Consultation-liaison psychiatry: past failures and new opportunities.

The frequency of suicide among physicians in the United States over the 5 1/2-year period March 1965 to August 1970 was studied. Suicides and possible suicides were identified through the obituary listings inJAMA. Confirmation of suicide was attempted for equivocal cases where possible. Within this time period, 530 deaths by suicide were identified, 489 in men and 41 in women. Analysis indicated that the rate in male physicians was approximately 1.15 times that of the overall male population, whereas for female physicians the rate was fully three times that expected on the basis of population values. For physicians 45 years of age and over, suicide rates were somewhat higher for men. Below that age, there was a marked excess among the women. Twelve of the 41 women were in training. The findings are consistent with reports of high rates of suicide among females in other professions. (JAMA228:323-328, 1974)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=353834&pdfFileName=jama_228_3_025.pdf

Suicide in male and female physicians

Consultation-Liaison Psychiatry

Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India. Aims: Translation and validation of the brief patient health questionnaire (BPHQ) as a screening tool for depression in major Indian languages. Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD) as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods. Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil. Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.

/pdf/translation-and-validation-of-brief-patient-health-4loy0khxxu.pdf

Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients

The character of danger

Varied Needs of Primary Physicians for Psychiatric Resources

The authors discuss the transference and countertransference reactions characteristic of a mental health service in a health maintenance organization Among the transference issues considered of greatest interest are responses to payment premium rather than fee-for-service; attitudes toward the limited duration of treatment and the circumscribed return-to-function goals; reactions to the therapist and to the HMO as authorities; and the effects of being a clinic patient on one's self-image The countertransference issues considered most significant include reactions by the therapist to being salaried rather than receiving fees for service; responses to self-exposure, peer review, and quality control; and alterations of the therapist's self-image related to such factors as his value system, cultural milieu, and therapeutic orientation

Transference and Countertransference in a Third-Party Payment System (HMO)

Varied needs of primary physicians for psychiatric resources. II. (Subjective factors).

720 primary (nonpsychiatrist) physicians responded to a mail distributed questionnaire investigating their attitudes to and practices with psychiatric education, psychiatrists and emotionally disturbed patients. Respondents were divided into two groups on the basis of whether or not they had attended postgraduate courses in psychiatry. Outstanding characteristics of the physicians who had taken courses compared to those who had not were: 1) a higher percentage in general practice than in a specialty, 2) greater confidence in their own psychiatric diagnostic and therapeutic skills, 3) higher estimates of psychiatric disorders in their practices, 4) more willingness to treat emotionally disturbed patients, including aftercare patients, 5) more competent use of psychoactive drugs for depression and schizophrenia, 6) greater interest in psychiatry, 7) stronger subjective needs for help with the management of their disturbed patients, and 8) higher frequency of personal psychotherapy. The two groups did not differ in: 1) evaluations of their previous educational experiences in psychiatry, 2) the hours per week devoted to medical practice, or the number of patients seen per day, 3) indications for intervention or preferred modes of treatment with psychiatric cases, 4) attitudes towards the usefulness of psychiatry, 5) frequency of making psychiatric referrals, and 6) skill with psychoactive drugs for anxiety.

Characteristics of physicians interested in psychiatric education.

A questionnaire investigating their attitudes and practices toward emotionally disturbed patients was responded to by 1,156 primary physicians. Respondents were subdivided into two groups according to whether or not they had undergone personal psychotherapy. The outstanding characteristics of the treated as compared to the untreated physicians were: (1) greater interest expressed in psychiatry; (2) more positive attitudes regarding psychotherapy; (3) greater confidence in their psychiatric-diagnostic skills; (4) higher rates of psychiatric diagnoses; (5) preference for nonauthoritarian approaches with their disturbed patients; and (6) higher attendance at postgraduate courses in psychiatry. Interestingly, the two groups did not differ in (1) the frequency or ease with which they undertook the management of their disturbed patients; (2) their desire for help in handling these patients; or (3) the frequency of referrals they made for psychiatric treatment.

Esther Haar

Papers

Varied Needs of Primary Physicians for Psychiatric Resources

Transference and Countertransference in a Third-Party Payment System (HMO)

Varied needs of primary physicians for psychiatric resources. II. (Subjective factors).

Characteristics of physicians interested in psychiatric education.

Characteristics of Physicians Who Have Had Psychotherapy