Showing papers in "Psychiatric Services in 1987"
TL;DR: The survey results showed that 8 percent of the state's prison inmates have severe psychiatric or functional disabilities that clearly warrant some type of mental health intervention, and another 16 percent have significant mental disabilities that require periodic services.
Abstract: To obtain a comprehensive picture of the levels of mental disability in the general state prison population in New York State, the authors gathered data on a random sample of inmates using a survey instrument adapted from the state's level-of-care surveys of the psychiatric population. The sample consisted of 3,332 inmates in the general prison population (9.4 percent) and 352 inmates in prison mental health units. The survey results showed that 8 percent of the state's prison inmates have severe psychiatric or functional disabilities that clearly warrant some type of mental health intervention, and another 16 percent have significant mental disabilities that require periodic services. The specific nature and extent of these disabilities need to be assessed before appropriate services can be developed.
98 citations
TL;DR: It is concluded that computerized administration of the DIS is as reliable as other methods but that exclusive reliance on the DIS for clinical diagnosis is inappropriate.
Abstract: A group of 150 psychiatric patients were administered the Diagnostic Interview Schedule (DIS) on two occasions, once by a trained layperson and once using a computerized interview format in which the patient interacted directly with the computer. Agreement between the two methods on 15 diagnoses was relatively modest, as indicated by a mean kappa score of .51, but was similar to agreement rates reported in other studies of the DIS. The discrepancies may have been due to the high number of acutely ill inpatients studied, patients' reporting more symptoms in one of the interviews, and difficulty translating some of the DIS questions to the computer. Patients had positive feelings about both methods, but a significant majority liked the computer interview better and found it less embarrassing. The authors conclude that computerized administration of the DIS is as reliable as other methods but that exclusive reliance on the DIS for clinical diagnosis is inappropriate.
92 citations
TL;DR: While expressed emotion may predict relapse, there is no evidence that it causes relapse and the evidence does not support the continued linkage of the three components of expressed emotion--criticism, hostility, and emotional overinvolvement--in a single global variable.
Abstract: Research on expressed emotion in the families of schizophrenic patients has seemed to offer a new perspective on environmental factors that cause relapse in schizophrenia. A review of the literature, however, reveals that while expressed emotion may predict relapse, there is no evidence that it causes relapse, Nor does the evidence support the continued linkage of the three components of expressed emotion—criticism, hostility, and emotional overinvolvement—in a single global variable. The authors also question the clinical significance of expressed emotion ratings and believe that treatment strategies based on them tend to blame relatives for the patient's continuing difficulties. They suggest that clinicians assess family responses in the context of the patient's behavior and life situation before helping families develop more effectual coping strategies.
89 citations
TL;DR: After instruction, more patients knew about specific side effects, including tardive dyskinesia, and both patients given only verbal instruction and those given minimum information about side effects had fewer problems with side effects.
Abstract: The authors measured knowledge about medication and its side effects, impact of side effects, and compliance in 30 chronic outpatients before and after they participated in two instruction sessions about their medication held one month apart. Instruction consisted of a verbal or a written and verbal presentation and minimum or maximum information about side effects. All patients' medication knowledge increased after both sessions. Those on high doses of neuroleptics given verbal and written information gained significantly more medication knowledge than those given only verbal information. After instruction, more patients knew about specific side effects, including tardive dyskinesia, and both patients given only verbal instruction and those given minimum information about side effects had fewer problems with side effects. Instruction did not affect compliance.
88 citations
TL;DR: Difficulty securing inpatient beds for public patients and heavy use of services by a small number of patients fitting the description of young adult chronic patients were mentioned by staff at most of Philadelphia's psychiatric emergency services as among the most important problems or changes.
Abstract: As part of an investigation of the causes of increased use of Philadelphia's seven psychiatric emergency services, staff of the services were asked to identify the problems and changing conditions facing them. Difficulty securing inpatient beds for public patients and heavy use of services by a small number of patients fitting the description of young adult chronic patients were mentioned by staff at most of the services as among the most important problems or changes. The staffs' perceptions were confirmed in the second part of the study, which analyzed emergency service data for fiscal years 1979 through 1985. The data analyses also indicated that the heavy users continued to make extensive use of emergency services for several years following their first admission, causing their total number of visits to climb from 3,048 in 1980 to 14,839 in 1985. The authors suggest immediate strategies for responding to the emergence of these young, very disturbed patients.
