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Biomedical subjects

T B Mackenzie

Publications and source records attributed to T B Mackenzie.

At least 37 records · Page 2Linked to original sources
PubMed1987

Suicide in the medical patient.

According to the statistical abstract of the United States for 1982-1983, there were 1,913,800 deaths in the United States in 1979. Twenty-seven thousand, or 1.4 percent of those deaths were by suicide, yielding a suicide rate of 11.9/100,000/year. The rate was highest (39.2/100,000) for white males sixty-five years and over and lowest (0.1/100,000) for black females between five and fourteen years. It is generally accepted that physical illness is a risk factor for suicide. If this is true, then in caring for persons with significant physical illness, physicians are dealing with a population at increased risk of suicide. In its opening section, this article will review the evidence that points to a positive correlation between suicide and physical illness. Next the association between specific illnesses, such as peptic ulcer and cancer, and suicide will be examined. Third, risk factors associated with the occurrence of suicide in medical-surgical hospitals will be reviewed. Fourth, the occurrence of suicide in relationship to medical procedures will be discussed. Fifth, the evaluation and management of suicidal patients in medical settings will be briefly considered. This review will not consider the relationship between physical illness and attempted suicide.

Adult↗
PubMed1987

Obsessive-compulsive disorder exacerbated during pregnancy: a case report.

An established obsessive compulsive disorder (OCD) in a twenty-six-year-old woman, characterized by obsessional fear of rat germs and ritualistic cleansing, was observed to worsen during pregnancy. The patient's OCD had followed a fluctuating course for three years but she had not previously experienced a decompensation of such duration and severity. During her pregnancy she became depressed and suicidal, was unable to care for her family and spent the majority of her confinement in the hospital. Several mechanisms are discussed which might explain the exacerbation.

Adult↗
PubMed1985

The outcome of antidepressant use in the medically ill.

To examine the feasibility of using antidepressant medication to treat major depressive syndromes in the hospitalized medically ill, we reviewed a series of psychiatric consultations meeting the following criteria: the consultant diagnosed a major depressive syndrome, treatment with an antidepressant was advised, the consultee initiated the antidepressant, and hospitalization had been prompted by a major medical illness. The final sample of 50 consultations, representing less than 5% of the case reviewed, was assessed by retrospective study of entries in the medical record. Judgments regarding response were thus a function of routine clinical observation and care. Drugs were not randomly assigned; rather, the choices represented ongoing clinical usage patterns. Two major points emerge from the data of the study. First, 32% of the trials were terminated due to side effects judged to be unacceptable by the physicians or consultants. Delirium accounted for half of such side effects; cardiotoxicity, however, was not evident. Second, only 40% of patients with medical illnesses, including malignant neoplasm, insulin-dependent diabetes, and epilepsy, responded to treatment. The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder.

Adult↗
PubMed1985

Data-based psychiatric consultation: applying mainframe computer capability to consultation.

Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.

Computers↗
PubMed1985

Pedagogic applications of a computerized data base.

The educational experience of medical students taking a 6-week clerkship in consultation psychiatry was augmented by clinical simulations. Using a microcomputer program and a video-display terminal the students are confronted with an actual case and asked to make specific recommendations. The program records their answers and then indicates what the consultant actually did. This method broadens the student's clinical exposure, provides prompt feedback, frees staff to supervise live patient contact, and offers the possibility of sharing clinical problems with other centers.

Aged↗
PubMed1984

Psychiatric consultation to geriatric medically ill inpatients in a university hospital.

Using hospital admissions data, medical records, and the Consultation-Liaison Outcome Evaluation System, we studied psychiatric consultation to hospitalized medical-surgical patients who were aged 60 years or older. In comparison with younger patients, the geriatric population was less often referred for psychiatric consultation. Those referred had less prior psychiatric history than the group aged less than 60 years. They received a different distribution of psychiatric diagnoses. Consultants recommended psychotropic medication and diagnostic actions more often for the elderly; the former was related to the presence of organic mental disorder. Concordance with consultants' recommendations and diagnoses did not vary with patients' age. Certain aspects of the consultation process are thus modified when geriatric patients are involved, and specific features of "geriatric consultation" are unique.

