The Psychiatric hospital最新文献

The authors describe three types of group psychotherapy settings on an adolescent service. The group setting which included all patients on the unit and employed multiple therapists and several nursing staff provided better communication, cohesiveness, and greater opportunity for staff training. Small groups provided comparatively more time for patient participation, less distraction, and better disclosure. Mixing patients from different units resulted in objective and keener observations by patients, but hall meetings became increasingly necessary to work out interpersonal issues among patients from the same unit. These observations by staff were confirmed by a patient questionnaire.

Since the early 1970s the federal government, private insurers, and employers have searched for ways to control health care costs. In 1972, Congress, dissatisfied with hospitals' utilization review efforts under the Medicare program created Professional Standards Review Organizations (PSROs). Ten years later when the Medicare reimbursement system underwent radical changes, the utilization review system remained more or less intact but had its name changed to Professional Review Organizations (PROs). The insurance industry has developed and employed, with varying levels of success, several cost-saving tactics, including deductibles and copayments for specialized care, limitation of benefits by diagnosis or facility type, exclusion of specific disorders, inclusion of dollar limits, pre-payment claims review for specific types of service, and post-payment review with retroactive denial of claims. Case management is the latest development in the ever-widening search to put a lid on health care costs. These attempts to measure the effectiveness of care vis a vis the dollar spent for it have been especially difficult for psychiatry, a less measurable science than other fields of medicine. Because psychiatry straddles the disciplines of sociology, psychology, and medicine, it is not easily understood. Inadequate documentation of care, a paucity of outcome studies, and confidentiality issues all combine to make utilization review particularly difficult in psychiatry. This paper will describe a collaboration between Blue Cross and Blue Shield of Maryland and four private psychiatric hospitals in the state that resulted in a workable, effective utilization review program acceptable to providers, payers, and patients.

In general hospitals, especially on acute medical-surgical, and general psychiatric units, geriatric patients are often exposed to attitudes of resentment or rejection. Individuals with treatable mental illnesses may be relatively neglected or dismissed as "senile," and their special needs not attended to. This tends to occur when the particular psychological issues of elderly patients are not shared by most of the other patients, and also when staff members are prejudiced about old people, either because of fear about their own aging or because of unresolved difficulties with parents or grandparents. The authors believe that age-specific geriatric units are the most effective treatment format for the elderly in need of psychiatric care. One example of such a unit opened in 1980, the Geriatric Psychiatry Unit currently in operation at the Johnston R. Bowman Health Center for the Elderly, a part of Rush-Presbyterian-St. Luke's Medical Center in Chicago, is described.

The staff reaction to the death from natural causes of a patient hospitalized on a psychiatric unit is described. The staff's response is conceptualized in terms of the stages of normal bereavement: denial, anger, depression, and resolution. Each stage is described and suggestions are given for its management. As with a suicide, a psychological autopsy can be conducted after a death from natural causes; an outline for such an autopsy is provided.

The authors used a large (n = 437) sample of depressed inpatients to determine if DSM-III criteria applied in a clinical setting defined distinct subgroups. Patients with diagnoses of depression, depression with melancholia, and depression with psychotic features were compared by age, sex, diagnoses (Axes I-V), treatment received, and treatment outcome. These data failed to support the DSM-III distinction between a melancholic and psychotic subtype. However, compared to other patients with major depression, patients with melancholic and/or psychotic features were: (a) older, (b) more likely female, and (c) more likely to be treated with somatic therapy.

This paper examines a predischarge group in a long-term adolescent psychiatric hospital as an arena for working through what might be called the fourth process of separation- individuation--the first being when the infant "hatches" from a symbiotic membrane to become an individuated toddler, the second in adolescence, and the third on admission to the psychiatric hospital.

Poor inter-rater reliability of the Strauss and Carpenter Outcome Criteria in hospital outcome study was attributed to lack of operational definition. A revision aimed at remedying this problem was used to rate a portion of the original sample of subjects. The revised form proved superior in interrater reliability for seven of the nine categories, suggesting that this more explicitly behavioral version may improve hospital outcome research.

As a part of a cooperative study of 79 psychiatric wards in 18 Veterans Administration hospitals with 12,000 resident patients, data were obtained on how staff members and patients address each other. It was found that first name usage by staff members and patients correlates with certain characteristics of psychiatric wards. Predominant first name usage tended to occur on wards with a high degree of patient autonomy, patient participation in discharge planning, nursing personnel wearing street clothes, etc. These characteristics are consonant with a particular ward model, namely that of a therapeutic community.