78 citations
TL;DR: A more inclusive notion of somatization should be developed that would substantiate the presence of this trait among different populations and, if operationalized, would facilitate research on this important phenomenon.
Abstract: Studies using a variety of diagnostic rating scales have identified much higher levels of somatic symptoms in Hispanic psychiatric patients, particularly those with a diagnosis of schizophrenia or depression, than in their An- glo counterparts. However, this cultural difference cannot be generally demonstrated by using DSM-IlI somatoform disorders criteria. Many patients with "unfounded" somatic symptoms have another DSM-III primary diagnosis that is often assumed to cause or explain the somatic symptoms. In addition, the true prevalence of unfounded somatic symptoms is hidden because of the strict criteria required for a DSM-III primary diagnosis of somatization disorder. The author believes a more inclusive notion of somatization should be developed that would substantiate the presence of this trait among different populations and, if operationalized, would facilitate research on this important phenomenon. This is relevant not only because of the cross-cultural variability of somatization traits but als...
78 citations
TL;DR: A model was generated to predict outcome of hospital treatment, using patient alliance ratings, axis I and II diagnoses and their combinations, and admission Global Assessment Scale scores, which showed patients with axis I substance abuse, adjustment, and somatoform disorders had the poorest alliance and the poorest outcomes.
Abstract: The effect of therapeutic alliance on treatment outcome in a stratified sample of 96 hospital inpatients was assessed by means of a 6-point alliance scale as well as by demographic, treatment history, and psychopathological data. Alliance was correlated with improvement at discharge but not with demographic or prior treatment characteristics. Symptom patterns and personality dysfunction were shown to be differentially related to the quality of the alliance. Patients with axis I substance abuse, adjustment, and somatoform disorders had the poorest alliance and the poorest outcomes. The authors generated a model to predict outcome of hospital treatment, using patient alliance ratings, axis I and II diagnoses and their combinations, and admission Global Assessment Scale scores.
74 citations
TL;DR: It is concluded that diagnosis alone is not an accurate predictor of length of stay but may have predictive ability when combined with other data.
Abstract: Recent emphasis on cutting the costs of psychiatric care and the possibility that reimbursement for psychiatric services will one day be based on diagnosis-related groups has stimulated debat about the proper length of psychiatric hospitalization. The authors review the literature on length of stay, focusing primarily on studies of the relationship between various patient and environmental variables and length of stay and studies comparing the outcomes of long and short hospitalizations. They conclude that diagnosis alone is not an accurate predictor of length of stay but may have predictive ability when combined with other data. Most studies found no differences in the outcomes of short and long hospitalizations. The authors identify numerous avenues for further research and are optimistic that a policy governing length of stay is within reach.
71 citations
TL;DR: The author defines capitation within the context of various health care reimbursement approaches, presents arguments for and against capitation, reviews the record of capitation for general medical care, and discusses proposals for capitation systems for high-risk patient groups.
Abstract: Capitation as a method of health care reimbursement has grown dramatically during the past two decades and may have a marked impact on funding for mental health services in coming years. The author defines capitation within the context of various health care reimbursement approaches, presents arguments for and against capitation, reviews the record of capitation for general medical care, and discusses proposals for capitation systems for high-risk patient groups. The potential benefits and risks of capitating mental health services for the general population and for high-risk groups are explored, and initial activities to develop a capitation system for chronic patients in two New York counties are described.
67 citations
TL;DR: Mr. Surber is assistant clinical professor in the department of psychiatry of the University of California, San Francisco and Ms Winider is director of psychiatnc nursing and Ms. Monteleone is associate director of Psychiatrist inpatient services at San Francisco General Hospital.
