Changes in suicidal behavior in child psychiatric inpatients.

This study of 49 preadolescent psychiatric inpatients, aged 6-12 years, evaluated changes from the time of admission to 7 weeks later in ratings of suicidal behavior, assaultive behavior, depression, hopelessness, and global functioning. Standard research instruments were used to measure these variables. There were significant decreases in suicidal behavior, assaultiveness, and depression and a significant increase in global assessment during the 7 weeks of hospitalization. Severity of suicidal behavior and severity of assaultive behavior at admission predicted a subsequent change in level of suicidal behavior. Furthermore, severity of suicidal behavior at admission was the best indicator of a change in severity of suicidal behavior.

Subtypes of suicidal and assaultive behaviors in adolescent psychiatric inpatients: a research note.

Among 129 adolescent psychiatric inpatients, four subgroups of suicidal and/or assaultive behaviors were identified. A suicidal-only subgroup with no evidence of assaultive behavior was characterized by depression, drug abuse and environmental stresses. An assaultive-only subgroup with no evidence of suicidal behavior exhibited aggressive symptoms and violence at home. A subgroup with both suicidal and assaultive behaviors experienced accidents and family violence. A fourth subgroup had neither suicidal nor assaultive behavior. This subgroup showed eating disorders, depression, minimal assaultiveness and few peer friendships.

Inner-city substance abuse patterns: a study of psychiatric inpatients.

Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to use hallucinogens, and schizophrenics were less likely to use opioids. In all cases in which sex, age, and personality disorder were significant, males, the young adult group, and those with personality disorder were more likely to be abusers. These three variables were all strong predictors of both multiple and extensive substance abuse. Overall, our findings suggest that in the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse. The coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls attention for changes within the conventional psychiatric milieu.

A comparison of psychopathology in child psychiatric inpatients, outpatients, and nonpatients. Implications for treatment planning.

A total of 308 preadolescents who were either psychiatric inpatients, psychiatric outpatients, or nonpatients were studied with semistructured interview research instruments that have been described previously. The three groups of children included 106 children consecutively admitted to a voluntary hospital psychiatric inpatient unit, 101 consecutively admitted children to the same voluntary hospital center psychiatric outpatient clinic, and 101 randomly selected nonpatients. The research instruments included a Spectrum of Suicidal Behavior Scale, a Spectrum of Assaultive Behavior Scale, a Precipitating Events Scale, General Psychopathology (recent and past) Scales, a Family Background Scale, a Child's Concept of Death Scale, an Ego-Functioning Scale, and Ego-Defense Scale, and a Medical-Neurological Assessment Scale. The results of the study indicated that the presence of recent depression and recent and past aggression, the use of such ego defenses as projection, displacement, and regression, and the experience of parental separation were significantly different for the three groups of children. Impulse control and reality testing were best in the nonpatients and poorest in the inpatients. The variables that best predicted the need for psychiatric hospitalization were suicidal behavior, recent depression, recent aggression, poor reality testing, and such ego defenses as projection and regression. Implications of these findings are discussed.

Suicidal behavior in child psychiatric inpatients and outpatients and in nonpatients.

One hundred one child psychiatric outpatients were assessed using a standard battery of measures to identify factors associated with suicidal behavior. Data on these outpatients were compared to those for psychiatric inpatients and nonpatients previously studied. The frequency of suicidal behavior among the outpatients (24.8%) was less than for a comparable group of inpatients (78.5%) but more than for a comparable group of nonpatients (12%). Four variables--recent general psychopathology, preoccupation with death, and recent and past depression--were significantly associated with suicidal behavior in the three groups of children.

Drinking patterns of inner-city black Americans and Puerto Ricans.

Alcoholic patients--183 Black Americans (62 women) and 132 Puerto Ricans (18 women)--at an inner-city alcoholism treatment program were surveyed using the Drinking History Questionnaire. Significantly more Puerto Rican men than Black men reported drinking distilled spirits, daily drinking, drinking in the morning to relieve a hangover, shakes when sobering up, blackouts when drinking, convulsions after a bout, psychoperceptual withdrawal symptoms and alcohol-related marital difficulties. Puerto Rican women were significantly older at the first time of drunkenness than the other groups. These women tended to drink at home daily and they reported a surprisingly high mean alcohol consumption. Significantly more Black women reported drinking to make friends. The tendency for Blacks to drink with their spouse, and to encourage their spouse to drink, was a major finding. This finding may have clinical implications for treatment and suggests that in lower class Black alcoholics a careful history of the drinking patterns of the spouse or living companion should be taken to determine the proper treatment approach.

Suicidal and assaultive behavior in children: classification, measurement, and interrelations.

In 102 children aged 6 to 12 years who were in a municipal psychiatric inpatient or outpatient clinic, the authors identified four groups of suicidal and/or assaultive behaviors. Logistic regression analyses showed that neurosis, intellectualization, and low levels of aggression predicted membership in the nonassaultive-nonsuicidal group; intense aggression, parental suicidal behavior, parental assaultive behavior, and compensation predicted it in the assaultive-suicidal group; depression, a minimum of aggression, and adjustment disorder predicted it in the suicidal-only group; and intense aggression and absence of depression predicted it in the assaultive-only group. Two clearly distinct types of suicidal children were delineated.

Predictors of assaultiveness in latency age children.

The authors evaluated the presence of assaultive behavior in 103 children, aged 6-12 years, seen in the psychiatric inpatient and outpatient services of a municipal hospital. No racial or ethnic differences were found. Boys were significantly more assaultive than girls and used fire setting and hitting with objects more often. Inpatients were significantly more assaultive than outpatients. Children with conduct disorders, specific developmental disorders, and mental retardation were more assaultive than those with neurotic disorders. Multiple regression analysis showed that the child's past aggressive behavior, absence of anxiety and depression, and parental assaultive behavior were the best predictors of assaultive behavior.