The Maine and Vermont three-decade studies of serious mental illness. I. Matched comparison of cross-sectional outcome.

BACKGROUND: This study compared long-term outcome of serious mental illness in two states using a matched design to assess psychiatric rehabilitation programmes; Vermont subjects participated in a model psychiatric rehabilitation programme, while the Maine group received more traditional care. METHOD: Maine and Vermont subjects (n = 269) were matched by age, sex, diagnosis, and chronicity. Demographic, illness, and life history information were abstracted from hospital records by clinicians blind to outcome. DSM-III criteria were applied retrospectively. Outcome was assessed by clinicians blind to history. RESULTS: Vermont subjects alive at follow-up (n = 180) were more productive (P < 0.0009), had fewer symptoms (P < 0.002), better community adjustment (P < 0.001) and global functioning (P < 0.001) than Maine subjects (n = 119). CONCLUSIONS: Outcome differences may be due to Vermont's model programme and a policy of allowing an earlier opportunity for community life.

Duration of fever prior to onset of a simple febrile seizure: a predictor of significant illness and neurologic course.

This study tested the hypothesis that the duration of fever prior to the onset of a simple febrile seizure may be an important clinical variable with respect to patient outcome. The duration of fever prior to seizure according to patient history was defined as either long (greater than or equal to 24 hours) or short (less than 24 hours). We hypothesized that simple febrile seizures which occur with a history of a fever of long duration (LDF) are more likely to be associated with a significant illness at presentation or a subsequent neurologically abnormal course than are simple febrile seizures which occur with a history of a fever or short duration (SDF). Of 100 cases which met study criteria for simple febrile seizures, nine had a LDF and 91 had a SDF prior to the development of a seizure. No statistical differences in age, sex, maximum fever recorded in the emergency department, duration of seizure, WBC, or electrolytes were found between patients with SDF and LDF (P less than 0.01). Of the nine patients with a LDF, all had either a significant illness at the time of initial visit or a subsequent neurologically abnormal course. Of the 91 patients with a SDF, 88 had a good outcome, while two had a significant illness at the time of visit, and one had a subsequent neurologically abnormal course. These results suggest that children with a history of LDF prior to the occurrence of a simple febrile seizure are more likely to have a serious illness at presentation or a subsequent neurologically abnormal course than are children with seizures which occur with a history of SDF.

Developmental functions in a chronic psychiatric population: diagnosis.

The research in psychopathology has revealed little interest in distinguishing between types of chronic mental patients. Chronics have usually been treated as a homogeneous group, and other possible subtypes have remained undefined because of the "melting-pot" effects of extensive hospitalization. Recently, there has been a renewed interest in the chronic patient, as well as in a differentiation of the largest group of such patients, the chronic schizophrenic. Ss were 129 inpatients at a state mental hospital in Maine. The present report begins the specification of a diagnostic system for chronic patients with the use of tasks that reflect developmental functions. Factor analysis of a set of developmental tasks, ranging from early reflex tests to later cognitive operations, resulted in a test battery which clearly defines specific developmental functions. Of most importance, the clusters of patients derived from these factors exhibited differential profiles indicating strengths and weaknesses on the developmental functions. The assumption of a developmental task sequence was not supported by the results, but the diagnosis of the chronic patient in terms of developmental functions appears promising.