Guide to CAT scanning in hospital psychiatry. Overview of clinical practice and criteria for use.

Advances in imaging techniques have resulted in increasing use of computed axial tomography (CAT) in clinical psychiatry. Treatable brain lesions predominantly manifesting as emotional and behavioral symptoms can be detected with relative ease and safety by CAT scanning. Criteria to select these high-risk psychiatric patients for CAT exam are vague and sparse compared to more abundant guidelines for scanning neurologic and medical patients with focal signs of physical abnormality. The few existing surveys of inpatient psychiatry CAT scanning reveal a 65-70% range of normal findings. As more and more patients are scanned, such an obviously large group of "normals" should not be exposed to current CAT exam costs and risks; at the same time, it is necessary to ensure that those psychiatric patients warranting the procedure are not neglected in referral. This article highlights clinical aspects of CAT brain imaging, summarizes the existing literature on inpatient psychiatry CAT scanning, and recommends initial criteria for CAT brain examination of hospitalized patients.

Overview: cerebrovascular accident and the hospitalized elderly--a multidimensional clinical problem.

A cerebrovascular accident is unwelcome at any age, but for the elderly it involves concerns. The abrupt onset of a cerebrovascular accident signals anew the already present fears of loss of control, death, insanity, disfigurement, loss of physical function, and sexual impairment. The accident can also result in worry about the possibility of explosive recurrence, disruption of thoughts and emotions, lengthy treatment away from home, and exhaustion of retirement funds. Therapeutic endeavors must be eclectic and individually tailored to address the special needs of the elderly patient, the highly technical and diverse health care team, the worried family, and the depression, delirium, and subtle clinical syndromes manifesting as poor patient motivation that often accompany a cerebrovascular accident.

Battered wife syndrome: overview of dynamics and treatment.

The authors review some pertinent features of the battered wife syndrome, including definitions, incidence, characteristics of wives, injury profiles, setting of the violence, psychodynamics, role of alcohol, family backgrounds, characteristics of husbands, coping responses of wives, seeking help, social support systems, recognition of the battering syndrome, prevention and treatment, and group therapy. Although force has long been used as a resource in family politics, we have just started to understand some of its precipitants, social and clinical consequences, and treatment options. The battering syndrome is not a disease per se because it cuts across socioeconomic and diagnostic categories. Controlled studies and national attention are required in order to understand more about this costly problem, which poses a treatment dilemma to clinical psychiatry.

Psychiatry clerkship success: skills and styles.

In recent years, medical students and psychiatry have been a provocative mix, causing much concern among students and faculty. Disagreement has been frequently offered regarding clerkship content, degree of learning, and even the basic importance of the topic of psychiatry itself. To help overcome these problems, 10 suggestions are offered for a curriculum learning skill foundation and 13 suggestions for clerkship teaching staff approach. These truism ingredients have been the major formula of a successful psychiatry teaching program as consistently reported by almost a decade of students and faculty. It is believed these principles might have wider applicability for enhancement of student recruitment to psychiatry residencies and for general stimulation of interest and learning in clerkship programs of various medical disciplines. Relevant literature is cited which addresses some of these individual issues.

The diagnosis and treatment of elderly patients: some practical guidelines.

Clinicians working with elderly patients must assist them in rediscovering strengths, rekindle their interests in activities and in other people, treat and perhaps cure their disabilities, and help them discover that life is worth living. The author presents a collection of practical evaluation and treatment suggestions to help the clinician take an integrated, basic health care approach to the older person. His guidelines cover such areas as interpersonal relationships between the clinician and the patient, psychosocial assessments, techniques for working with the elderly, treatment goals and tasks, and medication use. There is also a review of the literature on the treatment of the elderly patient.

Psychotherapy with phobic patients: the marriage relationship as the source of symptoms and focus of treatment.

Four patients demonstrating phobic symptoms occurring in the context of maladaptive marriages are presented. Thorough historical data collection is stressed. Similarities in family backgrounds and personality styles emerge in these cases and are discussed in relation to genesis of symptoms within the marital relationships. A psychotherapeutic approach is described and results of treatment examined.

Multiple sclerosis--presenting as depressive illness.

A diagnostic dilemma exists when clinicians face patients with atypical recurrent symptoms involving both physical and psychologic elements. Multiple sclerosis (MS) represents such a dilemma. Few authors address themselves to the significance of depressive illness as the initial presentation in MS. Three patients hospitalized solely due to recurrent emotional disorders are described. Depressive symptoms predominated. In each case no precipitant for depression was identified, no previous neurologic diagnosis was entertained by clinician or patient, and multiple prior psychotherapeutic interventions were unsuccessful. The episodic nature of the symptoms and poor response to usually effective treatments created a high index of suspicion for central nervous system disease. A diagnosis of MS was made based on subtle neurologic signs, spinal fluid gamma globulin elevations, and abnormalities in neuropsychological testing. Treatment involved integrated psychiatric and medical measures.

The role of the psychiatric consultant in the treatment of burned patients.

Two cases of seriously burned patients are presented which differ in initial psychiatric presentation and subsequent course. In each case, the role of the psychiatric consultant is described. The role includes direct evaluative and psychotherapeutic contact with the patient and liaison with the surgical and nursing staff. This dual approach is necessary for a consistent rehabilitative effort, particularly in hospitals that do not have a psychiatric liaison team.