Thomas Kalman | Weill Cornell Medicine (original) (raw)
Papers by Thomas Kalman
The Canadian Journal of Psychiatry, Jun 1, 1980
The case of an acutely depressed 34 year old man with a history of systemic sarcoidosis is presen... more The case of an acutely depressed 34 year old man with a history of systemic sarcoidosis is presented with the question of the psychiatric manifestations of sarcoidosis in mind. The literature on Central Nervous System Sarcoidosis is reviewed and the possibility that this condition may present with psychiatric symptomatology is raised. An emphasis is placed on maintaining a high index of suspicion regarding organic factors in cases such as this, particularly in the setting of a complex, multi-system disease such as sarcoidosis.
Canadian Psychiatric Association journal, Apr 1, 1978
Psychodynamic psychiatry, 2021
Medical-legal asylum evaluations, conducted by experienced clinicians, are one of the most import... more Medical-legal asylum evaluations, conducted by experienced clinicians, are one of the most important parts of an application for successfully being granted asylum. Over two-thirds of these are mental health evaluations. Customarily these evaluations are summarized and drafted as diagnostic statements, providing the attorney with clear, corroborative testimony demonstrating that the patient suffers from psychological sequalae directly related to the individual's previous experience of persecution in their home country. However, these medical-legal evaluations are usually devoid of a more holistic description of the asylum seeker. We propose addressing this deficiency, with several redacted examples from affidavits previously used in immigration court.
Journal of the American Academy of Psychoanalysis, 1988
The purpose of this paper is to present a brief outline of the methods and procedures needed to d... more The purpose of this paper is to present a brief outline of the methods and procedures needed to design, construct, and conduct a research study using a mailed questionnaire. Particular attention is paid to those details that have an impact on increasing response rates, as this will improve the validity of data collected. In addi tion, the paper focuses on suitability of this method for survey research in psychoanalysis.
The Canadian Journal of Psychiatry, 1981
A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her... more A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her psychosis. She had previously responded well to treatment with trifluoperazine but because of her history of medication non-compliance, a trial of fluphenazine enanthate was instituted. Despite the close chemical similarity between trifluoperazine and fluphenazine the patient failed to respond to the latter in either its oral or depot intramuscular form. Although it is not unusual for a patient to respond to one antipsychotic and not to another, the above case of intra-class non-responsiveness is indeed rare and not readily explained. We present this unusual case and discuss some possible explanations.
Psychodynamic psychiatry, Jun 1, 2012
background: Split-treatment, the provision of psychotherapy and psychotropic medication by two di... more background: Split-treatment, the provision of psychotherapy and psychotropic medication by two different professionals, has become prevalent in U.S. mental health care delivery, as more Americans receive prescriptions and American psychiatrists provide less psychotherapy. Historically, communication between professionals treating the same patient has been an accepted principle of optimal care, but there has been only one formal assessment (Avena & Kalman, 2010a,b) of whether or not such communication actually takes place in the private sector. This article supplements the aforementioned survey of psychotherapists with a survey of psychiatrists. Subjects and Methods: An eight-item survey was mailed to 150 full-time private practice psychiatrists in Manhattan and New Jersey. Questionnaires were completed anonymously and returned by mail. Data was gathered about years of practice experience, how many patients were seen in the prior month, and how many patients were also in psychotherapy with another professional. Frequency of communication with psychotherapists on behalf of these patients and for patients in treatment for six months or longer was also assessed. Lastly, information was compiled on which professional more frequently initiated the communication when it did occur. Results: Sixty-one psychiatrists, averaging 26.7 years in practice, returned surveys. For all respondents, the total number of medication-only patients seen in the last full month was 1903, of which 785 (41.25%) were in psychotherapy with another mental health professional. Respondents reported a total of 875 split-care patients in treatment for six months or longer, with no communication with the psychotherapist being reported on behalf of 24% of these individuals. Respondents indicated that they had initiated 68.4% of the most recent contacts with the other professional, and just 10 of 55 (18.2%) re
The Journal of Nervous and Mental Disease, 2015
Journal of the American Academy of Psychoanalysis …, 2008
... Male, Female. ... literature about various aspects of Internet pornography in many discipline... more ... Male, Female. ... literature about various aspects of Internet pornography in many disciplines, such as psychology, psychiatry, sociology, communications, gender studies, and ... especially when it comes to the attention of a clinician, pornography use or some other sex-related activity ...
