Care provision and community adjustment of rural consumers with serious mental illness.

The purpose of this study was to examine the predictors of successful community living in a sample of rural individuals with severe and persistent mental illness (N = 40). Multimeasure/multisource indicators of consumer status, care provider attitudes, and care provider support provision were employed to predict community adjustment as measured by satisfaction with quality of life. Separate semistructured interviews were conducted with consumers, their case manager, and a family member or adult home provider. Reliability of the measures was established within acceptable limits. The multiple regression analyses showed that life stress and informal care-provider attitudes satisfied the inclusion criteria. R2 was .61 (F[2, 37] = 29.10, p < .001). Quality-of-life satisfaction was predicted primarily by consumer status characteristics.

Development and validation of a behavioral observation measure for the syndrome of psychosis, intermittent hyponatremia, and polydipsia.

A behavioral observation scale (Virginia Polydipsia Scale; VPS) for monitoring drinking patterns was developed and its reliability tested during 25 hours of tandem ratings among six patients with the syndrome of psychosis, intermittent hyponatremia, and polydipsia (PIPS). These ratings were compared to those collected from a control group of six psychiatric inpatients who were similarly observed for 25 hours. The scale was subsequently used to assess day-long drinking in a single PIPS patient. Results demonstrated that the VPS can be reliably administered by trained raters and that it clearly differentiates the drinking patterns of PIPS patients from controls. In addition, our findings highlight associations among drinking behaviors, psychiatric functioning and low serum sodium concentration. On balance, these results support using observational measures of drinking behaviors in future studies of PIPS patients.

Relationship of the MacAndrew Scale to sensation seeking.

Findings of Baker, Beer, and Beer on use of the MacAndrew Scale in relating sensation seeking to alcoholism require comment. It is argued that the MacAndrew Scale does not provide interval level data below the cut-off score so correlations on such data should be point biserial.

Behavioral intervention to reduce water intake in the syndrome of psychosis, intermittent hyponatremia, and polydipsia.

We describe a non-intensive behavioral intervention using an A-B design with extended follow-up on an open psychiatric unit to reduce water intake in a 52-year-old man with the syndrome of psychosis, intermittent hyponatremia, and polydipsia. A reinforcement schedule contingent upon weight gain secondary to water intake was employed. Mean diurnal weight gain was 7.1 pounds during a 23-week baseline which dropped to 4.1 pounds following 23 weeks of treatment and at a 1-year follow-up. Estimated fluid consumption dropped from 10 liters to 4 liters daily and incidents of hyponatremia decreased by 62%.

The link between fluid intake and weight gain in psychosis.

Diurnal weight gain was found to be abnormal among 44 of 77 institutionalized chronically psychotic patients. All patients were weighed and urine samples obtained weekly for 3 weeks at 7 A.M. and 4 P.M. Diurnal weight gain was normalized as a percentage by subtracting the 7 A.M. weight from the 4 P.M. weight, multiplying the difference by 100, and then dividing the result by the 7 A.M. weight. Normalized diurnal weight gain (NDWG) was 2.504 +/- 1.266% for the 44 study patients with abnormal findings, .631 +/- .405% for the 16 acutely psychotic controls, and .511 +/- .351% for 29 normals. Urine excretion was related (r = .476, p = .001) to NDWG in the subgroup of study patients with abnormal NDWG, consistent with the observation that their fluid intake exceeded fluid excretion in the afternoon.

Virginia's experience with state-university collaboration.

The development of an active collaboration between the department of behavioral medicine and psychiatry of the University of Virginia School of Medicine and Western State Hospital is described. The collaboration includes clinical research and opportunities for training residents and medical students. University faculty provide clinical and administrative leadership at all levels of the hospital's organization. The hospital's clinical functioning has improved through direct involvement of university faculty in patient care, and its recruitment of physicians and psychologists has increased due to expansion of academic opportunities and program improvements. The authors use examples from the collaboration experience to illustrate key issues, such as strong leadership, sufficient resources, and an understanding of systems factors, that are necessary to overcome resistance to change.

Seasonal stability of water balance among schizophrenic patients subject to water intoxication.

