David Bienenfeld

Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model.

The understanding of adjustment to aging calls for models that illustrate the interaction of psychosocial and health factors. The authors surveyed a group of retired Catholic sisters, examining the contributions of psychosocial factors and religiousness to life satisfaction, psychological distress, and depression. Life satisfaction was best explained by a four-factor model that included mastery, social support, physical functioning, and religious commitment. General level of distress was best predicted by physical functioning, social support, and mastery, but not religiousness. Depression, on the other hand, was predicted by mastery, social support, and religious commitment. These data are consistent with a proposed model in which internal, external, and coping resources mediate the psychological impact of impaired functional status.

Use of Tricyclic Antidepressants in Recipients of Heart Transplants

Cardiac transplantation has become an accepted treatment for certain endstage cardiac disease patients. Depression and significant psychosocial stress among heart transplant recipients are not uncommon, but published reports about the use of antidepressants in these persons are very rare. The authors of this study report on a group of nine heart transplant recipients treated with antidepressant medicines. Seven patients achieved clinical remissions of their depression, and only two were unable to tolerate the noncardiac side effects of the medication. Indicators of autonomic, electrocardiographic, and hemodynamic functions showed no adverse effects. Although the study is based on a small sample, it appears that tricyclic antidepressants are safe and effective in heart transplant recipients.

Quantifying the Accuracy of Forensic Examiners in the Absence of a “Gold Standard”

This study asked whether latent class modeling methods and multiple ratings of the same cases might permit quantification of the accuracy of forensic assessments. Five evaluators examined 156 redacted court reports concerning criminal defendants who had undergone hospitalization for evaluation or restoration of their adjudicative competence. Evaluators rated each defendant’s Dusky-defined competence to stand trial on a five-point scale as well as each defendant’s understanding of, appreciation of, and reasoning about criminal proceedings. Having multiple ratings per defendant made it possible to estimate accuracy parameters using maximum likelihood and Bayesian approaches, despite the absence of any “gold standard” for the defendants’ true competence status. Evaluators appeared to be very accurate, though this finding should be viewed with caution.

Medical student abuse: perceptions and experience

Summary. A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10‐item attitude assessment about abusive behaviour were administered to the first‐and fourth‐year medical students at a mid‐west US university medical school. The first‐ and fourth‐year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth‐year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

Social implications of blepharoptosis and dermatochalasis.

Purpose To investigate the social implications of blepharoptosis and dermatochalasis. Methods Two hundred ten individuals rated whole-face photographs of a series of patients based on 11 different personal characteristics: intelligence, threat, friendliness, health, trustworthiness, hard work, mental illness, financial success, attractiveness, alcoholism, and happiness. Preoperative and postoperative photographs of both male and female patients with bilateral blepharoptosis and/or dematochalasis were used. The paired t test was used to compare preoperative versus postoperative ratings on the 11 characteristics. Results The preoperative photographs were rated more negatively than were the postoperative photographs (p < 0.01) on all 11 characteristics for both male and female patients by the 210 study subjects. Conclusions Members of our society view individuals with blepharoptosis and dermatochalasis negatively. These social attitudes may lead to unjust bias toward affected patients, and surgical correction probably provides benefits beyond improved visual function.

Liabifity and Accountability in Psychotherapy Supervision

The contemporary climate of medical-legal liability, and of increasing expectations of accountability from agencies that pay for psychiatric services and training stipends, has created an atmosphere within which issues of liability and accountability should be constructively addressed. The authors conducted a nationwide survey of psychiatry residency training directors and asked them to estimate the awareness of their supervisors of liability issues pertinent to the supervision of psychiatric residents learning psychotherapy. While the training directors assume that their faculty supervisors, including volunteer faculty, are familiar with issues of accountability, very few make tangible efforts to provide this information. The authors found that patients are not routinely informed of the identity of supervisors, although the patients are usually informed that a therapist is in training. The authors propose practical interventions whereby residency training programs could address the issues of faculty members’ awareness of their accountability, the education and training of supervisors, the documentation of supervisory sessions, and the attitudes and practices of psychotherapy trainees.

Incentives for Teaching Psychiatry

A questionnaire was sent to chairs and faculty in 137 academic departments of psychiatry regarding the methods used to promote teaching and their perceived value. The incentives most often used included promotion and retention, nomination to committees, and peer recognition. Least often used were bonuses and a designated teachers’ career track. Chairs and their faculty often disagreed as to whether some incentives were being used at all Recognition of teaching excellence was generally most highly valued as a useful incentive. Clarification of the nature and purpose of teaching incentives would likely improve their effectiveness.

Community vs. Private-Practice Psychiatrists: Lifestyle and Role as Related to Career Track

Around the late 1970s, the proportion Tasman, 1991; Clark & Vaccaro, 1987; Olafson, Klerman, & Pincos, 1993). Curof psychiatrists working in community mental health centers fell sharply. Some aurently, although some psychiatrists avoid even managed-care settings, others choose thors suggested that this was due to a change in psychiatrists’ roles in the public to work entirely in the public mental health sector. mental health system, which resulted in job dissatisfaction among all psychiatrists On the basis of the literature, we expected that psychiatrists currently working (Windle, Poppen, Thompson, & Marvella, 1988; Flaskeryd, 1986; Goldberg, Riba, & in community mental health centers would report a different “job description” than would psychiatrists in private, non-managed-care settings, and therefore would rePaulette Marie Gillig, M.D., Ph.D., is a Professor of Psychiatry in the Department of Psychiatry, port different reasons for choosing these School of Medicine, at Wright State University respective settings. We anticipated that in Dayton, Ohio. Ronald Markert, Ph.D.; David these choices would be based in part on Bienenfeld, M.D.; William Klykylo, M.D.; John lifestyle considerations, and in part on difRudisill, Ph.D.; Jerald Kay, M.D.; and James Bourgeois, O.D., M.D., also were affiliated with fering ideologies of the proper profesthe Department of Psychiatry at Wright State sional role of a psychiatrist (Baker & University. Baker, 1999). This research was supported by an educational research grant to Professor Gillig at Wright State University in Dayton, Ohio, from the Ohio Department of Mental Health. METHOD Address for correspondence: Paulette Marie Gillig, M.D., Ph.D., Professor of Psychiatry, Participants were a convenience sample Wright State University School of Medicine, of 272 full-time practicing psychiatrists seP.O. 927, Dayton, OH 45401. E-mail: pgillig@ your-net.com. lected from the American Psychiatric As-