American Journal of Psychiatry, 1980
Canadian Psychiatric Association journal, 1978
The case of a 23-year-old patient treated with haloperidol, imipramine, and benztropine mesylate ... more The case of a 23-year-old patient treated with haloperidol, imipramine, and benztropine mesylate is presented to illustrate an unusually severe reaction to the abrupt cessation of neuroleptic medication. In addition to the description of the withdrawal reaction, a possible explanation of the clinical phenomenon is offered.
Health and human rights, 2017
This paper reports the findings of a survey of medical students' attitudes toward torture and... more This paper reports the findings of a survey of medical students' attitudes toward torture and discusses variables that may correlate with those attitudes. In late 2016, 483 enrolled medical and MD-PhD students at the Weill Cornell Medical College received an anonymous, institutional review board-approved survey that included questions about torture and its effectiveness, demographic questions, inquiries about personal experiences of harassment or discrimination, and questions regarding engagement in human rights activities. Some questions were drawn from a 2008 University of Illinois survey of medical students' attitudes toward torture, the only prior such survey at a US medical university. Of the 483 students who were contacted, 121 (25%) returned completed questionnaires, with responses indicating strong opposition to torture and skepticism about its usefulness. Respondents expressed greater opposition to torture in this survey than those who participated in the 2008 surve...
The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, Dec 1, 2010
While more Americans are taking psychotropic medication than ever before, psychiatrists are provi... more While more Americans are taking psychotropic medication than ever before, psychiatrists are providing less psychotherapy, leading to the prevalence of "split-treatment" whereby two professionals provide care. Communication between clinicians treating the same patient has traditionally been an accepted principle of optimal care, however there has been no published data documenting whether or not private practice therapists actually do communicate with the psychiatrists who prescribe for their patients. A pilot study was conducted in which a nine-item anonymous survey was distributed to non-medical psychotherapists in Manhattan. Information was gathered about professional degree and discipline, duration and size of practice, and frequency of communication with professionals who prescribe for their patients. Fifty-three psychotherapists averaging over 21 years in practice returned completed surveys. Respondents reported on 1,197 psychotherapy patients, with 434 (36%) concurrently taking medication. No communication had taken place between psychotherapist and psychopharmacologist on behalf of 22% of the psychotherapy patients taking medication. Only 7 of the 53 respondents reported having quarterly communication with the prescribing physician for all split-care patients. Despite methodological limitations, study findings document that communication between professionals is not taking place on behalf of many patients in split-treatment. These findings raise questions about the quality and safety of treatment delivered in this fashion, about the need for guidelines for the conduct of split treatment, and perhaps about the traditionally assumed need for communication itself.
Psychiatric Services, Oct 7, 2014
Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental ... more Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary commitment.
Archives of General Psychiatry, 1981
Recent advances in psychiatric research methodology promise major progress. Simultaneously, howev... more Recent advances in psychiatric research methodology promise major progress. Simultaneously, however, mounting concerns about ethnics of human experimentation have resulted in increased scrutiny and regulation that threaten scientific productivity. Virtually no systematic data have been gathered about the effects of research participation on treatment outcome or patient satisfaction. In this study 56 hospitalized depressed patients, who had agreed to participate in psychobiological research protocols, were then randomly assigned to treatment on a research unit or on standard adult inpatient (nonresearch) units. Research participants received more diagnosis-related somatic treatments, had a longer mean length of stay, and experienced trends toward greater symptom reduction and better consumer satisfaction. We conclude that research participation may be helpful to patients but that more systematic study is needed to help to resolve ethical questions and to assist risk-benefit evaluations.
