Delirium is the organic mental disorder most often encountered by psychiatrists and other physicians. Early recognition and management of patients with this condition is critical. Its presence in medically ill patients is highly correlated with an increased mortality rate. In our study of patients who were referred for psychiatric consultation in a general hospital, a comparison was made of the demographic and clinical characteristics of those patients with delirium and those with other psychiatric disorders. We found that for almost all of the referrals (93%), either a physician or more frequently a nurse recorded well-known signs of delirium in their notes. The physicians indicated the possibility of an organic psychiatric condition in only one-third of the referrals, suggesting that doctors either may overlook the nurses' notes or they may not recognize the signs recorded as signs of delirium. A review of the literature suggests that physicians tend to overlook and misdiagnose this disorder. Possible reasons for this lack of recognition are discussed.
The purpose of this study was to evaluate the effect of desipramine, a tricyclic antidepressant with relatively specific noradrenergic effects, on bulimic behaviour, eating attitudes, and mood. Using a double-blind crossover design, 47 normal weight bulimics were randomly assigned to receive either desipramine (150 mg/day) for six weeks, no drug for three weeks, followed by placebo for six weeks, or the reverse sequence. At weeks 0, 2, 4, 6, 9, 11, 13, and 15, each subject was assessed using the EDI, SCL-90, POMS and binge records. Plasma desipramine levels were obtained at weeks 4 and 13. Twenty-four subjects completed the entire fifteen week protocol, while 23 dropped out. Desipramine was significantly more effective than placebo in reducing the frequency of weekly binding, weekly vomiting, and the fatigue scale of the POMS. No significant effect of the drug was obtained on the EDI or the SCL-90. The clinical effect was modest. Desipramine's antibulimic effects were not associated with an alleviation of depressive symptoms.
In order to determine the residents' perceptions toward their psychotherapy training, a questionnaire was distributed to 400 residents in the 16 Canadian psychiatric residency programs. The main areas studied were: the resident's demographic and educational characteristics; the residency program characteristics; the type of training available in different psychotherapeutic modalities; the analysis of quality and quantity of attention given to different elements of psychotherapy supervision (patient assessment, diagnostic formulation of treatment approach and goals); the degree of importance attributed by the residents to the above mentioned elements of psychotherapy supervision; and the residents' perception of their supervisor's attributes (examples: teaching ability and rapport). Forty-two percent of the residents completed the questionnaire. Residents mentioned that the most adequate supervision was for long-term individual psychotherapy cases and that behavioral and group therapy supervision was the least adequate. The three most essential qualities in a supervisor's profile were judged to be: capacity for the development of a good rapport with the trainee; ability to pinpoint residents' psychotherapy shortcomings and his willingness to help residents to overcome them; ability to teach. Three factors that significantly influenced the trainees perception of their psychotherapy training were: resident's age, a seminar in individual psychotherapy in the residency core program; having received more than one hour weekly of psychotherapy supervision. The understanding of patient's psychodynamics was the most adequately taught element during psychotherapy supervision.
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