syndromes are often undiagnosed or misdiagnosed and lead to unnecessary morbidity and noncompliance with recommended pharmacotherapy.

Adult↗
PubMed1976

Further examination of a biochemical test for suicide potential.

The use of biological data, especially adrenal cortical activity, to enhance the assessment of suicide potential has been suggested and briefly argued in the literature. In this report data is presented on two suicide patients. One patient suicided 8 months after her 4-month hospitalization during which time her 17-hydroxycorticosteroid (17-OHCS) excretion remained at low levels. The second patient suicided on his thirteenth hospital day; his 17-OHCS excretion was moderately elevated, but consistent with his high anxiety and depression ratings. One case is used to support the previous findings that low 17-OHCS affords the clinician no reassurance regarding suicidal risk in the future. The other case illustrates the difficulty in interpreting moderate elevation in arousal sensitive endocrine systems in light of clinically manifest anxiety and/or depression.

17-Hydroxycorticosteroids↗
PubMed1975

A test of the transmethylation hypothesis in acute schizophrenic patients.

Keeping biochemical determinations and clinical judgements independent, the authors investigated three aspects of the transmethylation hypothesis. They found that 26 acutely schizophrenic patients were no more likely to have bufotenine or N,N-dimethyltryptamine present in urine or elevated serum indolethylamine N-methyltransferase activity than 10 normal control subjects. The authors conclude that these are naturally occurring substances which are equally likely to be present in normal and schizophrenic subjects.

Acute Disease↗
PubMed1975

Functioning at the clinical-research interface: the clinical-research meeting.

The authors describe their experience in carrying out clinical and psychobiological research in a therapeutic milieu setting. The clinical-research meeting, composed of clinical-care staff with secondary research responsibilities, researchers, and acutely psychotic patients, proved to be a useful mechanism for identifying and resolving inevitable problems at the clinical-research interface and enhanced the effectiveness of research implementation and patient care. The authors discuss three specific areas where covert issues threatened to undermine the work of the unit-the abrogation of research responsibility, the abrogation of clinical responsibility, and intergroup competition and envy.

Acute Disease↗