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PubMed1997

Mortality of elderly patients with psychiatric disorders.

OBJECTIVE: The goal of this study was to evaluate the impact of common late-life mental disorders on the life expectancy and causes of death of older psychiatric patients. METHOD: The study population consisted of 809 older psychiatric patients who met DSM-III-R criteria for organic mental disorders, mood disorders, or psychotic disorders and who were discharged after a comprehensive multidisciplinary evaluation and acute inpatient treatment for their behavioral disorders. Dates and causes of death during a 5.75-year follow-up period were provided by the Pennsylvania Department of Health. Univariate and multivariate survival procedures were used to compare the survival rates of the three groups to each other and to a reference population of Pennsylvania residents. Causes of death were also tabulated according to ICD-9-CM and compared across the groups. RESULTS: Age, gender, race, and medical comorbidity made significant independent contributions to survival. When these variables were controlled, the survival of patients with organic mental disorders was less than half of that for patients with mood or psychotic disorders. However, all three groups experienced higher rates of mortality than the reference population, with standardized mortality ratios of 1.5 to 2.5. Deaths occurred from the usual spectrum of natural causes, with the exception that patients with mood disorders were more likely to have died from disorders of the digestive system and suicide. CONCLUSIONS: The mental disorders of late life have a significant negative impact on the survival of older psychiatric patients.

Age Factors↗
PubMed1990

The Carolina Nosology of Destructive Behavior (CNDB).

This article sets forth a multiaxial system for cataloging individuals who manifest destructive behavior toward themselves, others, or property. An initial codification to describe the characteristics of the destructive behavior of the individual is presented, followed by a description of a quaternary axial system which catalogs in a clinically relevant manner, individuals engaging in destructive behavior. The four axes presented and developed are Axis A--a medical diagnosis axis, Axis B--an axis of psychological correlates, Axis C--an axis of biological correlates, and Axis D--an axis of moral/cultural correlates. This nosology is proposed in order to standardize the coding of human destructive behavior. It is intended to be used by members of the clinical and research communities in order to compare patient types and their relationship to treatment interventions.

Aggression↗
PubMed1992

Neurologic outcome of patients with dorsolateral prefrontal leukotomy.

Few controlled studies of neurologic function in frontal leukotomy patients have been done. The authors compared neurologic examinations of patients who had bilateral leukotomies with those of psychiatric control subjects matched for age, diagnosis, and duration of illness. Cranial nerve dysfunction, abnormal involuntary movements, and primitive reflexes were common. No significant differences between the two patient groups were found. The leukotomized patients were less irritable than control subjects and had statistically higher seizure and death rates. Neurologic abnormalities are, thus, common in elderly chronic psychiatric patients. Surprisingly, patients with bilateral prefrontal leukotomy do not differ from well-matched psychiatric controls on most clinical tests of neurologic function.

Aged↗
PubMed1975

A survey of treatment modalities used by mental health clinicians and activity therapists.

An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. The final sample consisted of 68 respondents: 34 clinicians, 17 activity therapists, and 17 art therapists. The three respondent groups agreed on the same optimum treatment modality for five patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modalities for those patients.

Art Therapy↗
PubMed1975

Kansas: a survey of state hospital admissions from an area served by a mental health center.

The authors made a survey of all admissions to Topeka (Kans.) State Hospital from a three-county catchment area over an 11-year period during which a private psychiatric clinic in the area assumed the functions of a comprehensive community mental health center. The center's activities brought a significant decrease in the number of direct admissions to the hospital from the catchment area. However, the center consistently referred more patients with psychotic disorders to the state hospital than would be expected on the basis of over-all state hospital admissions. Similarly, a high proportion of patients with organic brain syndromes were admitted directly to the hospital from the three-county area. The authors say the findings suggest that the public mental hospital still has an important role to play on the delivery of mental health services.

Analysis of Variance↗
PubMed1977

Clinical applications of biofeedback: implications for psychiatry.

