Leslie Hartley Gise

Sexual Abuse and Premenstrual Syndrome: Comparison between a Lower and Higher Socioeconomic Group

Of 174 women presenting symptoms of premenstrual syndrome (PMS), 40% had a history as victims of sexual abuse. Thirty-three percent were of a high-SES (socioeconomic status) group and 52% of a low-SES group. The authors found a connection between sexual abuse and psychiatric hospitalization for women seeking treatment for PMS. Beck Depression Inventory scores were high, supporting current research indicating a prevalence of affective disorders in women seeking treatment for PMS. However, the authors found few differences between the high- and low-SES groups. Specific questioning regarding a history of adverse sexual experiences is critical in evaluating all patients.

Recording psychiatric consultations: A preliminary report☆

Two new forms, specifically designed for computer processing of data from a contemporary consultation-liaison service, are described. The need for such data and their immediate applicability to problems currently facing this psychiatric subspecialty are discussed. Clinical, administrative, and evaluation uses are reviewed. It is hoped that this work will provide a stimulus to consultation-liason practitioners to use this system or to develop similar systems that will permit documentation, exploration, and enhancement of the consultation-liaison effort.

Issues in the identification of premenstrual syndromes.

Lack of information about the natural history of the premenstrual syndromes may make efforts regarding classification and treatment misguided. Thus, we report a naturalistic and nonintrusive approach to the problem of identification of the premenstrual syndromes, with particular focus on the issue of compliance with 2 months of daily prospective record keeping. Seventy-nine patients presenting for treatment of severe premenstrual symptoms were evaluated with a structured interview, psychological tests, and 2 months of daily prospective ratings of their symptoms. Weekly group follow-up meetings were held to foster compliance with record keeping. The typical woman seeking treatment for premenstrual symptoms in this study was middle-aged, highly educated, highly functioning, living in an urban setting, either married with children and family responsibilites or single and living alone, and supporting herself by a high-level job. She was anxious and depressed with multiple medical and gynecological problems. Despite a highly stressful life, she functioned at a very high level, but had consulted mental health professionals in the past. In general, she did not want medication. Consistent with other reports, only 20% of women seeking treatment for premenstrual symptoms had a premenstrual syndrome prospectively confirmed on the basis of 2 months of daily ratings. However, 81% of those with a prospectively confirmed premenstrual syndrome stated that after the 2-month evaluation period their symptoms no longer interfered with their functioning.

Models of Mental Health Training for Primary Care Physicians

&NA; Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysiologic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs.

The liaison clinic: A model for liaison psychiatry funding, training, and research

While liaison or similar clinics have existed since at least 1931, they remain uncommon. The Mount Sinai Medical Center Liaison Clinic is presented as a model for psychiatric evaluation and care of medical patients as well as training, research, and funding. In addition, it is a model for linking general and mental health systems in the tertiary care setting. The first year of operation of the clinic is described, including the sources of referral, demographic data, psychiatric, and medical diagnoses, and type of clinic contact. A total of 96 patients were seen in 390 visits, equaling three quarters of a liaison fellows salary.

Models of mental health training for primary care physicians: a validation study

&NA; Since the majority of persons with alcohol, drug abuse, and/or mental disorders (19%) of Americans during any 6‐month period are seen exclusively within the general health sector, it is imperative to know the quality and quantity of mental health training for primary care residents. In this study, the five program training model types previously described—Consultation, Liaison, Bridge, Hybrid, Autonomous—are validated by a random sampling technique using a structured instrument to test eight hypotheses developed before data collection to preclude post hoc interpretations. Of 250 programs, 147 responded (60%): 67 Family Practice, 42 Primary Internal Medicine, and 38 Internal Medicine. Since all eight hypotheses were supported by the data, the construct validity of the program model types is significantly substantiated. Multiple discriminant analysis revealed that the relationships between twelve training program characteristics and the five program model types were such that the former could explain 57% of the variance in the latter and correctly classify 89% of the programs.

The role of psychiatry in the training of primary care physicians

The question of psychiatrys role in medicine, and in particular its role in the training of primary care physicians (PCPs), is heightened by the knowledge that 60% of the 15% of patients who have DSM-III diagnosable alcohol, drug abuse, and mental health (ADM) disorders are seen exclusively in the general health sector. In addition, although PCPs have a low recognition rate of ADM disorders and are pessimistic about their outcome even with treatment, they prescribe the majority of tricyclic and anxiolytic medications. Models of mental health training for PC residents in training are examined, with particular emphasis on competencies taught, pedagogic vehicles, disciplines of the mental health teacher, and the relationship to departments of psychiatry. A computerized approach to assist the mental health training of primary care physicians developed at the Mount Sinai School of Medicine and Northwestern is presented. Finally, critical policy issues with regard to psychiatrys future role in training is described.

Public Privates: Performing Gynecology from Both Ends of the Speculum

How could a book about pelvic examinations be interesting? Public Privates is intersting—and radical, political, and extreme—yet it contains little-known information and enlightening perspectives. It might seem strange that someone would write a book about pelvic examinations, but the author is a gynecology teaching associate (GTA), and 25 years ago, when GTAs began to teach breast and pelvic examinations to medical students, that seemed strange. Now it is commonplace, a valued and accepted way of teaching. (Since the teaching has changed, perhaps the practice of pelvic examination might also change. Criticism of traditional practice emerged with the womens movement of the 1970s, and reformers advocated the idea of women inserting their own speculums and looking at their cervixes. To date, this practice is not widespread but it would seem a useful option for selected patients.) Although paternalistic practices have been reduced over the past 25 years thanks to the

Premenstrual changes and reproductive-related depressions

of CY have been examined also in mice subjected to other stressor paradigms (behavioral despair and physical restraint), and do not produce effects as evident and reproducible as those observed when SD is applied. These results indicate that psychological stressors can control tumor metastasis by host’s antitumor resistance factors through neuroendocrine mechanisms. These factors appear relevant for tumor spread and curability by antitumor agents, with implications of interest for experimental and clinical situations.

Premenstrual Syndrome: A Clinician's Guide

Although some clinicians still doubt the existence of premenstrual syndrome (PMS), it is regarded as a legitimate medical condition. Furthermore, all practicing physicians, whatever the specialty, should know about the premenstrual syndromes, which can present with over 150 different symptoms that pertain to every specialty in medicine. Unfortunately, the diagnosis of a PMS is complicated. First, it is made differently from the way we are used to making most of our diagnoses in clinical medicine. Second, there is a spectrum from normal premenstrual changes to a full-blown premenstrual disorder that interferes with functioning, so distinguishing the different types of syndromes may be difficult. Third, without knowing it, women frequently either exaggerate or underestimate their symptoms. First, most diagnoses in clinical medicine are made retrospectively, that is, on the basis of a history, physical examination, and relevant laboratory tests. The diagnosis of a PMS, however, is not made on the basis