Showing papers in "Psychiatric Services in 2004"
TL;DR: The continuous casting process comprises continuously pouring a molten metal into a space surrounded with the hollow mold and the core of the above equipment, thereby solidifying the molten metal to form an ingot having a hollow.
Abstract: Continuous casting process for the production of hollow ingot using an improved direct chill casting equipment having a molding system comprising a hollow mold and a movable platform, wherein at least one core and a pipe for introducing outer air are provided, said core being made from a refractory material unwettable with a molten metal and having a convergent taper at the side and an air runner for introducing outer air, which is packed with an air-permeable material, at the bottom, and said pipe for introducing outer air extending upwards from the air runner and passing through the core. The continuous casting process comprises continuously pouring a molten metal into a space surrounded with the hollow mold and the core of the above equipment; cooling the molten metal only at the side wall of the hollow mold without cooling at the side of the core; thereby solidifying the molten metal to form an ingot having a hollow, wherein the interface of the frozen metal and the liquid metal is present at the position around the core; and continuously lowering the ingot thus formed while introducing spontaneously outer air into the hollow part via the pipe for introducing outer air and the air runner of the core.
822 citations
TL;DR: Investigation of stress reactions among 338 staff members in a hospital in East Taiwan that discontinued emergency and outpatient services to prevent possible nosocomial outbreak found that quarantine was the most related factor.
Abstract: The outbreak of severe acute respiratory syndrome (SARS) was unique because it was highly concentrated in health care settings and a large number of health care workers were infected. This study investigated stress reactions among 338 staff members in a hospital in East Taiwan that discontinued emergency and outpatient services to prevent possible nosocomial outbreak. Seventeen staff members (5 percent) suffered from an acute stress disorder; stepwise multiple logistic regression analysis determined that quarantine was the most related factor. Sixty-six staff members (20 percent) felt stigmatized and rejected in their neighborhood because of their hospital work, and 20 of 218 health care workers (9 percent) reported reluctance to work or had considered resignation.
805 citations
TL;DR: This shared leadership reframing the hows and whys of leadership will really give you the good idea to be successful.
Abstract: By reading, you can know the knowledge and things more, not only about what you get from people to people. Book will be more trusted. As this shared leadership reframing the hows and whys of leadership, it will really give you the good idea to be successful. It is not only for you to be success in certain life you can be successful in everything. The success can be started by knowing the basic knowledge and do actions.
619 citations
TL;DR: This study showed a direct correlation between estimated partial compliance and hospitalization risk among patients with schizophrenia across a continuum of compliance behavior.
Abstract: OBJECTIVE: The objective of this study was to evaluate the relationship between compliance with an antipsychotic medication regimen and risk of hospitalization in a cohort of California Medicaid patients with schizophrenia. METHODS: Compliance behavior was estimated by using a retrospective review of California Medicaid pharmacy refill and medical claims for 4,325 outpatients for whom antipsychotics were prescribed for treatment of schizophrenia from 1999 to 2001. Compliance behavior was estimated by using four different definitions: gaps in medication therapy, medication consistency and persistence, and a medication possession ratio. Patients were followed for one year and had an average of 19.1 dispensing events. Logistic regression models using each compliance estimate were used to determine the odds of hospitalization. RESULTS: Risk of hospitalization was significantly correlated with compliance. With all definitions, lower compliance was associated with a greater risk of hospitalization over and abov...
615 citations
TL;DR: In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences.
Abstract: OBJECTIVE:This study comprehensively assessed the work outcomes of employees with depression. METHODS: We collected baseline and six-month follow-up survey data from 229 employees with depression and two employee comparison groups: a group of healthy patients for the control group (N=173) and a group with rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes included new unemployment and, within the employed subgroup, job retention (versus job turnover), presenteeism (that is, diminished on-the-job performance and productivity), and absenteeism. RESULTS: At the six-month follow-up, persons with depression had more new unemployment—14 percent for persons in the dysthymia group, 12 percent for persons in the major depression group, and 15 percent for persons in the group with both dysthymia and major depression, compared with 2 percent for persons in the control group and 3 percent for persons in the rheumatoid arthritis group. Among participants who were still employed, those with dep...