Abstract: Mr. Surber is assistant clinical professor in the department of psychiatry of the University of California, San Francisco. Ms. Winider is director of psychiatnc nursing and Ms. Monteleone is associate director of psychiatnc inpatient services at San Francisco General Hospital. Dr. Havassy is assistant professor, Dr. Goldfinger is assistant cliniby AM Nicholi. Cambridge, Harvard University Press, 1978 4. Kauffman C, Grunebaum H, Cohler B, et al: Superkids: competent children of psychotic mothers. American Journal ofPsychiatry 136:1398-1402, 1979 5. Waldo MC, Roath M, Freedman R: Schizophrenia and parenting. Presented at the American Psychiatric Association annual meeting, Washington, DC, May 10-16, 1986 6. Grunebaum H, Cohler B, Kauffman C, et al: Children ofdepressed and schizophrenic mothers. Child Psychiatry and Human Development 8:219-228, 1978 7. Goodman SH: Children of emotionally disturbed mothers: problems and alternatives. Children Today, March-April 1984, pp 6-9 8. Liberman RP, Wallace CJ, Vaughn CE, et al: Social and family factors in the course of schizophrenia: towards an interpersonal problem-solving therapy for schizophrenics and their families, in The Psychotherapy of Schizophrenia. Edited by Strauss JS, Bowers M, Downey TW, et al. New York, Plenum, 1980
65 citations
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TL;DR: Patients may experience extensions in hospitalizations due to delays in decisionmaking by providers while they wait for results, schedule diagnostic tests, conduct discharge planning, or wait for consultation because of inadequate access to consultants and specialists.
Abstract: Current Findings in the Literature: Patients may experience extensions in hospitalizations due to delays in decisionmaking by providers while they wait for results, schedule diagnostic tests, conduct discharge planning, or wait for consultation because of inadequate access to consultants and specialists.1 Health IT applications that facilitate the transmission of important patient data to providers more quickly may reduce hospital stays in several ways. For example, health IT can help with the efficient and timely notification of available or critical results, or notification of when a consultant note is available.
TL;DR: In most studies, environmental variables were better predictors of outcome than were patient variables, suggesting the value of further research on environment and the importance of applying the results to program development.
Abstract: Although community residential placements are among the leading areas of program expansion for the chronic mentally ill, they have been designed without scientifically validated models. The author reviews the literature on the impact of residential environment on the course of serious mental illness. In most studies, environmental variables were better predictors of outcome than were patient variables. This overall finding suggests the value of further research on environment and the importance of applying the results to program development.
TL;DR: Assessing suicide risk requires evaluating the repeater's internal state of rage and dysphoria and it is recommended that future studies look closely at these internal states as well as at external factors.
Abstract: A significant number of adolescents treated for attempted suicide have made previous attempts and will make subsequent attempts These youths have a high risk of actually committing suicide To find predictive factors of suicide risk, the authors compared 43 adolescent patients who had attempted suicide once with 38 who reported multiple attempts The repeaters were less successful in school, displayed more hostility, reported more dysphoria, and had undergone more long-term stress The authors believe assessing suicide risk requires evaluating the repeater's internal state of rage and dysphoria; they recommend that future studies look closely at these internal states as well as at external factors
TL;DR: It is hypothesize that a moderately dense network is optimal for psychologically vulnerable individuals because it can be maintained under stress.
Abstract: The authors interviewed 30 patients under age 40 who had been hospitalized repeatedly to determine the relationship between social network density, or the extent to which network members know one another, and rehospitalization. They found that moderate levels of network density were associated with fewer days in the hospital. Time spent in the hospital was not related to network size, and patient diagnosis was not a good precdictor of hospitalization. The authors hypothesize that a moderately dense network is optimal for psychologically vulnerable individuals because id can be maintained under strees.
TL;DR: The author reviews the recent literature on the evaluation of partial hospitalization programs in North America and Europe and makes recommendations in the framework of this nomenclature.
Abstract: The author reviews recent studies on the evazluation of partical hospitalization programs in North America and Europe, The lack of a clear definition of partical hospitalization is one of the factors leading to its underutilization, many authorities believe After discussing the nomenclature and emphasizing the importance of classifying programs by function—day hospitals, Day treatment programs, and day care centers—the author reviews the recent literature and makes recommendations in the framework of this nomenclature
TL;DR: The author presents the key principles of a new postinstitutional ideology that focuses on helping patients attain the best possible adaptation to their illness regardless of the setting in which they are treated and hopes the ideology will infuse new hope and clinical expertise into work with people with chronic mental illness.
