Private Psychiatric Practice Research Articles

A Sabbatical Leave in a Private Psychiatric Practice

A Sabbatical Leave in a Private Psychiatric Practice

See and Feel Your Beaming Child

"See and Feel Your Beaming Child." Transactional Analysis Journal, 8(4), p. 338 Additional informationNotes on contributorsRudiger RogollRudiger Rogoll, TM, MD, is a psychiatrist in private practice in Markdorf, South Germany.

Diagnostic errors in psychiatry

Although the importance of nosology has been derided as “pigeonholing” by some American psychiatrists, the science of diagnosis has lately enjoyed a renaissance. Actually, whether or not a psychiatrist possessed diagnostic acumen had little effect on the outcome of treatment until the past two decades, because so much of treatment was nonspecific. But the increasing use of drugs, particularly neuroleptics, antidepressants, and lithium, has made precise diagnosis a necessity. In recent years, several authors have commented upon the misdiagnosis of manic-depressive patients—particularly catatonics 1—as schizophrenics 2 and a multihospital cross-national study 3 has suggested that American psychiatrists overdiagnose schizophrenia and underdiagnose affective disorder. The Iowa group 4 has demonstrated that strict criteria result in a much lower rate of diagnosed schizophrenia than does the “agreement of experienced clinicians” so often set as the standard. With the compilation of diagnostic criteria for psychiatric disorder by Feighner et al., 5 it became clear that 80% or more of psychiatric patients can be definitely classified according to standards that permit accurate prediction of treatment and prognosis. But today, the vast majority of psychiatric diagnoses still are not made on the basis of scientific criteria, and the category of “undiagnosed psychiatric disorder,” at least as used by clinicians, is virtually an empty set. To what extent strict criteria are used no one knows, but from anecdotal case reports in the literature they are probably not overutilized. The resulting margin for disagreement and for downright error is probably enormous. We propose now to review the kinds of erroneous diagnoses commonly made, the reasons for these errors, and their possible consequences. This report, based upon the experience of psychiatrists in private practice, deals with the diagnostic pitfalls encountered despite, or in some cases because of, the use of scientific diagnostic criteria.

Does personal future outlook cause self-esteem?

Melges et al. (1971) presented evidence that a client's sense of self-worth is highly correlated with his degree of optimism about his personal future. In the present study, the cross-lagged panel correlation (CLPC) technique was used to test their hypothesis that changes in personal future outlook lead to changes in self-esteem. Ninety-four outpatients in the private psychiatric practice of the senior author filled out the Decision-Making Evaluation Instrument used by Melges et al. to assess these two constructs as well as decision-making and outcome. Results did not support their implication that personal future outlook is causally predominant over self-esteem, nor did the results support their assumption that they were measuring a distinct construct of self-esteem.

Sex therapy in Australia.

A pilot study of forty consecutive couples referred to a private psychiatric practice for the diagnosis and management of sexual problems was conducted. The couples came from a socially diverse population and exhibited a wide range of sexual disorders. Diagnosis included general sexual inhibition, orgastic failure, vaginismus, impotence and premature ejaculation. Nine couples had severe interpersonal stress and of these, only one improved. Six out of thirteen couples where neurosis or psychosis was an important factor, improved. Of the eleven couples who were free of non‐sexual problems, eight became symptom‐free. A variety of treatment procedures including brief sex therapy were used. Assessment of the total clinical picture rather than diagnosis of the presenting sexual problem was used in determining treatment strategies.

