==================================HSR21================================== 21. Case management (advocacy, follow-up, aftercare, out-patient treatment) of the chronically mentally ill (de-institutionalized patient, psychiatrically disabled/disturbed). This treatment requires helping the person receive and manage housing, food, money, social activities, and medical care as well as other psychiatric therapies. 1 UI - 87123842 AU - Simon JI TI - Day hospital treatment for borderline adolescents. AB - Short-term psychiatric hospitalization for acute disturbances in adolescents has little effect on underlying developmental deficits. A day hospital treatment program based on psychoanalytic object relations concepts can provide an alternative to costly long-term inpatient hospital adolescent programs while limiting regressive and destructive behavior. An understanding of the characteristics and dynamics of borderline adolescent patients provided the basis for practical approaches that also were helpful to other patients. A review of the literature on the day treatment of borderline patients precedes a discussion of the diagnosis and dynamics of borderline adolescents. This is followed by a description of the methods utilized in a day hospital program whose goal was to potentiate a successful start of a longer-term psychotherapeutic process that could continue after discharge. Difficulties in prognosis and in designing verifying research are discussed. MH - Adolescence ; Borderline Personality Disorder/DIAGNOSIS/PSYCHOLOGY/ *THERAPY ; Combined Modality Therapy ; *Day Care ; Ego ; Hospitals, Psychiatric ; Human ; Personality Development ; Personality Disorders/ *THERAPY SO - Adolescence 1986 Fall;21(83):561-72 2 UI - 87123650 AU - Schene AH ; Gersons BP TI - Effectiveness and application of partial hospitalization. AB - Especially during the past 15 years, partial hospitalization (PHP) has been studied extensively. This article reviews the effectiveness and applicability of PHP. To clarify where PHP might fit into the overall mental health care system, the results of empirical research are evaluated with special attention to topics such as treated population, program evaluation, comparison of PHP with inpatient treatment, PHP as alternative to outpatient treatment, comparison of different PHP's, cost effectiveness and burden on the family. The general conclusion is that PHP can be a reasonable alternative to inpatient as well as to outpatient treatment, taking into account factors such as symptomatology, cost and family burden. PHP seems in particular to enhance social role functioning, which might be attributed to the fact that contact between patient and environment is not disturbed by hospitalization. Suggestions for further research are presented. Furthermore it is recommended in order to improve generalizability of results to differentiate the different functions PHP can fulfil in the mental health care system. MH - Ambulatory Care ; Behavior Therapy ; *Day Care ; Deinstitutionalization ; Family ; Home Nursing ; Human ; Mental Disorders/PSYCHOLOGY/*THERAPY ; Prognosis ; Social Adjustment SO - Acta Psychiatr Scand 1986 Oct;74(4):335-40 3 UI - 87097439 AU - Holburn CS TI - Maladaptive behavior merits fair treatment: a response to Seltzer and Krauss. AB - This response is a reaction to a study by Seltzer and Krauss (1984), in which dichotomous measurement of the behavior-problem variable gave rise to some potentially misleading implications about community-placement planning. Some difficulties in measuring this complex variable were reviewed and a more functional behavior assessment advocated. The problem of maladaptive behavior as an obstacle to deinstitutionalization has not yet been resolved. MH - *Deinstitutionalization ; Human ; Mental Retardation/*REHABILITATION SO - Am J Ment Defic 1986 Nov;91(3):211-6 4 UI - 87094314 AU - Diehr P ; Price K ; Williams SJ ; Martin DP TI - Factors related to the use of ambulatory mental health services in three provider plans. AB - The use of ambulatory mental health (MH) services by adults was studied in three provider plans: Blue Cross (BC), Group Health Cooperative (GHC) and United Healthcare (UHC), an experimental new plan in which a patient's primary care physician managed all of his care. Approximately 8.3% of the enrollees in each plan had some MH use in the 18 months of the study. We studied correlates of MH use (yes/no). Sex was not a significant predictor of MH use. In general, worse health and lower socioeconomic status (SES) were correlated with having at least one MH visit, but better health and higher SES were correlated with a higher quantity of use for those who had some MH use. The three insurance plans did not differ significantly in the proportion of people who had any MH services, but BC users of MH services had 2-3 times more MH visits and higher costs than GHC and UHC users. This suggests that the reliance on primary care providers in UHC and GHC may have changed the nature of MH care as compared to Blue Cross. The effects of income, MH need and symptom sensitivity on MH use were different among the three plans. MH - Ambulatory Care/*UTILIZATION ; Blue Cross/UTILIZATION ; Community Mental Health Services/*UTILIZATION ; Group Practice, Prepaid ; Health Maintenance Organizations/UTILIZATION ; Human ; Insurance, Psychiatric/ *UTILIZATION ; Mental Disorders/*THERAPY ; Referral and Consultation/ UTILIZATION ; Socioeconomic Factors ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. ; Washington SO - Soc Sci Med 1986;23(8):773-80 5 UI - 87077206 AU - Greer A ; McBride DH ; Shenkin A TI - Comparison of the nutritional state of new and long-term patients in a psychogeriatric unit. AB - Nutritional deficiencies have been implicated