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Total Care of the Psychiatric Patient
VOLUME VII. NUMBER 4
JULY - AUGUST, 1966
PSYCHOSOMATICS OFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
Total Care of the Psychiatric Patient Aaron W. Bortin, M.D.
• A MULTI-DIVISIONED Hospital Center, with a fully-equipped, accredited general hospital serving as its hub, offers such a wide range of facilities and services that it makes possible a total care program for the patient who is hospitalized for psychiatric treatment. Here at Brunswick, our General Hospital includes 26 beds set aside in two separate pavilions for admission of psychiatric patients. Our major neuropsychiatric facility, licensed for WI-beds, is one of the four c0ordinated hospital divisions that comprise our 662-bed Center. On admission each patient gets the following letter: As Director of Psychiatry, I extend to you my greetings. I am sending you this letter in the hope that it may help you to get your bearings in this new and unusual situation. I know how confused anyone must be in coming to a hospital which is so diHerent, with many new faces, and so many ways of doing things that it is hard to get matters straight. For the first 48 hours or so, you will be examined by internists and psychiatrists, have laboratory work performed, have x-rays of your chest, electrocardiograms taken, and other special tests that your doctor may feel necessary. This is to look for and correct physical irregularities and ailments, so that your improvement may be hastened. You will be deprived of matches and lighters, in accordance with Fire Laws, and your money checked at the office. You really don't need cash. Any purchases may be credited to your account as arranged with your family. Doctor Aaron Bortin is Director of Psychiatry, Brunswick Hospital Center, Inc., Amityville, L. I. This paper was presented at the Regional Meeting, Academy of Psychosomatic Medicine, at Brunswick Hospital, Amityville, L. I., N. Y., April 3, 1966.
July-August, 1966
Within the /irst few days, the Director of Occupational and Recreational Therapy will call on you with the hope of engaging you in such activities which will contribute to your recovery. These activities are part of our overall plan for total care of the patient. I will personally meet with you and help you in any way to make your time in the hospital as short as possible. I hope you will profit by your stay here and that you will leave with feelings of friendship. Following our personal meeting, our staff of psychiatrists will meet in conference and map out the best plan for your care. We are interested not only in making you feel better, but to actually be better. You may also write a personal letter to me if you think there is any special thing I can do for your comfort and well being.
Our treatment program is based on the conviction that mental illness is due to the interplay between constitutional, physiological, psychological, and socio-cultural factors which lead to maladjustment in life. Dr. Harvey J. Tompkins 1 says: "The psychiatric patient, particularly if he is ill enough to be hospitalized, needs a constellation of services readily available outside the psychiatric department of his local general hospital for his total treatment program." With this concept in mind, the total treatment of the patient requires the collaboration of psychiatrist, internist, surgeon, and other specialists, to treat co-existing states which frequently tilt the homeostasis of the individual. Psychological testing is done when required. Thus, many treatable conditions get the concerted attention of the various specialties. These include severe diabetes, hypertension, malnutrition, anemias of various etiologies,
111111IJII~.~III!lIJJll~ 11111111111111111
203
PSYCHOSOMATICS
endocrine disorders, thyroid dysfunction, pulmonary, cardiac, vascular and renal disorders, liver pathology, neurological and orthopedic defects. When the condition is reversible, treatment hastens psychiatric recovery. Where irreversible, our rehabilitation department, by prescription of the attending physician, effects the goal to make the patient as self-sufficient and useful as possible. In addition to psychiatric management, which includes psychopharmaceutical agents, electroshock treatments, group and individual psychotherapy, our comprehensive occupational and recreational department offers many attractions. There is a theatre for movies; also facilities for bingo games, dances, barbecues and other social functions; workshop, art, gymnasium, nine-hole golf course, bowling, hilliards and other diversionary projects. These help to maintain a better hold on reality and promote socialization and self-expression. For patients who spend a limited time of 30-60 days in the General Hospital facility, we must have limited goals. Patients are seen daily and individually for brief psychotherapy. These interviews are conducted face to face, and free association is discouraged. The sessions are focused on the current reality. It may be said that for many patients these sessions are often just an introduction to follow-up care by the referring physician, in the interest of maintaining a stabilized improvement. This total care concept has, for instance, allowed us to successfully treat a psychotically depressed woman with a history of bilateral amputation of the breasts for cancer with bone metastasis, who has had an adrenalectomy. Because of her lack of response to the psychic drugs a course of electroshock treatments was given and very helpful. In another instance, a woman with a history of coronary disease two years ago, was