401 citations
TL;DR: Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment and excluding persons with chronic health problems from mental health service evaluations restricts generalizability of research findings.
Abstract: OBJECTIVES: This study examined Medicaid claims forms to determine the prevalence, severity, and co-occurrence of physical illness within a representative sample of persons with serious mental illness (N=147). METHODS: Representativeness of health problems in the study sample was established through comparison with a larger sample of persons with serious mental illness enrolled in Medicaid within the same state. Standardized annual costs were then assigned to Medicaid claims diagnoses, and individual health problem severity was measured as the sum of estimated treatment costs for diagnosed conditions. RESULTS: Seventy-four percent of the study sample (N=109) had been given a diagnosis of at least one chronic health problem, and 50 percent (N=73) had been given a diagnosis of two or more chronic health problems. Of the 14 chronic health conditions surveyed, chronic pulmonary illness was the most prevalent (31 percent incidence) and the most comorbid. Persons with chronic pulmonary illness were second only ...
317 citations
284 citations
TL;DR: This is a very reasonable book that should be read and it is actually ease to get this book when the other people must walk around and go outside to get the book in the book store.
Abstract: This is a very reasonable book that should be read. The following may offer you the way to get this book. It is actually ease. When the other people must walk around and go outside to get the book in the book store, you can just be by visiting this site. There is provided link that you can find. It will guide you to visit the book page and get the racism a short history. Done with the download and get this book, start to read.
271 citations
TL;DR: Severity of psychiatric symptoms was negatively associated with a recovery orientation, and use of a variety of standard services were positively associated withA polarized view of biomedical and recovery perspectives on mental illness may be unfounded, given that these perspectives appear to be mutually reinforcing.
Abstract: OBJECTIVE: The concept of recovery has received increasing emphasis in the delivery of services to persons with schizophrenia. This study was an initial effort to develop an empirically based model of factors associated with a recovery orientation. METHODS: The authors reanalyzed data from 825 persons with schizophrenia who were assessed in the Schizophrenia Patient Outcomes Research Team (PORT) client survey. Multiple regression models were used to identify client and service use variables associated with each of four domains identified as important to a recovery orientation: life satisfaction, hope and optimism, knowledge about mental illness and services, and empowerment. RESULTS: In each regression model, the strongest relationship was observed between recovery orientation and lower severity of depressive symptoms. Both receipt of family psychoeducation and fewer side effects of medications were significantly and positively related to three of the four recovery domains. Psychotic symptoms were associa...
249 citations
TL;DR: The positive association between process measures-that is, greater levels of service intensity, satisfaction, and either treatment completion or retention-and treatment outcome strongly suggests that improvements in these key elements of the treatment process will improve treatment outcomes.
Abstract: OBJECTIVE: This longitudinal study conducted path analyses to examine the relationships between treatment processes and outcomes among patients in community-based drug treatment programs. METHODS: A total of 1,939 patients from 36 outpatient drug-free and residential treatment programs in 13 California counties were assessed at intake, discharge, three months after admission, and nine months after admission. Path analyses were conducted to relate the quantity and quality of services that were received in the first three months of treatment to treatment retention and outcomes at the nine-month follow-up. Patients were determined to have a favorable outcome if for at least 30 days before the follow-up assessment they did not use drugs, were not involved in criminal activity, and lived in the community. The path analyses controlled for patients' baseline characteristics. RESULTS: Greater service intensity and satisfaction were positively related to either treatment completion or longer treatment retention, w...
TL;DR: Forensic assertive community treatment is an emerging model for preventing arrest and incarceration of adults with severe mental illness who have substantial histories of involvement with the criminal justice system.
