摘要:

This articles reviews and analyzes studies on the utilization of care and patterns of care in psychiatric care organizations with a defined catchment area responsibility. Eight studies fulfilled the inclusion criteria. The main results of the studies were reviewed with regard to distribution of utilization, typical patterns of care, sociodemographic characteristics, clinical characteristics and, when appropriate, organizational characteristics related to utilization. The results show that a small proportion of patients use a large proportion of resources. Sociodemographic factors such as living alone or having no occupation in some of the studies predicted a higher utilization. Only one study reported sex differences, men being more common among heavy users. In most of the studies a psychosis diagnosis predicted a higher utilization. A history of prior contacts with psychiatric care predicted a higher utilization in 2 studies. It is concluded that future studies should make efforts to develop standardized models of classification of patterns of care to enhance possibilities of comparisons. Cost, as a common unit for summarizing and comparing resource utilization, has not been used, but is viewed as a highly relevant measure. Furthermore, measures of utilization should be separated from evaluations of outcome or quality of care. However, the latter is a neglected area that should also be promoted in studies of utilization of psychiatric care to create knowledge of the relationship of utilization to outcome.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03263.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In a 10‐year follow‐up study of 44 patients with tardive dyskinesia (TD), the majority (22 or 50%) had no change in their TD severity, 9 (20%) had an improvement and 13 (30%) had a worsening of their TD. Little difference was noted in those patients whose medication was decreased (n= 12) and those whose medication remained unchanged (n= 32). Of the women, 26% showed improvement as compared with 11% of the men. Also, patients whose TD improved had lower present neuroleptic dose than those whose TD worsened. These two factors should be studied in larger patient coho

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03264.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The purpose of this study was to determine whether (reported) parental overinvolvement and lack of affection identify initially healthy subjects at risk for depression. One thousand subjects from the province of Utrecht, the Netherlands were randomly selected by using telephone addresses and asked to participate in a one‐year prospective study on psychological risk factors of depression. From the 108 subjects that finally participated on both occasions, the reports of parental upbringing (Parental Bonding Instrument) of initially non‐depressed subjects with a Zung Self‐rating Depression Scale score below 49 points were used to predict new cases of depression one year later. Initially non‐depressed subjects who reported maternal overinvolvement in the upper quartile of the distribution had an 8.5‐fold increased risk (95% confidence interval 0.9 to 80.6) of becoming depressed one year later. Although initial reports of low paternal affection were positively associated with initial symptoms of depression, this characteristic failed to show predictive value. Parental upbringing deficiencies have frequently been shown in cross‐sectional inpatient studies in which retrospective retrieval from memory because of depressive state characteristics may have caused negative colouring. Our results would suggest that maternal overinvolvement reported in the absence of a depressed mood still proves to be an important psychological risk factor in the aetiology of

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03265.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In order to evaluate possible abnormal noradrenergic neuronal functional regulation in patients with panic disorder, the behavioral, biochemical and cardiovascular effects of intravenous yohimbine (0.4 mg/kg) and clonidine (2 μg/kg) were determined in 15 healthy subjects and 38 patients with panic disorder. A subgroup of 24 panic disorder patients were observed to experience yohimbine‐induced panic attacks and had larger yohimbine‐induced increases in plasma 3‐methoxy‐4‐hydroxyphenylglycol (MHPG) than healthy subjects and other panic disorder patients. A blunted growth hormone response to clonidine and a significant clonidine‐induced decrease in plasma MHPG was also observed in this subgroup of panic disorder patients. These data replicate and extend previous investigations, which are consistent with a large body of preclinical and human data relating increased noradrenergic neuronal function to human anxiety and

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03266.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A sample of 234 people between the ages of 60 and 95 was studied using the Brink‐Yesavage Geriatric Depression Scale (GDS). The GDS has good concurrent validity with the Hamilton Rating Scale for Depression with the Melancholia Scale (r= 0.77), which confirms the clinical utility of this scale. A factor analysis of principal components with an oblimin rotation was performed. The results obtained imply that structural validation cannot be made in relation to Beck's cognitive model of depression. It can be concluded that the elimination of the somatic items does not add any theoretical correspondence with the model, as the factors tend to group the various items into one dimensio