in the pathophysiology of various mental disorders. Life in institutions has been associated with development of nutritional deficiencies, the elderly being most at risk especially those with senile dementia. In this study nutritional status, particularly vitamin and essential mineral status was assessed in a group of 64 new admissions to a psychogeriatric unit and 49 long-term patients. The results indicated that psychogeriatric patients were at risk of experiencing nutritional deficiencies and those with senile dementia were likely to have more abnormalities than those with functional illnesses. Those patients in long-term care would appear to have a better nutritional state than those on admission. MH - Aged ; Avitaminosis/ETIOLOGY ; Comparative Study ; Deficiency Diseases/ *ETIOLOGY ; Dementia, Senile/*COMPLICATIONS ; Folic Acid Deficiency ; Hospital Units ; Human ; *Long Term Care ; Mental Disorders/ *COMPLICATIONS ; Minerals/DEFICIENCY ; *Nutritional Status ; Risk ; Support, Non-U.S. Gov't SO - Br J Psychiatry 1986 Dec;149:738-41 6 UI - 87073856 AU - Boyd JH TI - Use of mental health services for the treatment of panic disorder. AB - The author reports the results of five studies of panic disorder undertaken as part of the Epidemiologic Catchment Area Program of the National Institute of Mental Health (NIMH). This program involves community samples in New Haven, Conn. (N = 5,034), Baltimore (N = 3,481), St. Louis (N = 3,004), Durham, N.C. (N = 3,921), and Los Angeles (N = 3,132). Diagnoses were based on the NIMH Diagnostic Interview Schedule and DSM-III. Panic disorder led the list of disorders for which subjects in the five studies received ambulatory mental health services. Treatment rates for panic disorder were as high as or higher than those for somatization disorder, schizophrenia, and major affective disorders. Furthermore, panic attacks may have been the reason that many subjects with other disorders sought treatment. MH - Ambulatory Care/*UTILIZATION ; Anxiety Disorders/DIAGNOSIS/*THERAPY ; Catchment Area (Health) ; Community Mental Health Services/*UTILIZATION ; *Fear ; Human ; Mental Disorders/DIAGNOSIS/THERAPY ; *Panic ; Psychiatric Status Rating Scales ; Support, U.S. Gov't, P.H.S. ; United States SO - Am J Psychiatry 1986 Dec;143(12):1569-74 7 UI - 87073853 AU - Glick ID ; Fleming L ; DeChillo N ; Meyerkopf N ; Jackson C ; Muscara D ; Good-Ellis M TI - A controlled study of transitional day care for non-chronically-ill patients. AB - The authors randomly assigned 79 inpatients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called "transitional treatment: or a control treatment--weekly clinically believed to require intensive posthospital treatment to make the transition to the community. Although initially there was a significantly higher dropout rate from the control condition, at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome. Direct costs for the transitional treatment, however, were much higher. MH - Adolescence ; Adult ; Affective Disorders/*THERAPY ; Comparative Study ; Costs and Cost Analysis ; *Day Care/ECONOMICS ; Female ; Hospitalization/ ECONOMICS ; Human ; Male ; Middle Age ; Outcome and Process Assessment (Health Care) ; *Psychotherapy, Group/ECONOMICS ; Schizophrenia/*THERAPY SO - Am J Psychiatry 1986 Dec;143(12):1551-6 8 UI - 87058649 AU - Chodosh HL ; Zeffert B ; Muro ES TI - Treatment of dementia in a medical day care program. AB - An analysis was completed of 34 patients with dementia who attended a mixed medical day care program over a five-year period. The parameters reviewed included age, home situation, diagnosis, incidence of co-existent medical disorders, management by the social worker, nurses and neuropsychiatrist, the extent of social and program participation, length of stay, and disposition. There was a high incidence of medical problems which were managed effectively because of close nursing observation, availability of ancillary services, specialty clinics, and frequent communication with the community physicians. The social worker assisted families with the management of long-term planning for the dementia patients and the entire social-nursing-recreational therapy team devised programs which encouraged the patients to function at an optimum level. Neuropsychiatric management, including drug therapy, was an integral part of the program. Despite the fact that the dementia patients were at high risk, with an average age of 81 years the average duration of attendance was two years four months and only nine of the 34 patients ultimately required nursing home placement. It was concluded that the day care program served as a resource which devised, integrated, and supervised, in cooperation with the community physicians, the support network and management strategies for the dementia patients. MH - Aged ; Aged, 80 and over ; *Day Care ; Dementia/*NURSING ; Evaluation Studies ; Human ; Middle Age ; Support, Non-U.S. Gov't SO - J Am Geriatr Soc 1986 Dec;34(12):881-6 9 UI - 87056374 AU - Vidalis AA ; Baker GH TI - Factors influencing effectiveness of day hospital treatment. AB - One hundred consecutive admissions to a Psychiatric Day Hospital were studied. Outcome was assessed in terms of regularity and duration of Day Hospital attendance, transfer to inpatient care, and return to employment of unemployed patients. None of these outcome measures showed significant differences when groups of patients were compared according to age, sex or diagnosis. Similarly, no differences were found when patients living alone were compared with patients living with families, between employed and unemployed patients, between patients referred from in-patient care and those referred from out-patients, or when patients were compared