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Psychiatric consultations and ethics consultations - Similarities and differences

GENERAL HOSPITAL PSYCHIATRY 2000年第4期22卷 270-275页

作者： Leeman, CP Suny Downstate Med Ctr Dept Psychiat Brooklyn NY 11203 USA Suny Downstate Med Ctr Div Humanities Med Brooklyn NY 11203 USA

Although consultation-liaison psychiatry and clinical ethics both developed largely in response to the problems engendered try the new medical technology and the dilution of the traditional doctor-patient relationship, they represent distinct fields that rely on different, but overlapping, domains of expertise. To be effective, ethics consultants often need to augment their own background with psychiatric knowledge and skills. Consultation-liaison psychiatrists are well prepared to contribute to clinical Ethics but cannot serve effectively as ethics consultants without additional education and training. Several case examples are presented to elucidate these points and to illustrate the similarities and differences between psychiatric consultations and ethics consultations. (C) 2000 Elsevier Science Inc.

关键词：伦理学医学精神卫生服务/立法和法学精神卫生服务/标准医生病人关系精神病学/立法和法学精神病学/标准转诊和会诊美国老年人女(雌)性人类中年人

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A preliminary study of staff perception of psychiatric services in general hospitals

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GENERAL HOSPITAL PSYCHIATRY 1999年第1期21卷 57-61页

作者： Ito, H Kishi, Y Kurosawa, H Minist Hlth & Welf Natl Inst Hlth Serv Management Dept Hlth Care Econ Shinjuku Ku Tokyo 1620052 Japan Nippon Med Sch Dept Neuropsychiat Tokyo Japan

There has been increasing recognition of the importance of integrating physical and psychiatric cave under growing economic pressure. We conducted a survey of staff perception on psychiatric services in four general hospitals. The purpose of this study was to see differences among the staff in their recognition and expectation of the role of the psychiatric department and the need for psychiatric and other staff to work more closely together. Although 81% of psychiatrists recognized their role in acute psychiatry, only 42.6% thought that acute psychiatry was the most important role of psychiatry. Mooed disorders were recognized as a psychiatric category in 95.2% of psychiatrists and 54.8% of nonpsychiatrist physicians. Overall satisfaction with psychiatric services in psychiatric and other staff were 54.0% and 68.2%, respectively. Although 85.7% of psychiatrists answered that they supported staff in other departments that have psychiatric or psychological problems, only 53.5% of those staff in other departments were satisfied with their support. Staff in other departments expected psychiatric staff to establish consultation hotlines and to visit other departments regularly. Our results suggest that there are discrepancies between psychiatric and other staff in their perception of psychiatric services, and it is our belief that those gaps must be bridged for better collaboration in general hospitals. (C) 1999 Elsevier Science Inc.

关键词：医务工作者的态度卡方分布卫生保健提供联合/标准卫生保健调查医院综合/组织和管理职业间关系日本精神障碍/分类精神障碍/诊断精神障碍/心理学精神障碍/治疗精神卫生服务/组织和管理精神卫生服务/标准人员医院/心理学精神病科医院/组织和管理精神病科医院/标准精神病学/方法精神病学/标准人类

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Health promotion information: Sources and significance for those with serious and persistent mental illness

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ARCHIVES OF PSYCHIATRIC NURSING 2002年第6期16卷 263-274页

作者： MacHaffie, S Univ Washington Seattle WA 98195 USA

For 19 sources of health promotion information 41 adult outpatients with severe and persistent mental illness (SPMI) indicated by questionnaire how much information they received from each source and their opinion of its reliability. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists provided the most health promotion information and were regarded as the most reliable sources. Nurses and pharmacist were seen as providing more, and media and print sources as providing less, information than in similar studies of nonmentally ill samples. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists are significant sources of health promotion information for persons with SPMI - perhaps even more so than for those with no mental illness. Copyright 2002, Elsevier Science (USA). All rights reserved.

关键词：健康态度慢性病健康促进/方法健康促进/标准卫生服务易得程度/标准精神障碍/心理学精神病护理学/标准精神病学/标准问卷调查疾病严重程度指数华盛顿成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Diagnosis of depression by primary care physicians versus a structured diagnostic interview - Understanding discordance

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GENERAL HOSPITAL PSYCHIATRY 1999年第2期21卷 87-96页

作者： Tiemens, BG VonKorff, M Lin, EHB Univ Groningen Dept Psychiat NL-9700 RB Groningen Netherlands Grp Hlth Cooperat Puget Sound Ctr Hlth Studies Seattle WA 98101 USA

In this paper, false-negative and false-positive cases of depressive illness are examined, differentiating levels of disagreement between a primary care physician's diagnosis and a standardized research diagnosis. Two stratified random samples of primary cave patients in Seattle, USA (N = 373) and Groningen, The Netherlands (N = 340) were examined with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC). Physician's severity ratings and diagnosis of psychological disorder were obtained. Three levels of disagreement between physician and CIDI diagnosis were distinguished: 1) complete disagreement about the presence of psychiatric symptoms (true false-negative and true false-positive patients);2) disagreement over severity of recognized psychological illness (underestimated or overestimated);and 3) disagreement over the specific psychiatric diagnosis among those given a diagnosis (misdiagnosed or given another CIDI diagnosis). All three levels of disagreement were common. Only 27% of the false-negative cases were due to complete disagreement (true false-negatives), and 55% of the false positives were due to complete disagreement (true false-positives). The true false-negative patients were younger, more often employed, rated their own health more favorably, visited their doctor for a somatic complaint and made fewer visits than the underestimated, misdiagnosed, and concordant positive patients. Complete disagreement in depressive diagnoses between the primary care physician and research interview is not as frequent as indicated by an undifferentiated false-negative/false-positive false-positive analysis. Differentiating levels of disagreement does move justice to diagnostic practice in primary care and provides guidance on how to improve the diagnostic accuracy of primary cave physicians. (C) 1999 Elsevier Science Inc.

关键词：卡方分布抑郁/诊断抑郁/流行病学诊断鉴别假阴性反应假阳性反应卫生保健调查门诊病人/统计学和数值数据患病率初级卫生保健/标准初级卫生保健/统计学和数值数据精神病学/标准危险因素抽样研究疾病严重程度指数单盲法成年人女(雌)性人类男(雄)性中年人

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Health and society in the 21st century

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY 2000年第5期34卷 715-718页

作者： Larkins, R Univ Melbourne Fac Med Dent & Hlth Sci Parkville Vic 3010 Australia

Presents the transcript of the College Address delivered during the Annual Congress of the Royal Australian and New Zealand College of Psychiatrists in Adelaide, South Australia on April 27, 2000. Treatment of degenerative diseases of the brain; Impact of changes in the political and economic structure on the delivery of education and health; Consequences of free markets in health care.

关键词：澳大利亚生物技术/发展趋势卫生保健提供/经济学卫生保健提供/发展趋势预测卫生政策国家卫生规划/经济学国家卫生规划/标准新西兰精神病学/经济学精神病学/标准精神病学/发展趋势社会变迁美国人类

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On clinical trials in psychiatry

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BIOLOGICAL PSYCHIATRY 2000年第6期48卷 433-435页

作者： Greenhouse, JB Carnegie Mellon Univ Dept Stat Pittsburgh PA 15213 USA

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Psychiatrists' views of managed care and the future of psychiatry

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GENERAL HOSPITAL PSYCHIATRY 2000年第2期22卷 97-106页

作者： Regestein, QR Brigham & Womens Hosp Dept Med Div Psychiat Boston MA 02115 USA

Managed care aims to insure the health of a population rather than that of an individual. This paper compiles opinions of psychiatrists and others on managed care and lists ways managed cave potentially affects psychiatry. Managed cave reverses the economic incentives indemnity insurance gave doctors to prolong treatment. It encourages psychiatrists to spend less rime on empathic discussion and to tl:je move standardized, less costly treatments. Many psychiatrists feel distressed about how managed care has changed their practices. Capitation care will change it further. Current trends suggest the U.S. will use and train fewer psychiatrists. Psychiatrists will spend less time with individual patients and more tin-re planning and guiding the treatment of severely impaired patients. Many more psychiatrists will likely have unprecedented changes imposed on their careers. (C) 2000 Elsevier Science Inc.

关键词：伦理学医学管理医疗规划/经济学管理医疗规划/组织和管理管理医疗规划/发展趋势精神卫生服务/经济学精神卫生服务/立法和法学精神卫生服务/组织和管理精神病学/经济学精神病学/教育精神病学/组织和管理精神病学/标准精神病学/发展趋势舆论美国人类

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Depression and the right to die

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GENERAL HOSPITAL PSYCHIATRY 1999年第2期21卷 112-115页

作者： Leeman, CP SUNY Hlth Sci Ctr Dept Psychiat Brooklyn NY 11203 USA SUNY Hlth Sci Ctr Div Humanities Med Brooklyn NY 11203 USA

There is a complex relationship between depression and the capacity to forgo life-sustaining treatment. On the one hand, the courts have recognized a constitutionally protected right to die for competent persons;on the other hand, psychiatrists have tended toward the presumption of incompetence on the part of anyone who refuses lifesaving treatment. This traditional psychiatric viewpoint stems from experience with many patients whose wish to die disappears when their depression is successfully treated. (C) 1999 Elsevier Science Inc.

关键词：对死亡的态度决策抑郁/心理学安乐死/立法和法学安乐死/心理学生命支持疗法/心理学生命支持疗法/标准精神能力医生病人关系精神病学/标准转诊和会诊/标准死的权利/立法和法学自杀/心理学成年人女(雌)性人类男(雄)性中年人

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Variations in psychiatric practice - Neither unacceptable nor unavoidable, only under-researched

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BRITISH JOURNAL OF PSYCHIATRY 1999年第4期175卷 303-305页

作者： Gilbody, S House, A Univ York NHS Ctr Reviews & Disseminat York YO10 5DD N Yorkshire England Univ Leeds Div Psychiat & Behav Sci Leeds LS2 9JT W Yorkshire England

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An evaluation of an Australian videoconferencing project for child and adolescent telepsychiatry

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 21-23页

作者： Gelber, H Alexander, M Royal Childrens Hosp Mental Serv Melbourne Vic 3031 Australia

A user satisfaction survey of videoconferencing services for child and adolescent mental health was carried out over a two-year period in Victoria, Australia. The aims of the survey were to evaluate key utilization areas, effect on professional practice, and advantages and disadvantages of the videoconferencing service. Eighty questionnaires were sent out and 58 (73%) were returned. Consultations were reported as the most frequent use of videoconferencing equipment (62%), followed by clinical use (59%), supervision (36%), teaching (19%) and administration (14%). Fifty-seven per cent of respondents reported that videoconferencing had affected professional practice. Advantages of the services included cost savings (52%) while disadvantages included technological problems (40%). The findings show the benefits of videoconferencing for improving the delivery of mental health care in rural Australia.

关键词：成本及成本分析设备失效评价研究病人满意度精神病学/经济学精神病学/标准农村人口远程医学/经济学远程医学/标准维多利亚青少年儿童人类

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