Biomedical subjects
Publications and source records attributed to J O Lipkin.
A study is presented in which a number of variables describing psychiatric patients hospitalized within Veterans Administration Medical Centers are being investigated as potentially more predictive discriminators of resource consumption than the currently formulated diagnostic-related groups.
As many as four million Americans were stationed in Indochina during the Vietnam War; some 800,000 were assigned to the combat zone. These individuals are at especially high risk for developing posttraumatic stress disorder, a diagnostic category that appeared for the first time in DSM-III. The authors explore the reasons why many Vietnam veterans have developed the disorder. They discuss four broad types of disorders now being found among veterans, the problems in diagnosing and treating the disorder, and the theoretical basis in ego psychology for the behavior of veterans with the disorder. Also briefly outlined are some clinical considerations for therapists treating Vietnam veterans.
In planning for the continued care of its large veteran population, the Veterans Administration is taking into account needs generated by trends such as a decreasing incidence of schizophrenia among veterans, an increasing use of outpatient services, and an increasing number of veterans suffering from alcoholism and substance abuse. The authors discuss the characteristics of the three types of VA medical centers that serve psychiatric patients: small general hospitals without a medical school affiliation; large general hospitals with a medical school affiliation; and large general hospitals with large psychiatric populations. One major goal of future planning is to institute psychiatric services at all of the 172 VA medical centers. Another goal is to ensure that each facility with a medical school affiliation will have a day hospital, a day treatment center, and a mental hygiene clinic.
Seventy psychiatric staff members at various Veterans Administration hospitals made decisions concerning appropriate medication for 40 hypothetical cases. A profile presented for each case described the patient's status on eight symptom dimensions. The physician-judges examined each profile and specified appropriate drugs and dose levels for the case. Analyses focused on agreement among judges and on prescriptive strategies, the manner in which symptoms were weighted in specific drug decisions. When base rates were taken into account in determining chance levels, the judges failed to agree with each other significantly more than would be expected by change; this was true for their prescriptions of general class of medications, specific drugs, and dose levels. Differences among physicians were traceable to inconsistency in the use of symptom information and individual variations in prescriptive strategies, cue (symptom) weighting strategies of judges being dissimilar and sometimes contradictory.
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