according to their preferred types of Day Hospital activity. MH - Adult ; Affective Disorders/THERAPY ; *Day Care ; Female ; Human ; Male ; Mental Disorders/*THERAPY ; Middle Age ; Neurotic Disorders/THERAPY ; Personality Disorders/THERAPY ; Prognosis ; Schizophrenia/THERAPY ; Support, Non-U.S. Gov't SO - Int J Soc Psychiatry 1986 Autumn;32(3):3-8 10 UI - 87035604 AU - Friedman AS ; Glickman NW TI - Program characteristics for successful treatment of adolescent drug abuse. AB - The relationship to treatment outcome, as measured by reduction in drug use, of specific characteristics and elements of 30 drug-free outpatient programs for adolescents is reported. Admission and discharge data were obtained from National Institute on Drug Abuse-Client Oriented Data Acquisition Process on 5789 adolescents in the 30 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual clients, was the unit of analysis. While controlling for differences between programs on their client populations, multiple regression analysis indicated that the following characteristics of programs were found to predict the outcome criterion variable, to a statistically significant degree: treat a large number of adolescent clients; have a special school for school dropouts; have a relatively large budget; employ counselors or therapists who have at least 2 years' experience in working with adolescent drug abusers; provide special services such as vocational counseling, recreational services, and birth control services; use such therapy methods as crisis intervention, gestalt therapy, music/art therapy, and group confrontation; and be perceived by the clients as allowing and encouraging free expression and spontaneous action by clients. There was a high degree of replication of these findings across the two annual subsamples of clients; and the amount of variance in the treatment outcome criterion variable accounted for by the above-listed program characteristics was quite impressive. MH - Adolescence ; Ambulatory Care/*ORGANIZATION & ADMIN. ; Attitude to Health ; Community Mental Health Services/ORGANIZATION & ADMIN. ; Counseling ; Family Planning ; Female ; Human ; Male ; *Outcome and Process Assessment (Health Care) ; Probability ; Psychotherapy/METHODS ; Social Class ; Substance Abuse/PSYCHOLOGY/*THERAPY ; Support, U.S. Gov't, P.H.S. SO - J Nerv Ment Dis 1986 Nov;174(11):669-79 11 UI - 87027064 AU - Bell JS ; Gilleard CJ TI - Psychometric prediction of psychogeriatric day care outcome. AB - A comparison was made between sets of psychometric variables [the Clifton Assessment Procedures for the Elderly (CAPE)] and personal socio-demographic variables in predicting the outcome of psychogeriatric day care. Two groups of elderly patients referred for day care were investigated: 40 new admissions to a psychogeriatric day centre and 63 new admissions to psychogeriatric day hospitals. Discriminant function analysis was employed to compare the classification accuracy obtained from the personal socio-demographic variables and the CAPE psychometric data. The results demonstrated the incremental validity of the CAPE in predicting outcome of day care in both settings and support the routine use of such brief measures as appropriate screening procedures in these settings. MH - Aged ; Day Care/*PSYCHOLOGY ; Dementia, Senile/PSYCHOLOGY/*THERAPY ; Female ; Human ; Male ; Prognosis ; *Psychological Tests ; Psychometrics ; Referral and Consultation ; Social Environment SO - Br J Clin Psychol 1986 Sep;25 ( Pt 3):195-200 12 UI - 87023455 AU - Geller JL TI - Rights, wrongs, and the dilemma of coerced community treatment. AB - An outpatient treatment approach directed to patients with histories of psychotically based dangerousness, poor compliance, and recidivism is described. Cases are presented that suggest favorable outcomes of this approach, but the coercive nature of the treatment raises questions about the psychiatrist's violation of patients' rights and transgression of ethical standards. If psychiatrists are to successfully treat the most difficult chronic patients, can we do it without legally sanctioned, benevolent, coercive treatments? One model of such treatment is outpatient commitment. There is concern that without sound outpatient commitment statutes, we may witness the reemergence of asylums. MH - Adult ; After Care/LEGISLATION & JURISPRUD. ; Ambulatory Care/ *LEGISLATION & JURISPRUD. ; Case Report ; Coercion ; Commitment of Mentally Ill/LEGISLATION & JURISPRUD. ; Community Mental Health Services ; Ethics, Medical ; Female ; Forensic Psychiatry/*LEGISLATION & JURISPRUD. ; Human ; Male ; Mental Disorders/*THERAPY ; Middle Age ; Patient Advocacy ; Psychiatry/STANDARDS SO - Am J Psychiatry 1986 Oct;143(10):1259-64 13 UI - 87023454 AU - Bursten B TI - Posthospital mandatory outpatient treatment. AB - Mandatory outpatient treatment invoked after the patient has improved in the hospital is a relatively new development. Tennessee instituted this policy by statute in 1981. While people placed under the constraints of that law showed a reduction in rate of readmission, comparison with control groups failed to support the conclusion that these results are due to the forced outpatient constraints. The author discusses some procedure and policy considerations that stem from these findings. MH - After Care/LEGISLATION & JURISPRUD./STANDARDS ; Ambulatory Care/ *LEGISLATION & JURISPRUD./STANDARDS ; Attitude of Health Personnel ; Community Mental Health Services/STANDARDS ; Evaluation Studies ; Forensic Psychiatry/*LEGISLATION & JURISPRUD. ; Human ; Mental Disorders/ *THERAPY ; Patient Compliance ; Patient Readmission ; Personnel, Hospital ; Tennessee SO - Am J Psychiatry 1986 Oct;143(10):1255-8 14 UI - 87023262 AU - Klyczek