The psychiatric patient's right to effective treatment: implications of Osheroff v. Chestnut Lodge

Article Abstract:

The law suit Osheroff v. Chestnut Lodge, which has recently been settled out of court, is considered to be a landmark case in dealing with issues that currently confront psychiatry. The case involved an individual who claimed negligence in the treatment he received, which consisted primarily of individual psychotherapy, rather than drug treatment, for severe depression. The plaintiff was a 42-year-old doctor who, prior to treatment, had a two-year history of anxiety and depressive symptoms. He was initially treated as an outpatient, but no improvements occurred, and he was then hospitalized at Chestnut Lodge for about seven months. During this period he underwent psychotherapy four times a week, but received no drug treatment. The patient's condition worsened and he was transferred to another hospital where he received a combination of drug therapies to which he responded; within three months, he was well enough to discharge. While he was hospitalized, Dr. Osheroff lost his medical practice, his standing in the professional community, and the custody of his children. Believing that the extended hospitalization had caused this to happen, the patient filed suit against Chestnut Lodge claiming negligence. An initial decision by an arbitration panel favored the plaintiff, and prior to court appeal the parties came to settlement out of court. Although the case has been resolved, it stimulated a great deal of discussion within psychiatry, the medical profession, and the public at large. This case has pointed out the need for standards in psychiatric treatment from both a legal and ethical viewpoint. Osheroff v. Chestnut Lodge raised certain clinical issues regarding the utilization of criteria in making treatment decisions, and the validity of psychiatric diagnoses. In an attempt to define some standards for professional responsibility, certain recommendations have been made by the author, who participated in this case as a consultant. One of these responsibilities is to use effective treatments and to revise treatment plans or obtain a consultation if the patient does not respond. Reliance upon a single method of treatment should be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Osheroff, Rafael

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The relation between hypochondriasis and age

Article Abstract:

Some research has suggested that the elderly tend to be hypochondriacal and preoccupied with their bodies, but other studies contradict this, suggesting that it may be an unfounded stereotype. In the general medical population, hypochondriasis is estimated to be present in 0.4 percent to 14 percent of all patients. In the elderly, the prevalence is estimated to be between 3.9 percent and 33.0 percent. There appear to be peak periods for the onset of hypochondriasis: adolescence, the fourth and fifth decades, and over age 60. There are methodological problems in the research, however, making consensus on the definition and prevalence of hypochondriasis difficult. Two groups of patients were studied to determine the relationship between hypochondriasis and age. Group one consisted of 60 patients already diagnosed with hypochondria, and group two was a normal comparison group of 100 patients. Each group was then divided further into elderly (65 years old and over) and younger patients. Hypochondriacal symptoms were assessed with two questionnaires, and clinical diagnosis of the disorder was made on the basis of a structured interview and standard diagnostic criteria. Psychiatric status was assessed as well, as was medical history, life stress, and sensitivity to unpleasant but harmless bodily sensations. There was no significant age difference between the hypochondriacal and the comparison groups, and elderly patients did not have more symptoms than the younger patients. Though not a statistically significant finding, the elderly as a group actually scored lower on disease fear and disease conviction measures than the younger patients as a group. No support was found, therefore, for a relationship between age and hypochondriasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Aged, Elderly, Demographic aspects, Hypochondria, Hypochondriasis

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Law, science, and psychiatric malpractice: a response to Klerman's indictment of psychoanalytic psychiatry

Article Abstract:

In the April 1990 issue of The American Journal of Psychiatry, an article by Gerald L. Klerman discusses the case of Osheroff v. Chestnut Lodge. This litigation has been the subject of a great deal of controversy both within and outside of the mental health community. Briefly, the plaintiff was a patient suffering from depression who sued a psychiatric institution for negligence because he was treated only with psychotherapy, when he needed medications. The current article reviews the paper by Klerman regarding this case. Although Klerman qualifies his remarks as pertaining to clinical issues, the potential legal implications of what he has set forth are noteworthy. Because he is recognized as a leading authority in psychiatry, Klerman's remarks may be used as the basis for future malpractice suits against psychiatrists who are psychoanalytically oriented. Klerman has implied that psychoanalytic treatment alone is clinically improper and negligent when used as the only treatment for any depressive disorder. Although it may be argued that the psychiatrist is protected against legal liability if he adheres to the principles of informed consent, the essence of the standards of professional responsibility that are represented is to restrict the practice of the psychiatry. What Klerman presents as guidelines for the avoidance of malpractice are merely the imposition of his personal and subjective perception of what constitutes psychiatric responsibility. It is unfortunate that legal decisions often seem to be based upon the opinion of a few very vocal professionals. In the past, Klerman has been able to effectively represent the collective wisdom of the psychiatric profession, but in his latest position he fails to do this. (Consumer Summary produced by Reliance Medical Information, Inc.)

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