Carole S. Orleans

Binge eating in obesity: preliminary findings and guidelines for behavioral analysis and treatment.

Abstract Binge eating is a complex behavioral problem that often contributes to obesity and complicates standard behavioral weight reduction treatment. This paper reviews previous investigations of binge eating in overweight populations and presents new data from 280 participants in an intensive weight reduction program. These data corroborate clinical impressions that binge eating is frequently accompanied by interpersonal, self-esteem, and stress management deficits. Related preliminary findings aid in a functional analysis of binge behavior patterns and provide empirical support for diagnostic criteria suggested for bulimia in the Diagnostic and Statistical Manual III (DSM-III). Guidelines for a functional analysis of binge eating are presented and suggestions for a comprehensive behavioral and dietary approach to binge eating are outlined. Programmed bingeing is given special attention as one useful therapeutic strategy.

Worksite smoking cessation initiatives: Review and recommendations

Offering health lifestyle change assistance in the workplace represents a major challenge for behavioral scientists and behavior therapists in the 1980s. Business and industry are showing special interest in employee smoking cessation. This paper reviews a wide range of worksite smoking cessation activities and related research. Six types of intervention are discussed: educational campaigns; policies restricting workplace smoking; self-help programs; physical examination and physician advice; incentive programs; and actual smoking cessation services. Existing research is critically reviewed. Practical recommendations for improving and systematically evaluating worksite quit smoking initiatives are presented.

Models for evaluating teaching in consultation-liaison psychiatry

This paper reviews the purposes and methodologic requirements of conclusion-oriented research for evaluating outcomes of consultation-liaison (C-L) teaching in psychiatry. Requirements for replicating educational methods and outcomes, and for demonstrating cause-effect relationships between program inputs and program outcomes include: careful definition of educational methods; selection of valid and reliable outcome measures; and use of sound experimental designs. Barriers to meeting these methodologic criteria in C-L settings are identified, and methods for overcoming them are suggested. In addition, useful guidelines are provided for the educator wishing to conduct conclusion-oriented C-L research to determine teaching effectiveness.

Models for evaluating teaching in consultation-liaison psychiatry: II. Decision-oriented research.

The authors present a Program Audit Form (PAF), which can be used to evaluate liaison programs. Use of PAF illustrates the decision-oriented approach to evaluative research defined in Part I of this paper. The PAF includes three categories of information about the liaison program: (a) administrative arrangements, (b) program description, and (c) program feed-back. The information will provide the user with an overall picture of a Programs weaknesses and strengths, and a basis for making decisions about program change. The form is short and represents the minimal data program directors should have readily available without requiring technician time or research expense. Finally, it can be used to compare programs across institutions, because it includes descriptors of administrative arrangements.

Traditional vs. Consultation-Liaison Psychiatry Clerkships: A Closer Look

This year-long study compared training experiences and outcome of consultation-liaison (CL) and traditional psychiatry clerkships. CL students reported greater improvement in their ability to employ psychiatry skills with general medical patients, and more favorable changes in their attitude towards psychiatry as a potential specialty. Analyses of actual training experiences showed that these more positive CL outcomes were associated with greater experience in primary care settings and more positive senior staff relationships. The remainder of results agree with past findings showing no significant differences in knowledge, skill and attitude outcomes, and extend past findings by showing a parallel similarity in the content and methods of training across services. Directions for future research are suggested.

Undergraduate psychiatry education 1971-1976: Trends and findings

The authors review all articles on undergraduate psychiatry education appearing in three major journals over the past five years in order to integrate and evaluate diverse approaches to psychiatry teaching. They high-light promising curricular innovations, identify issues still needing investigation, and suggest useful curriculum evaluation strategies. Major conclusions are: (a) heightened student involvement, with patients, peers, and faculty, combined with recent efforts at focused skill training and at making psychiatry teaching more relevant to nonpsychiatric medicine have increased both teaching effectiveness and student satisfaction; (b) self-instructional and videotape teaching programs may be detrimental under some circumstances; and (c) despite enormous progress, psychiatric training is still incompletely integrated into the rest of the medical curriculum.

What Medical Students Retain from a Psychiatry Clerkship: Two Year Follow-Up Study

In this unique study, the authors examined the durability of psychiatry clerkship learning outcomes two years after the clerkship. Initial clerkship-related improvements in psychiatric skills were maintained over two years, except for a decline in skills to treat serious psychiatric disorders and an improvement in skills to make psychiatric referrals. Initial favorable attitude changes were maintained in some areas but reversed in others. Students rated psychiatric skills as less relevant to future practice needs at follow-up than immediately after the clerkship. But follow-up relevance ratings were still high and students saw themselves as having less psychiatric expertise than they would need in clinical practice.