JP ; Mann WC TI - Therapeutic modality comparisons in day treatment. AB - The deinstitutionalization of patients with chronic mental illness and shorter hospitalizations of individuals recently diagnosed as mentally ill has resulted in the establishment of an enlarged network of community mental health services. Diminished federal financial support calls for greater efficiency and accountability in the delivery of community-based mental health services. The purpose of this study was to determine whether differences in treatment approach relate to differences in outcome measures of symptom reduction, community tenure, and relapse. In a study of two day treatment centers, one offering twice as much activity therapy as verbal therapy, and the other offering twice as much verbal therapy as activity therapy, it was found that clients receiving primarily activity therapy achieved four times more symptom reduction, equivalent community tenure, and a three and a half times greater relapse rate than clients receiving primarily verbal therapy. MH - Adolescence ; Adult ; After Care ; Chronic Disease ; *Community Mental Health Services ; Comparative Study ; *Day Care ; Female ; Hospitalization ; Human ; Male ; Middle Age ; *Occupational Therapy ; Prognosis ; *Psychotherapy, Group ; Schizophrenia/*REHABILITATION SO - Am J Occup Ther 1986 Sep;40(9):606-11 15 UI - 86320711 AU - Minihan PM TI - Planning for community physician services prior to deinstitutionalization of mentally retarded persons. AB - This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two per cent of the conditions but only 8 per cent of the clients could be managed by a primary care physician. The most frequently required specialties were neurology, orthopedics, and ophthalmology. While primary care services and many of the necessary specialty services were available in the community to meet the needs of these individuals, several specialties essential to the medical care of this group were not available. These included orthopedics for the multiply-handicapped, neurology including behavioral neurology, and psychiatry. Deinstitutionalization policies which rely solely upon community physician services will lead to inadequate medical care in the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed. MH - Adolescence ; Adult ; Aged ; Chronic Disease ; Community Mental Health Services/*METHODS ; *Deinstitutionalization ; Female ; Human ; Male ; Massachusetts ; Mental Retardation/*THERAPY ; Middle Age ; Neurology ; Ophthalmology ; Orthopedics ; *Patient Care Planning ; Primary Health Care ; Questionnaires ; Time Factors SO - Am J Public Health 1986 Oct;76(10):1202-6 16 UI - 86313068 AU - Walgrove NJ TI - Mental health aftercare. Where is nursing? AB - The author reviews nursing's entrance into mental health aftercare and relates it to the problems that have ensued since the 50s. The role of the community mental health nurse is explored and compared with concepts of aftercare and perceptions of prominent psychiatric/mental health nursing authors. The realities of community mental health nursing in the '80s are contrasted with the thoughts and the ideas of others endeavoring to make contributions to the needs of discharged psychiatric patients. The author reminds us that aftercare begins before the patient leaves a psychiatric facility and stresses that nurses are a natural bridge between the hospital and the community. MH - After Care/*TRENDS ; Community Mental Health Services/ECONOMICS/MANPOWER/ TRENDS ; Forecasting ; Human ; Mental Disorders/NURSING/*THERAPY ; Nurse-Patient Relations ; Psychiatric Nursing/EDUCATION/*TRENDS ; Role ; United States SO - Nurs Clin North Am 1986 Sep;21(3):473-81 17 UI - 86313067 AU - Neal MT TI - Partial hospitalization. An alternative to inpatient psychiatric hospitalization. AB - Partial hospitalization programs provide alternatives to traditional inpatient hospitalization. The initial optimism generated by the development of partial hospital programs has been moderated by the realization that it is quite difficult to make changes in mental health care, even though the effectiveness of traditional approaches has not been demonstrated. Research findings about partial hospital programs have provided information that many persons formerly treated as inpatients can be treated in partial hospital programs, probably at an economic savings. Several conceptual models are briefly reviewed for providing direction and rationale to guide thinking, planning, and decision making regarding client care. Continual effort must be given to the development and expansion of useful models and sets of interventions for care directed not only at symptom reduction but toward facilitation of health induction. Partial hospitalization programs have the potential to provide the settings and services to meet this need. Changing times offer nurses new opportunities to consider alternatives for providing psychiatric care. It is a challenge which nurses are well prepared to accept. To ignore the current situation and the needs of clients, families, and communities for these services would be to lose an opportunity for nurses to share a significant role in providing services to psychiatric clients. MH - Comparative Study ; *Day Care ; Family Therapy ; *Hospitalization ; Human ; Inpatients ; Mental Disorders/NURSING/*THERAPY ; Models, Psychological ; Models, Theoretical ; Nurse-Patient Relations ; Patient Care Planning ; Research SO - Nurs Clin North Am 1986 Sep;21(3):461-71 18 UI - 86306714 AU - Bennett LA TI - Depressive symptoms among hospitalized and posthospitalized alcoholics in Yugoslavia. AB - Two clinical samples of male and female alcoholics undergoing inpatient hospital and posthospital treatment in