Chromatographic purification of human alpha 1 proteinase inhibitor from dissolved Cohn fraction IV-1 paste.

A novel chromatographic process for purification of alpha 1 proteinase inhibitor (alpha 1-PI) from Cohn fraction IV-1 paste is described. This process has been successfully scaled up to 50-1 columns. It involves DEAE chromatography, sulfopropyl (S) cation chromatography, tri-n-butyl phosphate (TNBP)-cholate treatment, a second S cation chromatography, freeze-drying and dry-heat. The process has been optimized for purity, yield, lipid removal, chemical usage and water consumption. Filtration after TNBP-cholate treatment plays a key role in ensuring a low lipid content in the final product. Pre-equilibration with high salt buffer is necessary to reduce the water consumption significantly during the ion-exchange chromatography equilibration step. The final product is approximately 95% pure by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, with a 64% to 70% yield from IV-1 paste.

Prospective payment for outpatient mental health services: evaluation of diagnosis-related groups.

General medical hospitals are applying diagnosis-related groups (DRGs) to define their case mix so as to make possible prospective estimates of costs per case. We apply DRGs to 1000 adults registered through an outpatient clinic. Results, based on 837 patients in eight DRGs, provide no reason to anticipate that DRGs or other selected variables thought to be associated with prognosis will help predict costs of most outpatient mental health care. We explain why these results should not be surprising, and we describe an alternative perspective that may be necessary in order to develop a viable prospective payment system that is based on costs per case.

Use of outpatient treatment during civil commitment: law and practice in Nebraska.

Applying the principle of least restrictive alternative in civil commitment seldom results in outpatient treatment, even after initial treatment in a more restrictive setting. We studied 18 committed persons who were receiving outpatient treatment and compared them with three patient groups that differed by admission status and treatment setting. We offered explanations as to why outpatient treatment seldom proved to be the final step toward release from commitment.

Development and application of criteria for classes of psychotherapy based on patients' requests for service.

Discrepancy frequently exists between the perspectives of psychotherapists and their patients about what problems and which patients are suitable for psychotherapy and how psychotherapy should be conducted. Lazare et al.'s (1972, 1975a) negotiated 'customer' approach attempts to correct this deficiency by providing mental health services that more fully take into account the specific service requests of patients. Lazare's 14 identified services were applied to develop profiles of each of four service types, including two classes of psychotherapy. Applying the criteria developed, 52.6 per cent of patients evaluated could be classified into one of four classes of service. Only two patients presented a pattern of service requests consistent with a broadly defined supportive psychotherapy. The three largest patient groups were then compared with respect to several classes of variables. Major differences were found between the non-psychotherapy group and the two psychotherapy groups, but not between the psychotherapy groups. Service requests of patients generally paralleled those perceived by the interviewers.

An attempt to validate the psychoticism scale of the Brief Symptom Inventory.

This study attempted to validate the psychoticism scale of the Brief Symptom Inventory (BSI) by comparing 31 schizophrenic patients with 98 non-schizophrenic patients. Unexpectedly, the schizophrenics did not exceed the non-schizophrenics on the psychoticism symptom dimension. None of a variety of controls and comparisons provided a basis for dismissing the finding. A rationale was introduced explaining why any attempt to match symptoms with the diagnosis of schizophrenia can at best meet with only qualified success.

Do fees help heal?

Fees for mental health services is a subject that is often discussed but seldom researched. Fee information that pertained to 112 adult outpatients who returned a follow-up questionnaire and 147 who did not return it was reviewed in light of several indices of patients' response to clinic services. The study also assessed impact of change in a facility's billing format. Differences in billing format were in terms of amount of charge and whether fees were per session or lump-sum. Nonparametric statistics were applied to determine any relationship that (a) assessment by the clinic, (b) source of payment, (c) assessment to the patient, and (d) payment had with (a) return to clinic, (b) number of sessions, and (c) reports of help and satisfaction. The only association found was between presence of third-party coverage and likelihood that the patient returned. Change in billing format did not bear upon return to the clinic or satisfaction with services rendered, but did influence payment. Finally, some of the findings suggest that payment is associated with a predisposition to honor requests and obligations.

Race as a factor in the perceived importance of the use of psychotropic medication.

The importance of getting medication as a reason for contacting an outpatient psychiatric service was studied from the perspective of white (N = 265) and black (N = 42) patients, together with their white interviewers. Interviewers rated the importance of getting medication as greater among blacks than whites. However, the finding did not seem to reflect difference in patient demography or disturbance, nor did it seem due to racial bias. Largely, it reflected a greater importance ascribed to getting medication by black patients, themselves.

Comparison of two methods of administering the Halstead Category Test.

Developed an alternative method of administering Halstead's Category Test that uses answer sheet and latent image developer. The method does not entail bulky apparatus operated by the examiner. There is lessened possibility of examiner error in providing reinforcement and in recording responses. Use of visual rather than auditory reinforcement makes the method useful with the deaf. Performance on alternative and standard methods by psychiatric inpatients (N = 50) was the same, which suggests that the two methods are equivalent.

A cognitive perspective applied to emancipation problems.

A cognitive theoretical perspective toward emotional distress and behavior disorders is described and then applied to developing both a classification of emancipation problems and a plan for intervention. Problems described include over-dependency, vacillation about dependency, and resistance to authority. The plan for intervention minimizes complications that a vigorously confrontive method often intensifies with adolescents. Instead, it entails accurate reflection of cognitions and thereby capitalizes on anti-expectation.