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PubMed1986

Small group work therapy for the chronic mentally ill.

In 1980 the authors reviewed the records of the first 130 patients to enter small group work therapy, a program begun in 1964 by Arkansas State Hospital and Arkansas Rehabilitation Services in which chronic schizophrenic patients live in group homes and work in Hot Springs. Forty-five of the original patients were still in the program in 1980. Although the patients had been hospitalized for an average of 11 years, they spent an average of seven years in the program, during which time their hospital utilization dropped significantly. Forty-two were discharged to settings offering greater independence. The authors focus on the role of a rehabilitative unit of Arkansas State Hospital known as the HIP unit, which, until it was closed in 1976, prepared patients to live and work with each other before entering small group work therapy.

Adult↗
PubMed1986

An innovative approach to assessing outcome of long-term psychiatric hospitalization.

The failure of research on long-term hospital treatment to show consistent relationships between length of stay and treatment outcome may reflect a need for more refined measures to evaluate long-term treatment. The authors developed an individualized method of assessing improvement in patients' major areas of impairment over the course of treatment. Using the new approach and two more traditional methods, the authors evaluated the outcome of 37 discharged long-term patients of a private psychiatric hospital who had been rated at admission and discharge on 21 variables related to ego function; affective symptoms; risk of suicide, self-destructiveness, and violence; substance abuse; level of treatment alliance; and, at discharge only, on overall level of improvement. Although the traditional methods failed to show a correlation between length of stay and most of the variables, the individualized approach found that a longer hospital stay was related to greater improvement in areas of most impaired functioning.

Adult↗
PubMed1986

Affective disorders and violence in adolescents.

Many adolescent affective disorders are rooted in biological vulnerability to stress and a predisposition to mood variations that are latent in childhood. As these stress-sensitive children encounter the normative helplessness and struggle for autonomy of adolescence, they may use violence, explosive rage, self-starvation, grandiose self-idealization, drug abuse, and suicidal behavior to relieve psychological helplessness and tension. They may begin a lifelong cycle of failure, disruption, and rejection by family and schools. The author describes adolescent depression and its biological underpinnings, deprivation syndromes, and manic-depressive illness, as well as the concept of affective violence in organic affective syndromes and episodic dyscontrol syndromes. These disorders call for multimodal treatment in which appropriate medication facilitates psychosocial intervention.

Adjustment Disorders↗
PubMed1986

Descriptive, biological, and theoretical aspects of borderline personality disorder.

Although the diagnosis of borderline personality disorder has reasonable interrater and test-retest reliability, its discriminative validity is poor. The authors review studies indicating that the patient group subsumed by the borderline category actually includes those with various affective, organic, and schizotypal disorders. They speculate that borderline personality disorder represents a broad range of affective disorders resulting in part from childhood object loss, which may impair the reinforcement mechanisms necessary for the development of competent object relations.

Animals↗
PubMed1987

The remedicalization of psychiatry.

The remedicalization of psychiatry does not mean the return to a reductionistic biomedical model of psychiatry or the renunciation of psychotherapy and psychodynamics. It does mean the refocusing of scientific advances in neurobiology and neuroscience as they affect psychiatric diagnosis and treatment, increased psychiatrist involvement in the treatment of the physically ill and in organized medicine, and revitalization of psychiatrists' clinical skills and knowledge through medical education. Within the medical context, the author addresses current problems in psychiatry related to standards, sub-specialization, scientific research, and stigma. He sees the development of standards as an essential professional responsibility, considers subspecialization within psychiatry to be inevitable, calls for increased involvement by psychiatrists in scientific research, and warns against permitting the stigma associated with mental illness to further erode psychiatry's boundaries by allowing disorders with an organic etiology to be "given away" to other specialties.

Humans↗
PubMed1987

Rehabilitation outcome of long-term hospital patients left behind by deinstitutionalization.

In 1979 a Massachusetts state hospital initiated a plan to transfer 54 long-term residents of two wards to the community through a series of increasingly independent working and living arrangements. This study assesses the patients' residential and vocational status and living skills over a five-year period beginning in February 1979. The patients demonstrated a significant increase in living independence, but only eight were able to live continuously in the community after their discharge, and 24 never left the hospital. Overall, vocational status did not improve, and living skills improved only slightly. Living skills and vocational status were predictive of living independence. The authors identify several steps that the mental health field should take to promote success among chronic patients, deinstitutionalized or not.

Activities of Daily Living↗
PubMed1988

Arrest rates among young adult psychiatric patients treated in inpatient and outpatient settings.

Within a statewide random sample of 611 young adult patients who received public inpatient, outpatient, and community residential care, 38 percent were found to have been arrested at least once in their adult lifetimes. Thirty-five percent had been arrested for felonies and 18.9 percent for violent crimes. Analyses by five major diagnostic groups showed that patients with a primary diagnosis of drug or alcohol abuse had the greatest overall frequency of arrests and also the greatest frequency of arrests for burglary, offenses against public order such as peace disturbance or loitering, and probation and parole violations. No significant differences between diagnostic groups were found for arrests for violent crimes. Characteristics that predicted which patients would be arrested in the year after receiving mental health services were a greater number of lifetime felony arrests, younger age, being black or a member of another minority group, and more years since first receiving public mental health care.