Zagreb, Yugoslavia, were evaluated for depressive symptomatology and extent of alcoholism, using self-report measures (Zung Self-Rating Depression Scale and Michigan Alcohol Screening Test). Higher levels of depressive symptoms and lower alcoholism scores were reported for the hospital group, in comparison with the posttreatment "Clubs of Treated Alcoholics: group. In the hospital, no significant relationships were found between levels of depression and extent of alcoholic indicators. In the club group, however, those alcoholics who remained depressed (at minimal or mild levels) are also those who perceived themselves as having greater consequences from the alcoholism. The cultural context and psychosocial drinking and postdrinking environments of the alcoholics and their families appear to be important factors in the decline of depressive symptoms among treated, abstinent alcoholics, as well as in the retention of such symptoms among a subset of the sober alcoholics. This suggests that treatment should place a high priority on reordering the social and personal life of the alcoholic and his or her family while also retaining whatever nondrinking social ties that the alcoholic had developed and valued before treatment. MH - Adult ; Alcohol Drinking ; Alcoholism/*COMPLICATIONS/DIAGNOSIS/THERAPY ; *Ambulatory Care ; Comparative Study ; Culture ; Depression/*DIAGNOSIS/ ETIOLOGY/THERAPY ; Depressive Disorder/*DIAGNOSIS/ETIOLOGY/THERAPY ; Female ; *Hospitalization ; Human ; Male ; Middle Age ; Personality Inventory ; Self-Help Groups ; Social Adjustment ; Social Environment ; Social Support ; Support, Non-U.S. Gov't ; Yugoslavia SO - J Nerv Ment Dis 1986 Sep;174(9):545-52 19 UI - 86306711 AU - Pfeffer CR ; Plutchik R ; Mizruchi MS TI - A comparison of psychopathology in child psychiatric inpatients, outpatients, and nonpatients. Implications for treatment planning. AB - A total of 308 preadolescents who were either psychiatric inpatients, psychiatric outpatients, or nonpatients were studied with semistructured interview research instruments that have been described previously. The three groups of children included 106 children consecutively admitted to a voluntary hospital psychiatric inpatient unit, 101 consecutively admitted children to the same voluntary hospital center psychiatric outpatient clinic, and 101 randomly selected nonpatients. The research instruments included a Spectrum of Suicidal Behavior Scale, a Spectrum of Assaultive Behavior Scale, a Precipitating Events Scale, General Psychopathology (recent and past) Scales, a Family Background Scale, a Child's Concept of Death Scale, an Ego-Functioning Scale, and Ego-Defense Scale, and a Medical-Neurological Assessment Scale. The results of the study indicated that the presence of recent depression and recent and past aggression, the use of such ego defenses as projection, displacement, and regression, and the experience of parental separation were significantly different for the three groups of children. Impulse control and reality testing were best in the nonpatients and poorest in the inpatients. The variables that best predicted the need for psychiatric hospitalization were suicidal behavior, recent depression, recent aggression, poor reality testing, and such ego defenses as projection and regression. Implications of these findings are discussed. MH - Aggression/PSYCHOLOGY ; *Ambulatory Care ; Child ; Comparative Study ; Depressive Disorder/DIAGNOSIS/PSYCHOLOGY ; Ego ; Female ; *Hospitalization ; Human ; Male ; Mental Disorders/DIAGNOSIS/*PSYCHOLOGY/ THERAPY ; Patient Care Planning ; Probability ; Projection ; Psychiatric Status Rating Scales ; Reality Testing ; Regression (Psychology) ; Suicide/PSYCHOLOGY ; Support, Non-U.S. Gov't SO - J Nerv Ment Dis 1986 Sep;174(9):529-35 20 UI - 86299465 AU - Randolph FL ; Lindenberg RE ; Menn AZ TI - Residential facilities for the mentally ill: needs assessment and community planning. AB - The planning and development of community-based facilities for the mentally ill have been hindered by many factors, one of which is the lack of an acceptable methodology for determining the housing needs of this population. This paper describes a consumer-oriented needs assessment strategy that provides a basis for planning residential facilities for the mentally ill. Survey results provided detailed descriptions of the population in need of residential programs, the types of facilities needed, the total volume of need for each, and the distribution of need. Implications for program planning are discussed as well as the advantages and disadvantages in utilizing this approach for establishing a basis for residential facilities planning for the mentally ill. MH - Adolescence ; Adult ; Aged ; Community Mental Health Centers/ *ORGANIZATION & ADMIN. ; Community Mental Health Services/ORGANIZATION & ADMIN. ; Crisis Intervention ; *Deinstitutionalization ; Foster Home Care/ ORGANIZATION & ADMIN. ; Halfway Houses/*ORGANIZATION & ADMIN. ; Hawaii ; Health Planning/*ORGANIZATION & ADMIN. ; Health Services Accessibility/ TRENDS ; Health Services Needs and Demand/*TRENDS ; Health Services Research/*TRENDS ; Hospitalization/TRENDS ; Human ; Mental Disorders/ *THERAPY ; Middle Age ; Support, U.S. Gov't, P.H.S. SO - Community Ment Health J 1986 Summer;22(2):77-93 21 UI - 86292816 AU - Searight HR ; Oliver JM ; Grisso JT TI - The community competence scale in the placement of the deinstitutionalized mentally ill. AB - Little systematic research has been directed towards the determination of appropriate residential placements for deinstitutionalized psychiatric patients. A previous study suggested that the Community Competence Scale (CCS), a 124-item multiscale instrument, had potential utility for community placement