Robert L. Tyson

A Study of Psychiatric Emergencies: Part I. Demographic Data

Psychiatric emergency evaluation and treatment are an increasingly important part of current psychiatric practice. Psychiatry residency training has been affected accordingly. Of particular importance has been the need to characterize the emergency population seen and to describe the changes in this population over time. At University Hospitals of Cleveland over the past nine years the psychiatric emergency population has doubled. There has also been a shift to a younger age group, evidence of better motivation, reduced incidence of hospitalization, and increased use of medications. At this hospital, Negro females constituted the largest group and contained the highest percentage of patients receiving medications. Possible reasons for these findings are discussed.

A STudy of Psychiatric Emergencies: Part III. Findings on Followup:

Criteria to measure the effectiveness of a psychiatric emergency consultation service include (1) whether or not the recommendations made were followed, and (2) the rate of hospitalizations in the followup period. Negro females were identified as following outpatient recommendations least often of any group. With this finding, the suitability of the classical recommendations available is discussed. The hospitalization rate for the psychiatric emergency group in the followup period is significantly higher than the national rate. This finding is independent of (1) hospitalizations effected at the time of the emergency evaluations and (2) psychiatric hospitalizations in the followup period. This result suggests that a large fraction of the psychiatric emergency population presents with extensive pathology which is not or cannot be dealt with in the context of the emergency consultation.

Neurotic Negativism and Negation in the Psychoanalytic Situation

Negativistic phenomena in the treatment of neurotic children and adults are examined and distinctions are made among negativism, negation, and denial. Clinical vignettes exemplifying various forms of negativism are presented and viewed as expressions of developmental, defensive, or characterological aspects of the personality. Hartmanns seminal concepts of the genetic fallacy, change of function, and secondary autonomy are employed. The addition of a developmental view provides a broader context within which to view the patients behavior and on the basis of which to formulate interpretive interventions.

A Study of Psychiatric Emergencies: Part II. Suicide

Suicide attempts or suicide ideation are often of critical importance in defining a psychiatric emergency. Follow-up studies of the psychiatric emergency population for the subsequent incidence of attempted or completed suicide are needed to identify high and low risk groups and to measure the effectiveness of the psychiatric emergency service. Suicide problems were presenting symptoms in 28.2 percent of psychiatric emergency evaluations seen in a three month period. The 10–29 decades for females and the 10–19 decade for males were represented significantly more often than older decades. Race and marital status were not related to suicide problems. There were seventeen known suicide attempts, but no known suicides in a six month follow-up period. This finding was contrasted with the results of a similar study done nine years previously at the same hospital and with a study done by the Cleveland Suicide Prevention Center, both of which found several suicides in the follow-up period. Possible reasons for the different results are discussed.

The Good Boy Syndrome and Malignant Academic Failure in Early Adolescence

The shift into adolescence coincides with an increase in academic demands that reveals a large diagnostic range of difficulties underlying academic underachievement or failure at this developmental stage. A group of compliant boys of high intelligence and proved abilities, previously apparently well-adjusted and well-liked, unexpectedly come to attention because of sudden academic failure. Their puzzling difficulties indicate a serious underlying disorder, including depression, which requires intensive treatment. Intrasystemic superego conflicts of ideals form an intrinsic part of the psychic picture.