204
treated with nitroglycerine, digitoxin and psychopharmaceuticals for cardiac pain radiating down the left arm with breathlessness, agitation and depression. Repeated evaluation by the internist, with serial ECG's revealed a static posterior wall infarction which was not believed to account for her symptoms. A course of electroshock treatments produced excellent improvement in her condition. In several instances psychiatric symptoms were prominent in cases which neurological examination, electroencephalograms and radio active isotopic brain scan revealed the presence of a brain tumor. Another interesting problem was one with a history of eight years of intensive psychotherapy, with an episode of psychosis, occuring in conjunction with facial spasms of ten years duration. A neurological examination and electroencephalogram showed a focus of abnormality, and the patient was cleared of all symptoms within a week on Dilantin. Follow-up studies revealed cerebral atrophy limited to one hemisphere. SUMMARY
Our treatment program is based on the conviction that mental illness is due to the interplay between constitutional, physiological, psychological, and socio-cultural factors which lead to maladjustment in life. Our total care concept enables us to treat the patient as a whole, not symptoms or mental illness per se. REt'ERENCES
J.: Psychiatric Treatment in and Private Hospitals. Amer. ]. 1966. p. 1012. A.: Administrative Psychiatry. Co. 1936.
l. Tompkins, Harvey
General Hospital of Psych. March 2. Bryan, William W. W. Norton &
Louden Hall Brunswick Hospital Center AmityviUe, L. I., N. Y.
Volume VII
JULY - AUGUST, 1966
PSYCHOSOMATICS OFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
Total Care of the Psychiatric Patient Aaron W. Bortin, M.D.
• A MULTI-DIVISIONED Hospital Center, with a fully-equipped, accredited general hospital serving as its hub, offers such a wide range of facilities and services that it makes possible a total care program for the patient who is hospitalized for psychiatric treatment. Here at Brunswick, our General Hospital includes 26 beds set aside in two separate pavilions for admission of psychiatric patients. Our major neuropsychiatric facility, licensed for WI-beds, is one of the four c0ordinated hospital divisions that comprise our 662-bed Center. On admission each patient gets the following letter: As Director of Psychiatry, I extend to you my greetings. I am sending you this letter in the hope that it may help you to get your bearings in this new and unusual situation. I know how confused anyone must be in coming to a hospital which is so diHerent, with many new faces, and so many ways of doing things that it is hard to get matters straight. For the first 48 hours or so, you will be examined by internists and psychiatrists, have laboratory work performed, have x-rays of your chest, electrocardiograms taken, and other special tests that your doctor may feel necessary. This is to look for and correct physical irregularities and ailments, so that your improvement may be hastened. You will be deprived of matches and lighters, in accordance with Fire Laws, and your money checked at the office. You really don't need cash. Any purchases may be credited to your account as arranged with your family. Doctor Aaron Bortin is Director of Psychiatry, Brunswick Hospital Center, Inc., Amityville, L. I. This paper was presented at the Regional Meeting, Academy of Psychosomatic Medicine, at Brunswick Hospital, Amityville, L. I., N. Y., April 3, 1966.
July-August, 1966
Within the /irst few days, the Director of Occupational and Recreational Therapy will call on you with the hope of engaging you in such activities which will contribute to your recovery. These activities are part of our overall plan for total care of the patient. I will personally meet with you and help you in any way to make your time in the hospital as short as possible. I hope you will profit by your stay here and that you will leave with feelings of friendship. Following our personal meeting, our staff of psychiatrists will meet in conference and map out the best plan for your care. We are interested not only in making you feel better, but to actually be better. You may also write a personal letter to me if you think there is any special thing I can do for your comfort and well being.
