摘要:

Cost-financed mental health facilities create opportunities for new patterns of mental health service analogous to community mental health centers in some ways and to HMOs in others. This paper describes the first facility based on such financing.The concept of cost-financed mental health practice is introduced and defined as including a multidisciplinary team serving a defined population of enrollees through prepaid or prebudgeted financing. The financing may be capitation based or generated through an agreed-upon budget for predefined services. Ordinary fee-for-service insurance creates purchasing power but no care system. Cost financing can create service mechanisms. The paper describes the clinical system made possible through such financing.The direct patient service systems for the United Auto Workers at the Johns Hopkins Hospital funded through cost financing included an early case-finding program, intake and evaluations specially designed for blue-collar workers, a full range of continuous treatment modalities, and programs in chronic care and rehabilitation. Programs in prevention, consultation, and education were also included. Consumer control was effected through elected officials of the labor union. The staffing pattern is described.The authors conclude that this clinical form has the potential to offer both the advantages of the community mental health center and of the private practice system.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Specific data are presented concerning the utilization profile of a cost-financed mental health facility. The utilization is enhanced by a mental health education campaign, but total utilization remains within manageable limits (13 per 1000). The visit rate is 8.5 units per patient and remains well within the plan's dollar limits. Comparison between utilizers and the population from which they are drawn shows disproportionate numbers of males in contrast to other outpatient insurance studies. This may be a unique feature of work-related programs. “Acting out” disorders are more common among these workers than in other psychiatric programs in the same geographic area.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Data are presented concerning the economics of a cost-financed mental health facility and a labor union insurance program. The total cost per insured enrollee for all mental health services did not exceed $5.41 per year. The cost per treated patient per year remained under $490. These data strongly support the feasibility of including mental health benefits in national health insurance.Costs are then compared between fee-for-service insurance and cost financing. Average costs per treated patient in the cost-financed facility were $302 over a 4-year period. Similar computations under fee-for-services financing showed costs of $824. The difference reflects much greater use of hospitalizations in the fee-for-service system.These data and the data from the preceding two papers on the clinical and utilization patterns of cost-financed facilities suggest that these facilities are practical clinical forms. Implications for national health insurance, HMO legislation, and community mental health centers are explored.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Trade names of drugs mentioned in this paper: haloperidol, Haldol (McNeil Laboratories, Fort Washington, Pa.); ehlorpromazine, Thorazine (Smith Kline and French, Philadelphia, Pa.); benztropine, Cogentin (Merck Sharp and Dohme, West Point, Pa.); diphenhydramine, Benadryl (Parke-Pavis, Detroit, Mich.).The effect of an anticholinergic antiparkinsonism drug, benztropine, on the therapeutic course of neuroleptie treatment in 18 schizophrenics was investigated in a double blind cross-over study involving haloperidol and ehlorpromazine. Significant therapeutic reversal was observed with benztropine in terms of the social, affective, and cognitive dysfunctions characteristically seen in schizophrenic psychosis. The hallucinatory behavior and disturbed attention were not so affected. The aspects of the clinical picture to show significant nontherapeutic change with benztropine differed with the stage of treatment and seemed to be determined by the kinetics of the therapeutic process. The effect was one of exacerbation of the disorder and not a toxic confusional state sometimes associated with anticholinergic drugs.The practical and theoretical significance of these findings was discussed. It was suggested that the benztropine reversal of therapeutic changes provided a valuable pharmacological model for understanding the neurobiological basis of schizophrenic decompensation and its restitution with neuroleptics. The reported data were considered as indirect evidence suggesting that cholinergic neuronal mechanisms are involved in both of these processes. It was speculated that these mechanisms may well be the cholinergic suppressor systems, such as the periventricular system, which function in reciprocal relationship with the facilitatory catecholamine pathways in the limbic organization and basal ganglia known to be affected by neuroleptics.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

On the basis of the original AVhitehorn-Betz data collected over a 16-year period, it is shown that all previously derived A-B scales of psychotherapist effectiveness using Strong Vocational Interest Blank (SVIB) items are deficient in terms of correlation with the original criterion and, frequently, in terms of reliability as well. The reasons for these deficiencies are discussed, and a new experimental A-B scale is formulated and tested for adequacy. This scale is shown to possess substantial internal consistency reliability and to have a high degree of correlation with the criterion even after the removal of possibly contaminating factors such as use of ancillary treatments, differences in patient prognosis, and changing practices and interests over time. It is further shown that none of the A-B scales has any validity with respect to female therapists in the original data pool.Exploration of the factor-analytic structure of this new scale and two other widely used A-B measures in terms of the occupational scales of the SVIB reveals differential loadings on four dimensions labeled verbal/conceptualvs.manual/practical, scientificvs.sales, social concern, and artisticvs.business-oriented. It is concluded that although male therapists' scores on the best of the A-B scales may, under certain circumstances, be related to short term judged improvement in patients treated, there is little evidence that high scoring therapists are more likely than low scoring ones to have a favorable, long range impact on diagnosed schizophrenics.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during non-paroxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally insignificant. The paroxysms occurred more often during the patient's silence than during the patient's speech (for two of the three patients) — talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the “A-B” variable. Various A-B scales have been used to predict differential process and outcome of A and B therapists with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapist-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors “make the difference” seems rather premature.A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled “schizophrenic” or “neurotic” in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-B research, but it clearly demands greater specificity in hypotheses and in research design.The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become “extinct.” To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significantly skewed in either the A or the B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1975

数据来源: OVID