1. Diurnal weight gain, afternoon hyponatremia, and polyuria were assessed for one year among eight male schizophrenics subject to water intoxication. 2. The authors normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. Weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. 3. NDWG ranged between 2.69 +/- .99 and 3.34 +/- 1.32 percent (F [3, 5] = .885, p = .509) during the four seasons of the year. 4. The seasonal decrease in afternoon serum sodium compared to its morning counterpart ranged between 4.23 +/- 1.96 and 6.14 +/- 2.82 mmol/l (F [3, 5] = 2.212, p = .205). 5. Seasonal polyuria ranged between 8.2 +/- 3.5 and 8.8 +/- 3.2 liters (F [3, 5] = .228, p = .873). 6. Among schizophrenics subject to water intoxication, the seasonal stability in our three parameters of water imbalance suggest they may be used to follow patients with altered water homeostasis over time. This finding has both clinical and research implications.

Abnormal diurnal weight gain among institutionalized patients with manic-depressive spectrum disorders.

We found diurnal weight gain to be abnormal among 41 institutionalized patients with manic-depressive spectrum disorders. They were weighed at 7 AM and 4 PM weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 AM weight from the 4 PM weight, multiplying the difference by 100, and then dividing the result by the 7 AM weight. NDWG was 2.216 +/- 1.513 percent for the study population, .631 +/- .405 percent for 16 young, newly admitted controls, and .511 +/- .351 percent for 29 normals. Abnormal NDWG may be an additional feature of manic-depressive spectrum disorders.

Development of water dysregulation during Arieti's third stage of schizophrenia?

We found abnormal diurnal weight gain among 25% of acutely psychotic patients with schizophrenia and 68% of chronically psychotic patients with schizophrenia. They were weighed at 7:00 AM and 4:00 PM weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7:00 AM weight from the 4:00 PM weight, multiplying the difference by 100, and dividing the result by the 7:00 AM weight, NDWG was 0.93% +/- 0.89% for the 36 acutely psychotic patients and 2.2% +/- 1.5% for the 68 chronically psychotic patients (F = 25.297, p less than 0.0001). Drugs did not explain this difference. Our data, though preliminary, suggest that water dysregulation, as manifested by abnormal diurnal weight gain, develops in schizophrenia as patients progress into Arieti's third stage of this disorder. A longitudinal study design, rather than our cross-sectional one, would be necessary to assess developmental changes in schizophrenia.

Survey of diurnal weight gain and urine volume in chronic schizophrenia.

We found diurnal weight gain to be abnormal among 39 chronic schizophrenic patients. The patients were weighed and urine samples obtained weekly for three weeks at 7 a.m. and 4 p.m. We normalized the dirunal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.075 +/- 1.331% for the 38 study patients, .631 +/- .405% for 16 acutely psychotic controls and .511 +/- .351% for 29 normals. Seventy-seven percent of the study patients had abnormal NDWG values and 62% were polyuric. NDWG related to urine volume (n = 39, r = .356, p = .026) with the variability in urine excretion explaining 13% of the variability in NDWG. We discuss factors that may have contributed to our findings.

Normalization of abnormal diurnal weight gain among chronically psychotic geriatric patients. Is abnormal diurnal weight gain a risk factor in chronic psychosis?

We studied 20 geriatric and 87 nongeriatric chronically psychotic male inpatients, 16 acutely psychotic male control subjects, and 14 male normal subjects. The subjects were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was .509% +/- .337%, 2.209% +/- 1.529%, .631% +/- .405%, and .533% +/- .410%, among the geriatric men, nongeriatric men, control subjects, and normal subjects respectively. Differences in diagnoses and drugs did not explain these findings. We hypothesize that abnormal diurnal weight gain may be a risk factor for premature death among chronically psychotic inpatients.

Antipsychotic drugs, lithium, carbamazepine, and abnormal diurnal weight gain in psychosis.

Diurnal weight gain was abnormal among 149 institutionalized chronically psychotic patients. We weighed patients weekly for 3 weeks at 7 A.M. and 4 P.M. and then normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 A.M. weight from the 4 P.M. weight, multiplying the difference by 100, and dividing the result by the 7 A.M. weight. The NDWG was 2.026% +/- 1.399% for patients and 0.511% +/- 0.351% for normals. The NDWG related (Spearman rho = 0.328, p less than 0.0001) to chlorpromazine equivalent dose. The absence of lithium and carbamazepine, lithium alone, carbamazepine alone, and the combination of lithium and carbamazepine did not alter NDWG. Our data suggest that antipsychotic drugs may contribute to abnormal weight gain in chronic psychosis but that lithium and carbamazepine do not.

