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Biomedical subjects

M A Wallach

Publications and source records attributed to M A Wallach.

At least 19 recordsLinked to original sources
PubMed1996

The course, treatment, and outcome of substance disorder in persons with severe mental illness.

Individuals with co-occurring substance abuse and severe mental illness are particularly vulnerable to negative outcomes. This paper reviews findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance-abuse programs; describes the movement toward programs that integrate both types of treatment at the clinical level; reviews evidence related to outcomes in integrated treatment programs; and discusses health-care policy changes that would encourage effective treatments.

Humans↗
PubMed1995

Long-term course of substance use disorders among patients with severe mental illness.

OBJECTIVE: This study assessed the long-term course of substance abuse and dependence among severely mentally ill patients. METHODS: A prospective, naturalistic, seven-year follow-up of severely mentally ill outpatients (most with schizophrenia and schizoaffective disorder) successfully located and reassessed 79.1 percent (N = 148) of the patients from the original study group. The follow-up study group was assessed for alcohol and drug use at baseline and seven-year follow-up by their case manager or primary clinician using the Case Manager Rating Scale (CMRS) for the assessment of substance-related problems among severely mentally ill patients. RESULTS: The prevalence of active substance use disorder changed little from baseline to follow-up. Alcohol abuse or dependence was present in 24 percent of the patients at baseline and 21 percent at follow-up, and drug abuse or dependence was present in 20 percent at baseline and 17 percent at follow-up. However, those with initial alcohol abuse had a higher rate of remission (67 percent) than those with initial alcohol dependence (33 percent). Similarly, those with initial drug abuse had a higher rate of remission (54 percent) than those with initial drug dependence (31 percent). CONCLUSIONS: The higher rates of change for those with initial substance abuse compared with substance dependence suggest that distinguishing between abuse and dependence may have important implications for assessment and prognosis of individuals with a dual diagnosis of a substance use disorder and severe mental illness.

Alcoholism↗
PubMed1992

Mental patients' attraction to the hospital: correlates of living preference.

Mental patients often show attraction to the hospital as a living alternative. In this study, 187 aftercare patients of an urban state hospital were examined for correlates of hospital attraction. Several variables, including background characteristics, psychosocial problems, psychiatric symptoms, substance abuse, and medication noncompliance, characterized the approximately 25% of the sample who showed hospital attraction. A logistic regression model for hospital attraction indicated that past hospital tenure, problems obtaining regular meals, positive symptoms of psychosis, and severe drug abuse contributed separately to the variance. The authors discuss the implications of these findings for treatment and public policy.

Activities of Daily Living↗
PubMed1991

Homelessness and dual diagnosis.

People who are dually diagnosed with severe mental illness and substance use disorders constitute 10%-20% of homeless persons. They are a heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs. In this article recent research on the epidemiology, subject characteristics, and service needs of the dually diagnosed homeless population is reviewed. Also, the range of evolving approaches to providing social services, housing, and mental health and substance-abuse treatments; the relevant system issues and legal issues; and problems with current research, as well as future research directions, are discussed. The importance of the distinction between providing appropriate living environments and mental health treatments emerges throughout.

Alcoholism↗
PubMed1991

Characteristic hostility in schizophrenic outpatients.

In this study of 133 schizophrenic outpatients, we assessed characteristic hostility and correlates of hostility over a 6-month period. Results showed that 13 percent of the study group were characteristically violent, 18 percent were characteristically threatening, and another 21 percent were irritable and argumentative. About half (48%) were without hostility. A multiple regression model identified six variables--housing instability, hallucinations or delusions, schizoaffective diagnosis, lack of depression, alcohol use, and bizarre behavior--that together accounted for over 50 percent of the variance in observed characteristic hostility. Hostility also predicted rehospitalization and total inpatient days during 1-year followup. Implications of these findings for assessment and future research are discussed.

Adult↗
PubMed1991

Housing instability and homelessness among rural schizophrenic patients.

