Relationships between psychology and psychiatry: the hidden issues.

The "… underlying bases of friction between professions of psychology and psychiatry" are explored. Friction emanating from psychiatry stems from the medical pretense of omniscience, an elevated regard for the M.D. degree, and the psychiatrist's position as "… low man on the medical totem pole." Activities of psychologists entering private practice represent "… an economic threat to psychiatrists." The "psychiatrist's theoretical dogmatism… can be attributed to lack of training and sophistication in the content and methods of psychology." Friction emanating from psychology stems from a claim to omniscience, an elevated regard for the degree in psychology, and psychologists trained in areas other than clinical becoming clinical psychologists "… by fiat alone… ." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychiatric will: II. Whose will is it anyway?

Reports that, in light of the present author's proposal of a "psychiatric will" (see record 1983-05532-001), P. S. Appelbaum (1979) has proposed an alternative solution to the involuntary commitment/patients' rights dilemma that would guarantee the psychiatrist's power to commit. Appelbaum's communication illustrates how the language of coercive psychiatry precludes the psychiatrist from formulating any other policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Defining the role of the consultant psychiatrist in a public mental health service

OBJECTIVE: The aim of this paper is to clarify elements of the role of a psychiatrist working in the public sector. METHOD: The relevant literature was examined to help clarify some of the reasons psychiatrists have been leaving the public sector and to help define the key roles of a psychiatrist working in the public sector. RESULTS: Two principal roles for the consultant psychiatrist in the public sector are identified: the psychiatrist as a clinician and the psychiatrist as a manager. The management role is contrasted with the role as an administrator and important differences between these roles are identified. The management role includes planning, advocacy and managing human resources. The importance of professional development in the career path for the newly qualified psychiatrist is discussed. CONCLUSIONS: The role of the psychiatrist in public sector psychiatry is a challenging and exciting one. Psychiatrists will start to return to the public sector when they recognise this new role for the consultant psychiatrist. This will be to the advantage of public sector psychiatry in general and to the job satisfaction of psychiatrists. The key features of the clinical role are the demonstration of sophisticated clinical skills, providing clinical leadership via supervision, being accountable for patient care and providing consultant opinion on complex clinical problems.     

Gypsum-bonded alumina dental investment for high-fusing casting

During the last 20 years family therapy has well been established as a supplementary or alternative therapy to individual therapy within child and adolescent psychiatry. Along with the further development and the change of concepts of family therapy there has been a greater interest in the interrelationship within the triad of patient-family-therapist, too. In the training of family therapists the meaning of the family of origin has been recognized. The implications of the therapeutic professional activities on the psychiatrist's family has not yet thoroughly considered, however. In the present paper the development and the characteristics of some main concepts of family therapy are described. Illustrated by a case report the influences of family oriented therapeutic activities over the therapist's family are presented. Finally the interrelationship between the patient's and the therapist's family are discussed as a constructive element of a mutual learning process.     

The ethics of tailoring the patient's chart

Because psychiatrists cannot include everything they observe and everything the patient says in the medical chart, they must select and tailor what goes into the chart. They should tailor the chart to focus on what is significant for the diagnosis and treatment of the patient. However, sometimes they tailor the chart for other purposes: to ensure that managed care will cover continued hospitalization, to protect themselves against malpractice claims, to secure a civil commitment, or to obtain a long-term placement for the patient. The authors of this paper present and analyze four cases in which psychiatrists tailor charts for these purposes. They discuss whether each psychiatrist's actions are ethically justified and consider whether tailoring the chart is a deceptive practice. In each case, they present reasons for and against this practice and suggest truthful alternatives designed to improve patient care, preserve social trust in the profession of psychiatry, and challenge serious failings in the health care system.     

Computerised diagnosis in acute psychiatry: validity of CIDI-Auto against routine clinical diagnosis

The validity of the self-administered CIDI-Auto for detecting ICD-10 diagnoses was assessed in a study of 126 patients admitted to an acute psychiatry unit. A comparison was made between the level of agreement of the CIDI-Auto with a psychiatrist and that between two psychiatrists. The CIDI-Auto generated an average of 2.3 diagnoses per subject, and the psychiatrists 1.3. Agreement measured by overall agreement and by Kappas between the CIDI-Auto and the psychiatrist's principal diagnosis was poor, whereas agreement between psychiatrists was good. At the level of general diagnostic class (e.g. substance use disorder, schizophrenic disorder, mood disorder), agreement between CIDI-Auto and psychiatrist on principal diagnosis was poor, Kappa = 0.23, while agreement between psychiatrists was good, Kappa = 0.69. The findings indicate that the self-administered CIDI-Auto has poor validity measured against clinical diagnosis for hospitalised patients of acute psychiatric services. Poor validity of computer-based diagnosis limits the diagnostic utility of these methods in clinical situations. It also creates uncertainty of diagnostic findings in survey use.     

Burnout: current knowledge and relevance to old age psychiatry

OBJECTIVES: To review the literature on burnout and consider its relevance to old age psychiatry and the role of the consultant. DATA SOURCES: Medline and PsychLit computerized databases. DATA SYNTHESIS: Burnout is a syndrome of emotional exhaustion, depersonalization and decreased sense of personal accomplishment which is recognized in people working in the human service professions and can have adverse effects on the workforce. There is little evidence of unique stressors related to care of elderly mentally ill people. Burnout is likely to be modified by workplace interventions. Relevant areas for intervention are political and social, organizational and management, training and personal issues. Support to consultants and their continuing professional development need to be radically reviewed.     

Face-to-face verbal interaction in school-based consultation: A review of the literature.

