ABSTRACT
This study describes a prospective six-month follow-up study of previously hospitalized psychiatric patients. Data are presented on social functioning and symptomatology derived from self-report scales administered to 60 patients. there was significant improvement in both symptomatology and social functioning on follow-up for all groups with the exception of the schizophrenic group, who exhibited little or no change. Residual change scores revealed more than expected change in 71 percent of schizophreniform patients, 70 percent of nondepressed patients, 53 percent of depressed patients, but only 20 percent of schizophrenic patients. These findings suggest that most patients sustain improvement after discharge and that many schizophreniform patients may have good prognoses.
Subject(s)
Hospitals, Psychiatric/standards , Outcome and Process Assessment, Health Care , Social Adjustment , Data Collection , District of Columbia , Hospital Bed Capacity, 100 to 299 , Mental Health Services , Regression AnalysisABSTRACT
This study is a two- to five-year follow-up of 40 patients who were discharged from a methadone maintenance program. Both "graduates" and prematurely discharged patients were surveyed. Forty-five percent of patients had been in treatment for one year or more. Outcome evaluation was based on a reduction of illicit drug use, an increase in social stability, and a decline in criminal activity. Eighteen of 40 clients were located and interviewed. Seven (39 percent) were found to be either drug free or using only prescribed methadone, and five had substantially reduced their drug use. Relapse to illicit drug use was associated with a pre-treatment history of poly-drug use, poorer work and arrest records, and a greater number of previous treatments. Abstinence appeared to be a realistic goal for only a few. The importance of retaining patients in treatment longer is discussed.
Subject(s)
Methadone/therapeutic use , Outcome and Process Assessment, Health Care , Substance-Related Disorders/drug therapy , District of Columbia , Follow-Up Studies , Hospital Bed Capacity, 100 to 299 , HumansSubject(s)
Hospitals, Psychiatric , Mental Disorders/drug therapy , Psychopharmacology/standards , Psychotropic Drugs/therapeutic use , Antidepressive Agents/therapeutic use , Bipolar Disorder/drug therapy , Depressive Disorder/drug therapy , District of Columbia , Humans , Lithium/blood , Schizophrenia/drug therapyABSTRACT
Of 49 newly hospitalized patients who met Research Diagnostic Criteria for primary unipolar depression and were given the dexamethasone suppression test (DST), significantly more patients admitted for suicide attempts than nonsuicidal patients had abnormal DSTs. All five patients who made subsequent suicide attempts (one completed) within 6 months after admission had had abnormal DSTs. These findings suggest that the tendency of endogenously depressed patients to attempt suicide is exacerbated by an underlying neurobiological disorder reflected by limbic-hypothalamic dysregulation and that depressed suicidal patients with abnormal DSTs represent a high-risk group for recurrence of suicidal behavior.
Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Suicide, Attempted/psychology , Adult , Depressive Disorder/psychology , Female , Hospitalization , Humans , Hydrocortisone/blood , MaleABSTRACT
Efforts to predict suicide and attempted suicide generally have yielded equivocal results. Neither single signs, standard psychological tests, specially devised tests, clinical judgments nor scales are found to be able to predict suicide at useful levels. Prediction of suicide is hampered by the relative rarity of this behavior together with the inadequate specificity of clinical characteristics and antecedent events. No highly unique descriptive attributes of suicide committers have been discovered. Within these existing limitations, a set of potential predictor variables are presented that may result in improved prediction of suicidal risk.
Subject(s)
Probability , Suicide/epidemiology , Humans , Risk , Social Environment , Suicide/psychology , Suicide, Attempted/epidemiology , United StatesABSTRACT
The dexamethasone suppression test (DST) was administered to 120 adolescent psychiatric patients at the time of hospitalization, and cortisol levels were measured at 4:00 p.m. and 11:30 p.m. on the day after a 1-mg oral dose of dexamethasone was given. Failure to suppress serum cortisol (i.e., cortisol level less than 5 micrograms/dl) was noted in 25 patients: 7 of 17 patients who met DSM-III criteria for major depressive disorder, 7 of 38 patients with dysthymic disorder, 7 of 47 patients with conduct disorder, and 4 of 15 schizophreniform patients. The predictive value of the DST for major depressive disorder was only 28%. Although adolescent patients with abnormal DSTs may eventually develop affective symptoms consistent with a major depressive disorder, the DST did not discriminate between major depression and other psychiatric diagnoses in these hospitalized adolescents.
Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Hospitalization , Hydrocortisone/blood , Adolescent , Depressive Disorder/blood , Diagnosis, Differential , Female , Humans , Male , Mental Disorders/blood , Mental Disorders/diagnosisABSTRACT
The initiation of a patient advocacy program in a private psychiatric hospital in 1980 was effective in significantly reducing the rate of hospital discharges against medical advice relative to the rate in 1979 and in 1978. There was also a concomitant increase in the rate of clinically approved discharges relative to that in 1979 and in 1978. The authors view the patient advocate as an objective intermediary who represents an acknowledgment of patients' rights and affords patients an opportunity to have some autonomy and an impact on the hospital system.
