Biomedical subjects
G D Strauss
Publications and source records attributed to G D Strauss.
Psychiatric hospitalization of adolescents for conduct disorder.
OBJECTIVE: The authors' goal was to review current published literature on the psychiatric hospitalization of adolescents with a diagnosis of conduct disorder. METHODS: The English-language literature from 1980 to 1991 cited in the MEDLINE database was searched using the key words conduct disorder, adolescent psychiatric hospitalization, psychiatric hospitalization criteria, adolescent psychiatric inpatient hospitalization, and adolescent psychiatric admissions. RESULTS: A diagnosis of conduct disorder or presenting symptoms and behaviors consistent with that diagnosis are commonly reported for adolescent psychiatric admissions. Estimates of the percentage of admissions to psychiatric inpatient treatment facilities of adolescents with conduct disorder or symptoms consistent with that disorder range from 30 to 70 percent. There are no research-based criteria for hospitalization of adolescents for conduct disorder, and systematic studies of the outcome of psychiatric hospitalization for this group have not been published. Comorbid psychiatric diagnoses and similar behavioral symptoms in conduct disorder and comorbid disorders complicate inpatient treatment of adolescents with conduct disorder. CONCLUSIONS: Studies of the outcome of psychiatric hospitalization of adolescents for conduct disorder are needed to determine the appropriate use of this modality.
Variable weight training in cystic fibrosis.
A six-month pilot study of variable weight training (VWT) was undertaken to assess its impact on body weight, pulmonary function, muscle size and strength, and social function in 12 adolescent and adult patients with moderately severe cystic fibrosis. Exercise for patients with cystic fibrosis (CF) has often been recommended as an adjunct to physical therapy, although aerobic exercise has not resulted in weight gain in CF. Compared to a three-month control period, six months of VWT resulted in significant increase in weight (2.88 kg, p less than .02), muscle size (1.6 to 1.8 cm upper arm, p less than .01), strength (increase from 16 to 32 muscle groups at normal strength, p less than .005), and decrease in residual volume (1.77 L, p less than .03) and RV/TLC (12.4 percent, p less than .02). There was no significant improvement in other measures of pulmonary or social function. VWT appears to be a form of exercise in which even moderately ill CF patients can engage safely, leading to desired weight gain and increased strength. These results warrant further study of the effects of VWT on pulmonary function and CF morbidity.
Group therapies for rheumatoid arthritis. A controlled study of two approaches.
An important unanswered question about rheumatoid arthritis (RA) is how the patient's psychological or emotional state relates to disease activity and functional status. No controlled studies of psychotherapeutic interventions in RA have been reported. To test the hypothesis that a psychosocial intervention would lead to improvement in functional status or disease activity, 57 RA patients were randomly assigned to 1 of 3 groups, which received: 1) conventional group psychotherapy; 2) group assertion/relaxation training; or 3) no treatment (control group). Patient and physician questionnaires collected at baseline, immediately after the interventions, and 12 months after baseline provided outcome data on functional status, social and psychological adaptation, psychological symptoms, and disease activity. There were few outcome measures for which either treatment resulted in significantly higher scores than were seen in controls, though more improvement did occur among patients who received conventional group psychotherapy.
Which veterans go to VA psychiatric hospitals for care: a pilot study.
In a study to determine whether certain factors could predict whether veterans seek psychiatric care at a Veterans Administration psychiatric hospital or at other public hospitals, data were collected on 644 visits by veterans to one VA psychiatric hospital and two non-VA public hospitals. Race, alcoholism, number of presenting problems, kind of prior psychiatric hospitalizations, and whether the disability was service-connected were significant factors in distinguishing veterans seeking psychiatric care at the different hospitals. Age, marital status, income, and transiency were not important factors. Minority status and alcoholism appeared to be independent of each other in predicting greater use of the VA hospital.
The quality of deans' letters from medical schools.
Residency training directors have noted considerable variability in the quality of deans' letters sent by medical schools on behalf of graduating students. A total of 212 deans' letters from 103 U.S. medical schools received by a large psychiatric residency program were rated by two of the authors. Of these, 26.9 percent were judged excellent, 49.5 percent average, and 23.6 percent poor. Excellent letters were characterized by detailed personal and academic comments; verbatim statements for each clinical clerkship; tactful , yet explicit, remarks about problems; and internal consistency. Poor letters were generally short regardless of content, offered global impressions about clerkship performance by fusing remarks from several different clerkships without identifying sources, or omitted important information that was quickly evident to the discriminating interviewer. Recommendations are offered for authors and readers of deans' letters and to medical students.
The cutting edge in psychiatry.
The authors sampled the views of 138 "experts" in psychiatry in relation to three questions: 1) What were the major accomplishments of 1970-1980? 2) What were the important publications of the decade? 3) What important questions will be answerable in the next decade? Advances in basic sciences and in psychopharmacology led the list for the past decade. Fourteen publications were mentioned four or more times; DSM-III headed the list. The experts predicted that we can anticipate advances in understanding the causes and in the treatment of major disorders. Despite methodological constraints, these results have implications for training medical students and house staff, for continuing education, and for the allocation of research resources.
A comparison of national and in-house examinations of psychiatric knowledge.
The search continues for the optimum method of assessing psychiatric residents' knowledge. In 1982, 72% of the U.S. residency programs gave the Psychiatry Resident In-Training Examination ( PRITE ). The authors compared the PRITE with an examination developed by their program. The two tests yielded highly correlated percentages of correct responses and resident rank orders for advanced residents, detected similar areas of weakness, had comparable dollar costs, and elicited similar, moderately high resident satisfaction. Important differences were the amount of information and feedback provided to residents and to the residency program and the time between the test and the feedback.
Assessing assessment: the content and quality of the psychiatry in-training examination.
The authors rated questions on the 1979 Psychiatry Resident In-Training Examination for the knowledge area assessed and for quality. The number of questions devoted to each of 35 knowledge areas varied widely, ranging from zero to 52. Thirty-one percent of the 300 questions were judged to be weak. Satisfactory questions and weak questions were not randomly distributed among knowledge areas. Areas such as psychopharmacology and neurology lend themselves to many satisfactory multiple-choice questions, while a substantial number of knowledge areas do not. Psychiatric examinations that employ multiple-choice questions should concentrate only on those areas which can be adequately assessed by this method.
Psychosocial adaptation in older cystic fibrosis patients.
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Testing psychiatric knowledge with in-house examinations.
Formal assessment during psychiatric training is becoming more common, not only to evaluate trainees but also to meet demands for educational and fiscal accountability. National norm-referenced tests such as the new psychiatry in-training examination may not meet the needs of many residency programs. The authors describe an alternate approach: an in-house test of psychiatric knowledge. The importance of educational objectives, test specifications, piloting the test, and item analyses is emphasized. The process is time-consuming, and the authors examine the advantages of this approach in terms of its costs.
Assessment of psychotherapy skills: the problem of interrater agreement.
Thirteen experienced supervising psychiatrists independently rated the psychotherapy interviews of six residents, using a detailed assessment instrument. Although interrater agreement was significantly greater than would be expected by chance, the extent of agreement was uniformly low. Agreement was significantly poorer for judgments about technique skills than about communication skills and for second-year than for first-year residents. Other factors, such as the faculty rank and training of the rater, did not covary significantly with observed ratings. The findings suggest that rating methods which purport to assess psychotherapy skills should undergo careful methodological evaluation and testing before they are accepted as valid assessment techniques.
Research training in psychiatry: a survey of current practices.
The authors surveyed current opportunities and research training practices in psychiatric residency programs. Although most programs offer at least a journal club and manb state that research experiences are available, very limited research resources are available to residents in many programs. The availability of research teaching is quite variable, and few programs budget or spend money for resident research. Further, very few programs require any direct reesarch experience. These findings offer a partial explanation for the shortage of research psychiatrists.
Psychosocial support for adults with cystic fibrosis: a group approach.
This article describes the first time-limited psychosocial support group for adults with cystic fibrosis (CF). The chronology of the group is traced, focusing on issues of importance for health professionals who work with patients with CF. Some of the issues raised by patient members include doubts about the competence of nonpediatricians to adequately treat CF; resentment towards "normals" (those without CF), including health professionals; and the desire to control as many areas of their lives as possible. Covert (ie, unrecognized) issues, the role of staff, risks, and outcome are detailed as a guide for others who may wish to conduct such groups. The literature on groups for medical patients and a rationale for the beneficial effects on the group are given.
Psychological assessment of adults with cystic fibrosis.
We administered a battery of self-rated objective and quantitative psychometric tests, including the MMPI, to a group of adult cystic fibrosis (CF) patients. Important findings were related to the age but not the sex of the patients. We found that older patients (i.e., over the median age of twenty-three) were more likely than younger patients to: 1) express emotional conflicts through physical symptoms, 2) be anxious or uncomfortable in social situations, and 3) have self-doubt. We could not confirm a previous report of increased depression or anxiety in adult CF patients. We discuss implication of these results for health professionals.