Psychiatric consultation for the medically ill elderly in the general hospital: need for a collaborative model of care.
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Adult↗
Biomedical subjects
F I Fawzy
Publications and source records attributed to F I Fawzy.
Data omitted from psychiatric consultation notes.
To assess how often psychiatric consultants omit written data from their consultation notes, the authors reviewed 78 initial consultation notes written by second-year psychiatric residents. Data considered essential for an adequate psychiatric evaluation were typically omitted. Categories that were observed to have the highest frequencies of missing data included family history of psychiatric illness (60.3%), history of substance abuse (44.9%), marital status (37.2%), previous psychotropic drug use (35.9%), previous psychiatric treatment (26.9%), and patient history of psychiatric illness (24.4%). The frequencies of omissions were significantly (p less than .001, except for the last item, p less than .01) higher than those from the consultation notes written by a second cohort of psychiatric residents who used a worksheet that listed data categories. The authors' findings argue for the use of worksheets delineating data categories to ensure that clinicians write adequate consultation notes.
Data Collection↗
Family composition, socioeconomic status, and adolescent substance use.
The hypothesis that deprivation in the form of parental absence and economic hardship causes youth substance use was tested in a study population consisting of two hundred sixty-two adolescents, ages 13 through 17, and one parent of each. No correlation between family composition and youth substance use was found. Two measures of socioeconomic status, family income and parents' subject rating, also revealed no correlation with youths' substance use behavior. However, when father's occupation was used to evaluate this relationship, significantly more abstainers were shown to have fathers who are professionals, and significantly more users had fathers occupying managerial or foreman-level positions; a possible explanation for this result is that occupation may somehow be related to parental style. The common sense assumption that parental absence and economic hardship are directly responsible for youth substance use is unsupported by our data.
Adolescent↗
Changes in AIDS risk behaviors among homosexual male physicians and university students.
Two samples of homosexual men, 64 physicians and 58 university students, reported profound decreases in several sexual practices linked to transmission of acquired immune deficiency syndrome (AIDS). The physicians showed the greater reduction. When sociodemographic variables, health beliefs, feeling of control over outcome, mood, sexual interest before the AIDS epidemic, and medical care utilization were correlated with decrease and/or increase in AIDS risk behaviors, the clusters of variables most strongly correlated with change in risk behaviors differed between the physicians and students. Interventions designed to change behaviors in AIDS high-risk groups should be tailored for specific subgroups.
Acquired Immunodeficiency Syndrome↗
Role of the physician in bereavement.
The purpose of this article is to set forth a clear and concise guide for physicians to use in their treatment of the bereaved. The physician's attitudes toward death and dying, as well as normal and abnormal grief reactions, are reviewed. The role of the physician prior to the time of death, at the time of death, and after the death are discussed. Models of hospital-based programs that can be of significant help to physicians in treating the bereaved are presented also.
Adaptation, Psychological↗
Illness concerns, attitudes towards homosexuality, and social support in gay men with AIDS.
High levels of illness-related psychologic distress, marked social stigmatization and loss of social support, and negative internalized feelings towards homosexuality have previously been reported in homosexual men with the diagnosis of acquired immune deficiency syndrome (AIDS). We assessed 50 homosexual or bisexual men who were within 3 months of their AIDS diagnosis with respect to medical status, illness concerns, attitudes towards homosexuality, and social support. Subjects reported levels of illness-related concerns comparable to previously studied cancer patients. Their attitudes towards homosexuality were similar to previously studied healthy homosexual males. Their social support needs were variable, as was their satisfaction with specific types of social support. Their social networks were moderately small. In this AIDS subject group, illness concerns, attitudes toward homosexuality, and social support satisfaction were significantly correlated with each other, and with previously reported levels of psychologic distress and subjective (but not objective) measures of health status.
Acquired Immunodeficiency Syndrome↗
Adaptation of adult bone marrow transplant recipient long-term survivors.
