Paul Errera

A psychiatric patient classification system. An alternative to diagnosis-related groups.

It is generally accepted that diagnosis-related groups (DRGs) for alcohol, drug, and mental disorders are inappropriate for inpatient prospective payment. To address this issue, the Veterans Administration (VA) supported a project to construct alternative classes that are more clinically meaningful, more homogeneous in their resource use, and that account for more variation in resource use among psychiatric and substance use cases than existing DRGs. This paper reports on this project. Using a data set containing universally available discharge data plus behavioral, social, and functional information obtained by a survey of 116,191 discharges from VA psychiatric beds, and with AUTOGRP as the classifying algorithm, a classification system was formed. Twelve psychiatric diagnostic groupings (PDGs) were identified, analogous to major diagnostic groups in the DRG system. Within each PDG, from 4 to 9 terminal groups of Psychiatric Patient Classes (PPCs) were formed and validated. The 12 substance abuse PPCs explain >31% of the variation in length of stay; for the mental disorder PPCs the variance explanation is >11%, a substantial improvement over DRGs that, for the same data set, explain <2 and 3%, respectively. With the addition of only 5 variables beyond those presently included in discharge data sets, greater precision for payment purposes can be achieved. Implications for adoption of this classification system are discussed.

Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties

Early psychopathology outcomes were compared in troops mobilized for Persian Gulf graves registration duty but differentiated by war-zone deployment. Constructs of interest were Axis I psychiatric disorders, particularly posttraumatic stress disorder (PTSD), negative affect states, and somatic complaints. Psychometric instruments, including the Structured Clinical Interview for DSM-III-R, were administered to troops attending drill exercises. Although similar in personal characteristics and reporting low rates of premorbid psychopathology, groups differed in the prevalence of PTSD diagnoses, anxiety and anger symptoms, and somatic complaints. Current and lifetime PTSD rates of 48% and 65%, respectively, suggest that the psychological aftermath of war-zone participation involving the gruesome task of handling human remains was profound. Language: en

Psychological symptoms and psychiatric diagnoses in operation desert storm troops serving graves registration duty

This clinical report describes symptoms of psychological and physical distress and psychiatric disorders in 24 Army Reservists who served war zone graves registration duty in support of Operation Desert Storm. Troops underwent comprehensive assessment for evidence of psychopathology that might be associated with war zone duty as one component of a debriefing protocol scheduled during regular drill exercises eight months after their return to the United States. Troops endorsed items suggestive of high war zone stress exposure, common symptoms of anxiety, anger, and depression, and multiple health and somatic concerns. Almost half of the sample met criteria for post-traumatic stress disorder, and diagnosis of this disorder was strongly associated with evidence of depressive and substance abuse disorders. The gruesome aspects of body recovery and identification in a war zone setting were cited as stressor elements of significant negative impact.

Some historical aspects of the concept, phobia.

SummarySome of the pertinent writings on phobias prior to the end of the nineteenth century are reviewed. The changing terminology is described, as well as early clinical formulations.

DRGs and psychiatry: Work in progress

A study is presented in which a number of variables describing psychiatric patients hospitalized within Veterans Administration Medical Centers are being investigated as potentially more predictive discriminators of resource consumption than the currently formulated diagnostic-related groups.

Teaching residents to recognize administrative issues in clinical situations.

Practicing physicians often have little interest in the administrative aspects of their field and meager respect for the skills which are necessary to accomplish what they view as some of the tedious facets of medicine. This paper attempts to examine these attitudes in psychiatric residents specifically as they reflect serious difficulties of training in the health caring process itself

A comparison of two populations within a psychiatric clinic.

When .seen in a community psychiatric clinic, the recently discharged state hospital patient frequently presents special challenges to those responsible for his after-care. The nature and extent of his problems, the quality of his communications, and the kinds of help he requires separate him from his fellow outpatients. A previous paper 1 illustrates with case material some of these problems and shows how they may be compotmded when the available therapists are residents in training. The present study presents additional data collected on a larger patient population.

Treatment of an adolescent with urticaria, using reserpine as an adjunct to therapy.

Summary1.An adolescent from a low-status family economically was treated successfully for chronic hives.2.Three important therapeutic aids were: (a) an initial remission of symptoms, simultaneous with the administration of reserpine; (b) the patients willingness from the start to be a captive audience; and (c) the relating of the therapist to the patient at the patients own level.