JAMA: The Journal of the American Medical Association, 1997
... Andreas Kapsalis, Jayne Hyland, Michael Fesi, Tim Fitzgerald, Mary Ellen Blanchard, Arlene Re... more ... Andreas Kapsalis, Jayne Hyland, Michael Fesi, Tim Fitzgerald, Mary Ellen Blanchard, Arlene Reinwald, Howard Reinwald, Kari Rosenblate, Howard Rosenblate, Lisa Bershe, Curt Bershe, Adam Hunter, James Corbett, Joyce Corbett, Jillian Corbett, and Jennifer Corbett. ...
While liaison or similar clinics have existed since at least 2932, they remain uncommon. The Moun... more While liaison or similar clinics have existed since at least 2932, they remain uncommon. The Mount Sinai Medical Center Liaison Clinic is presented as a model for psychiatric evaiuntion and care of medical patients as well as training, research, and funding. In addition, it is a model for linking general and mental health systems in the tertiary care setting. Thefirsf year of operation of the clinic is described, including the sources of referral, demographic data, psychiatric, and medical diagnoses, and type of clinic contact. A total of 96 patients were seen in 390 visits, equaling three quarters of a liaison fellow's salary. Psychiatric disorder is commonly treated by non- mental-health professionals. Reiger et al. (l) report that 54% of the U.S. population with mental disor- ders are treated in the general health care sector. The failure to detect and treat mental disorders appears to exist at all levels of care. In the tertiary care setting, this failure is not due to the u...
Despite controversy about the impact of sexual abuse on victims, accumulating evidence indicates ... more Despite controversy about the impact of sexual abuse on victims, accumulating evidence indicates that sexual abuse is a serious mental health problem. Rape falls under the larger category of sexual abuse, which includes molestation of children by adults in which overt coercion is not necessarily involved as it is in rape. The eradication of rape is contingent on educating our society to the meaning of the crime. Innovative and empathetic services to victims will serve as a deterrent by facilitating reporting, apprehension, and prosecution of assailants.
Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the... more Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the DSM-III-R criteria for LLPDD. The objectives were to 1) evaluate the individual symptoms presently required for the diagnosis and other symptoms, 2) determine the proportion of treatment-seeking women who meet the LLPDD criteria, and 3) explore the association between LLPDD and other mental disorders.
T is a fun vacation novel set against the mystery of the sometimes turbulent sea and the parable ... more T is a fun vacation novel set against the mystery of the sometimes turbulent sea and the parable of the prodigal son. Many plot lines allude to the parable, including the good character and the bad, going away and coming back, and loss and redemption, which turns out to be like recovery. The story starts with a short allegorical tale from the past and takes the reader on a trip from an urban, professional, competitive life to a nautical outpost on theOuter Banks and the special bonds of community and tolerance forged in rural, island life. The star of the show is a very successful lawyer troubled by a recent divorce and overconfidence. He winds up on the remote, island refuge of Ocracoke Island with a lot of other flawed characters. This small island is a magical place of healing for people whose lives had completely fallen apart and who had no place else to go. The plot has something in it for everyone: Vatican politics, faith and belief, adventure, bravery, alcohol, anger, action, and violence. The story reflects many elements of contemporary culture, such as the power of big institutions and money, the challenge of man against nature, and a nod to the past and old-school approaches like craftsmanship and do-it-yourself solutions. Hurley’s writing is beautiful and full of colorful, evocativemetaphors. Several themes are of interest to psychiatrists and other mental health professionals, such as teamwork, a medical-legal mystery, and the similarities of priests and therapists in promoting recovery. Although the book is full of flawed characters, it does not feel like a busman’s holiday. The first half of the book sets the stage for dramatic twists and turns of the plot that seem to mimic a turbulent sea. The novel is so engaging that each short chapter entices the reader to read one more. Of particular value are the characters, who are all studies in contradiction, “lost souls” in an “island purgatory” who were “captives to the addictions that enslaved them” and “washed up self-loathing bastards.” The author is male, and his male characters are better developed and more convincing than his female characters, who are somewhat stereotyped. Extraordinary circumstances confront the reader to wonder how he or she would react in the same situation. Despite the somewhat contrived, overly dramatic, and not entirely believable plot in the second half of the book, the good outweighs the bad. The story is dense and intriguing, full of passion, and prompts the reader to think about what he or she really cares about in life. Dr. Gise is clinical professor with the Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu.