Abstract: OBJECTIVE: Persons with severe mental illness are overrepresented in jails and prisons in the United States. A national survey was conducted to identify assertive community treatment programs that have been modified to prevent arrest and incarceration of adults with severe mental illness who have been involved with the criminal justice system. METHODS: Members of the National Association of County Behavioral Health Directors (NACBHD) were surveyed to identify assertive community treatment programs serving persons with criminal justice histories and working closely with criminal justice agencies. Programs were identified that met three study criteria: all enrollees had a history of involvement with the criminal justice system, a criminal justice agency was the primary referral source, and a close partnership existed with a criminal justice agency to perform jail diversion. Senior representatives of each program were subsequently contacted, and a telephone survey was administered to gather information about...
TL;DR: The child welfare system was actively engaged in arranging mental health services for youths in the foster care system, but the system was unable to maintain many youths in less restrictive living situations.
Abstract: OBJECTIVE: This study examined lifetime, 12-month, and current mental health service use among older youths in the foster care system and examined variations in mental health care by race, gender, maltreatment history, living situation, and geographic region. METHOD: The Service Assessment for Children and Adolescents, the Child Trauma Questionnaire, and the Diagnostic Interview Schedule were used in interviews with 406 youths in Missouri's foster care system who were aged 17 years. RESULTS: Ninety-four percent of the youths had used a mental health service in their lifetime, 83 percent used a mental health service in the past year, and 66 percent were currently receiving a mental health service. Lifetime rates for inpatient psychiatric care (42 percent) and other residential programs (77 percent) were exceptionally high. A quarter of the youths received mental health services before they entered the foster care system. Among youths who received residential services, half did not receive community-based s...
TL;DR: Disparities in depression treatment appear to be due mainly to differences in rates of initiation of depression treatment, given that rates of adequate care generally did not differ once treatment was initiated.
Abstract: OBJECTIVE: There is evidence of disparities in depression treatment by factors such as age, race or ethnicity, and type of insurance. The purpose of this study was to assess whether observed disparities in treatment are due to differences in rates of treatment initiation or to differences in the quality of treatment once treatment has been initiated. METHODS: Logistic regression models using data from the 2000 Medical Expenditure Panel Survey were estimated to assess the role of age, race or ethnicity, and type of insurance on rates of initiation of depression treatment for persons with self-reported depression and on rates of adequate treatment for those receiving treatment. RESULTS: African Americans and Latinos were significantly less likely to fill an antidepressant prescription than Caucasians. However, among patients who filled at least one prescription for an antidepressant, there were no racial or ethnic disparities in the probability of receiving an adequate trial of antidepressant medication. Af...
TL;DR: Screening for trauma history should be a routine part of mental health assessment and may significantly improve the recognition rate of PTSD, however, much work remains to be done in implementing appropriate treatment.
Abstract: OBJECTIVE: This study assessed the lifetime prevalence of traumatic events among consumers of a community mental health center by using a brief trauma screening instrument. This study also examined the relationship between trauma exposure and physical and mental health sequelae and determined whether the routine administration of a trauma screening measure at intake would result in increased diagnoses of posttraumatic stress disorder (PTSD) and in changes in treatment planning in a practice setting. METHODS: A 13-item self-report trauma screening instrument, a shortened version of the Trauma Assessment of Adults instrument, was incorporated into the intake assessment process at a community mental health center (CMHC). A total of 505 out of 515 consumers who presented to the CMHC consecutively were surveyed from May 1, 2001, to January 31, 2002. Data from the initial assessment on trauma exposure and on rate of PTSD diagnosis were examined, and a chart review was conducted on 97 cases (19 percent) to deter...
TL;DR: Stigmatization of schizophrenia was significantly higher than stigmatization of depression, and more positive attitudes toward treatment were associated with significantly less stigma, while psychiatric terminology had no impact on attitudes toward mental illness.
Abstract: Stigmatization of individuals with mental illnesses is widespread and serves as a major barrier to treatment. In a survey of 116 undergraduates, the authors examined the impact of diagnosis, attitudes about treatment, and psychiatric terminology on stigma associated with mental illness. Stigmatization of schizophrenia was significantly higher than stigmatization of depression. More positive attitudes toward treatment were associated with significantly less stigma. However, psychiatric terminology had no impact on attitudes toward mental illness. Significantly less stigmatization of mental illness was found among females than among males. Reducing the stigmatization of mental illness continues to be an important goal for mental health professionals.
