Psychiatric consultation in the nursing home. An inquiry among Amsterdam nursing home physicians

Psychiatric disorders are common among nursing home residents. However, little is known about psychiatric consultation in Dutch nursing homes. As an exploration of the topic, Amsterdam-based nursing home physicians were asked to rate a number of aspects of psychiatric consultation as performed in their nursing home. Striking differences are reported between 14 participating nursing homes with regard to the intensity of psychiatric consultation and the number of consultation requests, which seems low compared with the perceived psychiatric problems. Somatically ill and psychogeriatric residents are estimated to generate an equal number of consultation requests. Psychiatric consultation appears to be characterized by diagnostic clarification, medication recommendations and behavioral management advice whereas staff-directed activities are scarce. Physicians report shortcomings in psychiatric skills among care staff. Research is necessary concerning the psychiatric care delivered to nursing home residents, as well as with regard to the optimal model for psychiatric consultation services. Integration of psychiatric care in nursing homes with mental health care services appears to be desirable.     

Psychiatric illness in the medical profession: incidence in relation to sex and field of practice.

The overall incidence of psychiatric illness among the physicians of British Columbia during 1970-74 was 1.27% per year. The overall suicide rate was more than 36.5/100 000. Incidence was not dependent on sex or age. The two specialties with the highest incidence--ophthalmology and psychiatry--had previously been demonstrated to have significantly high rates of suicide. The highest incidence was among psychiatric residents; in other resident groups collectively the incidence was at the expected rate. Greater severity of illness and poorer prognosis was found in family physicians compared with specialists, although the incidence was the same in the two groups.     

Psychiatric illness in inpatients with neurological disorders: patients' views on discussion of emotional problems with neurologists.

The prevalence of psychiatric morbidity in inpatients with neurological disorders and the extent to which it is detected by neurologists were measured by using a two stage model of psychiatric assessment and from information recorded in the patients'' medical notes. The prevalence of psychiatric morbidity was estimated as 39%, of which 72% was unrecognised by the neurologists. Only a minority of patients with an uncertain physical diagnosis had a psychiatric illness, showing the error in assuming that a patient''s physical symptoms arise from a psychological disturbance if an organic aetiology cannot be determined. When the patients were interviewed on their discharge from hospital they were divided on whether they had wished to discuss their mood with neurologists while they were in hospital. The reasons that they gave suggested that interactions between patients and doctors and the lack of ward facilities for private consultations with doctors are important determinants of hidden psychiatric morbidity in medical inpatients.     

A humanistic library for physicians by physicians.

In 1986 the rate of infectious syphilis (primary and secondary) in Los Angeles County began to rise from previously stable levels of about 23.5 per 100,000 to peak at 55.6 per 100,000 in 1987. The incidence of congenital syphilis increased from 205 cases in 1987 to 575 cases in 1989. The county''s Sexually Transmitted Disease Program instituted a disease-specific plan to address the epidemic. Factors considered in designing the program included the high morbidity and mortality associated with congenital infection, the existence of latent infection, self-limiting symptoms, and the availability of an inexpensive screening test and curative treatment. Policy changes implemented comprised expanded screening, expanded surveillance, increased contact tracing, and the initiation of condom promotion programs. To evaluate the relative effectiveness of Los Angeles County''s syphilis control efforts, the epidemic curve for infectious syphilis was compared with trends in other urban areas. Although the rate of infectious syphilis climbed a year earlier in Los Angeles than in other cities, it returned to baseline levels when other cities'' rates remained at epidemic levels.     

Psychiatric manpower in British Columbia.

The ideal psychiatrist population ratio of 1:11 000, as accepted by the Ministry of Health in British Columbia and the British Columbia Medical Association, is probably inadequate since it does not take into account increased utilization and demand, the ageing of the population, the reduction in the work week of psychiatrists and the expected absence of of increased productivity of psychiatrists. The increase in utilization and demand reflects treatment of disorders with high prevalence and chronic outcomes whose needs were previously met, rather than psychiatrists "chatting with the worried well", as is sometimes alleged. The concentration of psychiatrists in Vancouver reflects the needs of both tertiary care and migration of psychiatric patients. It is not a local aberration and does not reflect over supply. An adequate psychiatrist to population ratio for large geographic areas is less than 1:10 000. The ratio for urban areas has not yet been determined, but is probably less than half of the overall ratio. In any case, more study of this issue is required before draconian health policy measures are undertaken to solve a perceived problem which may not exist.