Liaison Psychiatry has been a recognized sub-specialty of psychiatry since 1930 when the Rockefel... more Liaison Psychiatry has been a recognized sub-specialty of psychiatry since 1930 when the Rockefeller Foundation funded the development of full time departments of psychiatry at four medical schools. The teaching of the psychology of the medically ill, however, dates to the beginning of medicine — with doctors having the knowledge at some level of the relationship between psychosocial issues and bodily functions. But since the second world war when general hospital psychiatry came into its own, and during the last decade when liaison psychiatry gained support from training grants by the Psychiatric Education Branch, National Institutes of Mental Health there has been increasing rigor to the teaching and structure of this sub-specialty. At the same time it has become more and more clear that liaison psychiatry is distinct from consultation and requires advanced specialty training for its pursuit (1–3). This paper will first address the unique characteristics of liaison psychiatry and then describe goals, terminal objectives and enabling objectives for training candidates.
Psychiatrist-led outpatient group therapy for patients with significant mental illness or substan... more Psychiatrist-led outpatient group therapy for patients with significant mental illness or substance use problems is a powerful treatment vehicle for combining medical and psychosocial treatments in an efficient and accessible format. It was once widespread as the focus of treatment for persons with severe illness as they were shifted from state hospitals to community mental health centers (Stone 1993). Despite significant clinical evidence for its effectiveness, few psychiatrists currently run groups for these patients. Most psychiatrists experienced with group psychotherapy do not treat patients with severe mental illness and most psychiatrists specializing in the treatment of severe mental illness do not run groups. Today, group psychotherapy is rarely part of psychiatric residency training. Despite this course of events, as economics create pressure for systems change, group medical visits as an alternative to individual appointments will likely be encouraged. Likewise, as mental health and primary care systems converge, group treatments offer an attractive and efficient option for people seeking care outside traditional behavioral health settings.
Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by thei... more Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysioiogic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs. Available data indicate that the majority of persons with mental health problems are seen by general health providers, not by mental health specialists. The President's Mental Health Commission estimated that 15% of Americans suffer from some form of mental disorder (1). Regier et al. (2) report that only 21% of these people go to psychiatrists and to other mental health specialists, whereas 54% are seen exclusively by their primary care physician or by other health professionals.
JAMA: The Journal of the American Medical Association, 1997
... Andreas Kapsalis, Jayne Hyland, Michael Fesi, Tim Fitzgerald, Mary Ellen Blanchard, Arlene Re... more ... Andreas Kapsalis, Jayne Hyland, Michael Fesi, Tim Fitzgerald, Mary Ellen Blanchard, Arlene Reinwald, Howard Reinwald, Kari Rosenblate, Howard Rosenblate, Lisa Bershe, Curt Bershe, Adam Hunter, James Corbett, Joyce Corbett, Jillian Corbett, and Jennifer Corbett. ...
While liaison or similar clinics have existed since at least 2932, they remain uncommon. The Moun... more While liaison or similar clinics have existed since at least 2932, they remain uncommon. The Mount Sinai Medical Center Liaison Clinic is presented as a model for psychiatric evaiuntion and care of medical patients as well as training, research, and funding. In addition, it is a model for linking general and mental health systems in the tertiary care setting. Thefirsf year of operation of the clinic is described, including the sources of referral, demographic data, psychiatric, and medical diagnoses, and type of clinic contact. A total of 96 patients were seen in 390 visits, equaling three quarters of a liaison fellow's salary. Psychiatric disorder is commonly treated by non- mental-health professionals. Reiger et al. (l) report that 54% of the U.S. population with mental disor- ders are treated in the general health care sector. The failure to detect and treat mental disorders appears to exist at all levels of care. In the tertiary care setting, this failure is not due to the u...
Despite controversy about the impact of sexual abuse on victims, accumulating evidence indicates ... more Despite controversy about the impact of sexual abuse on victims, accumulating evidence indicates that sexual abuse is a serious mental health problem. Rape falls under the larger category of sexual abuse, which includes molestation of children by adults in which overt coercion is not necessarily involved as it is in rape. The eradication of rape is contingent on educating our society to the meaning of the crime. Innovative and empathetic services to victims will serve as a deterrent by facilitating reporting, apprehension, and prosecution of assailants.
Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the... more Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the DSM-III-R criteria for LLPDD. The objectives were to 1) evaluate the individual symptoms presently required for the diagnosis and other symptoms, 2) determine the proportion of treatment-seeking women who meet the LLPDD criteria, and 3) explore the association between LLPDD and other mental disorders.