TL;DR: Current employment status was significantly associated with cognitive performance, especially immediate verbal memory, total symptom severity, history of psychiatric hospitalization, and maternal education; and Vocational programs for persons with bipolar disorder would benefit from inclusion of a formal cognitive assessment to better assess work potential.
Abstract: OBJECTIVE: The purpose of this study was to identify variables associated with employment status among persons with bipolar disorder, including cognitive functioning, severity of symptoms, demographic variables, and variables related to course of illness. METHODS: The authors assessed the current employment status of 117 persons with bipolar disorder. Study participants' cognitive functioning was evaluated with the Repeatable Battery for the Assessment of Neuropsychological Status, the information and letter-number sequencing subtests of the Wechsler Adult Intelligence Scale III, and part A of the Trail Making Test. Symptoms were rated by using the Brief Psychiatric Rating Scale, the Hamilton Depression Scale, and the Young Mania Rating Scale. A stepwise multivariate logistic regression analysis was used to predict employment status. RESULTS: Fifty-one percent of the study participants had no current work activity, 21 percent worked part-time or as volunteers, and 27 percent had full-time competitive empl...
TL;DR: Patients with mental illness appeared to receive fewer pharmacy services than patients with cardiovascular disorders and barriers to receipt of counseling included a lack of privacy and inadequate training.
Abstract: Consumers of psychiatric medications or services may be stigmatized by health care providers. The authors surveyed community pharmacists (N=283) in the greater Toronto area to determine their attitudes toward and professional interactions with patients who used psychiatric medications and those who used cardiovascular medications. Despite generally positive attitudes, pharmacists reported feeling more uncomfortable discussing symptoms and medications with patients who have mental illness than with patients who have cardiovascular problems. Patients with mental illness appeared to receive fewer pharmacy services than patients with cardiovascular disorders. Barriers to receipt of counseling included a lack of privacy and inadequate training. Adequate training in mental health may be key in improving the professional interactions of community pharmacists toward patients who use psychiatric medication.
TL;DR: Adherence to treatment for bipolar disorder may be enhanced by interventions that address issues of appropriately taking medications to manage illness, and promotion of adherence must be integrated into the medication management of bipolar illness.
Abstract: OBJECTIVE: Because about one-third of persons with bipolar illness take less than 30 percent of their medication and because nonadherence is associated with rehospitalization and suicide, the literature was searched to identify controlled studies of enhancement of treatment adherence among persons with bipolar disorder. METHODS: Studies published up to October 2003 were evaluated. Those selected for review were controlled trials that used samples of adults with a diagnosis of bipolar disorder and that measured adherence to either mood-stabilizing medication or psychotherapy. Information was extracted on the diagnostic composition and size of the study group, the type and duration of the intervention, the method of measuring adherence, and outcomes. RESULTS: Eleven studies met inclusion criteria. Although the literature on enhancing treatment adherence among persons with bipolar disorder is limited, the existing data are promising and demonstrate development over time in our understanding of how best to ma...
TL;DR: Police officers viewed persons with schizophrenia as being less responsible for their situation, more worthy of help, and more dangerous than persons for whom no mental illness information was provided.
Abstract: OBJECTIVE: A significant portion of police work involves contact with persons who have mental illness. This study examined how knowledge that a person has a mental illness influences police officers' perceptions, attitudes, and responses. METHODS: A total of 382 police officers who were taking a variety of in-service training courses were randomly assigned one of eight hypothetical vignettes describing a person in need of assistance, a victim, a witness, or a suspect who either was labeled as having schizophrenia or for whom no information about mental was provided. These officers completed measures that evaluated their perceptions and attitudes about the person described in the vignette. RESULTS: A 4 × 2 multivariate analysis of variance (vignette role by label) examining main and interaction effects on all subscales of the Attribution Questionnaire (AQ) indicated significant main effects for schizophrenia label, vignette role, and the interaction between the two. Subsequent univariate analyses of varian...
