==================================HSR06================================== 6. Interested in attitudes or prejudices of psychotherapists (psychiatrics) towards 'difficult', high-risk, multi-problem and low income clients or patients; the impact of such attitudes, expectations, or prejudices on subsequent treatment with this population. Also look for 'YAVIS' - the young, attractive, verbal, intelligent and successful client. These are 'most desirable' in contrast to? 1 UI - 87077207 AU - Armstrong MS ; Andrews G TI - A survey of practising psychiatrists' views on treatment of the depressions. AB - The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when improvement with psychotherapy did not occur. MH - *Attitude of Health Personnel ; Australia ; Case Report ; Depressive Disorder/PSYCHOLOGY/*THERAPY ; Human ; Methods ; *Psychiatry ; Quality Assurance, Health Care ; Random Allocation SO - Br J Psychiatry 1986 Dec;149:742-50 2 UI - 87073858 AU - Burti L ; Mosher L TI - Training psychiatrists in the community: a report of the Italian experience. AB - In 1978 a revolutionary mental health act was passed in Italy. By closing large mental hospitals and replacing them with community programs, it required a radical shift in psychiatric practice. The authors discuss the background philosophy, principles, and practical implications of this change. They describe a model program and training design of a 4-year residency in which psychiatrists learn the skills for community work while actually working in the community. The residency differs from most U.S. residencies in having trainees responsible for patients wherever they are being treated (residents are not rotated between services), its strong team orientation, and the value placed on community work. MH - Adult ; Attitude of Health Personnel ; Case Report ; Community Mental Health Services/LEGISLATION & JURISPRUD./*MANPOWER ; Continuity of Patient Care ; Deinstitutionalization ; Female ; Health Facility Closure ; Human ; Internship and Residency/METHODS ; Italy ; Mental Disorders/ THERAPY ; Psychiatry/*EDUCATION ; Support, Non-U.S. Gov't SO - Am J Psychiatry 1986 Dec;143(12):1580-4 3 UI - 87050456 AU - Andrews S ; Vaughan K ; Harvey R ; Andrews G TI - A survey of practising psychiatrists' views on the treatment of schizophrenia. AB - Practicing psychiatrists' views about the treatment of schizophrenia were investigated as part of a Quality Assurance Project. A questionnaire which asked for treatment recommendations for each of four case descriptions of patients with schizophrenia was mailed to a one-in-six random sample of Australian psychiatrists; 90% responded. Psychiatrists almost uniformly advocated the use of antipsychotic drugs and usually recommended concurrent supportive psychotherapy or family/social intervention procedures. The recommendations varied systematically, according to the initial history obtained and to the initial response to treatment. MH - *Attitude of Health Personnel ; Australia ; Health Surveys ; Human ; Methods ; Professional Practice ; *Psychiatry ; Quality Assurance, Health Care ; Schizophrenia/*THERAPY SO - Br J Psychiatry 1986 Sep;149:357-64 4 UI - 87050359 AU - Wilkinson G ; Williams P TI - Development of scales to measure treatment attitudes in psychiatry. AB - We used multiple regression analysis to modify and shorten two scales for measuring practitioners' attitudes to psychotherapy and drug therapy. The resulting scales have been combined in a 21-item questionnaire (Treatment Attitudes in Psychiatry Scales (TAPS] which is brief and easy to use, and should have wide application in psychiatry. The results of a concurrent validation of the scales, using two large groups of consultant psychiatrists who were members of either the Biological Psychiatry or Psychotherapy Section of the Royal College of Psychiatrists, show the extent to which their attitudes to psychotherapy or drug therapy tend to overlap. Polarisation of attitudes was more evident in the results from the Biological Psychiatry Section. A method is described by which scores obtained with the TAPS can readily be compared with those obtained by the criterion groups. MH - *Attitude of Health Personnel ; Female ; Human ; Male ; Mental Disorders/ DRUG THERAPY/*THERAPY ; Middle Age ; *Psychiatry ; *Psychological Tests ; Psychotherapy ; Support, Non-U.S. Gov't SO - Br J Psychiatry 1986 May;148:581-6 5 UI - 87027142 AU - Parkes CM TI - Care of the dying. The role of the psychiatrist. AB - This paper examines the negative assumptions held by many of the staff of terminal care units and argues the case for involving psychiatrists and members of allied professions in a variety of roles which are of great importance to the future of terminal care. MH - Attitude of Health Personnel ; Grief ; Human ; Nursing Staff/PSYCHOLOGY ; *Physician's Role ; Professional-Family Relations ; *Psychiatry ; *Role ; Social Support ; *Terminal Care ; Voluntary Workers/PSYCHOLOGY SO - Br J Hosp Med 1986 Oct;36(4):250, 252, 254-5 6 UI - 87010612 AU - L:opez S ; Hernandez P TI - How culture is considered in evaluations of psychopathology. AB - A mail survey was conducted to explore how mental health professionals take culture into account in their evaluations of psychopathology and to assess their reported attitudes toward the role of culture in their work. The respondents were 118 licensed social workers, psychologists, and psychiatrists from the state of California. Their reported attitudes and behavior represent a culturally sensitive position. For example, 83% of the sample indicated that they consider culture for most or all of their culturally different patients. A total of 96 therapists provided brief case summaries describing how they took culture into account for a given patient. A qualitative analysis revealed that culture is considered throughout the evaluation and treatment process. Furthermore, 35 case summaries referred to changes in the therapists' clinical evaluations as a result of considering culture. All but three of the case summaries indicated that clinicians judged the problems to be less severe or less pathological when thought to be cultural in nature. The risk of dismissing actual psychopathology as culturally normative behavior is considered. MH - Adolescence ; Adult ; *Attitude of Health Personnel ; California ; Child ; *Culture ; Female ; Human ; Male ; Mental Disorders/*DIAGNOSIS/ PSYCHOLOGY/THERAPY ; Mental Health Services ; Minority Groups ; Questionnaires ; Research ; Support, Non-U.S. Gov't SO - J Nerv Ment Dis 1986 Oct;174(10):598-606 7 UI - 86319390 AU - Malt UF TI - DSM-III and Norway. History, attitudes and future. AB - The first Norwegian evaluation of the DSM-III system of classification occurred in 1980. A Norwegian translation of the diagnostic criteria was published as part of a textbook in psychiatry in 1984. The Mini DSM-III (Quick reference) was published in 1985. The DSM-III system has been generally well accepted in Norway and is currently used in most research projects besides the ICD system. Several training courses have been arranged for senior psychiatrists and psychologists. Introduction to the DSM-III system is also part of the obligatory training course for psychiatric residents in Norway. From 1987 Norway will use a clinical modification of the ICD-9 system of classification. This modification applies 5 digit coding and includes diagnostic categories found in the DSM-III system but not in the 4 digit ICD-9 version. The DSM-III system of classification represents a major step forward in psychiatric classification. However, revisions are necessary to increase clinical validity. Although Norwegian psychiatry has been inspired by the DSM-III system, Norway remains committed to the ICD systems. The goal must be to make further revisions of the DSM-III and ICD systems, and in the end unite the strengths of these two systems of psychiatric classification. MH - Attitude of Health Personnel ; *Forecasting ; Human ; *Manuals ; Mental Disorders/CLASSIFICATION/*DIAGNOSIS ; Norway SO - Acta Psychiatr Scand [Suppl] 1986;328:7-9 8 UI - 86301840 AU - Daniels ML ; Linn LS ; Ward N ; Leake B TI - A study of physician preferences in the management of depression in the general medical setting. AB - Although more than 30% of ambulatory medical patients are depressed, little is known about how their depression is managed in the primary care setting. We surveyed 282 primary care physicians at two internal medicine and four family medicine programs. We asked these physicians to describe how they actually managed depression in their depressed medical patients and how they would manage ten hypothetical depressed medical patients. Demographic and attitudinal data were also obtained. Physicians reported that they utilized a wide variety of treatments for their depressed patients. They indicated that they would recommend counseling twice as many depressed patients as they would recommend medicating or referring. Over 30% of the variance in self-reported preferences to recommend particular treatments for depression was accounted for by physician characteristics. Prior experience with a treatment strategy was a significant factor in predicting a recommendation for future use of a treatment independent of other considerations such as endorsement of positive attitudes about the efficacy or benefits of a treatment. Prior experience was also more important than physician sociodemographics as a predictive variable. The clinical and educational implications of these findings for psychiatrists and primary care physicians are discussed. MH - Adult ; Ambulatory Care ; Antidepressive Agents/THERAPEUTIC USE ; Attitude of Health Personnel ; Counseling ; Depressive Disorder/DIAGNOSIS/ *THERAPY ; Exertion ; Female ; Human ; Male ; Primary Health Care ; *Referral and Consultation ; Support, Non-U.S. Gov't ; Tranquilizing Agents, Minor/THERAPEUTIC USE SO - Gen Hosp Psychiatry 1986 Jul;8(4):229-35 9 UI - 86289599 AU - Johnson TM TI - Medical education and practice on the periphery: consultation psychiatry and the psychosocial tradition in American medicine. AB - The culture of American medicine has both central biomedical and peripheral psychosocial traditions, a pluralism which demands further study. Anthropologists have traditionally learned a great deal about any culture by studying the socialization process, and the same is true of medicine. In consultation-liaison psychiatry, the peripheral position of the psychosocial tradition can be better understood as psychiatrists teach students and residents how to assist biomedical specialists in the care of their hospitalized patients. Through such student socialization, the use of the technology of biomedicine by psychiatrists for both the manifest function of patient care and the latent function of cementing interprofessional relationships is revealed. In consultation psychiatry, students are also taught that the object of their ministrations is not the patient, but all members of the ward milieu, a focus which is not characteristic of the biomedical tradition. Students in consultation psychiatry are inculcated with attitudes and values which are divergent from those of the biomedical tradition; the competitive presentation and selective assimilation of such elements of professional ideology by students further betrays the peripheral position of psychosocial concerns in medicine. This position is also highlighted by the teaching of 'survival strategies' to students and residents in psychiatry, designed to increase the likelihood of acceptance by biomedical specialists. These include mimicking biomedical approaches to diagnosis and treatment, viewing biomedical specialists as patients who are unwitting victims who can be cured with the right treatment, manipulating symbols and using metaphors of biomedicine to affirm the basic kinship of all physicians, and otherwise promoting psychiatry as central to modern medicine. Yet, the psychosocial tradition, itself, is not homogeneous.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Attitude of Health Personnel ; *Consultants ; Education, Medical ; Human ; *Interprofessional Relations ; Patient Care Team ; *Psychiatry/ EDUCATION SO - Soc Sci Med 1986;22(9):963-71 10 UI - 86276415 AU - Fink PJ TI - Dealing with psychiatry's stigma. AB - The stigma associated with psychiatry is the most critical problem facing the profession, the author contends. He identifies the major sources of stigma as psychiatrists' internal conflicts over treatment ideologies and methods and the hostility between psychiatrists and other physicians that has led to disparagement of psychiatry as a medical specialty. To combat the stigma he recommends that highest priority be given to efforts to unify the profession and to increase psychiatry's participation in organized medicine. He also urges psychiatrists to limit self-revelation and self-exploration in the media, to emphasize the broad range of knowledge and skills that makes them uniquely suited to perform evaluative and triage functions, and to halt the current practices of shunting whole classes of patients off to other disciplines for care and of educating other disciplines in psychiatric techniques. MH - Health Occupations/EDUCATION ; Hostility ; Human ; *Interprofessional Relations ; Mass Media ; Personality ; Politics ; *Prejudice ; *Psychiatry ; Self Disclosure SO - Hosp Community Psychiatry 1986 Aug;37(8):814-8 11 UI - 86251333 AU - Enzer NB ; Singleton DS ; Snellman LA ; Maccio ME TI - Interferences in collaboration between child psychiatrists and pediatricians: a fundamental difference in attitude toward childhood. AB - The relationship between pediatrics and child psychiatry has been discussed at length. Opportunities seem to exist for cooperation between the two specialties, and yet difficulties exist. This study compared attitudes toward childhood held by pediatricians and child psychiatrists, as well as by residents at the beginning and end of training in pediatrics, psychiatry, and child psychiatry. The attitudinal assessment tool was a 30-item questionnaire consisting of literary quotations with which respondents were asked to agree or disagree. The results suggest that pediatricians view childhood more positively than do child psychiatrists. These attitudinal differences exist at the beginning of residency training. Recommendations are made regarding how to facilitate better collaboration between pediatricians and child psychiatrists. MH - *Attitude of Health Personnel ; *Child Psychiatry ; Comparative Study ; Human ; Internship and Residency ; *Interprofessional Relations ; *Pediatrics ; Questionnaires SO - J Dev Behav Pediatr 1986 Jun;7(3):186-93 12 