Changing characteristics of schizophrenic patients admitted to state hospitals.

OBJECTIVE: Characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 were studied to examine changes in the demographic profile of the patient population and in principal sources of payment for hospitalization over the study period. METHODS: Information on patients' demographic characteristics and principal payment sources was obtained from a nationally representative data base compiled about every five years by the National Institute of Mental Health. RESULTS: Among schizophrenic patients admitted between 1970 and 1986, the proportion of African-American males increased. By 1986 patients were less likely to pay for care through private insurance or their own resources. They were more likely to receive Medicare and to lack medical insurance. Medicare use increased largely among white patients, and medical indigency largely among African-American patients. CONCLUSIONS: Changes in the characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 may be related to changes in nosology, in the prevalence of schizophrenia, and in the types of patients likely to be admitted to state hospitals. The increase in the number of medically indigent patients accentuates the need for more adequate finding of state hospitals.

Clients/patients with a principal diagnosis of affective disorder served in the inpatient, outpatient, and partial care programs of specialty mental health organizations, United States, 1986.

Of the 1.7 million persons under care on April 1, 1986 in the psychiatric inpatient, outpatient, and partial care programs of specialty mental health organizations nationwide, approximately 365,500 persons, or 22 percent, had a principal diagnosis of affective disorder. The vast majority of these persons, 84 percent, were under care in outpatient programs; 10 percent, in inpatient programs; and 6 percent, in partial care programs. Approximately 833,000, or 21 percent, of the 3.9 million persons admitted during 1986 to these same psychiatric programs had a diagnosis of affective disorder. Fifty-nine percent of persons with affective disorders were admitted to inpatient programs; 37 percent, to outpatient programs; and 4 percent, to partial care programs. Overall, most persons with affective disorders admitted to and under care in each of the three program types were female, white, and between the ages of 25 and 64. Most persons admitted to and under care in inpatient and partial care programs had a history of prior inpatient mental health care, while most persons in outpatient programs had never been treated in an inpatient psychiatric care setting. The principal source of payment used by persons with affective disorders varied by type of program setting. Blue Cross or other commercial insurance was the most common source of payment used by persons within inpatient programs, personal resources were used most often by persons under care in outpatient programs, and some type of public funds was used most often within partial care programs. Most persons with affective disorders were referred to inpatient and outpatient programs by family or friends, or were self-referrals. Most persons in partial care programs with affective disorders were referred to the program by an inpatient, outpatient, or another partial care mental health service. Services received by persons with affective disorders also varied by program setting. In general, drug and individual therapy were the leading types of treatment provided in inpatient programs. Individual therapy was the leading type of treatment provided, followed by drug therapy, in outpatient programs. Within partial care programs, no single type of treatment predominated.

Characteristics of persons served by private psychiatric hospitals, United States: 1986.

Overall about 71,000 persons were under care in the inpatient, outpatient, and partial care programs of private psychiatric hospitals in the United States on April 1, 1986, and about 300,000 persons were admitted to these programs during 1986. Inpatient programs served the largest number of people, 223,851; outpatient programs served 133,217; and partial care programs served a much smaller population, only 13,541. The relative distribution of persons admitted, versus persons under care, differed considerably by type of program. Although the number of those admitted was larger than the number of those under care for both inpatient and outpatient programs, the difference between the two populations was much more pronounced within inpatient programs (chart A). Most of the persons admitted to private psychiatric hospitals in 1986 were admitted to inpatient programs, 207 thousand or 69 percent of all admissions, while most of those under care were outpatients, 47 thousand or 66 percent of all those under care on a single day. Children and youth under age 18 comprised the largest percentage of persons under care in inpatient programs, while persons in the 25-44 age group comprised the largest percentage of those admitted to inpatient programs. Approximately 41 percent of all persons under care in inpatient programs were under 18 years of age, compared with only 20 percent of all persons admitted to inpatient programs. The large number of children and youth found in the population under care within inpatient programs indicates the high median length of inpatient stay for persons within this age group (41 days compared with 24 days overall). Children and youth and the 25-44 year group each represented over one-third of those admitted to outpatient programs. The 25-44 age group made up the largest percentage of persons under care in outpatient programs and among those admitted to partial care programs. Among those under care within partial care programs, differences among age groups were not statistically significant. Of persons admitted to partial care programs, 92 percent had a history of some type of prior mental health treatment; for those admitted to inpatient and outpatient programs, the corresponding percentages were 70 percent and 48 percent, respectively. Affective disorders were a frequently occurring diagnostic grouping, comprising almost half of all persons admitted to and under care in inpatient programs, approximately one-third of those admitted and those under care in partial care programs, and around one-fourth of those admitted to and under care in outpatient programs.(ABSTRACT TRUNCATED AT 400 WORDS)

Care of persons with schizophrenia: a statistical profile.