Although there is a small literature on psychosocial and psychiatric aspects of bone marrow transplants (BMT) in adult recipients during the BMT hospitalization phase, adaptation of long-term adult BMT recipient survivors has received little study. This study surveyed the adaptation of BMT recipient survivors over age 17 who were an average of 42 months posttransplant. Study variables included the recipients' current self-reported health status, mood state, social role function, self esteem, life satisfaction, and relationships with their BMT donors and other family members. A companion study of those who donated BMT to the recipients eligible for this study was also performed. The study participants were preponderantly young adults who currently were in an intimate relationship and vocationally active. About 1/4 of the subjects reported ongoing medical problems. Also, 15-25% reported significant emotional distress, low self-esteem, and less-than-optimal life satisfaction. The subjects' current quality of relationship with their donors was highly correlated with many measures of their psychosocial status. The findings indicate that about 75% of BMT recipient long-term survivors are doing well from a psychosocial as well as a medical standpoint, that the recipient-donor relationship may be sensitive to any changes in the recipient's status, and that 15-20% of BMT recipient survivors report a degree of psychological distress that might benefit from specific psychological/psychiatric intervention.
Adult↗
Psychological adjustment of adult bone marrow transplant donors whose recipient survives.
The psychosocial and psychiatric impact of donating bone marrow (BM) has received little study. This mail questionnaire study of bone marrow donors whose recipient had survived more than one year post-BMT was undertaken to document the psychosocial consequences of donation on "successful" BM donors. Demographic, mood state, self-esteem, current life satisfaction, and donor-recipient relationship characteristics, donor-perceived approval from family members, and donor attitudes about BM donation were studied. A companion study of BM recipients was also performed to provide comparative data on the psychosocial status of donors and recipients. As a group BM donors manifested little emotional distress, high self-esteem, and a high degree of current life satisfaction. Donors reported little change in their relationships with their recipients since the BMT. However the current quality of their relationships with their recipients was highly correlated with several recipient health status and psychosocial variables, suggesting that recipient deterioration might significantly adversely impact donor psychosocial status. From 10% to 20% of donors indicated at least some negative consequences of donating.
Adult↗
Patterns of cigarette, alcohol, and other drug use among children and adolescents: a longitudinal study.
Findings are presented from an 18-month longitudinal study of substance use behavior among 400 children and adolescents, ages 9-17 at the first interviews. Patterns of use from two sequential interviews are reported. Descriptive results are presented as simple frequencies and cross-tabulated with demographic items (age, sex, ethnicity, and socio-economic status). Patterns of use over an 18-month period are examined for cigarettes, alcohol, marijuana/hashish, and other drugs. Four patterns are assessed for each of these substances--abstention at both the first and second interviews; abstention at the first, but not the second interview; use at the first interview, abstention at the second; and use at both interviews.
Adolescent↗
Changes in DST before and after a bone marrow transplant conditioning regimen: a pilot study.
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Adult↗
Psychiatric aspects of bone marrow transplantation: a review and current issues.
BMT represents a major medical advance and offers to most individuals who undergo this procedure the only hope for long term survival. The current psychiatric literature is anecdotal and mostly restricted to discussion of psychiatric issues related to the BMT hospitalization itself. There is substantial agreement about the important psychiatric issues concerning BMT recipients, their families, and the BMT team. However, many post-BMT hospitalization psychiatric and psychosocial issues need attention: the psychological impact of being a BM donor, the consequences of BMT for donor-recipient relationships, the long-term family consequences of BMT, and the long-term cognitive, neuroendocrine, sexual/reproductive, and psychosocial status of BMT survivors. Hopefully, these issues will be increasingly rigorously and effectively addressed in the near future, so that effective psychiatric and psychosocial interventions can be developed which maximize the psychosocial outcome of those affected by BMT.
Adaptation, Psychological↗
Acquired immune deficiency syndrome (AIDS) and consultation-liaison psychiatry.
