Prevalence of dual diagnoses of mental and substance abuse disorders in general hospitals.

Data from a 1980 discharge survey of general hospitals were analyzed to determine the prevalence of cases with coexisting diagnoses of mental and substance abuse disorders. Twelve percent of total cases (or 208,000 episodes) had dual diagnoses, a proportion similar to that found in another analysis of 1985 data. Of these cases, 55.5 percent had a primary diagnosis of an alcohol or drug disorder, most commonly alcohol- or drug-induced organic brain syndrome. Thirty-four percent of cases with a primary diagnosis of mental disorder had depressive neurosis, 24 percent had psychosis, and 19 percent had personality disorder. An additional 18.9 percent of all cases had two or more mental or substance abuse disorders. Dual-diagnosis cases had a shorter mean hospital stay than cases with mental disorder only.

Characteristics of psychiatric discharges from nonfederal, short-term specialty hospitals and general hospitals with and without psychiatric and chemical dependency units: the Hospital Discharge Survey data.

Hospitalization for mental disorders (Major Diagnostic Categories 19 and 20) was examined using the 1980 Hospital Discharge Survey (HDS) data. We added to the HDS data by noting whether each hospital had a specialized psychiatric and/or chemical dependency unit, especially noting short-term specialty psychiatric and chemical dependency hospitals. Of the approximately 1.7 million episodes with MDC-19 and -20 diagnoses in the nation's nonfederal short-term hospitals in 1980, 13.5 percent were in specialty hospitals. Of the remaining general hospital episodes: 31 percent occurred in hospitals with only psychiatric units, 5 percent in hospitals with only chemical dependency units, 31 percent in hospitals with both types of specialized treatment units, and 33 percent in hospitals with neither type of unit. The last figure is much less than previously thought. The five hospital types may be arrayed on a continuum of resource utilization and severity of cases treated, with general hospitals with no special units at one end, specialty hospitals at the other, and general hospitals with psychiatric or chemical dependency units intermediate. Presence or absence of a chemical dependency unit influences a hospital's profile in this regard, particularly for MDC-20. Future studies should take into account the presence of a chemical dependency unit.

A family development approach to studying factors in the management and control of childhood diabetes.

The study of family factors that relate to diabetes management and metabolic control is crucial because of the family's central role in this management. Four sequential phases of diabetes management are specified in this review: (1) the pre-onset stage; (2) the onset, crisis stage; (3) the accommodation stage; and (4) the stabilization stage. Each stage can be expected to influence the following stage. Thus, each is important to later management of the condition. No theory of family functioning provides a satisfactory framework for understanding the complex relationships between family development and diabetes. The Peabody Family Development Model is introduced as a more complex and systematic way of understanding the stages of management and the long-term view of the individual and family development. Individual and family are acting and reacting, and at the same time, coping with outside influences while moving from one life stage to the other. Historic factors of family and community influence one's view of the world and, consequently, the way regular routines are carried out. Individual characteristics influence individual behavior at any given point in time. The model has at its core a stress-support paradigm, and has an ecologic frame of reference. Behavior is a result of all preceding factors, and information processed is fed back into the system. The Peabody Family Development Model is a way to organize a variety of information on family functioning and to specify how it might relate to the control of diabetes in children.