This article presents the latest information available from the National Reporting Program for Mental Health Statistics on the distribution and characteristics of persons with schizophrenia served by organized, specialty inpatient, outpatient, and partial care mental health programs. Results are presented separately for persons under care at one point in time and for persons admitted over a 1-year period, in order to examine the potential for change in each type of care. Findings show that about 900,000 persons with schizophrenia were served in 1986; that inpatient and outpatient programs were relatively equivalent in total numbers served, but that considerably more patient turnover occurred in inpatient programs; and that partial care programs, although small, were evolving as a locus of care for persons with schizophrenia. Some variations were observed among the different types of organizations offering each type of care, and characteristics of clients/patients that could lead to changes in each type of care were evident. Overall, the findings present a useful composite picture of specialty mental health care for persons with schizophrenia. The need for longitudinal, prospective research is noted.

Treatment patterns for schizophrenia in psychiatric hospitals.

This paper analyzes the patterns of clinical treatments prescribed to patients diagnosed with schizophrenia who were admitted to state and county mental hospitals, private for-profit psychiatric hospitals, and private nonprofit psychiatric hospitals in July 1980. Treatment patterns were specified by examining the distribution of treatment types provided to patients over a 3-month period through standard tabular arrays and matrix analysis that holds constant the number of treatment types received by the patients. Data for this study are based on nationwide patient sample surveys and facility enumerations conducted in 1980 by the Survey and Reports Branch, National Institute of Mental Health. Clear differences and similarities emerged among the three types of hospitals in terms of the number and type of treatments provided to patients with schizophrenia. In general, patients with schizophrenia admitted to private psychiatric hospitals received a more comprehensive care regimen (generally inclusive of individual therapy) than similarly diagnosed patients admitted to state and county mental hospitals; private nonprofit psychiatric hospitals had marginally discernible treatment patterns from private for-profit psychiatric hospitals, especially with respect to assignment of group and self-care skill training.

National trends in use of psychotherapy in psychiatric inpatient settings.

The use of individual, family, and group psychotherapy at a national sample of state and county mental hospitals, private psychiatric hospitals, and psychiatric services in nonfederal general hospitals in 1975 and in 1980 or 1981 was studied. Patients with organic or alcohol-related disorders were generally less likely to receive psychotherapy than were those with schizophrenia. Patients' educational level, gender, or race did not appear to influence the use of psychotherapy, but older patients were less likely to receive psychotherapy, particularly group or family therapy. During the study period, the percentage of patients receiving psychotherapy at nonfederal public general hospitals rose dramatically and by 1981 was almost equal to or even a little higher than the percentages at nonpublic general hospitals and private hospitals, a sign that public general hospitals have made an impressive adjustment to their increased role in caring for the severely mentally ill.

The National Reporting Program for Mental Health Statistics: history and findings.

The National Reporting Program for Mental Health Statistics had its origins in the decennial U.S. census, with enumeration of the "insane and idiotic" in 1840. A series of special censuses of the insane and feebleminded in public and private hospitals and other institutions began in 1904, and annual censuses of patients in mental institutions were conducted from 1926 to 1946. The National Institute of Mental Health of the Public Health Service took over responsibility for the annual census of patients in mental institutions in 1947. Coverage and content remained the same until the mid-1960s, when only State and county mental hospitals were included in the census. Because the annual census could not provide the data needed, separate programs were begun for inpatient and outpatient service. These were integrated into the National Reporting Program in 1966. Trend data for the last 40 years describe how the specialty mental health sector has developed. Non-Federal general hospitals with separate psychiatric services increased dramatically, from 81 in 1940 to 1,531 in 1982, as did community mental health centers, from 125 in 1965 to 691 in 1980. There was generally less emphasis on inpatient care and more on outpatient care. Full-time equivalent staff in specialty mental health facilities increased from about 325,000 in 1970 to about 432,000 in 1982. Expenditures by facilities also increased dramatically.

