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Biomedical subjects

S A Cohen-Cole

Publications and source records attributed to S A Cohen-Cole.

At least 19 recordsLinked to original sources
PubMed1995

An assessment of rates of psychiatric morbidity and functioning in HIV disease.

This study examined demography, rates of psychopathology, and functional impairment in HIV-seropositive women and men in a large, urban, public outpatient infectious disease clinic. Fifty-three percent of the women and 70% of the men met Structural Clinical Interview for DSM-III-R criteria for psychiatric disorders. Current mood disorders were the most frequent diagnoses, followed by psychoactive substance abuse/dependence disorders and psychotic disorders. Seventy-six percent of the women and 90% of the men had previous psychiatric histories, including 59% of the women and 55% of the men who had psychiatric histories prior to their knowledge of HIV seroconversion. Depressed subjects reported significant impairment in physical, social, and role functioning. Similarly, impairment in physical functioning was highly correlated with self-reported anxiety symptoms. These data suggest considerable past and current psychiatric comorbidity in HIV-infected individuals seeking medical care, and draw attention to the need for recognition and aggressive psychiatric treatment, particularly for those depressed and anxious patients with impaired functioning.

Activities of Daily Living↗
PubMed1994

The efficacy of intensive biopsychosocial teaching programs for residents: a review of the literature and guidelines for teaching.

OBJECTIVE: To review research evaluations of intensive biopsychosocial training programs for nonpsychiatry residents, and determine whether this research showed sufficient rigor and consistent beneficial impact to allow initial research-based teaching guidelines. DATA SOURCES: An English-language literature search used MEDLINE (1966-93), Psychological Abstracts (1967-93), and Educational Resource Information Clearinghouse (1966-93) as well as bibliographic reviews from prominent peer-reviewed articles and consultation with an expert. STUDY SELECTION: From among several hundred articles about biopsychosocial training, only 12 studies met the selection criteria: at least 100 contact hours of training for nonpsychiatry residents and an evaluation of efficacy. DATA EXTRACTION: The three authors independently assessed these 12 studies and made a consensus decision based on explicit criteria. Successful and unsuccessful programs were distinguished from among those classified as quasi-experimental or experimental to identify programs of sufficient rigor to meet the study objective; success was defined as learning beyond knowledge and residents' acceptance of teaching. DATA SYNTHESIS: Four successful quasi-experimental or experimental programs showed the following uniquely beneficial features: 1) protected time for residents; 2) teaching that was required, structured, multidimensional, and balanced between learner-centered and teacher-centered approaches; 3) teaching methods that used normal as well as psychosocially disturbed patients, nonpsychiatrist teachers, and special teaching techniques; and 4) inclusion in the curriculum of interviewing, interpersonal skills, doctor-patient relationship, and patient education. Two unsuccessful quasi-experimental or experimental programs were unidimensional and unstructured, and used predominant or isolated teacher-centered approaches. Features found in both successful and unsuccessful programs were experiential teaching, psychiatrist and other mental health professional teachers, use of disturbed patients, training to manage patients' psychosocial problems, teaching directed toward knowledge acquisition, teaching about treatment, and university affiliation. CONCLUSIONS: Four rigorously studied, successful programs showed a common pattern of intensive biopsychosocial teaching that produced, in aggregate, improvement in residents' knowledge, attitudes, skills, and self-awareness. Although there is need for more definitive research, these data are sufficiently compelling and consistent to provide initial, research-based teaching guidelines.

Curriculum↗
PubMed1993

Perspectives on patient-doctor communication.

Until recently, the content, structure, and function of communication between doctors and patients has received little attention and has been excluded from the realm of scientific inquiry; as a result, most clinicians have had little formal training in communication skills. In this paper leaders in doctor-patient communication present four approaches that are currently used as the basis for clinical training and research, summarize the progress made in forming a consensus, and outline the implications of these perceptions for practicing physicians.