JAMA: The Journal of the American Medical Association, 1983
This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal ... more This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal transplant recipients and patients undergoing hemodialysis. Fifty-seven of 98 transplant recipients and 44 of 89 patients undergoing dialysis returned questionnaires designed to collect demographic information and to detect psychiatric morbidity. The two groups differed significantly only in that the patients undergoing dialysis were both older and medically sicker than the transplant recipients. Forty-six percent of the transplant group and 48% of the dialysis group could be identified as psychiatrically impaired either by their scores on the General Health Questionnaire or by a history of prior psychiatric treatment. The finding of nearly equivalent psychiatric morbidity in these two groups does not support the often-held notions about psychological advantages of transplantation over dialysis. We conclude that psychiatric morbidity in patients with chronic renal failure is high and appears not to be related to the choice of treatment.
The Journal of Psychotherapy Practice and Research, Feb 1, 1998
Psychodynamic psychiatry, 2012
Split-treatment, the provision of psychotherapy and psychotropic medication by two different prof... more Split-treatment, the provision of psychotherapy and psychotropic medication by two different professionals, has become prevalent in U.S. mental health care delivery, as more Americans receive prescriptions and American psychiatrists provide less psychotherapy. Historically, communication between professionals treating the same patient has been an accepted principle of optimal care, but there has been only one formal assessment (Avena & Kalman, 2010a,b) of whether or not such communication actually takes place in the private sector. This article supplements the aforementioned survey of psychotherapists with a survey of psychiatrists. An eight-item survey was mailed to 150 full-time private practice psychiatrists in Manhattan and New Jersey. Questionnaires were completed anonymously and returned by mail. Data was gathered about years of practice experience, how many patients were seen in the prior month, and how many patients were also in psychotherapy with another professional. Frequ...
Psychiatric services (Washington, D.C.), 2010
Hospital & community psychiatry, 1983
Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental ... more Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary comm...
The Canadian Journal of Psychiatry, Jun 1, 1980
The case of an acutely depressed 34 year old man with a history of systemic sarcoidosis is presen... more The case of an acutely depressed 34 year old man with a history of systemic sarcoidosis is presented with the question of the psychiatric manifestations of sarcoidosis in mind. The literature on Central Nervous System Sarcoidosis is reviewed and the possibility that this condition may present with psychiatric symptomatology is raised. An emphasis is placed on maintaining a high index of suspicion regarding organic factors in cases such as this, particularly in the setting of a complex, multi-system disease such as sarcoidosis.
Canadian Psychiatric Association journal, Apr 1, 1978
Psychodynamic psychiatry, 2021
Medical-legal asylum evaluations, conducted by experienced clinicians, are one of the most import... more Medical-legal asylum evaluations, conducted by experienced clinicians, are one of the most important parts of an application for successfully being granted asylum. Over two-thirds of these are mental health evaluations. Customarily these evaluations are summarized and drafted as diagnostic statements, providing the attorney with clear, corroborative testimony demonstrating that the patient suffers from psychological sequalae directly related to the individual's previous experience of persecution in their home country. However, these medical-legal evaluations are usually devoid of a more holistic description of the asylum seeker. We propose addressing this deficiency, with several redacted examples from affidavits previously used in immigration court.
Journal of the American Academy of Psychoanalysis, 1988
The purpose of this paper is to present a brief outline of the methods and procedures needed to d... more The purpose of this paper is to present a brief outline of the methods and procedures needed to design, construct, and conduct a research study using a mailed questionnaire. Particular attention is paid to those details that have an impact on increasing response rates, as this will improve the validity of data collected. In addi tion, the paper focuses on suitability of this method for survey research in psychoanalysis.
