The Psychiatric quarterly
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The Psychiatric quarterly · Jan 1995
Clinical and administrative consequences of a reduced census on a psychiatric intensive care unit.
The Psychiatric Intensive Care Unit at the FDR VA Hospital is a specialized ward designed to assess and treat suicidal and assaultive patients. Since its creation in 1983, over 1600 admissions have taken place. The authors have previously reported that patients referred for aggressive behavior had a statistically significant higher recidivism rate, as well as a statistically significant longer length of stay. ⋯ When the census cap was decreased, the referral pattern changed and the patients were even more likely to be aggressive. Length of stay decreased dramatically leading to a unit with a significantly higher turnover rate. Clinical and administrative concerns are also discussed.
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The Psychiatric quarterly · Jan 1992
Review Case ReportsTailoring adult psychiatric practices to the field of geriatrics.
The United States' population is aging. Epidemiological surveys suggest significant rates of mental illness amongst the rapidly growing over-65 cohort. ⋯ This article synthesizes key issues and concepts as an introduction to geropsychiatric practice-in particular, a) the interface between medical illness and psychiatric expression in the elderly, b) delirium, c) dementia, and d) depression-and considers their interactions. Finally, there is a brief overview of geriatric psychopharmacology, followed by clinically-oriented discussions of each of the major classes of psychotropics as applied to a geriatric population.
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The Psychiatric quarterly · Jan 1992
Historical ArticleSystems ethics and the history of medical ethics.
This paper reviews the current conclusions in medical ethics which have followed the 1969-1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thinking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. ⋯ The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and "political correctness" in medical ethics.
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Since 1950, between three and ten percent of American medical school graduates selected psychiatric careers. Until 1989, the direction of the ratio of medical school applicants to acceptance was the best predictor for medical school graduates entering psychiatry; a declining ratio predicts more students become psychiatrists. ⋯ In an attempt to understand the historical context of these trends and suggest implications and actions for the next decade, this paper presents data on the psychiatric career choice of U. S. medical school graduates beginning with the medical school graduates of 1950.
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The oft-quoted aphorism that "laughter is the best medicine" is examined. Specifically, three big drops in the shower of claims regarding the benefits of humor in treating physical and mental disorders are evaluated. First, studies of the effects of mirth and laughter on the physiology of the body reveal both good and bad news. ⋯ The type of patient, the kind of humor, the type and severity of illness, the psychosocial contexts-all of these factors should be considered. Third, the infusion of humor into psychotherapy is great news for some therapists and awful news for others. A number of more balanced approaches point up the probability that when mirth is incorporated into therapy judiciously, appropriately, and meaningfully it can be of value.