Faculty Bibliography

This study reports the process and outcome of a mental health policy change designed to relieve overcrowding in the 10 municipal adult psychiatric inpatient units in New York City. The authors describe the strategies used to achieve a limited change in admission policies and analyze the effect of this change on the municipal hospitals. Comparison of conditions before and after the policy change suggests its positive impact. Results are discussed in reference to the model of incrementalism in policy making, emphasizing the need for comprehensive rational planning, the training of mental health professionals in policy making, and further research on this important area of psychiatry.

Based on the observation that Hispanic depressed patients appear to receive lower dosages of antidepressants, the clinical records of 41 Hispanic and 21 Anglo, female outpatients receiving antidepressants were compared. All the patients had been diagnosed by two psychiatrists as suffering from a major depressive episode according to the DSM III criteria. The records showed that the Anglo patients received about double the dosage of antidepressants given to the Hispanic patients. The Hispanic patients complained more about side effects, but the treatment outcome was comparable in both groups. Apart from pharmacokinetic factors, the authors suggest that these clinical observations may be due to the fact that Hispanic depressed patients express depression in terms of somatic symptoms which are often similar to the side effects produced by antidepressants. Clinicians ought to familiarize themselves with the psychological, sociocultural, and biologic characteristics of the patient, and should approach the chemotherapy in a differential manner. Controlled prospective studies should be designed to test the hypotheses generated by this study.

Using an anonymous questionnaire, the authors assessed the professional relevance of outpatient and inpatient curricula and the didactic value of different parts of the clerkship for 80 junior medical students randomly assigned to a pilot clerkship. Significantly more medical students preferred outpatient to inpatient psychiatry; they supported the view that working with outpatients is more useful, rewarding, and educational for the nonpsychiatrist physician. The implications of this study include the need to increase the outpatient psychiatric experience in medical school, the importance of surveying the impact of learning settings on students, and the reasonableness of adapting the curriculum to the didactic needs of students.

The authors review the literature on and systematize the factors influencing medical students' choice of psychiatry as a specialty. The results indicate that students who are single, from large metropolitan areas, uninterested in religion, politically liberal, interested in humanitarian ideas, who score low in authoritarianism, have a high capacity to tolerate ambiguity, have a high level of anxiety and fear of death, and have low self-esteem are likely to choose psychiatry. In medical school, the students likely to choose psychiatry have a lower class rank and express positive attitudes toward psychiatry and psychiatrists. Exposure to and taking responsiblity for patients, especially patients with good prognoses, are crucial factors encouraging students to be psychiatrists.

Generally, clinicians assessing mental status interpret patients' nonverbal behavior in terms of its discharge, expressive, interactional, or neurological properties. The present study addresses the conceptualization of hand movement behavior as related to central cognitive processes, and attempts to identify encoding-related motor behavior by comparing the hand movements of subordinate bilingual subjects in situations of dominant- and nondominant-language and low- and high-imagery verbalization. Compared to the parallel dominant-language situation, subjects verbalizing in their nondominant language produced more speech-primacy and groping hand movements. Also, in comparison with the verbalization about a high-imagery topic, when the subjects encoded a low-imagery topic they displayed more pointing movements. Unless they are aware of these movements, clinicians evaluating bilingual patients may interpret an increase in encoding-related motor activity as reflecting psychopathology. Apart from this psychodiagnostic significance, hypothetical implications of these findings for the study of aphasia and information processing mechanisms are discussed.

Bilingualism is known to affect the communicative behavior of the individual. This paper describes the implications of the bilingual experience for the process of dynamic psychotherapy, and presents recommendations to psychotherapists treating the bilingual population

The authors administered 6 g of L-dopa to 8 schizophrenic patients and 750 mg of chlorpromazine to 7 schizophrenic patients. Chlorpromazine showed only a modest advantage over L-dopa and only on some Brief Psychiatric Rating Scale factor scores, and at maximum dosage the thought disturbance factor score in the L-dopa-treated group was not worse than at baseline. The results suggest that L-dopa is associated more with toxic than with schizophreniform symptoms and that there is adaptation to its effects. The authors discuss implications of these findings for the dopamine hypothesis of schizophrenia