Reviews the school-based consultation research pertaining to face-to-face verbal interactions between a consultant and a consultee. Drawing from the counseling and psychotherapy literature, 2 types of research methodologies for studying face-to-face interaction are presented. The 1st type, termed content coding, categorizes the content of both consultant and consultee verbalizations and allows for an examination of the relationship between categories of consultee verbalizations as a function of various categories of consultant verbalizations. The 2nd methodology, relational coding, is more reflective of the relationship between participants and categorizes verbalizations relative to the content and intent of the message of the previous speaker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impression management: Patient perceptions of the efficacy of psychiatric self-presentation.

Studied the perceived efficacy of patients' attempts to influence discharge dates through psychiatric self-presentation as a function of the perceivers' own self-presentation inclinations and length of hospitalization. 40 male patients on an acute treatment ward and 40 on a chronic treatment ward heard 1 of 4 taped interviews on which an ostensible patient revealed that he planned to engage in either healthy or sick self-presentation and that the psychiatrist of this ostensible patient was either in favor of or opposed to discharge. Judgments about when the taped patient would be discharged were influenced by the taped patient's plans but not by his psychiatrist's opinion. Ss' chronicity but not self-presentation inclinations were related to their judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical management of anxiety disorders in psychiatric settings: Psychology's impact on evidence-based treatment of children and adults.

The role of psychologists in psychiatric settings has evolved over the past century from primarily conducting psychological evaluations to being the vital and integral link (sometimes the only such link) to the delivery of scientifically sound assessment and treatment methods. Consequently, the role of the psychologist, with respect to the scientist-practitioner model, has expanded to include collaborator with, consultant to, and teacher of our colleagues in psychiatry. In the integrated areas of research and treatment of anxiety disorders, psychologists have been at the forefront of developing, evaluating, and disseminating empirically supported methods for the range of these conditions in children, adolescents, and adults. Issues common to psychologists practicing in psychiatric settings are discussed in this article, specifically with reference to the tasks and issues encountered by the anxiety specialist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of consultants in the provision of psychological services to the university community.

Attempted to justify the provision of psychological services within the university community by consultation. In this context, 4 main issues are discussed. The recommendations of the Kirk Committee concerning the provision of consulting services to the university community are summarized. 5 views of the consultant task and consultant role models are presented. 2 role models for the university consultant, emphasizing the consultant as a facilitator of social integration and/or the consultant as a facilitator of appropriate action toward distressed individuals are recommended. (French summary) (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic community and new roles for clinical psychologists.

"The psychologist in the therapeutic community, as in many other settings, does formal class teaching with psychology interns, nurses, psychiatric technicians and other student and staff personnel in such subject areas as psychopathology and group psychotherapy and other group techniques. He also provides community education through talks to lay groups." The psychologist may have an administrative role; as a team member he may have the role of assistant team leader, or of acting team leader in the psychiatrist's absence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

Consultant as Confidant.

This article deals with something that is probably a common experience to every seasoned consultant but is rarely discussed in an academic journal. The authors are unaware of any research studies on the topic: the consultant as confidant. They discuss the role of the consultant as confidant through their personal experience and by bringing to bear consulting and other psychological literature. They also discuss why there is a need for consultants as confidants, the experience of being a confidant, violations of the role, and some guidelines for performing the role of confidant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Evaluation for Cost Estimators by Reliability Interval Method

Most consultant selection models stress the importance of past performance. However, there are so far very few studies on evaluating consultant’s performance. It hampers the whole process of the selection model. This paper tries to establish a systematic approach in developing a consultant’s performance evaluation model for the evaluation of the performance of cost estimators in the construction industry of Hong Kong. Nominal group technique is adopted in identifying the decision criteria for the evaluation, and a reliability interval method (RIM) is developed to assess the importance weighting of each criterion. The RIM allows statistical analysis and fuzzy assessment of the weight. The results report the weights of each decision criterion and its subcriterion in evaluating cost estimator’s performance. Interestingly, the results show that traditional functions of cost estimator are the least treasured from the clients. Proactive and professional advice is considered to be much more important. The study is highly relevant to industry practitioners in assessing performance of costs estimators, as well as to researchers in further developing the consultant selection model.     

How Canadian coordinators of graduate psychiatric education view psychologists.

Investigated the views toward psychologists as expressed by 16 Canadian coordinators of postgraduate education in psychiatry. The majority of Ss opposed psychologists holding senior administrative roles in departments of psychiatry and believed that psychologists should continue to be organized in divisions within departments of psychiatry. Considerable respect was evident for the clinical and academic skills that psychologists possess, and there was nearly unanimous support for psychologists holding academic appointments in departments of psychiatry. Most Ss approved of psychologists conducting psychotherapy as well as supervising psychiatric residents on psychotherapy cases and supported psychologists' involvement in the training of psychiatrists and vice versa. Views about eligibility of psychologists for senior administrative roles in psychiatry departments were related to views on other issues concerning psychologists. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variables affecting group mental health consultation for teachers.

Examined the contribution of consultant style and group environment to consultee attitude toward the consultant and toward group mental health consultation. Ss were 150 student teachers who participated in 10-wk consultation groups. Consultees completed a consultant-style questionnaire, a 90-item group environment scale, and 2 semantic differentials. Data analysis indicated that identifiable process variables do contribute significantly to consultee attitude toward the consultant and toward group mental health consultation. Specifically, 94% of the variance in attitude toward consultation and 60% of the variance in attitude toward consultant are explained by clusters of items representing consultant style and by group environment subscales. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)