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Biomedical subjects

L Kirstein

Publications and source records attributed to L Kirstein.

15 recordsLinked to original sources
PubMed1979

A health care program for hospital staff.

This paper illustrates the significance of one aspect of psychiatric consultation to questions of general hospital health care delivery. The contractual arrangements, implementation, and evaluation of a health care delivery program for nonprofessional hospital employees are presented. Changes in patients' perception of treatment were evaluated by random surveys of representative clinic and ward populations before and after this program was implemented. The program was evaluated by precourse-postcourse questionnaires completed anonymously by the hospital personnel group. The program was found to be successful in generating lists of major health care delivery problems and some possible solutions. The majority of personnel enjoyed and benefited from this program. A conceptual framework and implications of psychiatric consultation for problems of general health care delivery are discussed.

Adaptation, Psychological↗
PubMed1979

Temporal disorganization and primary affective disorder.

The authors used a self-rating scale of thinking process disorganization to measure degree of temporal disorganization in a group of 38 rigorously categorized psychiatric inpatients. Patients diagnosed as having primary affective disorder, depressed type, were significantly different from those with either a character disorder or schizophrenic diagnosis; both schizophrenic and character disorder groups showed variable temporal disorganization scores, and the primary affective disorder group showed consistently high levels of temporal disorganization. Diagnosis was more important than symptom measures in relationship to temporal disorganization scores.

Adult↗
PubMed1978

Sociodemographic factors and military psychiatric hospitalization.

This study of race, rank, and psychiatric hospitalization was conducted to provie more information about the impact of social class factors on military inpatient treatment. A retrospective review of the charts of all commissioned officers admitted over a 16-month period along with control groups of airmen and sergeants matche for time of admission was undertaken at a large military training center. Groups were compared on sociodemographic variables (age, race, rank, sex, marital status, length of service, and education background) as well aa clinical variables (referral source, chief complaint, diagnosis, length of stay, and outcome). The implications of briefer hospitalizations for the youngest group of patients (the airmen) are discussed. The over-representation of black enlisted soldiers as psychiatric patients and organizational means of rectifying this situation are discussed.

Adult↗
PubMed1978

Sexual involvement with patients.

Three cases of sexual activity between patients and staff members were presented and determinants and consequences of this type of acting out behavior were discussed. Patients sexual behavior was in part motivated by a need to avoid feelings of loneliness and anxiety and a consequence of the sexual behavior was the recurrence of symptoms and behaviors noted upon admission. The staff members were noted to become more self preoccupied and less involved with both staff and patients following the sexual behavior. The role of the ward psychiatrist in preventing such patient staff interactions includes his taking responsibility for educational and supervisory needs of the staff, his being involved in the creation and maintenance of the ward's moral code and his awareness of group and organizational factors that may impede open staff communications.

Acting Out↗
PubMed1977

Effects of lithium carbonate on motor activity in mania and depression.

A telemetered movement recording system and nursing ratings of behavior were utilized to assess spontaneous motor activity and symptom intensity of 15 patients with affective illness before and during lithium carbonate treatment. Prior to treatment, patients rated hyperactive-elated, angry, and agitated had more motor activity, and patients rated anergic and retarded had less motor activity. Lithium carbonate treatment was not associated with any uniform change in motor activity for all patients; however, patients with a decrease during treatment in thought disorder, motor agitation, and hyperactivity-elation had a decrease in motor activity, and patients who had a decrease in depressed mood, anergia, motor retardation, and social withdrawal had an increase in motor activity. The decrease in activity of manic patients, except for the 11 p.m. to 3 a.m. period of apparent sleep, appeared to occur fairly uniformly throughout the 24-hour period, but the increase in activity of the depressed patients occurred mostly during the daytime. The data indicate that lithium does not exert a strong and consistent direct effect on spontaneous motor movement, and that when changes in movement do occur, they relate to changes in clinical states.

Adult↗
PubMed1977

Thyroid function and growth hormone secretion in amitriptyline-treated depression.

The authors studied changes in indices of thyroid function prospectively in a group of 11 patients given amitriptyline to treat depression. The drug caused no significant alteration in these indices, but scores on the Hamilton Depression Rating Scale improved significantly. In another group of subjects with depression, the stimulation of growth hormone secretion by L-dopa was unaffected by amitriptyline therapy.

Adult↗
PubMed1977

[Spike discharges on stimulation with diffuse and patterned light in epileptic and non-epileptic patients (author's transl)].