Communication↗
PubMed1992

Terminal cardiomyopathy, splitting, and borderline personality organization.

A 63-year-old married man with idiopathic terminal cardiomyopathy was admitted to the medical service for treatment of advanced heart failure. A psychiatric consultation was requested to assist the medical treatment team in dealing with the patient's abusive behavior. The case is presented and discussed within the context of understanding the borderline personality in the medical setting.

Adaptation, Psychological↗
PubMed1987

Adrenoleukodystrophy: frequency of presentation as a psychiatric disorder.

Adrenoleukodystrophy (ALD) is an inheritable clinical disorder in which very long chain fatty acids accumulate in several tissue types. ALD is underrepresented in the psychiatric literature, although the disorder may cause an organic brain syndrome, often misdiagnosed as another psychiatric problem. A survey of 109 reported cases of ALD revealed that 39% presented with some psychiatric sign or symptom, whereas 17% presented exclusively as a psychiatric problem. A computed axial tomogram (CAT) head scan is recommended to rule out ALD in psychiatric patients suspected of having organic brain disease, as a characteristic image may be found in ALD patients who have brain involvement.

Adrenoleukodystrophy↗
PubMed1987

Major depression and physical illness. Special considerations in diagnosis and biologic treatment.

Major depression is a painful and debilitating condition that often occurs in association with severe physical illness. Accurate diagnosis is problematic because sadness is a frequent "normal" reaction to physical illness and because many other symptoms of depression, such as anorexia and fatigue, can also be caused by the physical illnesses themselves. We review the clinical research that helps to clarify these diagnostic issues and present guidelines for the diagnosis and biologic treatment of patients with concomitant major depression and physical illness.

Antidepressive Agents, Tricyclic↗
PubMed1986

Recent research developments in consultation-liaison psychiatry.

With the major changes in health care and general hospital practice in the last decade, practice and research in consultation and liaison psychiatry have also changed dramatically. The authors present a selected review of recent advances and implications for five important topics in consultation-liaison research: diagnosis, disease mechanisms, biologic treatments, health services, and psychosocial treatments for medical disorders.

Disease↗
PubMed1984

Teaching psychiatry to nonpsychiatrists: II. A model curriculum.

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists at varying levels of experience. Given the many problems involved in these educational efforts, as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically-validated educational principles may lead to greatly improved effectiveness. In the first section of a two-part series, the authors reviewed educational methodology as it relates to the development of objectives, the selection of teaching procedures, and the use of evaluation techniques. The present paper, part-two, describes in detail a "model" curriculum for primary care residents that was developed according to these principles of educational methodology.

Curriculum↗
PubMed1983

Teaching psychiatry to non-psychiatrists: I. The application of educational methodology.

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists, at varying levels of experience. Given the many problems involved in these educational efforts as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically validated educational principles may lead to greatly improved effectiveness. In this first section of a two-part series, the authors review educational methodology as it relates to the development of training objectives, the selection of teaching procedures, and the use of evaluation techniques. Part two presents a detailed "model" curriculum for primary care residents, developed according to the principles of educational methodology.

Attitude of Health Personnel↗
PubMed1982

An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline.

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.

Adult↗
PubMed1982

Attitudes of nonpsychiatric physicians toward psychiatric consultation.

The authors report on an opinion survey of 200 nonpsychiatric attending physicians at a university teaching hospital about the process and outcome of consultation psychiatry. Over-all, physicians felt that 37 per cent of their patients had problems with significant psychological components, but that consultation was indicated for only 11 per cent. Physicians reported a high level of global satisfaction with consultations; 68 per cent were satisfied frequently or almost always. Factor analysis reduced consultees' evaluations of 18 different consultation activities to five dimensions, with patient disposition considered the most important and services to medical and ward staff the least important. Analysis of differences by specialty revealed that family medicine physicians seemed the most oriented to psychological issues and surgeons the least.

Attitude of Health Personnel↗