Our treatment program is based on the conviction that mental illness is due to the interplay between constitutional, physiological, psychological, and socio-cultural factors which lead to maladjustment in life. Dr. Harvey J. Tompkins 1 says: "The psychiatric patient, particularly if he is ill enough to be hospitalized, needs a constellation of services readily available outside the psychiatric department of his local general hospital for his total treatment program." With this concept in mind, the total treatment of the patient requires the collaboration of psychiatrist, internist, surgeon, and other specialists, to treat co-existing states which frequently tilt the homeostasis of the individual. Psychological testing is done when required. Thus, many treatable conditions get the concerted attention of the various specialties. These include severe diabetes, hypertension, malnutrition, anemias of various etiologies,
111111IJII~.~III!lIJJll~ 11111111111111111
203
PSYCHOSOMATICS
endocrine disorders, thyroid dysfunction, pulmonary, cardiac, vascular and renal disorders, liver pathology, neurological and orthopedic defects. When the condition is reversible, treatment hastens psychiatric recovery. Where irreversible, our rehabilitation department, by prescription of the attending physician, effects the goal to make the patient as self-sufficient and useful as possible. In addition to psychiatric management, which includes psychopharmaceutical agents, electroshock treatments, group and individual psychotherapy, our comprehensive occupational and recreational department offers many attractions. There is a theatre for movies; also facilities for bingo games, dances, barbecues and other social functions; workshop, art, gymnasium, nine-hole golf course, bowling, hilliards and other diversionary projects. These help to maintain a better hold on reality and promote socialization and self-expression. For patients who spend a limited time of 30-60 days in the General Hospital facility, we must have limited goals. Patients are seen daily and individually for brief psychotherapy. These interviews are conducted face to face, and free association is discouraged. The sessions are focused on the current reality. It may be said that for many patients these sessions are often just an introduction to follow-up care by the referring physician, in the interest of maintaining a stabilized improvement. This total care concept has, for instance, allowed us to successfully treat a psychotically depressed woman with a history of bilateral amputation of the breasts for cancer with bone metastasis, who has had an adrenalectomy. Because of her lack of response to the psychic drugs a course of electroshock treatments was given and very helpful. In another instance, a woman with a history of coronary disease two years ago, was
204
treated with nitroglycerine, digitoxin and psychopharmaceuticals for cardiac pain radiating down the left arm with breathlessness, agitation and depression. Repeated evaluation by the internist, with serial ECG's revealed a static posterior wall infarction which was not believed to account for her symptoms. A course of electroshock treatments produced excellent improvement in her condition. In several instances psychiatric symptoms were prominent in cases which neurological examination, electroencephalograms and radio active isotopic brain scan revealed the presence of a brain tumor. Another interesting problem was one with a history of eight years of intensive psychotherapy, with an episode of psychosis, occuring in conjunction with facial spasms of ten years duration. A neurological examination and electroencephalogram showed a focus of abnormality, and the patient was cleared of all symptoms within a week on Dilantin. Follow-up studies revealed cerebral atrophy limited to one hemisphere. SUMMARY
Our treatment program is based on the conviction that mental illness is due to the interplay between constitutional, physiological, psychological, and socio-cultural factors which lead to maladjustment in life. Our total care concept enables us to treat the patient as a whole, not symptoms or mental illness per se. REt'ERENCES
J.: Psychiatric Treatment in and Private Hospitals. Amer. ]. 1966. p. 1012. A.: Administrative Psychiatry. Co. 1936.
l. Tompkins, Harvey
General Hospital of Psych. March 2. Bryan, William W. W. Norton &
Louden Hall Brunswick Hospital Center AmityviUe, L. I., N. Y.
Volume VII