Effectiveness of everyday occupations for changing client behaviors in a community living arrangement.

OBJECTIVE: This study examined the effect of three occupations-based interventions for reducing the frequency of dysfunctional behaviors (disruptive vocalizations, distraction of others, withdrawal from appropriate social interactions) in two women with dual (i.e., developmental, psychiatric) conditions. Additionally, the duration of time spent appropriately engaged was examined. METHOD: A single-subject, multiple baseline, across-subjects design, with two dually diagnosed residents in a Community Living Arrangement (CLA), was used to evaluate change in four behaviors under three alternating conditions. Condition 1 was CLA (morning and evening combined) compared with the school and sheltered workshop, Condition 2 was CLA morning, and Condition 3 was CLA evening. Intervention consisted of engagement in everyday occupations associated with the school-workshop and CLA settings as well as a positive reinforcement program. RESULTS: Using occupations-based interventions and a behavior modification program, 5 of 6 behaviors improved significantly in the school-and-workshop setting compared to the CLA, under Condition 1. Under Condition 2, the morning occupations-based intervention in conjunction with positive reinforcement for active participation significantly improved 4 of 6 behaviors for the two residents. Similarly, under Condition 3--the evening occupations-based intervention--4 of the 6 targeted behaviors improved significantly. CONCLUSION: The use of everyday occupations as interventions, in conjunction with positive reinforcement for active participation, was effective for decreasing dysfunctional behaviors and increasing functional behaviors in two women with dual conditions who resided in a CLA.

Analysis of sexual disparity of violent behavior in PCP intoxication.

We performed a retrospective chart analysis of 33 patients with an Emergency Department discharge diagnosis of phencyclidine (PCP) intoxication. All 33 cases presented to the Emergency Department between November 1986 and April 1987. Thirty of the 33 patients (91%) were classified as mildly intoxicated (per clinical syndrome as described by Aronow and Done) while the remaining 3 patients (9%) were moderately intoxicated. Two of the patients (6%) required benzodiazepine therapy for agitation while an additional 3 patients (9%) required haloperidol for psychotic symptoms. Twenty-three patients (70%) did not require any medication. Of particular interest was our finding that 11 of the 27 males (41%) required leather restraints for agitation or violent behavior while none of the 6 female patients required leather restraints (Fisher's exact test, p = 0.00078). While nursing perception of physical strength may be a confounder, level of agitation and violent behavior is our primary indication for use of restraints. We believe that there is a sexual disparity in level of agitation and violent behavior induced by PCP. We hypothesize that this may be due to pharmacokinetic factors (such as difference in body fat distribution between the sexes) or biological differences in the central nervous system.