Diurnal weight gain among patients with mental retardation.

We compared the diurnal weight gain of 46 patients with mental retardation to that of 21 patients with organic mental syndromes. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. Normalized diurnal weight gain was abnormal among one fourth of patients with mental retardation and two thirds of those with organic mental syndromes. Differences in age, sex, baseline weight, antipsychotic drugs, lithium, carbamazepine, blood pressure, and pulse did not explain our results. We believe that our findings provide additional evidence to separate patients with mental retardation from those with psychosis.

Abnormal diurnal weight gain among chronically psychotic patients contrasted with acutely psychotic patients and normals.

We found diurnal weight gain to be abnormal among 28 institutionalized chronically psychotic patients. They were weighed daily for 15 days at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.8 +/- 1.3% for the 28 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls, and 0.511 +/- 0.351% for 29 normals. Ninety-three per cent of the study sample had NDWG values above the upper limit of normal. Sex, diagnosis, smoking, baseline weight, blood pressure, and pulse did not explain these observations. NDWG related (N = 28, r = 0.552, P = 0.002) to antipsychotic drug dose. The implications of our findings are discussed.

Diurnal weight gain in chronic psychosis.

We found diurnal weight gain to be abnormal among 93 chronically psychotic patients, most of whom had schizophrenia. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. NDWG was 1.7 +/- 1.0 percent for the study sample, 0.6 +/- 0.4 percent for 16 acutely psychotic controls, and 0.5 +/- 0.4 percent for 29 normals. More than 60 percent of the study sample had abnormal NDWG values. NDWG related to antipsychotic drug dose (r = 0.290, p = 0.005) with variability in drug dose accounting for 8 percent of the variability in NDWG. This report provides yet another piece of evidence that disordered water balance is common in chronic psychiatric patients. The etiology is unknown, but it may relate to subtle brain abnormalities in the regulation of fluid intake and excretion.

Failure of antipsychotic drug dose to explain abnormal diurnal weight gain among 129 chronically psychotic inpatients.

1. The diurnal weight gain was found to be abnormal among 129 chronically psychotic inpatients. 2. The patients were weighed at 7 a.m. and 4 p.m. weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. 3. NDWG was 2.2 +/- 1.5 percent for 87 male patients compared (p less than .0001) with .53 +/- .41 for 14 male controls. 4. NDWG was 1.8 +/- 1.0 percent for 42 female patients compared (p less than .0001) with .49 +/- .30 for 15 female controls. 5. Seventy percent of male and female patients had NDWG values greater than two standard deviations above the mean values of controls. 6. Differences in age, sex, morning weight, antipsychotic drugs, lithium, carbamazepine, phenytoin, blood pressure, and pulse did not explain these findings.

Diurnal weight gain as a predictor of serum sodium concentration in patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome).

Ten male patients (mean age 37.3 +/- 6.4 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent measurement of weight, sitting and standing blood pressure, and serum sodium concentration at 7 a.m. and 4 p.m. weekly for 8 consecutive weeks. Blood pressure was higher in the afternoon than in the morning. The diurnal decrease in serum sodium (141.4 +/- 2.8 to 134.2 +/- 4.8 mEq/l) was associated with a diurnal increase in weight (78.4 +/- 9.7 to 80.0 +/- 10.3 kg). When the weight increase was normalized by dividing by 7 a.m. weight (NDWG), the following relationship evolved: diurnal serum sodium decrease = 3.060 + [201.728 x NDWG]. Therefore, NDWG accounted for 63.1% of the variability of serum sodium. Using the known relationship of plasma water, total body water, and total body weight, we calculated that antidiuresis (afternoon weight gain) accounted for 62.5% of afternoon hyponatremia. Thus, two separate methods of calculating the relationship between antidiuresis and hyponatremia provided remarkably similar findings. We derived a table to predict 4 p.m. serum sodium values based on 7 a.m. weight, 7 a.m. serum sodium, and 4 p.m. weight.