The authors briefly describe biofeedback techniques such as EMG feedback, temperature feedback, and heart rate feedback, along with reports from the literature about their application to specific problems such as subvocalization while reading, Raynaud's disease, cardiac arrhythmias, and epilepsy. Many clinical applications of biofeedback are aimed at inducing relaxation, a state that has important psychotherapeutic potential. The authors suggest that biofeedback could be used to reduce a patient's general level of arousal or as an adjunct to behavior therapy or insight therapy. While there have been no reports in the literature of any harmful effects secondary to feedback training, the authors caution that some patients may respond negatively to an objectively measured state of relaxation.

Anxiety↗
PubMed1983

Deinstitutionalization and the survival of the state hospital.

Despite vigorous efforts at deinstitutionalization, the state mental hospital continues to be the locus of care for a wide variety of patient populations. The authors examined the changes in one state hospital's clientele between 1972 and 1980 and discovered a 50 percent reduction in long-stay patients, a 27 percent increase in admissions, and the emergence of a new long-stay population. The authors say that the modern state hospital can be conceptualized as several different facilities under a single administrative roof rather than as a monolithic structure. They conclude that mental health planners must acknowledge the continued existence of a group of patients whose needs are perhaps best served by the state hospital. Strategies must be developed to use the existing hospital resources in the most efficient and effective manner.

Adolescent↗
PubMed1984

The New York State community support system: a profile of clients.

In 1979 the New York State Office of Mental Health contracted with the authors and their colleagues for an independent evaluation of its community support services (CSS) program for the chronically mentally ill in the four upstate mental health regions. As a first step in their program evaluation, the authors present initial findings from a 1981 survey of 844 clients sampled from seven selected CSS program sites. The demographic characteristics, clinical characteristics, and levels of functioning of the CSS client sample are discussed and compared with similar data collected by the National Institute of Mental Health (NIMH) in a 1980 survey of chronically disabled adults in its national community support program (CSP). The authors also present a profile of the services received by the CSS clients and, whenever possible, they compare these services with those received by the NIMH CSP clients.

Adult↗
PubMed1984

A study of medication refusal by involuntary psychiatric patients.

The authors evaluated 31 patients consecutively admitted to a locked acute treatment unit in California to determine the severity of their symptomatology, their attitudes toward treatment, and whether they would refuse medication if they had the opportunity (patients in California do not have the right to refuse). Fifteen patients indicated that they would refuse medication if given the opportunity. Although they did not differ in diagnosis from the other patients, they showed evidence of more severe psychosis and higher mood elevation and had less positive attitudes toward treatment. Two-week follow-up of 12 patients in the refuser group showed that they were less likely to refuse drugs and were clinically improved; however, six of the patients still preferred to refuse medication despite their clinical improvement. The authors discuss their findings in the context of the broader issue of when a mentally ill person should be forced to give up the power to make decisions about drug treatment.

Adult↗
PubMed1984

Public mental hospital work: pros and cons for psychiatrists.

The extensive literature concerning public mental hospitals has largely been written from the perspective of administrators and systems analysts; most of the reports emphasize the frustrations and problems of working in public mental hospitals and the continued exodus of psychiatrists from these facilities. The author addresses the pros and cons of such a career choice from the viewpoint of one who has been an "Indian" rather than a "chief" for a decade. He suggests that the current financial situation in both private practice and academia makes work in public mental hospitals increasingly attractive.

Career Choice↗
PubMed1985

Psychiatric diagnosis in a state hospital: Manhattan state revisited.

Studies have documented the predeliction of New York hospitals to overdiagnose schizophrenia and to underdiagnose affective disorders. To further investigate that predeliction following the introduction of DSM-III diagnostic criteria, seven clinical experts at the Manhattan Psychiatric Center reevaluated the charts of 131 randomly selected patients and conducted clinical reviews of two subgroups of the sample. Rediagnosis essentially reversed the ratio of schizophrenia to affective disorder shown in the charts, indicated a lack of documented DSM-III criteria for the chart diagnoses, and revealed significant numbers of undiagnosed disorders. The diagnostic, prognostic, and treatment implications of the findings are discussed, especially the need for more precise differential diagnosis according to DSM-III criteria.

Affective Disorders, Psychotic↗