Referral patterns to and from inpatient psychiatric services: a social network approach.

Interorganizational linkages have assumed more import for mental health service systems during the past three decades because of increased levels of complexity in service delivery patterns. This analysis examines these linkages from a relational perspective, with network of patient referral patterns as the basic unit. Multidimensional scaling is employed to discern patterns of interorganizational linkages in national patient referral data collected by the National Institute of Mental Health in 1975 and 1980 for patient samples from inpatient psychiatric services of state and county mental hospitals, private psychiatric hospitals, and public and nonpublic general hospitals. The multidimensional scaling techniques distinguish two structural characteristics of the interorganizational linkages of psychiatric inpatient services--public vs private services, and drift over time in referral patterns. Public and private inpatient psychiatric services are differentiated principally in terms of degree of interaction with legal agencies and private practice psychiatrists. Chronological change in referral patterns is characterized principally by changes in the degree of interaction with other inpatient or outpatient psychiatric services. Methodologically and theoretically, the techniques and findings described can enhance our understanding of interorganizational linkages and dynamics.

Psychiatric services to adolescents: 1970-1980.

A study based on the National Institute of Mental Health's Sample Survey Program for 1970, 1975, and 1980 provides an overview of the services to adolescents supplied by the mental health sector. Data are presented mainly for nonfederal general hospitals, state and county hospitals, private psychiatric hospitals, and, to a lesser extent, outpatient clinics. Among the trends found by the analysis are that private psychiatric and private general hospitals admitted an increasing share of adolescents while state and county hospitals admitted fewer; the overall proportion of younger adolescents admitted for inpatient treatment increased; all types of study facilities except state and county hospitals admitted relatively low proportions of adolescent substance abusers; and the use of psychotropic drugs decreased in some types of facilities, especially for younger adolescents.

The "chronic" mental hospital patient.

The rapid decrease in the resident population of state hospitals over the last decade has engendered a debate over the future role of the state hospital in the overall mental health services system. The authors report on a 1979 study of more than 2,000 state hospital patients designed to evaluate the characteristics of the current hospital population. Their findings document the existence of a new long-stay population that in many ways is similar to the old long-stay population that existed before deinstitutionalization. Continued hospitalization of the new population of long-stay patients, who now are younger than the old long-stay patient group, could cost more than $500 million dollars a year. The authors discuss the difficulty in predicting future trends from the existing data and outline four areas for future research.

On the mode of action of ACTH on the isolated perfused adrenal gland.

1. Isolated cat adrenal glands were perfused with Locke solution, and the corticosteroid outputs in response to adrenocorticotrophin (ACTH) were studied.2. Steroid outputs varied with the ACTH concentration, as well as with the duration of exposure to a given ACTH concentration.3. Omission of calcium from the perfusion medium markedly depressed ACTH-evoked steroid release. The steroid output was directly related to the extracellular calcium concentration up to 0.5 mM.4. During a constant exposure to ACTH, steroid output was maintained for at least 2-3 hr, provided that calcium was present in the perfusion medium.5. Strontium, but not barium or magnesium, replaced calcium in maintaining the secretory response to ACTH.6. Magnesium depressed ACTH-evoked secretion in the presence of calcium, and this depression of secretion was antagonized by increasing the calcium concentration.7. Prolonged perfusion with sodium-free or potassium-free solutions did not markedly inhibit steroid output in response to ACTH. Excess potassium (56 mM) did not produce a consistent or marked increase in spontaneous steroid output and did not affect the response to ACTH.8. The steroid content of adrenal glands perfused with Locke solution and exposed to ACTH was about 10% of the amount which was secreted. By contrast, adrenal glands perfused with calcium-free media and exposed to ACTH contained much higher amounts of steroid, despite the negligible amount secreted.9. These data suggest that calcium plays a critical role in the mechanism of corticosteroid secretion from the adrenal cortex.