General hospital psychiatry
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Gen Hosp Psychiatry · Sep 1993
Case ReportsCrisis hospitalization on a psychiatric emergency service.
The availability of short-stay beds for brief admissions to a Psychiatric Emergency Service (PES) is a model that meets a variety of patient and system needs, allowing time to develop alternatives to hospitalization or gain diagnostic clarity, serving a respite function, providing a hospital setting that does not gratify dependency needs, and relieving inpatient census pressures. An eight-bed service for brief inpatient stays of up to 3 days was developed on a PES which serves a large nine-country catchment area in northeastern New York State. Admissions to this unit would otherwise have gone to a medical school teaching hospital psychiatric unit or a state psychiatric center. ⋯ The PD patients had a strong association with suicidality and some association with substance abuse, whereas the schizophrenics had more psychiatric symptomatology. PD patients were more likely to be discharged, leading us to propose a rationale for why this group may be uniquely suited to this approach. The study was replicated after a year on another sample of 51 consecutive admissions, confirming the earlier results and providing a 1-year follow-up on the program.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gen Hosp Psychiatry · Sep 1993
Case ReportsIs there a relationship between reflex sympathetic dystrophy and helplessness? Case reports and a hypothesis.
Five case reports that illustrate the possible contribution of psychological factors in the etiopathogenesis of reflex sympathetic dystrophy (RSD) are presented. All five patients at the time of physical trauma were confronted with a significant loss that either accidentally coincided with the trauma, or was related to the experience of the trauma itself. The patients' reaction to the loss was invariably characterized by helplessness. A biopsychosocial hypothesis which considers the possible role of psychophysiological and behavioral aspects of helplessness in the precipitation, maintenance, and/or enhancement of RSD is outlined.