UI - 86249800 AU - Fritz GK ; Bergman AS TI - Child psychiatrists' characteristics, communication, and competence as described by pediatricians in a national survey. AB - A nationwide survey of pediatricians was undertaken to evaluate pediatricians' attitudes and utilization patterns regarding child psychiatrists. The response of 1,089 pediatricians (69% of those surveyed) to open-ended questions in the survey are described. A wide variety of strongly-held beliefs concerning child psychiatrists' usefulness as collaborators and consultants in training and in clinical practice are identified. The implications of these findings for both medical specialties are discussed. MH - Attitude of Health Personnel ; *Child Psychiatry ; Clinical Competence ; Communication ; Human ; *Interprofessional Relations ; *Pediatrics ; Questionnaires ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; United States SO - Int J Psychiatry Med 1986-87;16(1):91-100 13 UI - 86246296 AU - McGuire J ; Borowy T ; Kolin I TI - Attitudes toward mental health professionals in a hospital-based community mental health center. AB - This study examined the attitudes of several diverse subject groups in a large medical center toward various mental health professionals. The groups consisted of: general hospital staff; professional mental health workers; and psychiatric in-patients. Subjects evaluated a selection of 11 professional health related role titles (clinical psychologist, physician, psychiatrist, etc.) and the categories "me: and "mental patient: by marking a series of 19 seven-step rating scales, each composed of bipolar anchoring adjectives. Additionally, a "familiarity: rating for each of the role titles was obtained. An "understanding: and a "value: cluster were derived from the 19 adjectives along with an overall favorability-unfavorability score for each role title. It was expected that subjects would "value: mental health professional roles more strongly than they would indicate an "understanding: of these same roles. Secondly, it was expected that the hospital setting itself, the subject's role within that setting, and the degree of familiarity with the role being rated would have a significant impact on the subject's attitude. Results generally supported the above expectations. Overall ratings of the professional groups were consistently high, with less difference between the "health: designations (physician, nurse) and the "psych: designations than has been previously reported in the literature. MH - *Attitude of Health Personnel ; *Community Mental Health Centers ; Human ; Interprofessional Relations ; *Patient Care Team ; Referral and Consultation SO - Community Ment Health J 1986 Spring;22(1):39-48 14 UI - 86239730 AU - Weissman SH ; Bashook PG TI - A view of the prospective child psychiatrist. AB - A questionnaire distributed to the 1,033 medical students who matched into postgraduate year 1 psychiatric positions in 1982 and 1983 obtained data on personal characteristics, career plans before entering medical school, future career plans, attitudes toward personal psychotherapy, and plans for psychotherapy or psychoanalysis during residency. The results for the 579 residents (56%) who responded are reported. The authors explore differences and similarities between respondents who planned to go into general or child psychiatry as they began general psychiatric residency training. They found two clusters of prospective child psychiatrists: one psychoanalytically oriented and the other eclectically oriented. The authors discuss the implications of this clustering. MH - Attitude of Health Personnel ; *Child Psychiatry ; Comparative Study ; Female ; Human ; Internship and Residency ; Male ; Pediatrics ; Psychiatry ; Psychoanalytic Therapy ; Psychological Theory ; Psychotherapy ; Questionnaires ; Students, Medical/*PSYCHOLOGY SO - Am J Psychiatry 1986 Jun;143(6):722-7 15 UI - 86217608 AU - Johnson R ; Ananth J TI - Physically ill and mentally ill. AB - Undetected physical illnesses in psychiatric patients are common. Why do so many physical illnesses go undetected? These disorders are difficult to detect and need an elaborate consultatory process. Some of the problems may be related to the fact that psychiatrists do not do physical examinations. Clues suggesting an organic etiology may be attributed to psychodynamic issues by many physicians. In this paper, seven case reports are presented to illustrate the following: perform your own physical examination; do not attribute physical signs to dynamic issues; all physical signs should be explained; be alert to atypical presentations; conduct relevant laboratory workup; avoid bias against unattractive patients; and pose specific questions to consultants. MH - Attitude of Health Personnel ; *Diagnostic Errors ; Human ; Mental Disorders/*DIAGNOSIS ; Patients/PSYCHOLOGY ; Physical Examination ; Physicians/PSYCHOLOGY ; Psychiatry/*STANDARDS ; Referral and Consultation SO - Can J Psychiatry 1986 Apr;31(3):197-201 16 UI - 86208304 AU - Franzini LR ; Casinelli DL TI - Health professionals' factual knowledge and changing attitudes toward transsexuals. AB - General practitioners (GPs), obstetrician-gynecologists, urologists, psychiatrists and clinical psychologists (total N = 202) were randomly surveyed to assess their knowledge of the syndrome of transsexuality and their attitudes toward transsexual patients and sex reassignment surgery. A low return rate, though, requires that the present data be interpreted prudently. Where possible, the current findings were compared with the attitudinal data published in 1966 by Green, Stoller and MacAndrew. Over this interval an increasingly liberal and favorable trend in attitudes was noted amongst all medical specialties. 'Liberal' refers to a willingness to recommend a surgical remedy and 'favorable' refers to a less psychopathological perspective of the syndrome and greater social acceptance of these individuals. In the present sample GPs tend to hold the most conservative views, while clinical psychologists consistently endorse the most liberal positions. No differences emerged among the five groups of health care professionals on the factual knowledge assessment. MH - *Attitude of Health Personnel ; *Health Education ; Human ; Physician-Patient Relations ; *Sex Education ; Transsexualism/*PSYCHOLOGY/ THERAPY SO - Soc Sci Med 1986;22(5):535-9 17 UI - 86168933 AU - Groveman AM ; Nathan PE ; Fagley NS ; Brown EW TI - Impediments to psychiatric hospital discharge: what different professional groups think. AB - Perceived impediments to psychiatric hospital discharge were investigated across six professional groups. Seventy-nine psychologists, psychiatrists, social workers, rehabilitation personnel, registered nurses, and psychiatric aides were asked to select five behaviors and five other factors that they believed impeded hospital discharge. Violent behaviors, such as suicide, homicide, and damaging property, and financial factors, such as inadequate funds and inadequate living arrangements, emerged as the two areas that hospital staff consistently selected as principal impediments to discharge. Treatment plans of 20 patients were surveyed to ascertain whether the behaviors and other factors identified by staff were reflected in treatment goals. MH - Allied Health Personnel/PSYCHOLOGY ; *Attitude of Health Personnel ; Female ; Hospitals, Psychiatric/*STANDARDS ; Human ; Male ; Medical Staff, Hospital/PSYCHOLOGY ; Mental Disorders/*THERAPY ; Nursing Staff, Hospital/PSYCHOLOGY ; *Patient Discharge ; Personnel, Hospital/PSYCHOLOGY ; Social Work, Psychiatric ; Support, Non-U.S. Gov't SO - J Clin Psychol 1986 Mar;42(2):377-82 18 UI - 86127760 AU - Jampala VC ; Sierles FS ; Taylor MA TI - Consumers' views of DSM-III: attitudes and practices of U.S. psychiatrists and 1984 graduating psychiatric residents. AB - The authors surveyed U.S. psychiatrists and psychiatric residents graduating in 1984 about their use and views of DSM-III. Although the majority approved of DSM-III generally, 35% of the psychiatrists and 20% of the residents said they would stop using it if it were not required. Residents accepted DSM-III better than did practicing psychiatrists. Many of the respondents doubted the validity of some diagnoses and stated that many of their patients did not satisfy criteria needed for the DSM-III diagnoses in their records. Most respondents did not use all DSM-III axes and did not want new axes. The authors discuss the survey results and their implications for revision of DSM-III. MH - *Attitude of Health Personnel ; Human ; *Internship and Residency ; Manuals/*STANDARDS ; Medical Records/STANDARDS ; Mental Disorders/ CLASSIFICATION/*DIAGNOSIS ; *Psychiatry/EDUCATION SO - Am J Psychiatry 1986 Feb;143(2):148-53 19 UI - 86110025 AU - Griffith EE ; Griffith EJ TI - Racism, psychological injury, and compensatory damages. AB - Psychiatrists and other mental health professionals have paid only modest attention to the idea that discriminatory conduct causes emotional suffering for those who are the object of it. However, courts have held that if such racist conduct is willful and outrageous and the ensuing suffering is severe, the plaintiff has a reasonable claim to compensatory damages. The authors trace these developments in the legal arena in both tort actions and complaints under civil rights statutes. They also point out how psychiatrists could be more influential in sharpening considerations about the idea that racism causes psychological injury. MH - Blacks ; Civil Rights/LEGISLATION & JURISPRUD. ; Human ; Mental Disorders/ *ETIOLOGY ; Physician's Role ; *Prejudice ; Psychiatry ; Race Relations/ *LEGISLATION & JURISPRUD. ; Shame ; United States ; Wit and Humor SO - Hosp Community Psychiatry 1986 Jan;37(1):71-5