decisions. In the present study, the CCS was administered to 52 deinstitutionalized patients placed in an urban boarding home, a rural boarding home, and urban apartments. No significant differences on the CCS occurred attributable to urban vs. rural setting; accordingly, the urban and rural boarding home groups were combined. The CCS discriminated between patients placed in boarding home and apartment settings after variability between the groups associated with age and diagnosis had been removed. The CCS discriminated more effectively between the groups than did prior hospitalization, subsequent rehospitalization, or the Social Competence Scale (SCS). The CCS was significantly positively correlated with the SCS and significantly negatively correlated with previous hospitalization and age. MH - Adult ; Bipolar Disorder/THERAPY ; Community Mental Health Services ; *Deinstitutionalization ; Depressive Disorder/THERAPY ; Female ; Halfway Houses ; Hospitalization ; Human ; Male ; Mental Disorders/*THERAPY ; Mental Retardation/THERAPY ; Middle Age ; Organic Mental Disorders/ THERAPY ; Personality Disorders/THERAPY ; *Psychological Tests ; Schizophrenia/THERAPY ; *Social Adjustment SO - Am J Community Psychol 1986 Jun;14(3):291-301 22 UI - 86289832 AU - Solomon P ; Davis JM TI - The effects of alcohol abuse among the new chronically mentally ill. AB - In recent years, there has been a growing recognition of the high incidence of alcohol abuse among the new generation of chronically mentally ill. This article reports on a study that tracked a subgroup of the chronically mentally ill, those discharged from state psychiatric hospitals, through an entire community mental health aftercare system and its major auxiliary human service agencies. Those who were assessed by hospital discharge social workers as having a need for alcoholism services were found to be less likely to be referred for aftercare and to make contact with aftercare agencies post discharge; and for those with an alcoholism problem who do make contact, they generally received less service than those who did not have a need for alcoholism services. The professionals in both the mental health and alcoholism fields need to work together to better meet the needs of the chronically mentally ill with an alcohol problem. MH - Adult ; *After Care ; Alcoholism/*COMPLICATIONS/THERAPY ; Chronic Disease ; Counseling ; Female ; Hospitals, Psychiatric ; Human ; Male ; Mental Disorders/*COMPLICATIONS ; Ohio ; Patient Readmission ; Referral and Consultation ; Support, Non-U.S. Gov't SO - Soc Work Health Care 1986 Spring;11(3):65-74 23 UI - 86281782 AU - McAuliffe WE ; Ch'ien JM TI - Recovery training and self help: a relapse-prevention program for treated opiate addicts. AB - Recovery Training and Self Help (RTSH) is a new form of psychosocial treatment for drug addiction. Developed as an outpatient group aftercare modality for opiate addicts in New England and Hong Kong, it significantly reduced the probability of relapse to illicit opiates and helped unemployed subjects find work. Based on a social theory of addiction and health promotion principles, the four-part program features a weekly recovery training session, a weekly self-help style session, weekend recreational and social activities, and a support network of long-term ex-addicts. Recovery training follows a 26 week sequence of didactic presentations and exercises that systematically address predictable causes of relapse, while the other clinical components provide motivation and support for continued abstinence and social reintegration. The authors believe that RTSH should have a wide range of applicability. MH - Adaptation, Psychological ; After Care/*METHODS ; Combined Modality Therapy ; Human ; Narcotic Dependence/PSYCHOLOGY/*REHABILITATION ; Recreation ; Recurrence ; *Self-Help Groups ; Social Behavior ; Social Support ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - J Subst Abuse Treat 1986;3(1):9-20 24 UI - 86266132 AU - Hughes JR ; Hatsukami DK ; Mitchell JE ; Dahlgren LA TI - Prevalence of smoking among psychiatric outpatients. AB - The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented. MH - Adult ; *Ambulatory Care ; Comparative Study ; Cross Sectional Studies ; Female ; Hospitalization ; Human ; Male ; Manic Disorder/COMPLICATIONS/ PSYCHOLOGY ; Mental Disorders/COMPLICATIONS/*PSYCHOLOGY ; Middle Age ; Schizophrenic Psychology ; *Smoking/PREVENTION & CONTROL ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Am J Psychiatry 1986 Aug;143(8):993-7 25 UI - 86250650 AU - Dominguez RA ; Goldstein BJ ; Jacobson AF ; Steinbook RM TI - Comparative efficacy of estazolam, flurazepam, and placebo in outpatients with insomnia. AB - The efficacy and safety of estazolam, an investigational triazolobenzodiazepine, and flurazepam were compared in 65 insomniac outpatients. Patients completed sleep questionnaires each morning. Global evaluations demonstrated that both treatments were significantly superior to placebo. However, estazolam was preferred over flurazepam in a global rating that reflected how well rested and refreshed the subjects felt on arising. Improvement in complaints of difficulty in going to sleep showed only a trend toward significance favoring estazolam and flurazepam over placebo. Residual daytime drowsiness and fatigue accounted for approximately 70% of all side effects with both active treatments. Significantly more side effects occurred with flurazepam than with estazolam. Flurazepam-treated patients had a significantly more severe rating of adverse reactions than did placebo-treated patients. MH - Adult ; Aged ; *Ambulatory Care ; Benzodiazepine Tranquilizers/ *THERAPEUTIC USE ; Clinical Trials ; Comparative Study ; Double-Blind Method ; Drug