==================================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