TL;DR: Psychiatric inpatients smoke at high rates, yet interventions to treat this deadly addiction are rare, and nicotine withdrawal left unaddressed may compromise psychiatric care.
Abstract: OBJECTIVE: Despite high rates of tobacco use among psychiatric patients, such patients are one of the least studied groups of smokers, and little is known about their access to cessation treatment. This study examined delivery of tobacco cessation services in a smoke-free inpatient psychiatric setting. METHODS: Medical records of 250 psychiatric inpatients who were admitted from 1998 to 2001 were randomly selected and systematically reviewed. RESULTS: A total of 105 patients (42 percent) were identified as current smokers; the mean±SD number of cigarettes that they smoked per day was 21±15. Smokers evidenced statistically greater agitation and irritability compared with nonsmokers. None of the smokers received a diagnosis of nicotine dependence or withdrawal, and smoking status was not included in treatment planning for any patient. Nicotine replacement therapy was prescribed for 59 smokers (56 percent); of these patients, 54 (92 percent) used it. Smokers who were not given a prescription for nicotine rep...
TL;DR: Service use after the terrorist attack was related to mental status and to the amount of trauma and stress experienced, and overall, white respondents, those aged 25 to 64 years, and those with a primary care physician were more likely to use services.
Abstract: OBJECTIVE: A survey assessed use of mental health services and psychiatric medications in New York City four to five months after the September 11, 2001, attack on the World Trade Center. METHODS: A telephone survey using random-digit dialing was conducted among 2,001 adult householders. RESULTS: During the interviews, 7.6 percent of respondents reported use of mental health services in the past 30 days and 7.7 percent reported use of psychiatric medications. Factors associated with service use included experiencing four or more lifetime traumatic events, experiencing two or more stressful life events in the past 12 months, having posttraumatic stress disorder (PTSD), and having depression. African-American and Hispanic respondents were less likely than white respondents to use services. Greater service use after the attack was associated with a graduate education, increased alcohol use after the attack, and depression. Factors associated with medication use included being in either of two age groups (25 ...
TL;DR: Depressive disorders among perinatal women are highly prevalent and may have profound impact on infants and children, more work is needed to enhance detection and referral at public-sector obstetric clinics.
Abstract: OBJECTIVE: This study assessed rates of detection and treatment of minor and major depressive disorder, panic disorder, and posttraumatic stress disorder among pregnant women receiving prenatal care at public-sector obstetric clinics. METHODS: Interviewers systematically screened 387 women attending prenatal visits. The screening process was initiated before each woman's examination. After the visit, patients were asked whether their clinician recognized a mood or anxiety disorder. Medical records were reviewed for documentation of psychiatric illness and treatment. RESULTS: Only 26 percent of patients who screened positive for a psychiatric illness were recognized as having a mood or anxiety disorder by their health care provider. Moreover, clinicians detected disorders among only 12 percent of patients who showed evidence of suicidal ideation. Women with panic disorder or a lifetime history of domestic violence were more likely to be identified as having a psychiatric illness by a health care provider a...
TL;DR: Children who were treated by a mental health specialist were less likely to drop out of treatment and had a larger number of visits, and Severity of illness, psychiatric hospitalization, and managed care insurance coverage were associated with lower risk of dropout and greater intensity of care.
Abstract: Objective: This study examined use of mental health services among children and adolescents with private insurance who were entering treatment. Variations in service use were examined by age, gender, diagnosis, recent psychiatric hospitalization, and type of insurance. Differences between children who received treatment from mental health professionals and those who were treated by primary care physicians were also examined. Methods: Drawn from a large database, the sample comprised 11,659 new users of mental health services. Service use was defined as the total number of days children were retained in treatment and the total number of mental health contacts recorded. Results: The overall mean number of visits within a six-month period was 3.9. The average duration of treatment was 75.36 days. Children who were treated by a mental health specialist were less likely to drop out of treatment and had a larger number of visits. Severity of illness, psychiatric hospitalization, and managed care insurance coverage were also associated with lower risk of dropout and greater intensity of care. Conclusions: Children’s access to services does not guarantee sustained involvement in treatment. To more fully address the nature of service use among children, a closer look at specific barriers to continued involvement in services is needed. (Psychiatric Services 55:1022–1028, 2004)
TL;DR: When caregivers of patients with bipolar illness experience a high burden, patient outcome is adversely affected because the relationship is mediated through families' affective response and patients' medication adherence.