The Canadian Journal of Psychiatry, 1981
A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her... more A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her psychosis. She had previously responded well to treatment with trifluoperazine but because of her history of medication non-compliance, a trial of fluphenazine enanthate was instituted. Despite the close chemical similarity between trifluoperazine and fluphenazine the patient failed to respond to the latter in either its oral or depot intramuscular form. Although it is not unusual for a patient to respond to one antipsychotic and not to another, the above case of intra-class non-responsiveness is indeed rare and not readily explained. We present this unusual case and discuss some possible explanations.
Psychodynamic psychiatry, Jun 1, 2012
background: Split-treatment, the provision of psychotherapy and psychotropic medication by two di... more background: Split-treatment, the provision of psychotherapy and psychotropic medication by two different professionals, has become prevalent in U.S. mental health care delivery, as more Americans receive prescriptions and American psychiatrists provide less psychotherapy. Historically, communication between professionals treating the same patient has been an accepted principle of optimal care, but there has been only one formal assessment (Avena & Kalman, 2010a,b) of whether or not such communication actually takes place in the private sector. This article supplements the aforementioned survey of psychotherapists with a survey of psychiatrists. Subjects and Methods: An eight-item survey was mailed to 150 full-time private practice psychiatrists in Manhattan and New Jersey. Questionnaires were completed anonymously and returned by mail. Data was gathered about years of practice experience, how many patients were seen in the prior month, and how many patients were also in psychotherapy with another professional. Frequency of communication with psychotherapists on behalf of these patients and for patients in treatment for six months or longer was also assessed. Lastly, information was compiled on which professional more frequently initiated the communication when it did occur. Results: Sixty-one psychiatrists, averaging 26.7 years in practice, returned surveys. For all respondents, the total number of medication-only patients seen in the last full month was 1903, of which 785 (41.25%) were in psychotherapy with another mental health professional. Respondents reported a total of 875 split-care patients in treatment for six months or longer, with no communication with the psychotherapist being reported on behalf of 24% of these individuals. Respondents indicated that they had initiated 68.4% of the most recent contacts with the other professional, and just 10 of 55 (18.2%) re
The Journal of Nervous and Mental Disease, 2015
Journal of the American Academy of Psychoanalysis …, 2008
... Male, Female. ... literature about various aspects of Internet pornography in many discipline... more ... Male, Female. ... literature about various aspects of Internet pornography in many disciplines, such as psychology, psychiatry, sociology, communications, gender studies, and ... especially when it comes to the attention of a clinician, pornography use or some other sex-related activity ...
American Journal of Psychiatry, 1980
Canadian Psychiatric Association journal, 1978
The case of a 23-year-old patient treated with haloperidol, imipramine, and benztropine mesylate ... more The case of a 23-year-old patient treated with haloperidol, imipramine, and benztropine mesylate is presented to illustrate an unusually severe reaction to the abrupt cessation of neuroleptic medication. In addition to the description of the withdrawal reaction, a possible explanation of the clinical phenomenon is offered.
Health and human rights, 2017
This paper reports the findings of a survey of medical students' attitudes toward torture and... more This paper reports the findings of a survey of medical students' attitudes toward torture and discusses variables that may correlate with those attitudes. In late 2016, 483 enrolled medical and MD-PhD students at the Weill Cornell Medical College received an anonymous, institutional review board-approved survey that included questions about torture and its effectiveness, demographic questions, inquiries about personal experiences of harassment or discrimination, and questions regarding engagement in human rights activities. Some questions were drawn from a 2008 University of Illinois survey of medical students' attitudes toward torture, the only prior such survey at a US medical university. Of the 483 students who were contacted, 121 (25%) returned completed questionnaires, with responses indicating strong opposition to torture and skepticism about its usefulness. Respondents expressed greater opposition to torture in this survey than those who participated in the 2008 surve...
