摘要:

Recent research suggests that, despite the development of effective psychiatric treatment, there is marked underuse of care. This pilot study had the objective of dissecting the process of care in an attempt to understand outcomes for patients with major affective disorder and for their families. Twenty-four patients with a DSM-III diagnosis of major affective disorder were identified 12 to 18 months after hospital admission in three countries (Italy, Japan, and the United States). The patients, their families, and their doctors were interviewed separately and then together, using instruments measuring delivery of treatment (using an ideal treatment criteria set) and percentage of achievement of treatment goals. These measures were then (using parametric and nonparametric statistics) correlated with resolution of the index episode and the patient's global outcome (using the Global Assessment Scale). The data demonstrated that physicians delivered about half (52%) and, subsequently, achieved about half (54%) of what would be considered ideal care to patients and other family members. The mean resolution of the index episode at follow-up was only 3.0 (on a 0- to 5-point scale). There was a significant positive association between the most important outcome measure, i.e., the resolution of the episode, and the achievement of treatment goals for both the patient (p <07) and the family (p <05). Patients and families with the best resolutions received significantly more good treatment than those with the worst resolutions (p <02), most notably with regard to medication (p <002).

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

From a sample of 2809 mood disorder patients hospitalized between 1913 and 1940, we selected for detailed study 914 patients with at least a 5 year follow-up and 103 patients who committed suicide within 5 years of discharge. Patients with clearly mood incongruent delusions or an onset associated with a physical illness were excluded. Based on the presence or absence of manic symptoms, this cohort of 1017 cases was divided into 297 bipolar and 945 unipolar patients. Bipolar patients had an earlier age of onset and admission and were more likely to be delusional and hallucinated. They also had more sudden onsets, more previous admissions, worse premorbid characteristics, and more problems with alcohol, but more patients were discharged as recovered. Unipolar patients were more often female and married, more likely to have made previous suicidal attempts, and more likely to have experienced a precipitating event. On a mean follow-up of 13.5 years, only 11% of the bipolar and 22% of the unipolar patients experienced no futher episodes of mania or depression. Of the bipolar group, 77% had to be rehospitalized, as did 56% of the unipolars. Only 2% of the sample had manic episodes with no lifetime depressions; this small group had the best outcome. One third of all the patients were rated unimproved on follow-up. Thirteen percent committed suicide, usually within 1 year of discharge. Bipolar patients had the worst outcome, with 43% rated unimproved. The sample was split by odd or even case number and one half was used to construct a prognostic scale significantly correlated with long-term outcome. It was cross-validated on the other half of the sample with little shrinkage. Patients with non-drug-treated affective disorders hospitalized half a century ago were found to have polyepisodic illnesses with a frequently chronic course.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Although many clinicians have long believed that personality pathology may interfere with the effectiveness of treatment of axis I disorders, until recently there were no empirical studies on the subject. This report reviews the recent literature with regard to the following questions: a) Does personality pathology predict negative outcome of treatment for axis I disorders? b) If so, are there specific personality traits or disorders that account for such a negative outcome?The literature review reveals a robust finding that patients with personality pathology have a poorer response to treatment of axis I disorders than those without such pathology. Specific axis I disorders reported on include DSM-III major depression, panic disorder, and obsessive-compulsive disorder. Both inpatients and outpatients have been studied.There is too little literature to determine whether certain pathological personality traits are especially important, but there is enough to provide methodological guidance for future studies. Such studies should use standardized measures of personality and outcome, should match personality and nonpersonality groups on severity of the axis I disorder, and should be certain that axis I diagnoses are not confounded by axis II symptoms.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This paper describes the use and effectiveness of outpatient commitment in inducing compliance with treatment among chronically mentally ill “revolving door” patients, those who recurrently become dangerous and revolve though civil commitment courts as well as state mental hospitals. Patient characteristics, treatment modalities, and mental health center actions to ensure compliance are described. Comparison of those patients ordered to outpatient commitment with those having other court dispositions (involuntary hospitalization and release) indicates that outpatient commitment induces compliance and leads to treatment maintenance even after the court order terminates.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A variety of pharmacological approaches have been introduced to reduce cocaine craving and use. Most of these have been tested in open-label, noncontrolled trials; there is a need for more definitive placebo-controlled investigations. An overview of research design issues involved in the planning of such studies is presented. Discussion of the potential aims of drug trials and the basic principles of methodology and data analysis is intended to facilitate the undertaking of such studies by clinicians in the field of substance abuse as well as by clinical researchers not currently working in substance abuse.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In one sample of 104 male Vietnam combat veterans, we found that five heart rate parameters from a psychophysiological assessment could correctly discriminate 75% of the sample into those with PTSD and those without it. Using a stepwise approach, we found adding 10 blood pressure parameters increased discrimination to 80%, while adding five parameters from frontal electromyograms did not increase discrimination. Cross-validation of the heart rate parameters on a new sample of 96 veterans resulted in 83% correct discrimination.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Because concerns have been raised about high levels of psychopathology in military children, the authors used standardized psychopathology rating scales to survey 213 six to twelve-year-old children of military parents and their parents. Results from children's symptom self-reports, as well as from teachers' ratings of children, indicated that children's symptom levels were at levels consistent with national norms. In contrast, parents' (especially mothers') ratings of children were significantly higher than national norms, as were parents' ratings of their own symptoms. Also, parents' own symptom reports showed somewhat stronger relationships with life stressors presumably affecting the child than did the children's and teachers' reports. Results suggest that parents' reports of children's symptoms may be mediated by the effects of military life stressors on the parents, but these stressors do not necessarily result in higher symptoms in the children. Overall results do not support the notion that levels of psychopathology are greatly increased in children of military parents. Further studies of military families should address the effects of rank and socioeconomic status, housing, and the current impact of life stressors on the parents as well as the children in order to avoid drawing erroneous conclusions about parts or all of the military community.

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1991

数据来源: OVID