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6 results

  • Undervalued and overlooked: the importance of private space in liaison psychiatry

  • James Booker, Victoria Cleak
  • Journal:
    BJPsych Advances / Volume 29 / Issue 6 / November 2023
    Published online by Cambridge University Press:
    07 July 2022, pp. 393-395
    Print publication:
    November 2023
    • Article
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  • Access to private space for psychiatric assessments is crucial to facilitate the effective gathering of salient information while preserving the dignity of patients. In this article, we discuss the current availability of private space for liaison psychiatry services on in-patient wards in general hospitals and reflect on how this affects communication with patients. Additionally, we propose solutions for healthcare trusts in addressing this issue.

  • Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion

  • Mary F. Wyman, Erin M. Jonaitis, Earlise C. Ward, Megan Zuelsdorff, Carey E. Gleason
  • Journal:
    International Psychogeriatrics / Volume 32 / Issue 3 / March 2020
    Published online by Cambridge University Press:
    28 August 2019, pp. 393-405
  • Objectives:

    We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression.

    Design:

    We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression.

    Setting:

    Lower-income neighborhoods in a Midwestern city.

    Participants:

    411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening.

    Measurements:

    SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors.

    Results:

    Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression.

    Conclusions:

    Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.

  • 8 - Assessment and management of medical-surgical disaster casualties

  • from Part III - Clinical care and interventions
    • By R. James Rundell, Professor of Psychiatry Mayo Clinic College of Medicine 200 First Street, SW, West 11 Rochester, MN 55905, USA
  • Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
  • Book:
    Textbook of Disaster Psychiatry
    Published online:
    09 August 2009
    Print publication:
    01 November 2007, pp 164-189

  • Summary

    This chapter identifies how postdisaster patient triage and management can incorporate behavioral/psychiatric assessment and treatment, merging behavioral and medical approaches in the differential diagnosis and early management of common psychiatric syndromes among medical-surgical disaster or terrorism casualties. A postdisaster screening examination to triage and identify early psychiatric casualties can be thought of as a tertiary survey that focuses on the most common psychiatric sequelae. Government and organizational responses play an important role in limiting psychological contagion and may help to lessen overburdening of the healthcare system after a terrorist event or disaster. In a postdisaster hospital or hospice setting, depression is common. The utility of antidepressant medications is limited by the several weeks needed for the agents to be effective. Careful management of the public education and risk communication aspects of disaster and terrorism has multiplier effects in terms of preventing inappropriate and costly utilization of healthcare resources.

  • 5 - Detection of psychiatric disorders in the general hospital

  • from Part I - Basic skills
  • Edited by Geoffrey Lloyd, Priory Hospital, London, Elspeth Guthrie, University of Manchester
  • Book:
    Handbook of Liaison Psychiatry
    Published online:
    10 December 2009
    Print publication:
    24 May 2007, pp 83-101

  • Summary

    Trainees in liaison psychiatry are frequently surprised to find that the detection and management of psychiatric disorders in the general hospital is a complex and time-consuming process. This chapter considers those aspects of psychiatric assessment that are unique to the general hospital, and offers guidance on the assessment of the most prevalent psychiatric symptoms. The assessment process starts as soon as the referral is received. Ideally, the referral should ask a specific question about a patient's psychological health, or ask for guidance on the psychological components of a more complex management problem. Many referrals to liaison psychiatry services are for patients in whom depression or anxiety are suspected. Physical illness is a predictor of completed suicide, so that an assessment of risk should form part of every patient evaluation. Rating scales can supplement information obtained during clinical interviews, whilst assessing medically ill patients.

  • Combining psychiatric and psychological approaches in the inpatient assessment of aggression in a client with moderate intellectual disability

  • Ian M Grey, Brian McClean, Leena Kulkarni, John Hillery
  • Journal:
    Irish Journal of Psychological Medicine / Volume 20 / Issue 3 / September 2003
    Published online by Cambridge University Press:
    13 June 2014, pp. 91-95
    Print publication:
    September 2003

  • The literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.

  • Substance use history taking by trainee psychiatrists: “There is a tide in the affairs of men…”

  • Alistair Grandison, Hugh Williams, Adenekan Oyefeso, Luiz Dratcu
  • Journal:
    Irish Journal of Psychological Medicine / Volume 18 / Issue 1 / March 2001
    Published online by Cambridge University Press:
    13 June 2014, pp. 24-26
    Print publication:
    March 2001

  • Objectives: To investigate the extent and quality of substance use history taking by trainee psychiatrists.

    Method: A retrospective clinical casenote audit of admissions to an acute inner city psychiatric unit during three randomly selected months. Data on substance use history taking was recorded by means of a specially designed study checklist.

    Results: In almost three-quarters (45, 73%) of admission episodes trainee psychiatrists had made some mention of substance misuse. However, substance use history taking often occurred subsequent to the initial clinical assessment and varied greatly in quality.

    Conclusions: The need for a brief, standardised substance use screening questionnaire, easily incorporated into the existing psychiatric interview format is highlighted.