Detecting alcohol use disorders in the severely mentally ill.

The frequent co-occurrence of alcoholism with serious mental illnesses ("dual diagnosis") necessitates that clinicians are able to recognize its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but that their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatric treatment in an affiliated outpatient clinic were interviewed after their clinic therapists and rehabilitation counselors had been asked questions pertaining to their general health and substance use. The members were interviewed with two screening tests, the CAGE and the SMAST, and a clinical DSM-III-R diagnosis of alcohol use disorder was established. Both the SMAST and CAGE had good sensitivity and the addition of a screener enhanced the clinicians' ability to detect alcohol use disorders.

The epidemiology of alcohol, drug, and mental disorders among homeless persons.

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.

The COSTAR programme. 1: Improving social networks of the long-term mentally ill.

The present study examined the socio-demographic, clinical, cognitive, social behaviour and social network characteristics of the 97 patients in contact with the COSTAR programme--a mobile treatment and case management service for the long-term mentally ill in inner-city Baltimore. Compared with shorter-contact patients, those in contact for more than one year showed no change in symptoms, or in cognitive or global function. They did manifest improved social function, especially for slowness, personal hygiene and posturing. The long-contact group showed improvements in the quality and quantity of their social networks. Our results suggest that a home-based treatment system can help patients to reverse a vicious cycle of social isolation and to establish supportive social contacts.

Health and mental health problems of homeless men and women in Baltimore.

A study of homeless people in Baltimore, Md, focused on their health and other characteristics, with special emphasis on their needs for services. In the first stage, 298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data. In the second stage, a subsample of 203 subjects was randomly selected from the baseline survey respondents to have systematic psychiatric and physical examinations. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions is demonstrated and data are provided on the subjects' needs for mental health and substance abuse services.

Medical care of chronic psychiatric outpatients.

Chronic psychiatric patients often fail to receive adequate general medical care. In a study of 42 outpatients in a psychosocial rehabilitation program, 93 percent were found to have at least one problem warranting assessment, treatment, or follow-up. Minor gynecologic disease was the most common problem among women and gross dental disease among men. Only 11 percent of the men's and 26 percent of the women's problems were receiving appropriate care. Seventy-seven percent of the previously unrecognized problems were found just by routine physical examination and hematocrit determination. Medical care for chronic psychiatric patients would improve if psychiatric clinics provided simple medical screening and if therapists were aware of their patients' general health needs.

Mental health and social characteristics of the homeless: a survey of mission users.

Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.

Lateral ventricular enlargement associated with persistent unemployment and negative symptoms in both schizophrenia and bipolar disorder.

Forty-six patients with schizophrenia or bipolar disorder and 46 individually matched normal volunteers underwent computed tomographic (CT) scans of the head. The ventricular-to-brain ratio was strongly associated with persistent unemployment and negative symptoms in both patient groups. Previous findings of relative lateral ventricular enlargement in a proportion of schizophrenic and bipolar patients were also replicated. Implications of the relationship between CT changes and chronic unemployment among the patients are discussed.

Community support systems and urban mental health.

The many social systems of which individuals are members have an important role in promoting and restoring mental health. Pilot projects have shown that "natural" support systems in communities can collaborate with mental health professionals in programs designed to promote mental health in communities. Government plans for community support systems for deinstitutionalized psychiatric patients have been very inadequate and have largely ignored natural support systems. Planners and providers should take advantage of the considerable resources for support which already exist in urban communities.

Typhoid catatonia responsive to ECT.

Twelve patients with typhoid fever presented with a catatonic syndrome that persisted after other signs of the fever had disappeared. The syndrome was distinct from the delirium seen in typhoid fever and did not have the characteristics of an affective or schizophrenic illness. Electric convulsion therapy produced rapid and lasting improvement.