Age Factors↗
PubMed1983

Consultation-Liaison outcome evaluation system. I. Consultant-consultee interaction.

The Consultation-Liaison Outcome Evaluation System characterizes the effectiveness of consultative activities. The initial phase of the system identifies consultees' responses to psychiatric consultants' recommendations and diagnoses and the variables critical to concordance with the use of quantitative measures. The observed incidence and concordance rates of the consultant-consultee interaction were integrated (1) to establish a concordance hierarchy clarifying consultees' priorities in seeking psychiatric consultation, (2) to provide reference points to guide psychiatric consultants' clinical actions, (3) to establish tentative standards with which to evaluate the effectiveness of psychiatric consultation, and (4) to signal the need for further outcome studies and the development of data-based consultation practices.

Clinical Competence↗
PubMed1983

Consultation outcomes. The psychiatrist as consultee.

The frequent coexistence of psychiatric and medical illness supports the need for excellent medical care on inpatient psychiatric services. Effective use of consultation is an important element in ensuring this care. In our study of medical-surgical consultation to an inpatient psychiatric service during a two-year period, outcome variables, such as frequency of and concordance with drug and diagnostic action recommendations, were determined and compared with similar data for psychiatric consultations to medical-surgical services. Thirty-eight percent of cases received a consultation. Patients seen by a consultant had a longer hospital stay. Twenty-seven and forty-six percent of consultantions contained a drug or a diagnostic action recommendation, respectively. The concordance of psychiatric consultees was 79% for drugs and 75% for diagnostic action recommendations. Comparison with medical-surgical consultations done by psychiatric consultants revealed important important differences and similarities.

Adult↗
PubMed1983

The initial patient interview. Identifying when psychosocial factors are at work.

Timely identification of psychosocial factors is crucial to the diagnosis and treatment of all patients. Identification depends on the use of interview techniques that maximize the patient's opportunity to raise psychosocial concerns. In addition to recognition of psychosocial factors, management of "difficult" patients requires identification of their unstated demands and a capacity to respond in a neutral, rational manner.

Attitude of Health Personnel↗
PubMed1983

Organic anxiety syndrome.

DSM-III defines and offers diagnostic criteria for organic affective, organic delusional, and organic personality syndromes but provides no organic personality syndromes but provides no organic equivalent for anxiety disorders. Nevertheless, symptoms of anxiety characterize such conditions as hyperthyroidism and pheochromocytoma. The authors define and formulate diagnostic criteria for an organic anxiety syndrome and discuss the theoretical and therapeutic implications.

Adrenal Gland Neoplasms↗
PubMed1983

When psychiatrists are liable: risk management and violent patients.

In an era of rapid discharge and community treatment, psychiatrists must assess, with insufficient information, their patients' potential for committing a violent act outside of the hospital every time they authorize a pass or a discharge. The authors review court decisions on prediction of dangerousness and research data on the risk of homicide, assault, and suicide among released mental patients. They then discuss a risk-management approach to decision-making that consists of three components--risk assessment, risk evaluation, and risk reduction. The authors also provide a decision table that clinicians can use to identify factors that suggest a high risk of violence in a patient's current status, history, and treatment response.

Financial Management↗
PubMed1983

Clinical applications of DSM-III in consultation-liaison psychiatry.

The authors examine the clinical application of DSM-III from the perspective of the consultation-liaison psychiatrist. They discuss contributions of DSM-III that have refined psychiatric diagnosis in medical-surgical settings, including the multiaxial system, a broader approach to the organic mental disorders, introduction of the category of psychological factors affecting physical condition, and an improved classification of disorders that present with physical symptoms. However, some areas of continuing ambiguity remain, such as how much discretion a clinician has to discount somatic symptoms related to physical illness in the diagnosis of depression, the implications of exempting bereavement from diagnostic status, and uncertainty about what constitutes evidence of an etiological relationship.

Diagnosis, Differential↗