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Biomedical subjects

J J Schwab

Publications and source records attributed to J J Schwab.

At least 19 recordsLinked to original sources
PubMed1989

Consultation-liaison psychiatry: a historical overview.

The author reviews the history of consultation-liaison psychiatry from its roots in the 1751 charter of the Pennsylvania Hospital in Philadelphia. The field has evolved through three distinct phases and has currently entered a fourth stage, called the consolidation phase, which is characterized by shrinkage of programs, marked reduction in liaison activities, and anxiety about its validity and future. While the survival of consultation-liaison psychiatry is threatened by inadequate financial resources, the author believes that the increasing demand for C-L psychiatrists will eventually mandate a greater investment in the special expertise they offer.

History, 19th Century↗
PubMed1988

Risk for depression in families over time: a pilot epidemiologic study.

A random sample of 34 families from the general population were studied over a 15-month period to determine their risk for depression over time. Adults and children in the families were interviewed three times during the 15-month period. Risk for depression was evaluated using four screening instruments, including the Diagnostic Interview Schedule. At the original interview, 40 percent of the families contained one or more members at risk for depression. The 15-month family incidence rate for risk for depression was 26 percent and of continued good mental health 74 percent. The mental health status of 35 percent of the families changed during the 15-month period, suggesting that longitudinal studies can provide a more accurate profile of family mental health than studies of families at a single point in time.

Adolescent↗
PubMed1987

Residency education in for-profit general hospitals.

In May, 1983, when the new University of Louisville teaching hospital was opened under the auspices of Humana Corporation, it became the first university hospital operated by a for-profit corporation. We describe the agreement that launched this venture and summarize the experiences of the Department of Psychiatry and Behavioral Sciences with Humana, Inc., during the past 3 years. We review our impressions of both the positive and negative effects that the for-profit managing style has had thus far on the teaching programs of the Department. Based on our experiences, there are financial and other benefits, but we think that there are also potential dangers for the future of psychiatric education inherent in the administration of a teaching hospital by a for-profit corporation. The "atmosphere of business" that pervades the climate of opinion in the United States in the 1980s and is merely epitomized by the increasing role of enterpreneurial groups in medicine can be antithetical to principles of psychiatry and has implications for psychiatric education in the future. Awareness of these developments is a task for psychiatric education and, when it is possible, comparative studies of residents and their programs in nonprofit and for-profit hospitals should be conducted.

Hospitals↗
PubMed1987

Depression and internal medicine.

Although the Fathers of Internal Medicine described melancholia and wrote extensively about the affective disorders, internists continue to have difficulties diagnosing their medical patients' depressions. Consequently, it often falls to the psychiatric consultant to make the diagnosis amongst the medical population. We present current concepts of affective disorder that should be clinically relevant to the psychiatrist who works with internists and their patients. Early, accurate diagnosis of depressed medical patients requires increased awareness of depression, observation of the patient's appearance and mood, sensitivity to his or her feelings, and specific questioning about symptoms, losses, and stressors. For depressed medical patients, we present a comprehensive treatment program which often should include: 1) supportive psychotherapy, 2) antidepressant medications; and 3) resocialization or rehabilitation. We outline certain indications for psychiatric referral, and urge psychiatrists and internists to work together closely. Increasing the sensitivity of our colleagues in internal medicine toward affective illness should lead to more prompt identification and treatment of medical patients' depressions.

Depressive Disorder↗
PubMed1984

Anxiety in depression.

Even though anxiety in depression is a common clinical condition, there is controversy about its status. Can these patients be dichotomized as having either anxiety or depression, or are there three categories--certain anxiety states, anxiety in depression, and the specific depressive disorders? A review of the findings from four major lines of research on anxiety in depression reveals contradictory results. Anxious depression may be a distinctive entity. The guidelines for diagnosis presented here emphasize the necessity to identify anxious depressed patients and to differentiate them from those with distinctive anxiety states or depressive disorders. Tricyclic medications, such as doxepin, combined with supportive psychotherapy are the treatment of choice for patients with anxiety in depression.

Adult↗
PubMed1981

Change and psychopathology: epidemiologic considerations.

The authors report data collected on 3674 subjects between 1970 and 1974 as part of an epidemiologic field survey of mental disorder in the southeastern United States, an area which was undergoing rapid sociocultural change. Rates of mental disorder, as measured by the Global Psychopathology Scale, are presented for various sociodemographic groups and are consistent with trends found in previous studies. Analysis of variance and multiple regression techniques are used to explore the relationships among awareness of social change, sociodemographic variables, and psychopathology. Low awareness of change is found to be consistently associated with low psychopathology scores across all socioeconomic groups. The authors postulate a "denial" or "filter" mechanism which may protect particularly vulnerable individuals from the psychic distress accompanying social change.

Adolescent↗
PubMed1979

The development of an acute short-term inpatient child psychiatric setting: a pediatric-psychiatric model.

The authors describe the establishment of a unit for children that emphasizes the integration of the pediatric model of acute, short-term inpatient care with the psychological and developmental perspective of the psychiatric model. Of the 145 children admitted during the first year, more than 33% manifested aggressive or hyperactive behavior and 25%, depression or suicidal behavior. Eighty-five percent were discharged to their homes or previous residences after an average length of stay of 24 days. The authors suggest that similar units established in children's hospitals or general hospitals could help meet the urgent need for acute inpatient psychiatric care of children in this country.

Adolescent↗
PubMed1977

Mortality and community mental health. The Alachua County, Florida, mortality study.

This study reports the results of a household survey and search of death certificates that show a relationship between depression, anxiety, and subsequent mortality. It is part of an effort to develop practical epidemiologic techniques for continuous assessment of community mental health. Use is made of the population attributable mortality rate, estimated from a comparison of the prevalence of a given factor in life and at death. The study estimated attributable mortality prospectively by following up participants in a mental health survey of Alachua County, Florida, for up to four years. Of eight mental scales examined, five (mood, depression, somatic symptoms of anxiety, the Health Opinion Survey, and selected psychopathologic symptoms) showed significant association of scores with community mortality. The data suggest linkages of mental factors to mortality of an order of magnitude sufficient to warrant consideration of these factors as leading causes of death.

Anxiety Disorders↗
PubMed1976

Depression among the aged.

Depression in the elderly is a public health problem that will increase in magnitude as a progressively larger proportion of our population consists of those over the age of 65. Epidemiologic studies indicate that the elderly are in need of physical and mental health care. New data from 1,645 respondents in a Southeastern county show the high frequency of depressive symptomatology in the elderly and a significant relationship between poverty and depressive symptomatology. Predominant symptoms were lowered spirits, feeling helpless, a gloomy outlook on the future, a sense of powerlessness, and difficulties with sleep and appetite. A social psychiatric orientation is needed to supplement the more traditional psychodynamic formulations of depression in the aged. Adverse social conditions and cultural biases deprive the elderly person of a requisite level of self-esteem and place him at risk for depression. Treatment included humanistically based psychotherapy which can be carried out by doctors, the use of antidepressants, medications, and the development of social support systems.

Aged↗