Abstract: OBJECTIVE: This study evaluated the direct and indirect effects of family burden and affective response on medication adherence and outcome among patients with bipolar disorder. METHODS: Data were examined for 126 patients who were consecutively admitted to the psychiatric service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I or II disorder or for schizoaffective disorder, manic type, and their family caregivers. A total of 101 pairs of patients and family caregivers (80 percent) completed 15 months of study and were included in the analyses. Patients and their identified caregivers were assessed within two weeks of either discharge from the index inpatient admission or initiation of outpatient treatment (baseline assessment). Patients and caregivers were also assessed seven and 15 months after the baseline assessment. Structural equation modeling was used to evaluate caregivers' influences on patients' medication adherence seven months after baseline and on cl...
TL;DR: On the basis of this small sample, supported employment seems to be more effective over the long term, with benefits lasting beyond the first one to two years.
Abstract: OBJECTIVE: Supported employment has steadily increased in prominence as an evidence-based mental health practice, and research shows that the service significantly improves employment outcomes over one to two years. The objective of this study was to examine the outcomes of supported employment ten years after an initial demonstration project. METHODS: The study group consisted of 36 clients who had participated in a supported employment program at one of two mental health centers in 1990 or 1992. Clients were interviewed ten years after program completion about their employment history, facilitators to their employment, and their perceptions of how working affected areas of their lives. RESULTS: Seventy-five percent of the participants worked beyond the initial study period, with 33 percent who worked at least five years during the ten-year period. Current and recent jobs tended to be competitive and long term; the average job tenure was 32 months. However, few clients made the transition to full-time em...
TL;DR: The data do not suggest that offenders with dual diagnoses have a distinct clinical background, but rather that substance abuse is an important feature that affects their real or perceived level of functioning, engagement with the criminal justice system, and dependence on social service institutions in the community.
Abstract: OBJECTIVE: The study compared offenders who had severe mental illness only and offenders who had severe mental illness and substance abuse problems—dual diagnoses—to determine whether these groups differed. Offenders with dual diagnoses who were involved with the criminal justice system at different levels were compared to explore their profiles and experiences after release. METHODS: Secondary data collected on offenders who had diagnoses of severe mental illness and of substance abuse in Massachusetts were used to examine sociodemographic, clinical characteristics, and criminal justice characteristics, service needs, and community reentry experiences in the first three months postrelease of 265 offenders with major mental illness and 436 with dual diagnoses. RESULTS: Offenders with dual diagnoses were more likely to be female and to have a history of being on probation and of using mental health services. On release from correctional custody, they had more immediate service needs than offenders with men...
TL;DR: Both major and minor psychiatric disorders were undertreated in Taiwan, and it is necessary for the public health department and the general population to emphasize mental illness education, prevention, and treatment in Taiwan.
Abstract: OBJECTIVE: About 96 percent of all residents of Taiwan were enrolled in the National Health Insurance (NHI) program in 2000. This study used claims data from the NHI database to determine the prevalence of and the demographic characteristics that are associated with psychiatric disorders. METHODS: A total of 200,432 persons, about 1 percent of Taiwan's population, were randomly selected from the NHI database. Persons under the age of 18 years and persons who were not eligible for NHI in 2000 were excluded, leaving 137,914 persons available for this study. Data for enrollees who had at least one service claim during 2000 for ambulatory or inpatient care for a principal diagnosis of a psychiatric disorder were classified into one of the psychiatric disorder categories according to ICD-9-CM diagnostic criteria. Data from the 2000 NHI study were compared with data from a 1985 community survey, the Taiwan Psychiatric Epidemiological Project, to determine how the prevalence of psychiatric disorders changed over...