Adult↗
PubMed1990

Characteristics of repeatedly assaultive psychiatric inpatients.

Investigations of assaults in psychiatric hospitals have found that a small proportion of inpatients are responsible for a large percentage of the violence that occurs. In a large state hospital patients who were repeatedly violent (recidivists) were compared with patients who were violent only once or twice (nonrecidivists), and the relationships between repeatedly violent behavior and gender, age, and diagnosis were examined. All reports of violent incidents over a six-month period for a population of 1,552 inpatients--a total of 497 incidents involving 313 patients--were reviewed. Seventy patients were involved in three or more incidents each and were responsible for 53 percent of all violence. Recidivist men inflicted serious injuries at a rate ten times higher than that for all the other violent patients. Recidivist women were significantly younger than nonrecidivist assaultive women and were about the same mean age as the assaultive men. Recidivist women were also more likely to have organic brain disorder or personality disorder.

Adult↗
PubMed1990

Patterns of service use and costs in model day hospital-in programs in Boston and Tucson.

Patterns of service use and costs in two similar model day hospital-inn programs for psychiatric patients in publicly funded hospitals in Boston and Tucson are compared. Implementation of the programs resulted in cost savings at both sites, although mean annual costs per patient were much lower in Tucson than in Boston. Compared with patients at the Boston site, patients in Tucson had more admissions but shorter stays and fewer days in the program during a 12-month follow-up period. Site-specific differences in the programs, in local practice patterns, and in state mental health funding levels may have influenced cost differences.

Arizona↗
PubMed1991

Diagnosis and treatment of psychiatric disorders in medically ill inpatients.

Medical and surgical inpatients with coexisting psychiatric disorders pose several challenges to the consulting mental health professional in the general hospital. A major challenge is determining whether presenting signs and symptoms have a medical or psychiatric basis. Making such a determination requires a careful history, a mental status examination, and the utilization of bedside screening and diagnostic instruments. Recommended treatments include psychotherapy, psycho-education, and pharmacotherapy. However, psychotropic drugs must be used with caution because of potential interactions with drugs prescribed for medical conditions. Studies indicate that timely psychosocial interventions can improve the medical patient's mental health and have the potential to reduce length of hospital stay and utilization of health services.

Comorbidity↗
PubMed1992

Psychiatric morbidity in developing countries and American psychiatry's role in international health.

Economic and social change in the developing countries of Asia, Africa, Latin America, and the Pacific Islands is associated with increased rates of behavior-related illnesses, including psychiatric disorders, alcoholism, and substance abuse. Between 10 and 20 percent of the presenting problems in primary care settings in those countries are psychosocial. The authors provide an overview of the epidemiology of psychiatric and psychosocial morbidity in developing countries and summarize its effect on medical care systems in those settings. They suggest that American psychiatry increase its involvement in improving mental health care in developing countries. Consultation should be directed toward priorities determined locally in those countries, including assessment of current clinical practices, applied epidemiologic research, and training of indigenous researchers.

Adolescent↗
PubMed1992

Primary health care in the CMHC: a role for the nurse practitioner.

Although persons with chronic mental illness have a high incidence of physical health problems, they are often ill equipped to seek care within complex health care systems and tend to depend on community mental health centers as their only source of regular health care. The authors describe a role for the nurse practitioner in assessing the medical needs of chronic mentally ill outpatients at a community mental health center and in devising strategies to meet those needs. The nurse practitioner's activities include direct physical health screening and treatment, referral for specialized medical services, consultation, research, and staff and patient education.

Community Mental Health Centers↗
PubMed1993

Frequent psychiatric visitors to a Veterans Affairs medical center emergency care unit.

OBJECTIVE: The study examined characteristics of patients who made repeat visits to the psychiatric emergency service of a Veterans Affairs medical center. METHODS: Computer records of patients who visited the emergency service were retrospectively examined for a one-year period after their index visit. Patients were divided into three groups according to the number of visits; nonrepeaters had only one visit, occasional repeaters had two or three visits, and frequent repeaters had four or more visits. RESULTS: Of 1,144 patients who visited the emergency service during the one-year study period, 26 percent were occasional repeaters and 8 percent were frequent repeaters; the latter group accounted for 24 percent of all visits. Schizophrenic patients were overrepresented among frequent repeaters. Compared with nonrepeaters, repeat visitors were admitted to the hospital more often and were less likely to be referred to an outpatient clinic for follow-up. Frequent repeaters were more likely than occasional repeaters to revisit within one month and to visit during evening hours. CONCLUSIONS: One-third of patients seen during a one-year period revisited the emergency service, a rate substantially higher than those reported for large urban non-VA hospitals. The higher rate may have been due to the longer sampling period, to a more seriously ill population, or to fewer community resources for veterans because of misperceptions about their eligibility.

Adult↗