Carlyle H. Chan

An evaluation of mood states among first-year residents.

To examine the need for preventive and treatment interventions, a prevalence study was conducted to ascertain the rate of depressive symptomatology and other negative mood states among 112 first-year residents The participation rate was 54%. Subjects (N = 61) were administered the Beck Depression Inventory and Profile of Mood States in personal interview sessions. The Profile measures five negative mood states, namely, “tension-anxiety,” “depression-dejection,” “anger-hostility,” “fatigue-inertia,” “confusion-bewilderment,” and one positive state, “vigor-activity.” A 15.5% rate of depression was found, which is lower than a rate of 23 5%, also measured by Becks inventory, among a sample of university undergraduates and 19 9% among an adult sample from the general population. No differences were observed among residency programs or sex on Becks scale; however, significantly higher scores were found for women on the “depression-dejection” dimension of the Profile. The mean scores on all negative mood dimensions of the Profile were below the mean for university undergraduate norms. Neither sleep nor hours worked over the past week were associated with increased Beck scores. These results indicate that sleep deprivation and long work hours did not contribute to depression among the subjects who participated in the study. Female interns, however, appear to be at increased risk of depression, and adequate support systems need to be provided.

Improvement of Depression and Parkinsonism during ECT A Case Study

Improvement in signs of parkinsonism and symptoms of depression was observed in a patient with Parkinsons disease who underwent a course of ECT for depression. Empirically this patient was observed by a blind rater to show a pattern of improvement in parkinsonian signs similar to that observed in parkinsonian patients treated with L-dopa. The time course of improvement of this patients depression was also seen to parallel improvement in his Parkinsons disease. These results are consistent with the hypothesis that ECT increases catecholamine synthesis and more specifically would be evidence that ECT improves depression by increasing norepinephrine synthesis.

The First Postresidency Position: Correlations with Training Program Characteristics

The authors surveyed psychiatric residency directors to determine the first positions chosen by 1978 and 1979 graduates and any correlates to these choices. Over half of these graduates spend the majority of their time working in the public sector. Residents who chose academic careers were more likely to have trained at highly ranked programs and at large programs. Other correlates included completion of an internship and foreign medical graduate status. Two-thirds of the graduates remained in the geographic state where they trained. The findings have relevance for policy planners and those interested in academic manpower issues.

Moonlighting by psychiatric residents

Much of the literature on resident moonlighting has been editorial in nature. Very little information on psychiatric residents’ moonlighting practices and attitudes exists. The authors developed an instrument that was mailed to survey the chief residents of all 203 Accreditation Council for Graduate Medical Education—approved psychiatry residencies, with 137 (67.5%) programs responding. According to the responses, the percentage of residents moonlighting increased with each successive year of training, with an average of 31 hours per resident per month. The two major reasons given for moonlighting were payment of living expenses (58%) and repayment of student loans (24%). No supervision was provided to 22% of the moonlighting residents. Only 10% of the programs proscribed moonlighting by their residents. To better assess the positive and negative effects of moonlighting, it is time to truly monitor and guide the moonlighting experience for both residents and their programs.

Psychiatric Resident Moonlighting: A Review and Modest Proposal

Moonlighting by psychiatric residents remains controversial, with debate surrounding the ethical, legal, financial, and educational risks involved in the practice. The authors present a literature review of resident moonlighting, which encompasses the policy positions of various organizations responsible for graduate medical education; surveys of various groups and specialties regarding the prevalence, form, and justification for moonlighting; and models of moonlighting programs in several institutions. The authors conclude with specific proposals for research regarding psychiatric resident moonlighting and, more importantly, emphasize the need for research on the effects of moonlighting on resident performance and education.