T is a fun vacation novel set against the mystery of the sometimes turbulent sea and the parable ... more T is a fun vacation novel set against the mystery of the sometimes turbulent sea and the parable of the prodigal son. Many plot lines allude to the parable, including the good character and the bad, going away and coming back, and loss and redemption, which turns out to be like recovery. The story starts with a short allegorical tale from the past and takes the reader on a trip from an urban, professional, competitive life to a nautical outpost on theOuter Banks and the special bonds of community and tolerance forged in rural, island life. The star of the show is a very successful lawyer troubled by a recent divorce and overconfidence. He winds up on the remote, island refuge of Ocracoke Island with a lot of other flawed characters. This small island is a magical place of healing for people whose lives had completely fallen apart and who had no place else to go. The plot has something in it for everyone: Vatican politics, faith and belief, adventure, bravery, alcohol, anger, action, and violence. The story reflects many elements of contemporary culture, such as the power of big institutions and money, the challenge of man against nature, and a nod to the past and old-school approaches like craftsmanship and do-it-yourself solutions. Hurley’s writing is beautiful and full of colorful, evocativemetaphors. Several themes are of interest to psychiatrists and other mental health professionals, such as teamwork, a medical-legal mystery, and the similarities of priests and therapists in promoting recovery. Although the book is full of flawed characters, it does not feel like a busman’s holiday. The first half of the book sets the stage for dramatic twists and turns of the plot that seem to mimic a turbulent sea. The novel is so engaging that each short chapter entices the reader to read one more. Of particular value are the characters, who are all studies in contradiction, “lost souls” in an “island purgatory” who were “captives to the addictions that enslaved them” and “washed up self-loathing bastards.” The author is male, and his male characters are better developed and more convincing than his female characters, who are somewhat stereotyped. Extraordinary circumstances confront the reader to wonder how he or she would react in the same situation. Despite the somewhat contrived, overly dramatic, and not entirely believable plot in the second half of the book, the good outweighs the bad. The story is dense and intriguing, full of passion, and prompts the reader to think about what he or she really cares about in life. Dr. Gise is clinical professor with the Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu.
Liaison Psychiatry has been a recognized sub-specialty of psychiatry since 1930 when the Rockefel... more Liaison Psychiatry has been a recognized sub-specialty of psychiatry since 1930 when the Rockefeller Foundation funded the development of full time departments of psychiatry at four medical schools. The teaching of the psychology of the medically ill, however, dates to the beginning of medicine — with doctors having the knowledge at some level of the relationship between psychosocial issues and bodily functions. But since the second world war when general hospital psychiatry came into its own, and during the last decade when liaison psychiatry gained support from training grants by the Psychiatric Education Branch, National Institutes of Mental Health there has been increasing rigor to the teaching and structure of this sub-specialty. At the same time it has become more and more clear that liaison psychiatry is distinct from consultation and requires advanced specialty training for its pursuit (1–3). This paper will first address the unique characteristics of liaison psychiatry and then describe goals, terminal objectives and enabling objectives for training candidates.
Psychiatrist-led outpatient group therapy for patients with significant mental illness or substan... more Psychiatrist-led outpatient group therapy for patients with significant mental illness or substance use problems is a powerful treatment vehicle for combining medical and psychosocial treatments in an efficient and accessible format. It was once widespread as the focus of treatment for persons with severe illness as they were shifted from state hospitals to community mental health centers (Stone 1993). Despite significant clinical evidence for its effectiveness, few psychiatrists currently run groups for these patients. Most psychiatrists experienced with group psychotherapy do not treat patients with severe mental illness and most psychiatrists specializing in the treatment of severe mental illness do not run groups. Today, group psychotherapy is rarely part of psychiatric residency training. Despite this course of events, as economics create pressure for systems change, group medical visits as an alternative to individual appointments will likely be encouraged. Likewise, as mental health and primary care systems converge, group treatments offer an attractive and efficient option for people seeking care outside traditional behavioral health settings.
Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by thei... more Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysioiogic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs. Available data indicate that the majority of persons with mental health problems are seen by general health providers, not by mental health specialists. The President's Mental Health Commission estimated that 15% of Americans suffer from some form of mental disorder (1). Regier et al. (2) report that only 21% of these people go to psychiatrists and to other mental health specialists, whereas 54% are seen exclusively by their primary care physician or by other health professionals.
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