Abstract: The emergence oftbe young adult chronic patient, and the attendant perception that deinstitutionalization has failed, may be viewed as the inevitable result of the success of deinstitutionalization. Deinstitutionalization gave freedom to the mentally ill, but in doing so it left patients free to struggle on their own. The deinstitutionalization ideology failed to predict the difficult clinical reality that most patients do not readily choose the identity of chronic mental patient and are reluctant to make use of available treatment programs. The author presents the key principles of a new post institutional ideology that focuses on helping patients attain the best possible adaptation to their illness regardless of the setting in which they are treated. He hopes the ideology will infuse new hope and clinical expertise into work with people with chronic mental illness.
TL;DR: The authors' literature review indicates that many standardized self-rating scales and interview schedules can accurately assess mental illness among Indians, provided they are modified to reflect cultural heritage and experiences.
Abstract: It is widely recognized that the cultural uniqueness of American Indians and Alaska Natives must be reflected in the methods of diagnosing and treating their mental health problems, but empirical validation of specific diagnostic instruments and treatment has been slow in coming. The authors' literature review indi- cates that many standardized self-rating scales and interview schedules can accurately assess mental illness among indians, provided they are modified to re- fiect cultural heritage and experiences. Group therapy is increas- ingly chosen as a psychiatric treatment for American Indians, as are family-network therapy and several traditional Indian therapies. The authors also re- view the demographics and psychiatric epidemiology of Amencan Indians and Alaska Natives.
TL;DR: It is asserted that community support programs must provide continuing assistance with physical health care and offers suggestions for better addressing the problem.
Abstract: A study of a group of chronic mentally ill patients from an intensive community support program revealed that 53 percent of the subjects had undiagnosed medical problems and 36 percent had known medical problems requiring initiation of or a change in treatment. These high percentages may be explained by the severity of the subjects' psychiatric problems, the questionable quality of their past physical care, and the difficulties chronic patients have in appropriately seeking and using either physical or mental outpatient health care. The author asserts that community support programs must provide continuing assistance with physical health care and offers suggestions for better addressing the problem.
TL;DR: CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care, the authors believe.
Abstract: Comments gathered in a national survey of community mental health center (CMHC) psychiatrists indicate that many suffer from burnout. Of the 96 respondents who provided comments, 46 expressed dissatisfaction with their work in CMHCs, 14 expressed satisfaction, and seven had mixed feelings. Factors contributing to the respondents' disatisfaction included a lack of administrative support and validation, low pay, responsibility without authority, and pressure to sign documents related to patients unknown to them. Factors contributing to their satisfaction were having a variety of tasks, being valued for having uniquely comprehensive experience, being supported in the clinical oversight role, being in charge of CMHC operations, and working in a CMHC affiliated with an academic center or the medical community. The authors believe that CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care.
TL;DR: Uncleanliness should not be labeled as part of a syndrome, but that it is a sign that may lead to recognition of a causative disorder, and the author suggests that eccentric personality factors may account for their living conditions.
Abstract: Community nurses and other community workers often encounter persons who live in conditions of extreme uncleanliness, but not much attention has been paid to the causes of this behavior. The author surveyed 12 community health centers in Sydney, Australia, to obtain data on specific aspects of personal and home cleanliness for persons under their care. Of the 83 subjects identified as living in unclean conditions, 15 were age 60 or younger. Almost two-thirds had some degree of memory impairment, and 40 percent were or had been heavy drinkers. However, 12 subjects did not have obvious physical or mental disorders, and the author suggests that eccentric personality factors may account for their living conditions. He believes uncleanliness should not be labeled as part of a syndrome, but that it is a sign that may lead to recognition of a causative disorder. He recommends further study of the problem.
TL;DR: The author presents six case examples that illustrate the association of firesetting behavior with schizophrenic, affective, and personality disorders as well as with alcohol abuse and mental retardation.
Abstract: Firesetting by adult psychiatric patients is a symptom found in many primary disorders; it is rarely a reflection of the classic disorder, pyromania, as historically defined. The author emphasizes the importance of clinically addressing firesetting behavior and presents six case examples that illustrate the association of firesetting behavior with schizophrenic, affective, and personality disorders as well as with alcohol abuse and mental retardation. Current understanding of the phenomenon indicates that firesetters have significant social deficits, and successful therapeutic interventions based on a social learning model are beginning to be documented.
TL;DR: Ten major factors that shape and define all referrals are identified: the practitioner's capacity to recognize and define mental illness, the availability of resources, economic incentives, the amount of clinical information available, patient attitudes toward referral, and provider group influences.