Presenting problems and diagnosis

As an object of widespread criticism, psychiatric diagnosis has amassed a voluminous body of literature, most of it being focused on questions of validity, reliability, and consistency. Even though germane to the issue, less attention has been directed to the process of diagnostic decision making, i.e., how such assessments are made, what identifiable factors they are based on, and so forth. The work of Gauron and Dickinson, 6 Petzel and Gynther, 4 Sandifer et al., 5 and Kendall 7 are among the few studies addressed to these questions. This paper continues this line of inquiry by exploring psychiatric diagnosis in relation to presenting problems. At times a presenting problem is simply a short-hand verbal account of a person's “story”. Generally, however, it is a composite presentation that also includes accounts about his condition made by “significant others” acting as complainant and/or concerned party, as well as the clinician's gross observations. Except for the work of a few investigators, 8–10 presenting problems remain a relatively unexplored area. Taken at face value, without interpretation or inference, presenting problems provide a unique body of information. As such, they constitute one of the few variables that stand at the interfaces of demographic, psychosocial, and clinical data and can thus provide a fruitful, empirically-grounded research tool. Accordingly, data and findings are presented from a recent community-wide survey of psychiatric utilization, 11 i.e., specifically, the presenting problems of a 1-year adult population of applicants (unduplicated count) who sought psychiatric care from either a large urban mental health center or from the private sector (i.e., the office and hospital clientele of psychiatrists in private practice; 86% of the private psychiatrists cooperated and participated in the study).

Psychiatry and social class

The role that patients' social class plays in the diagnoses that they are given and the treatments that are recommended for them, has been of continuing interest to the mental health profession. Charges of “bias” have not been infrequent. Examination of this issue was the primary focus of this study. Thirthy psychiatrists in private practice and thirty-eight experienced clinicians from a community mental health center were presented with four psychiatric case descriptions. They were asked for their diagnoses and treatment recommendations. Each case description contained upper class or lower class cases. This paper reports on the diagnoses that were made and the treatment modalities that were recommended by private and public practitioners, using social class as the independent variable.

A-B therapist characteristics vs. psychotherapy outcome: current status and prospects.

For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the "A-B" variable. Various A-B scales have been used to predict differential process and outcome of A and B therapist with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapists-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors "make the difference" seems rather premature. A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled "schizophrenic" or "neurotic" in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-Bresearch, but it clearly demands greater specificity in hypotheses and in research design. The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become "extinct." To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significatly skewed in either the A or B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.

Restructuring staff time; the eight-day week.

A group of psychiatrists in private practice who also provide services for inpatients of a private psychiatric hospital in Birmingham, Alabama, tested and adopied an eight-day week. In conjunction with hospital social workers they form teams that alternate in working ten hours a day for eight consecutive days, Monday through Monday, then have six days off. All team members work on each Monday. After 16 months of the new schedule there was a significant drop in the average length of hospitalization and cost per patient and in the absenteeism of the staff.

La Amistad: Starting an Inpatient Program for Severely Disturbed Young Adults

Because of the lack of adequate local facilities for young people with schizophrenia-related illnesses, a psychiatrist in private practice established an inpatient program in a remodeled house next to his office. The main treatment method is behavior modification; family and group therapy and group activities are also used. Houseparents live on the premises, but the residents are responsible for the day-to-day operation of the house, and the patient government monitors all activity. Follow-up 44 months after the program opened showed that about three-fourths of the 70 residents who had left were considered improved or much improved.

Perspectivism in Psychotherapy

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsLawrence FriedmanLawrence Friedman, M.D., psychiatrist in private practice in New York City.

COFFEE, DOUGHNUTS, AND KAVANAUGH

Family Court ReviewVolume 10, Issue 1 p. 1-5 COFFEE, DOUGHNUTS, AND KAVANAUGH Philip Kavanaugh M.D., Philip Kavanaugh M.D. Psychiatrist in private practice in San Diego, California.Search for more papers by this author Philip Kavanaugh M.D., Philip Kavanaugh M.D. Psychiatrist in private practice in San Diego, California.Search for more papers by this author First published: September 1972 https://doi.org/10.1111/j.174-1617.1972.tb00004.x EDITOR'S NOTE: Excerpts, from a paper delivered at the Tenth Annual Conference of Conciliation Courts, on May 18, 1972, at San Diego, California. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume10, Issue1September 1972Pages 1-5 RelatedInformation

Confidentiality and the psychiatrist in private practice.

Confidentiality and the psychiatrist in private practice.

Enforced outpatient treatment of advantaged pseudosociopathic neurotically disturbed young women.