The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, Dec 1, 2010
While more Americans are taking psychotropic medication than ever before, psychiatrists are provi... more While more Americans are taking psychotropic medication than ever before, psychiatrists are providing less psychotherapy, leading to the prevalence of "split-treatment" whereby two professionals provide care. Communication between clinicians treating the same patient has traditionally been an accepted principle of optimal care, however there has been no published data documenting whether or not private practice therapists actually do communicate with the psychiatrists who prescribe for their patients. A pilot study was conducted in which a nine-item anonymous survey was distributed to non-medical psychotherapists in Manhattan. Information was gathered about professional degree and discipline, duration and size of practice, and frequency of communication with professionals who prescribe for their patients. Fifty-three psychotherapists averaging over 21 years in practice returned completed surveys. Respondents reported on 1,197 psychotherapy patients, with 434 (36%) concurrently taking medication. No communication had taken place between psychotherapist and psychopharmacologist on behalf of 22% of the psychotherapy patients taking medication. Only 7 of the 53 respondents reported having quarterly communication with the prescribing physician for all split-care patients. Despite methodological limitations, study findings document that communication between professionals is not taking place on behalf of many patients in split-treatment. These findings raise questions about the quality and safety of treatment delivered in this fashion, about the need for guidelines for the conduct of split treatment, and perhaps about the traditionally assumed need for communication itself.
Psychiatric Services, Oct 7, 2014
Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental ... more Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary commitment.
Archives of General Psychiatry, 1981
Recent advances in psychiatric research methodology promise major progress. Simultaneously, howev... more Recent advances in psychiatric research methodology promise major progress. Simultaneously, however, mounting concerns about ethnics of human experimentation have resulted in increased scrutiny and regulation that threaten scientific productivity. Virtually no systematic data have been gathered about the effects of research participation on treatment outcome or patient satisfaction. In this study 56 hospitalized depressed patients, who had agreed to participate in psychobiological research protocols, were then randomly assigned to treatment on a research unit or on standard adult inpatient (nonresearch) units. Research participants received more diagnosis-related somatic treatments, had a longer mean length of stay, and experienced trends toward greater symptom reduction and better consumer satisfaction. We conclude that research participation may be helpful to patients but that more systematic study is needed to help to resolve ethical questions and to assist risk-benefit evaluations.
JAMA: The Journal of the American Medical Association, 1983
This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal ... more This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal transplant recipients and patients undergoing hemodialysis. Fifty-seven of 98 transplant recipients and 44 of 89 patients undergoing dialysis returned questionnaires designed to collect demographic information and to detect psychiatric morbidity. The two groups differed significantly only in that the patients undergoing dialysis were both older and medically sicker than the transplant recipients. Forty-six percent of the transplant group and 48% of the dialysis group could be identified as psychiatrically impaired either by their scores on the General Health Questionnaire or by a history of prior psychiatric treatment. The finding of nearly equivalent psychiatric morbidity in these two groups does not support the often-held notions about psychological advantages of transplantation over dialysis. We conclude that psychiatric morbidity in patients with chronic renal failure is high and appears not to be related to the choice of treatment.
The Journal of Psychotherapy Practice and Research, Feb 1, 1998
Psychodynamic psychiatry, 2012
Split-treatment, the provision of psychotherapy and psychotropic medication by two different prof... more Split-treatment, the provision of psychotherapy and psychotropic medication by two different professionals, has become prevalent in U.S. mental health care delivery, as more Americans receive prescriptions and American psychiatrists provide less psychotherapy. Historically, communication between professionals treating the same patient has been an accepted principle of optimal care, but there has been only one formal assessment (Avena & Kalman, 2010a,b) of whether or not such communication actually takes place in the private sector. This article supplements the aforementioned survey of psychotherapists with a survey of psychiatrists. An eight-item survey was mailed to 150 full-time private practice psychiatrists in Manhattan and New Jersey. Questionnaires were completed anonymously and returned by mail. Data was gathered about years of practice experience, how many patients were seen in the prior month, and how many patients were also in psychotherapy with another professional. Frequ...
Psychiatric services (Washington, D.C.), 2010
Hospital & community psychiatry, 1983
Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental ... more Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary comm...