Abstract: Psychiatric referral practices of the clergy, primary care physicians, and mental health care specialists are examined in relation to the three stages of the referral process: the identification of a mental health problem, the decision to refer, and the selection of a treating professional. Referral practices within health maintenance organizations are also described to illustrate how organizational structure affects this process. Based on a literature review, the authors identify and discuss ten major factors that shape and define all referrals. They are the practitioner's capacity to recognize and define mental illness, the availability of resources, economic incentives, the amount of clinical information available, patient attitudes toward referral, the practitioner's therapeutic background, the practitioner's role perception, practitioner-patient interaction, interpractitioner relations, and provider group influences. The authors end with a critique of current mental health referrals.
TL;DR: The author chronicles her 20-year battle with schizophrenia and her growing acceptance of her illness and describes her own strategies for preventing relapse.
Abstract: The author chronicles her 20-year battle with schizophrenia and her growing acceptance of her illness. She has committed herself to leading the fullest life her disease will allow and to educating others about mental illness. While she does not deny that hospitals have their place in the treatment and stabilization of acute psychiatric problems, she believes community-based residential treatment programs are most successful in promoting long-term gains because they provide a protected yet flexible environment in which to build confidence and social skills. She believes mentally ill individuals need to be educated about their illnesses and require appropriate supportive psychotherapy, pharmacotherapy, access to support groups, and structured activities, such as working, attending school, and training for a job. She describes her own strategies for preventing relapse.
TL;DR: Health insurance claims of families covered by Aetna's Federal Employees Health Benefit Program from 1980 through 1983 were analyzed to determine if any changes in total health care utilization and costs were associated with the initiation of mental health treatment.
Abstract: Health insurance claims of families covered by Aetna's Federal Employees Health Benefit Program from 1980 through 1983 were analyzed to determine if any changes in total health care utilization and costs were associated with the initiation of mental health treatment. A total of 26,915 families in which at least one member received mental health treatment were compared with a randomly selected group of 16,468 families in which no member had received mental health treatment. Total health care costs for those receiving mental health treatment were significantly higher than costs for the comparison group. However, those costs dropped significantly after initiation of mental health treatment and continued to decline over the study period. The biggest declines occurred among persons age 45 and older, a finding that may have important policy considerations.
TL;DR: A method for more accurately projecting service needs of minority groups based on population data and on sample surveys of needs is described, which helps define more equitable service goals for all population groups.
Abstract: Most studies of utilization of mental health services by ethnic groups have used parity as a measure of whether members of ethnic groups are receiving a fair share of services. The level of services is assumed to be adequate if the percentage of ethnic group members in the treatment population is the same as the group's percentage in the general population. However, service planning based on achieving parity fails to consider whether some groups have higher levels of need than others. The authors describe a method for more accurately projecting service needs of minority groups based on population data and on sample surveys of needs. The results help define more equitable service goals for all population groups.
TL;DR: The authors identify several steps that the mental health field should take to promote success among chronic patients, deinstitutionalized or not.
Abstract: In 1979 a Massachusetts state hospital initiated a plan to transfer 54 long-term residents of two wards to the community through a series of increasingly independent working and living arrangements. This study assesses the patients' residential and vocational status and living skills over a five-year period beginning in February 1979. The patients demonstrated a significant increase in living independence, but only eight were able to live continuously in the community after their discharge, and 24 never left the hospital. Overall, vocational status did not improve, and living skills improved only slightly. Living skills and vocational status were predictive of living independence. The authors identify several steps that the mental health field should take to promote success among chronic patients, deinstitutionalized or not.
TL;DR: The results of the study augment recent research demonstrating the inadequacy of relying on diagnosis alone--as is the case for psychiatric services under the current Medicare prospective payment system--to predict resource consumption.
Abstract: A study to determine patient characteristics that are predictive of treatment costs was conducted at the Neuropsychiatric Institute and Hospital of the University of California, Los Angeles. Using nursing care time utilized and length of stay as measures of resource consumption, the study identified several characteristics, such as age and the presence of medical comorbidities, that are predictive of the costs of delivering care. Besides providing information valuable to administrators for product costing, the results of the study augment recent research demonstrating the inadequacy of relying on diagnosis alone—as is the case for psychiatric services under the current Medicare prospective payment system—to predict resource consumption.