Tolerance ; Estazolam/ADMINISTRATION & DOSAGE/METABOLISM/ *THERAPEUTIC USE ; Female ; Flurazepam/ADMINISTRATION & DOSAGE/METABOLISM/ *THERAPEUTIC USE ; Human ; Insomnia/*DRUG THERAPY/PSYCHOLOGY ; Kinetics ; Male ; Middle Age ; Placebos ; Sleep/DRUG EFFECTS SO - J Clin Psychiatry 1986 Jul;47(7):362-5 26 UI - 86241312 AU - Hogarty GE ; Anderson CM ; Reiss DJ ; Kornblith SJ ; Greenwald DP ; Javna CD ; Madonia MJ TI - Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotion. AB - Relapse rates averaging 41% in the first year after discharge among schizophrenic patients receiving maintenance neuroleptic treatment led to the development of two disorder-relevant treatments: a patient-centered behavioral treatment and a psychoeducational family treatment. Following hospital admission, 103 patients residing in high expressed emotion (EE) households who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder were randomly assigned to a two-year aftercare study of family treatment and medication, social skills training and medication, their combination, or a drug-treated condition. First-year relapse rates among those exposed to treatment demonstrate a main effect for family treatment (19%), a main effect for social skills training (20%), and an additive effect for the combined conditions (0%) relative to controls (41%). Effects are explained, in part, by the absence of relapse in any household that changed from high to low EE. Only the combination of treatment sustains a remission in households that remain high in EE. Continuing study, however, suggests a delay of relapse rather than prevention. MH - Adult ; *After Care ; Attitude to Health ; *Behavior Therapy ; Clinical Trials ; Emotions ; Family ; *Family Therapy ; Female ; Follow-Up Studies ; Human ; Male ; Psychiatric Status Rating Scales ; Psychotic Disorders/ DRUG THERAPY/PSYCHOLOGY/THERAPY ; Recurrence ; Schizophrenia/DRUG THERAPY/ *THERAPY ; Schizophrenic Psychology ; Social Adjustment ; Support, U.S. Gov't, P.H.S. ; Tranquilizing Agents, Major/*THERAPEUTIC USE SO - Arch Gen Psychiatry 1986 Jul;43(7):633-42 27 UI - 86239776 AU - Kofoed L ; Kania J ; Walsh T ; Atkinson RM TI - Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders. AB - Thirty-two patients with coexisting substance abuse and other psychiatric disorders were treated in a unique outpatient pilot program that used techniques drawn from both psychiatric and substance abuse treatment. Eleven patients remained in treatment for 3 or more months, and seven completed a year or more of treatment. Severity of associated psychiatric illness did not affect retention in treatment. Drug-abusing patients and those with personality disorders dropped out quickly; patients with a history of reliable outpatient treatment involvement tended to remain in treatment. Treatment retention was associated with reduced hospital utilization. The authors suggest guidelines for management of patients with coexisting substance abuse and other psychiatric disorders. MH - Adult ; Alcoholism/REHABILITATION ; *Ambulatory Care/ECONOMICS ; Cost Benefit Analysis ; Disulfiram/THERAPEUTIC USE ; Female ; Hospitals, Veterans ; Human ; Male ; Mental Disorders/COMPLICATIONS/*THERAPY ; Middle Age ; Outpatient Clinics, Hospital/ECONOMICS ; Patient Dropouts ; Pilot Projects ; Substance Abuse/COMPLICATIONS/*THERAPY ; Support, U.S. Gov't, Non-P.H.S. SO - Am J Psychiatry 1986 Jul;143(7):867-72 28 UI - 86142549 AU - Yates WR TI - The National Institute of Mental Health epidemiologic study: implications for family practice. AB - The National Institute of Mental Health has begun a five-site epidemiologic study of the prevalence and incidence of common psychiatric illnesses. Preliminary results reveal a high prevalence of substance abuse disorders in men and a high prevalence of affective and anxiety disorders in women. Evaluation of health care provider utilization shows that women and elderly patients with mental health problems are more likely to visit primary care providers only for mental health problems. The results have important implications for the research and curriculum of family practice. MH - Adult ; Affective Disorders/OCCURRENCE ; Aged ; Ambulatory Care/ *UTILIZATION ; Anxiety Disorders/OCCURRENCE ; Curriculum ; Epidemiologic Methods ; Family Practice/EDUCATION ; Female ; Human ; Male ; Mental Disorders/*OCCURRENCE ; Middle Age ; National Institute of Mental Health (U.S.) ; Substance Use Disorders/OCCURRENCE ; United States SO - J Fam Pract 1986 Mar;22(3):251-5 29 UI - 86208302 AU - Dworkin RJ ; Adams GL ; Telschow RL TI - Cues of disability and treatment continuation of chronic schizophrenics. AB - Serious questions have arisen concerning the retention of the chronically ill in outpatient community mental health clinics (CMHC). This study tests a model based upon sociological theories of disability and the sick role to explain differential continuation in treatment among schizophrenics. We hypothesized that economic, social and medical cues facilitate a patient's self-definition of disability and contribute to continuation in treatment. Data were collected from the clinical charts of 879 chronic schizophrenic patients at five CMHC's. Hypotheses were tested using OLS multiple regression and logistic regression. Findings indicated level of functioning may be an important explanatory variable. Analysis strongly indicated the efficacy of the medical model in the area of treatment continuation. MH - Chronic Disease ; Combined Modality Therapy ; Community Mental Health Centers ; *Continuity of Patient Care ; *Deinstitutionalization ; *Disability Evaluation ; Female ; Human ; Male ; Middle Age ; *Primary Health Care ; Prognosis ; Schizophrenia/DIAGNOSIS/*THERAPY ; Schizophrenic Psychology ; Sick Role ; Tranquilizing Agents, Major/ THERAPEUTIC USE SO - Soc Sci Med 1986;22(5):521-6 30 UI - 86185044 AU - Braithwaite S ; Thomasma DC TI - New guidelines on foregoing life-sustaining treatment in incompetent patients: an anti-cruelty policy. AB - When certain ailments are an overwhelming and irremediable encumbrance, treatment directed at other curable ailments, although life-saving, cannot effectively achieve the goals of medicine. We are morally constrained from perpetuating the effects of a hopeless injury without prospect of benefit to the patient. An anti-cruelty policy is proposed as a new guideline for foregoing life-sustaining treatment that transcends the doctrines of "substituted judgment: or "reasonable persons: for certain incompetent patients. We propose the use of "anti-cruelty care: as an active chart order or progress note, and suggest that institutional ethics committees or governing bodies recommend its implementation. MH - Adolescence ; Case Report ; Cerebral Palsy/COMPLICATIONS ; Emotions ; *Ethics, Medical ; *Euthanasia ; *Euthanasia, Passive ; Family ; Human ; Hypercalcemia/ETIOLOGY/THERAPY ; Life Support Care/*STANDARDS ; Male ; *Mental Disorders ; Mental Retardation/COMPLICATIONS ; Pain ; Patient Advocacy/*STANDARDS ; Testicular Neoplasms/COMPLICATIONS/THERAPY SO - Ann Intern Med 1986 May;104(5):711-5 31 UI - 86181291 AU - Segraves RT ; Schoenberg HW ; Goldman L ; Ivanoff J TI - Psychiatric treatment of erectile dysfunction in urology outpatient clinic. AB - This study examined the feasibility of establishing a satellite psychiatry service in a urology outpatient clinic for the express purpose of engaging men with inhibited sexual excitement in psychiatric treatment. This approach appeared to be more successful as judged by complete referrals and symptom remission than referral to a psychiatry clinic. MH - *Ambulatory Care ; Chronic Disease ; Comparative Study ; Evaluation Studies ; *Hospital Departments ; Human ; Impotence/DIAGNOSIS/ETIOLOGY/ *THERAPY ; Male ; Marriage ; Middle Age ; *Psychotherapy, Brief ; Referral and Consultation ; Socioeconomic Factors ; *Urology Department, Hospital SO - Urology 1986 Apr;27(4):322-7 32 UI - 86156371 AU - Coryell W ; Noyes R Jr ; House JD TI - Mortality among outpatients with anxiety disorders. AB - An earlier follow-up of inpatients with panic disorder attributed excess mortality among men to death from unnatural causes and from cardiovascular disease. The present study sought to determine the stability of this finding with a 12-year follow-up of 155 outpatients with anxiety neurosis. As in the first study, men were twice as likely to die as expected, and this excess in deaths was attributable to cardiovascular disease and suicide. Given the small numbers in both studies, however, the link between panic disorder and excess cardiovascular mortality remains tentative. MH - *Ambulatory Care ; Anxiety Disorders/*MORTALITY ; Cardiovascular Diseases/ MORTALITY ; *Fear ; Female ; Follow-Up Studies ; Human ; Iowa ; Male ; *Panic ; Sex Factors ; Suicide/OCCURRENCE ; Support, Non-U.S. Gov't SO - Am J Psychiatry 1986 Apr;143(4):508-10 33 UI - 86142692 AU - Sierles FS ; Chen JJ ; Messing ML ; Besyner JK ; Taylor MA TI - Concurrent psychiatric illness in non-Hispanic outpatients diagnosed as having posttraumatic stress disorder. AB - Twenty-five consecutive admissions to an outpatient group therapy program for combat veterans meeting DSM-III criteria for posttraumatic stress disorder were systematically screened using operational diagnostic criteria for other coexisting psychiatric conditions, past or present. Eighty-four percent had coexisting conditions which, with one exception, were not significantly different in prevalence from those of an inpatient sample of combat veterans previously reported by the authors. The exception was a lower frequency of drug dependence in the outpatients compared with the inpatients. The authors conclude that a high proportion of conditions and symptoms--particularly alcoholism, antisocial personality, drug abuse, depression, and anxiety--can be routinely expected to coexist with posttraumatic stress disorder when it is diagnosed in Vietnam combat veterans. MH - Adult ; *Ambulatory Care ; Ethnic Groups ; Hospitalization ; Human ; Male ; Mental Disorders/COMPLICATIONS/*DIAGNOSIS ; Middle Age ; Psychotherapy, Group ; Stress Disorders, Post-Traumatic/*COMPLICATIONS/PSYCHOLOGY/ THERAPY ; Substance Dependence/COMPLICATIONS/DIAGNOSIS SO - J Nerv Ment Dis 1986 Mar;174(3):171-3 34 UI - 86127771 AU - Goodman AB ; Siegel C TI - Elderly schizophrenic inpatients in the wake of deinstitutionalization. AB - The authors investigated the factors relating to the observation that in a large state hospital, there is an age-related increase in the ratio of patients with a DSM-II diagnosis of paranoid schizophrenia to those with a diagnosis of nonparanoid schizophrenia. Elderly inpatients (N = 1,518) treated over a 5-year period were studied and the hypotheses of proportionately greater numbers with late onset of paranoid conditions, longer lengths of stay for recently admitted paranoid patients, and changing diagnosis over time were tested and rejected. The data suggest that the buildup among the elderly of those diagnosed under DSM-II to have paranoid conditions is due to patients admitted well before age 54. The authors discuss the reasons for the poor prognosis of this group. MH - Age Factors ; Aged ; *Deinstitutionalization ; Female ; *Hospitalization ; Hospitals, Psychiatric/UTILIZATION ; Hospitals, State/UTILIZATION ; Human ; Length of Stay ; Male ; Mental Disorders/DIAGNOSIS ; Middle Age ; Prognosis ; Schizophrenia/*DIAGNOSIS ; Schizophrenia, Paranoid/DIAGNOSIS SO - Am J Psychiatry 1986 Feb;143(2):204-7