OBJECTIVE: The authors examined housing instability among treated schizophrenic patients in a rural area and compared the findings with those from their previous study of urban patients. METHOD: Seventy-five patients with schizophrenia or schizoaffective disorder who were treated in a rural mental health center were assessed with research interviews and ratings by their clinical case managers. The patients were followed for 1 year to identify episodes of psychiatric hospitalization, incarceration, and literal homelessness. RESULTS: Of the 75 patients, 19 (25%) had housing situations characterized as unstable by their case managers. For the majority, housing instability signified tenuousness of living arrangements rather than literal homelessness. Noncompliance with medications, alcohol use, and negative symptoms accounted for 30% of the variance in unstable housing. During follow-up, the unstably housed patients, compared to those in stable living situations, were no more likely to be rehospitalized but were somewhat more likely to be jailed and significantly more likely to be literally homeless. CONCLUSIONS: In the authors' previous study of urban psychiatric patients, unstably housed patients were more likely to be literally homeless, highly symptomatic, and rehospitalized during follow-up than the rural patients with unstable housing. Better outcomes in the rural area appeared to be related to the greater availability of housing alternatives and to intensive case management. For patients with unstable housing in both settings, noncompliance with medications and substance abuse, as well as housing arrangements, should be assertively addressed.

Adult↗
PubMed1990

A study of the relationship of maximal perioral muscle pressure and tonic resting pressure using a pneumohydraulic capillary infusion system.

The tonic (resting) and peak (maximum) lip pressures of 100 subjects were measured. The purpose was to evaluate the validity of the assumption that high peak pressures are indicative of high tonic pressures and vice versa. This paper describes the equipment and techniques devised to test these pressures. The results showed no statistically significant relationship whatsoever between tonic and peak lip pressures. We, therefore, suggest that maximum lip pressures not be used as a diagnostic aid in orthodontics.

Equipment Design↗
PubMed1989

Alcohol use and abuse in schizophrenia. A prospective community study.

The authors examined patterns of alcohol use among 115 DSM-III schizophrenics discharged from the state hospital and participating in an urban aftercare program. According to ratings by mobile outreach clinicians, 45% of the patients used alcohol, and 22% were clearly abusing alcohol. Alcohol use was associated with younger age, male sex, street drug use, medication noncompliance, lack of psychosocial supports, increased symptomatology, chronic medical problems, and a higher rate of rehospitalization. Even minimal drinking, not considered alcohol abuse by clinicians, predicted rehospitalization during 1-year prospective follow-up.

Adult↗
PubMed1989

Housing instability and homelessness among aftercare patients of an urban state hospital.

Homelessness as a dimensional concept reflecting instability of community living arrangements was examined in an urban state hospital's sample of 187 aftercare patients with chronic mental illness. According to ratings by outreach clinicians, 17 percent of the patients were predominantly homeless, and 10 percent were occasionally homeless over the six months before evaluation. Younger, male patients were more likely to be homeless. Homelessness was strongly associated with abuse of alcohol and street drugs, treatment noncompliance, and a variety of psychosocial problems and psychiatric symptoms. Homeless patients were viewed by their primary clinicians as attracted to the hospital as a living alternative and, during prospective one-year follow-up, had a much higher rate of rehospitalization.

Adult↗
PubMed1989

Substance abuse among the chronic mentally ill.

Substance abuse was examined in a group of 187 chronic mentally ill patients living in the community. According to ratings by aftercare clinicians, approximately onethird of the sample abused alcohol, street drugs, or both during the six months before evaluation. Patients who were dually diagnosed with substance abuse and mental illness differed from those with mental illness alone in several respects: they were younger and more often male; were less able to manage their lives in the community in terms of maintaining regular meals, adequate finances, stable housing, and regular activities; showed greater hostility, suicidality, and speech disorganization; and had poorer medication compliance. In addition, they were nearly twice as likely to be rehospitalized during one-year follow-up. Substance abuse, appeared to add the problems of disruptive, disinhibited, noncompliant behaviors to chronic mental illness.

Adult↗
PubMed1988

Mental patients' attitudes toward hospitalization: a neglected aspect of hospital tenure.

Recent research on hospital tenure has neglected mental patients' attitudes toward hospitalization. The authors consider problems with past research on these attitudes and examine "living preference"--the patient's preference for living in the hospital or the community. Assessments of patients' living preferences were obtained from clinicians working with 187 chronically mentally ill patients in a state hospital aftercare program. These assessments strongly predicted both components of hospital tenure--rehospitalization and in-hospital days--during a 1-year follow-up. The authors point out the conceptual, heuristic, and practical clinical advantages of examining living preference rather than traditional correlates of hospital tenure.

Aftercare↗