Acquired Immune Deficiency Syndrome (AIDS) is a new highly lethal transmissible syndrome that occurs primarily in identified high-risk groups. The number of AIDS cases has been doubling approximately every 6 months in the United States since 1981. A large number of healthy HTLV-III seropositive individuals, and a significant number of individuals with AIDS-related complex (ARC), who are at increased risk for eventual development of AIDS, have been identified. At least one third of AIDS patients develop neurologic disease prior to death. Organic mental disorders are frequent in AIDS and can have devastating consequences. Severe psychologic distress and functional psychiatric syndromes are also common. The psychosocial effects of AIDS for patients, family and friends, and health-care professionals are discussed in relationship to the psychosocial consequences of other serious medical illnesses including cancer. An ideal comprehensive program to meet the needs of "AIDS affected" individuals is presented, as are the authors' views on the tasks of C-L psychiatrists in participating in the comprehensive care of these individuals.
Acquired Immunodeficiency Syndrome↗
Drinking patterns and problems among female children and adolescents: a comparison of abstainers, past users, and current users.
The sociopsychological factors that underlie drinking behavior among 197 young girls, ages 9 through 17, are explored. Three groups-youthful abstainers, former users, and current users-were interviewed, as were their parents. These comparison groups are contrasted on 110 variables. The relative merits of four competing explanations of youthful drinking behavior-deprivation, personal deficiency, hedonistic peer culture, and family pathology-are assessed.
Adolescent↗
Consultation-Liaison outpatient clinics.
This paper describes the history of the provision of psychiatric services to outpatients in general (medical) hospitals in the United States. It also reviews the rationale for the development of consultation-liaison psychiatric clinics that have been created to meet the psychiatric needs of these patients. Results of a random survey of current consultation-liaison psychiatry outpatient clinics are presented and recommendations are made for a model outpatient clinic.
Adolescent↗
Psychotherapy as an adjunct to supervised fasting for obesity.
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Adult↗
Patterns of substance use among children and youth: a longitudinal study.
This report presents a set of findings from a three wave 36 month longitudinal study on the use of cigarettes, alcohol, marijuana/hashish and other drugs by a population of children and adolescents ranging in age from 9 to 17 at the time of first interview. Gross differences in percentages of subjects reporting using substances across the three data collection intervals are found to be quite small. However, when these differences are examined in detail, it is found that a good deal of initiation of use by some subjects and curtailing of use by others stands behind the relatively small net changes in use from one interval to another. Escalation in substance use, from less mood altering to more mood altering substances, is found to exist, but to appear far less frequently than "initial" multiple drug use. Finally, "intensity" of use of one substance is found to be somewhat related to age and very strongly related to the use of other substances. Limitations of findings due to episodic rather than continuous monitoring of substance use are noted.
Adolescent↗
Preventing nursing burnout: a challenge for liaison psychiatry.
The authors conducted a study to assess and compare the level of job satisfaction among five groups of registered nurses working at UCLA Hospital. Fifty-seven female nurses completed the MMPI, Locus of Control Test, Work Environment Scale, and a questionnaire designed to assess job satisfaction. Results showed that there were no significant personality differences among the five groups of nurses. Significant differences between some of the groups were found in demographic variables and in work-related variables such as involvement, task orientation, work pressure, sense of authority on the job, and perceived communication with peers or other groups in the work environment. Nurses on the Medicine unit tended to have lower overall job satisfaction than those in the other units. The involvement of the Psychiatric Liaison Service on the five nursing units is described and discussed as a possible method for providing psychosocial support to the nurses and reducing high turnover rates.
Adult↗
Generational continuity in the use of substances: the impact of parental substance use on adolescent substance use.
Two hundred sixty-two adolescents, ages 13 through 17, and one of the parents of each, interviewed separately, are compared with regard to their use of substances. Youthful subjects in each comparison group are similar in age, sex, ethnicity and socioeconomic status. Results show a variety of relationships between parental use of coffee, cigarettes, beer and wine, hard liquor and marijuana/hashish and adolescent use of such substances. Generally, parental use of these substances is moderately to strongly related to use by their children. The strongest relationships are found for coffee, mother's use of cigarettes, and father's use of hard liquor. All of these relationships are not linear. For example, fathers who are moderate drinkers of hard liquor are more likely to have adolescent children who are substance users. Two theories of intergenerational substance use are discussed.
Adolescent↗