This paper reviews the psychotherapeutic treatment of twenty-five young women who presented with problems of disturbed and antisocial behaviour including promiscuity, failing in school, alcohol and drug abuse and general social ineptitude. A combination of individual and group psychotherapy was used following an initial period of hospitalization. The principal features of the method were the use of money as a reward for remaining in psychotherapy and reporting regularly for work, together with partial or complete separation of the patient from her parents during psychotherapy. Psychotherapy was used in an active form between the therapist and the patient, and the therapeutic model containing elements of support, insight and direct advice interwoven in a flexible fashion and superimposed on the basis of a warm, real and positive relationship. An enforced program of work or job training was a requirement of continuing the psychotherapeutic relationship with the therapist. The treatment program made it possible to differentiate sociopathic from pseudosociopathic patients, and the results of treatment in the latter group were good. The outcome of therapy in the sociopathic patients was poor. The methods described are offered as a possible model which could be used in private psychiatric practice for patients who have both biological and socioeconomic advantage.

The changing identity of the psychiatrist in private practice: a symposium.

The changing identity of the psychiatrist in private practice: a symposium.

Trends in Psychiatric Treatment: A Report of a Private Psychiatric Practice

The author analyzes the character of his private practice over a 15-year period (1951-1966) with regard to diagnosis, type of service provided, and length of treatment. The data from 600 patients revealed a shift toward briefer therapy as well as a tendency to avoid hospitalization. Generally, use of dynamic diagnoses proved more satisfactory than use of standard diagnostic categories. The author stresses the value of further studies of private practice, especially because of their potential usefulness in community mental health planning.

Some differences between published norms and data from matched controls as a basis for comparison with psychiatrically-disturbed groups.

Over the years 1959 to 1962 a study was made of a series of 72 male neurotic patients referred to general hospital and private psychiatric practice in Leeds, the results of which were submitted for an M.D. Thesis (Little, 1966). It emerged clearly that the neurotic group was divisible into two major sub-groups differing significantly in a wide range of personality and other premorbid variables. Various objective tests and measurements were used; in the present context we wish to concentrate attention on five: (1 and 2) The N and E Scales of Eysenck's Maudsley Personality Inventory, (3) Tanner's Discriminant Androgyny Scale, (4) Parnell's Ponderal Index, and (5) The Rees-Eysenck Body Index.

Controlled Evaluation of Psychotropic Drugs in a Private Psychiatric Practice Doxepin vs. Amitriptyline (Elavil)

Controlled Evaluation of Psychotropic Drugs in a Private Psychiatric Practice Doxepin vs. Amitriptyline (Elavil)

Trapped: Families and Schizophrenia

To investigate the relationship between family life and schizophrenia Rogler and Hollingshead studied intensively 20 families in which husband, wife, or both had recently developed schizophrenia, and 20 control families. All subjects were of the lowest socioeconomic class, living in slums or housing projects in San Juan, Puerto Rico. Psychiatrists in private practice interviewed separately each husband and wife. Trained field workers repeatedly visited the families and their relatives and associates. By the end of the three-year research period the life history and present situation of each of the 80 subjects was well known to the investigators. After describing the research design and methods, the authors present and discuss their findings. They discovered that those individuals who developed schizophrenia had backgrounds and childhoods essentially indistinguishable from those people who did not become psychotic. It was in the year or so prior to the onset of the psychosis that the subjects

SURVEY OF PRIVATE PSYCHIATRIC PRACTICE. REPORT ON A FIELD TEST.

IN THE PROVISION of community based mental health services, private psychiatrists play a vital role in the array of consultation, evaluation, diagnosis, and treatment services offered to the mentally ill or emotionally disturbed residents of the area. The National Institute of Mental Health which collects data on patients served in a wide variety of psychiatric resources in the country (outpatient psychiatric clinics, psychiatric day-night units, psychiatric services of general hospitals, mental hospitals, and institutions for the mentally retarded)^1-5has heretofore not collected information from this important psychiatric resource—private practice. Studies in selected areas^6-9have indicated that probably as many outpatients are seen by private psychiatrists as by psychiatric clinics which in 1962 served an estimated 750,000 persons in the United States.²Data on the number and kinds of patients seen and the services provided by private practitioners would contribute to