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Biomedical subjects

M Rahav

Publications and source records attributed to M Rahav.

16 recordsLinked to original sources
PubMed1998

Outcomes of homeless mentally ill chemical abusers in community residences and a therapeutic community.

OBJECTIVES: The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated. METHODS: A total of 694 homeless mentally ill chemical abusers were randomly referred to two community residences or a therapeutic community. All programs were enhanced to treat persons with dual diagnoses. Subjects' attrition, substance use, and psychopathology were measured at two, six, and 12 months. RESULTS: Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment, and 13 percent completed 12 months or more. Clients retained at both types of program showed reductions in substance use and psychopathology, but reductions were greater at the therapeutic community. Compared with subjects in the community residences, those in the therapeutic community were more likely to be drug free, as measured by urine analysis and self-reports, and showed greater improvement in psychiatric symptoms, as measured by the Center for Epidemiological Studies--Depression Scale and the Brief Psychiatric Rating Scale. Their functioning also improved, as measured by the Global Assessment of Functioning scale. CONCLUSIONS: Homeless mentally ill chemical abusers who are retained in community-based residential programs, especially in therapeutic communities, can be successfully treated.

Adult↗
PubMed1998

HIV infection risks among homeless, mentally ill, chemical misusing men.

This study attempts to identify the specific role that each of three conditions afflicting homeless, mentally ill, chemically misusing (HMICM) men plays in exposing these men to the risk of HIV infection. Three hundred and fifteen HMICM men (33 of whom were HIV+) were interviewed on intravenous drug use (IVDU) and sex practices. Two scales of risky IVDU practices and sex conducts were constructed and analyzed in relation to HIV status. The severity of homelessness, mental illness, and chemical misuse, then, were analyzed as possible predictors of risky IVDU and sex practices. Strong correlations were found between IVDU practices and HIV seropositivity, and between risky sex conduct and HIV seropositivity. Serious depression was the strongest predictor of risky IVDU practices. Prolonged homelessness was the condition most associated with risky sexual conduct. This study concludes that HMICM men are at high risk for HIV infection, stemming, predominately, from two conditions: depression, leading to risky IVDU practices, and homelessness, leading to risky sex conduct with two separate types of risky behavior.

Adult↗
PubMed1997

On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.

Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right.

Adult↗
PubMed1997

Pre- and post-admission attrition of homeless, mentally ill chemical abusers referred to residential treatment programs.

AIMS: To assess the magnitude and psychopathologic predictors of attrition among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City. DESIGN: Homeless, MICAs were randomly referred to a therapeutic community (TC) or community residence (CR) and monitored with regard to pre- and post-admission attrition. SETTINGS: Community based treatment facilities modified to treat both substance abuse and major mental illness. PARTICIPANTS: Homeless individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs. MEASUREMENTS: Attrition rates and selected scales of psychopathology. FINDINGS: From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at their assigned facility; 247 (36%) failed to show up for treatment; and 212 (31%) dropped out of treatment at some point during the first 12 months. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high demand approach, than the CR, a low demand approach. CONCLUSION: Clinicians should consider the TC as a viable treatment option for MICAs.

Adult↗
PubMed1995

When social problems converge: homeless, mentally ill, chemical misusing men in New York City.

Despite their pervasiveness in large American cities, homeless, mentally ill, chemical misusing (HMICM) people have rarely been studied as a sociological phenomenon. In this study, 518 HMICM men who sought community-based treatment were interviewed at length on their psychosocial characteristics, family background, and childhood history. The findings show these HMICM men to have severe psychiatric and substance misuse problems. Examination of their family background reveals a common pattern represented by the absence of their fathers and often of their mothers from very early age. Fatherlessness and social rootlessness are hypothesized as related to the HMICM syndrome.

Adult↗
PubMed1986

Distribution of treated mental illness in the neighborhoods of Jerusalem.

The authors compared the rates of treated mental illness among ethnically advantaged Ashkenazic Jews and ethnically disadvantaged Sephardic Jews in four areas of Jerusalem defined by socioeconomic status. They found that the rates of illness were higher in areas of lower socioeconomic status, that the Ashkenazim had higher rates of illness than the Sephardim in the areas of lower status, and that there was a comparatively high rate of illness among the Ashkenazim in the very religious Jewish neighborhoods. They interpret these findings on the basis of the theories of social causation and social selection, including genetic transmission.

