Two-year outcome of team-based intensive case management for patients with schizophrenia.

OBJECTIVES: Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. METHODS: Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. RESULTS: Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. CONCLUSIONS: A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

Necker cube reversals, arousal and psychopathy.

Necker cube reversals were studied in a group of 24 arrested men in three experimental sessions; two weeks, one week and immediately before trial. The first session was assumed to represent a moderate laboratory stress due to the novelty of the situation, and the last session a real-life stress associated with anticipation of appearing in court. Both were superimposed on the sustained real-life stress of being in jail. There were no stress-related changes between the three sessions in the rate of apparent change (RAC) of the Necker cube. The intra-individual stability of RAC was extremely high. There were significant positive correlations between RAC in all sessions, and a psychopathy-related inventory scale, the Gough delinquency scale.

Urinary catecholamines, stress, and psychopathy: a study of arrested men awaiting trial.

The urinary excretion of adrenaline (A) and noradrenaline (NA) in a group of 24 arrested men was measured in three experimental sessions: 2 weeks, 1 week, and immediately before trial. The first session was assumed to represent a moderate laboratory stress due to the novelty of the situation and the last session a real life stress, associated with anticipation of appearing in court. Both are superimposed on the sustained real life stress of being in jail. There was no significant increase in A or NA in the last, presumedly the most stressful session. However, when personality measures were taken into account, there were significant and consistent differences in the pattern of A and NA excretion over the sessions between subgroups of subjects. Subjects high in psychopathy did not react with an increase in either A or NA in the last, presumedly the most stressful session. They also had conspicuously lower NA excretion, as compared to subjects low in psychopathy and relative to their own A excretion. Subjects low in psychopathy showed a reversed pattern.