The effects of photic stimulation with intermittent diffuse light and patterned flash were compared in 587 patients. The diagnosis of epilepsy was unquestionable in 216 patients and suspected in 150 cases while 221 patients had no evidence of epileptic attacks. None of these patients had a history of photosensitive epilepsy. A grid pattern with squares subtending 22' of arc was used in the first 28 patients while the following 379 patients were tested with a checkerboard pattern of corresponding size. In 51 cases generalized spikes or spike-waves and/or occipital spikes were obtained. These discharges were elicited by diffuse light as well as by patterned flash in 37 patients. 11 cases were insensitive to pattern. In 3 cases spike discharges were seen only with patterned light while diffuse light was without effect. The response consisted in 13 cases of generalized spikes and spike-waves. 12 of these had an unquestionable epilepsy. Occipital spikes only were seen in 38 patients; 22 of these suffered from epilepsy. Patterned light was in no case found to be more effective than diffuse light for eliciting generalized epileptic discharges. In the 3 cases where only patterned light produced spikes, these were restricted to occipital regions. As occipital spikes do not have the same significance for the diagnosis of epilepsy as generalized spikes the addition of patterned flash to diffuse light stimulation does not seem to be of great value.

Adolescent↗
PubMed1976

Utilization review, attempted suicide, and involuntary hospitalization.

A patient's refusal to participate in recommended treatment is a problem faced in all branches of medicine. However, psychiatry faces special problems because of its authority to impose hospitialization of suicide attempters, cases were identified where there was indepdent agreement between both the experts' standards and the treating resident psychiatrists that hospitalization was required. Despite this agreement, the patients were not hospitalized because the patients refused. By most criteria, these patients were a high risk group. They had made repeated suicide attempts, used lethal means which eventuated in serious medical consequences, and were still suicidal when referred for treatment. The emergency room psychiatrists reported feeling confused, anxious, and annoyed in dealing with these patients, and the patients signed out against medical advice. A review of these cases indicated that discussions of social control vs. medical responsibility and clear criteria for hospitalization should be incorporated into residency training programs since the emergency room resident faces these tension-producing issues frequently with several different types of patients. Moreover, utilization review criteria may help to set standards which will assist the psychiatrist in making these difficult decisions.

Adult↗
PubMed1976

CSF amine metabolites, clinical symptoms, and body movement in psychiatric patients.

The relationships between CSF monoamine metabolites (HVA and 5HIAA), nurses' ratings of clinical symptoms, and telemetered measures of motor movement of ten schizophrenic and ten depressed patients were investigated. There was a significant negative correlation between CSF 5HIAA and both agitation ratings and motor movement in the schizophrenics. CSF HVA correlated positively to anxiety and anger in the depressives. The schizophrenics had a significantly higher CSF HVA than the depressives which appeared unrelated to motor movement. The effects of serotonin turnover and arousal in schizophrenia and the association between CSF metabolite gradients, stress, motor movement, and biogenic amine levels in depression are discussed.

Adult↗
PubMed1975

Utilization review and suicide attempts. Exploring discrepancies between experts' criteria and clinical practice.

The discrepancies between experts' criteria for hospitalization of suicide attempters with actual clinical practice were explored to develop utilization review criteria which reflect current clinical thinking and which could form guidelines for the assessment of clinical care. Experts' criteria predicted that a hospitalized group of suicide attempters did not require hospitalization and that a nonhospitalized group of suicide attempters required hospitalization. Examination of the discrepancies between clinical practice and experts' criteria not only revealed that incorporation of clinical measures of depressive symptomatology could improve the experts' criteria for hospitalization but also showed that clinicians did not hospitalize a group of markedly symptomatic and socially impaired white suicide attempters. Clinician and patient factors that may have contributed to this decision making and the application of these findings for utilization review are discussed.

Adolescent↗
PubMed1975

Utilization review of treatment for suicide attempters.

The authors describe an effort to develop criteria for utilization review of treatment for suicide attempters. Explicit criteria proposed by a panel of experts as essential determinants for hospitalization of these patients were compared with actual clinical practice. It was found that according to the experts' criteria (which were operationalized into rating assessments), over half of the outpatient sample should have been hospitalized. After multiple regression analysis was carried out on the criteria, however, four predictors showed that only 20 percent of the outpatients should have been hospitalized. The authors discuss the issues these findings raise about the criteria of the experts, their utility for research, their validity, and their implications for utilization review.

Decision Making↗
PubMed1975

Utilization review of treatment of suicide attempters: chart review as patient care evaluation.

The authors reviewed the charts of 36 nonhospitalized suicide attempters who were identified by utilization review as requiring hospitalization. In 16 of the cases, the authors judged the treatment given to have been adequate because of an absence of a history of psychiatric treatment and/or the rapidity with which outpatient treatment was instiituted. Ten of the cases were judged to have been inadequately treated. This finding pointed to have been inadequately treated. This finding pointed to specific deficiencies in the training of residents and the delivery of psychiatric services and illustrates how chart review can be used to upgrade psychiatric care.

Adolescent↗
PubMedDate not supplied

Rehospitalization.

Explore the source record for details and available documents.

Adult↗