Health Status↗
PubMed1984

Opinions on mental illness in Israel.

The study used the Cohen and Struening OMI questionnaire to survey the opinions on mental illness and the mentally ill in Israel's population, and identify underlying domains behind these opinions. Factor analyzing the Israeli respondents' scores on the OMI questionnaire, there was found to be marked similarity in the gestalts underlying the opinions on mental illness in Israel and those found in numerous studies in the U.S.A. The study identified four distinct domains behind people's opinions on mental illness in Israel: social restrictiveness, mental health ideology, authoritarianism and interpersonal etiology. The paper reports the mean score on each of the OMI questionnaire items. These data suggest that people in Israel hold dual, inconsistent opinions on the mentally ill. On the one hand they showed a great deal of liberalism, tolerance and human orientation on issues concerning the treatment of mental illness, their civil rights and their acceptance into the main stream of society. On the other hand, the respondents demonstrated fear, mistrust and rejection of the mentally ill on issues concerning close, more intimate involvement with them. The study found opinions on the mentally ill to be affected by people's education, age and religiosity.

Adolescent↗
PubMed1984

The reliability of psychiatric diagnosis in Israel's Psychiatric Case Register.

To determine the reliability of psychiatric diagnoses in the Israel Psychiatric Case Register, DSM-III criteria were applied to case record abstracts of first admissions to a large psychiatric hospital in Jerusalem. The DSM-III diagnoses were compared with ICD-8 records diagnoses. Between 40 and 50% of those originally diagnosed as schizophrenia were re-diagnosed into less severe categories. The proportion diagnosed as affective disorder doubled from 21% for ICD-8 diagnoses to 40% for DSM-III diagnoses. The unreliability concerned the diagnoses of schizophrenia and affective disorder. Findings suggest that the introduction of standardized diagnostic criteria in Israel will lead to a substantial increase in the number of cases diagnosed as affective disorder, although difficulties involved in differentiating schizophrenia from the major affective disorders remain. The DSM-III findings suggest a high prevalence of affective disorders among Jews.

Adolescent↗
PubMedDate not supplied

Mentally ill chemical abusers in residential treatment programs: effects of psychopathology on levels of functioning.

Measures of psychopathology among mentally ill chemical abusers (MICAs) were examined as predictors of levels of functioning in two types of community based, residential programs: therapeutic community (TC) and community residence (CR). Non-significant associations were generally observed between scales of psychiatric symptoms (e.g., depression, psychotic ideation, cognitive disorientation, and hostility) and counselors' ratings of the residents' capacity to meet the social and interpersonal expectations of the programs (e.g., personal care, involvement in interpersonal relationships, and development of work skills). The study suggests that individuals with moderately severe psychopathology can be successfully engaged in residential treatment, even in programs with relatively high expectations for interpersonal involvement and functioning, such as the therapeutic community.

Activities of Daily Living↗
PubMedDate not supplied

Characteristics and treatment of homeless, mentally ill, chemical-abusing men.

Comparing two types of treatment modalities in treating homeless, mentally ill, chemical-abusing (HMICAs) men and studying their characteristics, 723 HMICAs were interviewed on their childhood and family background and their psychiatric and substance abuse disorders, and then randomly assigned into either therapeutic community (TC) or community residence (CR) programs. The TC and CRs were found to differ from one another in their intake and admission procedures, their preadmission and postadmission dropout rates, and the effects of treatment on psychological status. The TC admitted their clients into treatment faster, tended to take more impaired clients, and had a lower preadmission dropout rate than the CRs did. The CRs had a lower postadmission dropout rate and were able to retain clients longer than the TC did. Comparing clients who stayed in treatment one year or longer, the TC appears to be more effective than the CRs in reducing depressive, psychotic, and functional symptoms. HMICAs' childhood and family background reveal severe parental deprivations and high prevalence of alcohol and other drug abuse, mental illness, and criminal behavior among the clients' parents. HMICAs' characteristics suggest that these men are completely outside mainstream society. They are severely impaired psychiatrically, chronically addicted, and often involved with the criminal system, thus occupying multiple deviant roles.

Adult↗