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03267.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In search of features of prognostic importance, a cohort of patients admitted to a mental hospital in 1925 was investigated by means of multivariate clustering techniques. Using K‐means cluster analysis or Q‐factor analysis, a group containing cases with unfavourable prognosis was isolated. Other groups derived were prognostically heterogeneous. One group of patients, in early phases similar to good prognosis schizoaffective psychoses, could be distinguished and characterized by non‐symptom items. There was initial periodicity and onset was acute. They were, on average, younger than the other subjects and there was no personality deviation or emotional disturbance before onset of disease. A family history of mental illness was rare. Two of the factors were positively and negatively characterized by items covering familial history of mental illness, thus seemingly confirming the familialvssporadic distinction in the subclassification of schizophrenia. Though the clinical pictures were distinctively different at the time when the ratings underlying the analysis were made, approximately the same proportion of cases in the two groups had independently been diagnosed as paranoid schizophrenia ‐ also taking the course of illness into account. It could furthermore be shown that the population at risk ‐ siblings and children of subjects ‐ as well as the observed number of years at risk in these groups were significantly smaller in the sporadic group than in the familial group. This was a combined effect of a lower fertility in subjects and parents in the sporadic group and a higher rate of drop out due to mortality and other reasons among siblings of these subjects. The same tendency was indicated when subjects with and without family history irrespective of factor belongingness were compared. It cannot be concluded that the familialvssporadic distinction is without relevance in the research on schizophrenia, but its essence may easily be obscured, if the population at risk is not taken i

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03268.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Urine sample from 402 victims of ski accidents were analyzed for the presence of benzodiazepines (BZD) and alcohol. Eighty‐one (20%) samples were positive for alcohol; BZD were detected in 34 (8.5%) cases. Ten of the samples (2.5%) were found to be positive for both alcohol and BZD. Subjects who were positive for either alcohol or BZD or both were older than the other persons examined. The prevalence of alcohol was significantly higher among male accident victims. BZD intake could be demonstrated to have a significant influence on the severity of injuries. Besides an increased awareness of the need for skier education regarding drug use, heightened attention of medical caregivers is warranted to inform their patients about potential accident hazards in sport activities when BZD are prescribe

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03269.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

This study examines the relationship between folate, vitamin B12and severity of cognitive impairment in patients with Alzheimer's disease (AD) as compared with other disorders associated with cognitive impairment. The patients were 97 consecutive referrals to an AD clinic. Forty patients had either possible or probable AD. 31 had other dementias (OD) and 26 had mild cognitive impairment (cognitively impaired, not demented; CIND). Patients had blood drawn for serum, red cell folate and B12, as well as other biochemical indicators of nutrition, within 24 h of the Mini‐Mental State Examination (MMSE). In the AD group, only B12was significantly correlated with MMSE. Using regression analysis, B12contributed significantly to variance in MMSE. There was no correlation between MMSE and serum, red cell folate or B12in the OD or CIND group and no significant correlation between MMSE and other nutritional indices in any group. These findings suggest the possibility of a specific relationship between B12levels and severity of cognitive impairment in patients with A

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03270.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The aim of the study was to search for a multidimensional order in the psychopathology of the functional mental disorders in general. A heterogeneous group of 192 patients was investigated by means of a semistructured interview based on the Comprehensive Psychopathological Rating Scale. Principal component factor analysis revealed 5 clinically meaningful dimensions interpretable as representing dysregulation of emotion and motivation, perceptual and behavioural disintegration and dysregulation of autonomic functions.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03271.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A retrospective cohort study was undertaken of all 1047 first‐ever psychiatric service attenders to Christchurch general psychiatric services in 1981. All episodes of care were examined to the end of 1989. Only 24% of contacts were as an inpatient. Long‐term contacts and frequent presenters formed only 15% of the sample. Nearly all cases not immediately discharged remained within the adult general service. Demographic and clinical variables and patterns of resource use are discus

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1992.tb03272.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY