Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rosenhan revisited.

The author revived the methodology used by David Rosenhan in his controversial 1973 study, titled "On Being Sane in Insane Places" (Rosenhan, see record 1973-21600-001) in order to evaluate whether progress has occurred in the mental health field over the past several decades. In a seminal study by Rosenhan (1973), 8 people without any history of psychiatric illness presented themselves at various mental hospitals. Each of these pseudopatients arrived at the admissions office complaining of a single (feigned) symptom: vague auditory hallucinations. They were all admitted to the hospital, and their average length of stay was 19 days, despite the fact that once they were on the unit, they ceased feigning the symptom and behaved normally. Rosenhan claimed that the results of this study illustrated the powerful role of context in determining how people's behavior is regarded and raised serious questions about the validity of psychiatric diagnoses. The present study is a replication of sorts, modified to suit the contemporary, postdeinstitutionalization state of mental health care. The findings suggest that a significant shift has occurred in mental health care since 1973. At the time of the original study by Rosenhan (1973), the troubling issue was the ease with which people could receive an unwarranted diagnosis and unnecessary treatment for a nonexistent mental disorder. In today's mental health care environment, the troubling issue is the difficulty involved in obtaining treatment that is warranted for conditions that are present. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing HIV-Risk Behavior Among Adults Receiving Outpatient Psychiatric Treatment: Results From a Randomized Controlled Trial.

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Disclosure Conundrum: How People With Psychiatric Disabilities Navigate Employment.

The vocational rehabilitation and mental health literatures usually urge people with psychiatric disabilities to disclose their disability at work. Reasons for preferring disclosure include the opportunity to invoke rights conferred by the Americans with Disabilities Act of 1990, the risk of losing federal disability benefits when earning a higher income, and the belief--held by many professionals--that people with psychiatric disabilities will experience permanently debilitating symptoms. However, a newer model of recovery from psychiatric disability challenges these assumptions. A qualitative study of people with psychiatric disabilities explored these issues. The participants were current or former recipients of social security benefits provided to persons with significant disabilities. Participants described complex situations around employment and disclosure, which were more difficult to resolve than disclosure advocates have recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods for studying course of illness with severely mentally ill adults

This study examined methods for obtaining course of illness data on adults who are severely mentally ill. A convenience sample (N = 60) was recruited within 4 programs serving different subgroups of adults with severe mental illness. Forty-three participants were able to complete follow-up interviews, using a life chart format to report on personal history in the domains of housing, employment, finances, psychiatric service utilization, health problems, use of psychotropic medication, drug and alcohol use, social relationships, and other major life events. Corresponding information was abstracted from treatment records and examined for concordance with self-reports. Results showed distinct areas of concordance, including recent (1 year) life events, psychiatric care, psychotropic medications, and use of alcohol. Areas of disagreement included legal problems, illicit drug use, and general health. With multiple data sources, it is possible to involve a range of adults with severe mental illness in research and to incorporate their knowledge into course of illness studies.     

Evaluating Outcomes of Rehabilitation for Severe Mental Illness.

Improving the quality of life of individuals with severe mental illness has been the focus of considerable research. With advances in treatments for severe mental illness, particularly in psychiatric rehabilitation, evaluating outcomes has become increasingly important. Given the complex and multidimensional nature of severe mental illness, outcome evaluation of psychiatric rehabilitation is particularly difficult. This article addresses issues in evaluating psychiatric rehabilitation outcomes, including key outcome domains, selection of methods and measures, and meaningful use of results. Continuing conceptual and methodological issues are discussed. Also, future directions are explored, including evaluating multidimensional treatment effects and interactions and building an integrated understanding of all of the outcomes involved in psychiatric rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opinions about mental illness in the personnel of two large mental hospitals.

The present research is directed at clarifying the attitudes of the people who work with psychiatric patients. A sample of over 1000 such individuals, ranging from office and kitchen help to psychiatrists in 2 VA hospitals, filled out a specially devised attitude scale. Factor analysis isolated 5 major factors: 2 reflecting negative attitudes (one in which their difference and inferiority to normals was stressed, the other reflecting a desire to place strong social restrictions on them both during and after hospitalization); 2 positive attitude factors (one based on an almost moral sense of obligation to help unfortunates, the other on more professional attitudes towards their treatability). The 5th factor was defined by attitudes towards etiology of psychiatric illness in relation to psychological development. Clear-cut differences of opinion were at the different levels of professional training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Situations associated with admission to an acute care inpatient psychiatric unit.

This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex-related alcohol expectancies predict sexual risk behavior among severely and persistently mentally ill adults.

Three hundred three adults (57% male, average age 42 years) with severe and persistent mental illness receiving treatment at community mental health clinics completed a survey, which included B. C. Leigh's (1990) sex-related alcohol expectancy scale and measures of alcohol use and sexual risk behavior. Hierarchical logistic regression analyses, controlling for drinking behavior, revealed that participants with stronger expectancies that drinking would lead to enhanced sexual experience were more likely to have drank prior to intercourse and that, among participants who drank prior to intercourse, those with stronger expectancies that alcohol would lead to riskier sexual behavior were more likely to have engaged in sexual risk behavior. Implications for preventing HIV infection among people with severe mental illness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental hospital. A study of institutional participation in psychiatric illness and treatment.

Reviews the book, The mental hospital. A study of institutional participation in psychiatric illness and treatment by Alfred H. Stanton and Morris S. Schwartz (see record 2005-02933-000). This is a rich and rewarding book. It is a report of research, conducted in collaboration by a psychiatrist and a sociologist, into the social organization of a psychiatric hospital and into the effects of this social organization on the behavior of patients. Although it is primarily intended as a contribution to administrative psychiatry, it is also a major contribution to the general literature of social science and, in particular, to the broad area of personality and social structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary afferent depolarizations of sensory origin within contact-sensitive mechanoreceptive afferents of a crayfish leg

Recordings from the central branches of single identified dactyl sensory afferent (DSA) neurons in a crayfish in vitro preparation were performed to study modifications of the sensory message occurring before the first central synapse. These afferents comprised hairs and force-sensitive mechanoreceptors with phasic and phasotonic response characteristics in the terminal segment (dactyl) of the crayfish leg. More than one afferent spike size was often observed in intracellular recordings from these afferents, thus indicating the presence of electrical coupling between the central processes of DSA fibers. Additionally, in identified DSA fibers with large spike sizes, primary afferent depolarizations (PADs) of up to 15 mV were observed, which sometimes triggered antidromic spikes in the afferent. Nevertheless, PADs were clearly inhibitory, because they shunted the afferent spikes. They exhibited the following properties. First, each PAD was preceded by an afferent spike from a neighboring hair, indicating that the PADs had a sensory rather than central origin. Second, PADs could follow high frequencies of afferent discharges without failure, a property suggestive of monosynaptic connections, but because PAD latencies varied by +/-0.5 ms it is more likely that they were mediated by a disynaptic pathway. Third, although PADs were evoked in an extremely reliable manner, their amplitude varied in a quantal manner. Most unitary PADs were the result of the release of < 12 quanta, the mean quantal content lying between 4 and 5; quantal size was large, approximately 1 mV. Fourth, PADs showed facilitation in some fibers, whereas in others they became much smaller when occurring at brief intervals. We suggest that PADs may be an efficient and parsimonious way to limit sensory inflow in space and time, allowing the crayfish to identify precisely both weak and strong mechanical stimuli.     

The mental health of men with a psychiatric disorder or traumatic brain injury: Wives' labeling and husbands' perceived control.

Objective: To investigate the relations among wives' labeling of their husbands' psychiatric disorder or brain injury as an organic illness, the husbands' perceived control over their disabilities, and the husbands' mental health. Participants: 57 male clients of the Department of Rehabilitation, Israel's Ministry of Defence (26 with a psychiatric disorder and 31 with a traumatic brain injury) and their wives. Measures: Illness Labeling Questionnaire, the Perceived Control Over Illness Questionnaire, and the Mental Health Inventory. Results: Husbands' mental health was low but did not differ according to disability; wives' labeling of husbands' condition was negatively related to the husbands' mental health; husbands' perceived control was positively related to their mental health for both disabilities. Conclusion: Organic illness labels, even when adopted by the wives of the persons with the disability, seem to be negatively related to that person's mental health, whereas perceived control over a mental disorder or a brain injury seems to contribute positively to mental health, independently of how the disorder or injury is labeled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of mental disorder in remand prisoners: consecutive case study

OBJECTIVE: To define the prevalence of mental disorder and need for psychiatric treatment in new remand prisoners and to determine to what extent these are recognised and addressed in prison. DESIGN: Study of consecutive male remand prisoners at reception using a semistructured psychiatric interview. SETTING: Large remand prison for men (HMP Durham). SUBJECTS: 669 men aged 21 years and over on remand, awaiting trial. MAIN OUTCOME MEASURES: Prevalence of mental disorder at reception, prisoners need for psychiatric treatment, identification of mental disorder by prison reception screening, and numbers placed appropriately in the prison hospital. RESULTS: 148 (26%) men had one or more current mental disorders (excluding substance misuse) including 24 who were acutely psychotic. The prison reception screening identified 34 of the men with mental disorder and six of those with acute psychosis. 168 men required psychiatric treatment, 50 of whom required urgent intervention; 16 required immediate transfer to psychiatric hospital. Of these 50, 17 were placed on the hospital wing because of mental disorder recognised at prison screening. CONCLUSION: Not only is the prevalence of mental disorder, in particular severe mental illness, high in this population, but the numbers identified at reception are low and subsequent management in prison is poor.     

Psychology training in emergency services.

Describes the training of psychology interns and postdoctoral fellows in the Emergency Department of the University of Rochester Medical Center. The psychiatric service receives almost 4,000 patient visits a year. The primary focus of the emergency service is psychological first aid. There is also a follow-up clinic for hard-to-reach patients. The clinic requires students to learn short-term crisis intervention therapy and uses the services of a wide range of mental health professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.

Objective: Individuals with psychiatric disabilities experience 90% unemployment rates; however, individuals experience 61% employment rates when engaged in high-fidelity individual placement and support programs. To build on current research of variables influencing employment outcomes, we hypothesized that an Incentive factor and a Barrier factor are related to employment status. This mixed method study developed the Employment Commitment Measure (ECM) and explored the correlation between employment commitment and employment status. Method: In our 1st phase of this mixed method study, we developed the ECM consisting of an Incentive factor with 5 items and a Barrier factor with 6 items through community-based participatory research. In our 2nd phase of this mixed method study, 198 randomly picked individuals with psychiatric disabilities completed a demographic survey and the ECM. We completed independent sample t tests with Bonferroni correction, cross-tabulated chi-square analyses, confirmatory factor analysis, Cronbach's alpha tests, a logistic regression, and a slope plotting. Results: The ECM consists of 11 items, with 5 items loading on an Incentive factor and 6 items loading on a Barrier factor. Results indicated that the Incentive factor scores were associated with employment status and significant differences on Incentive factor scores between employed and unemployed participants. Results indicated nonsignificant differences between employed and unemployed participants by age, education, gender, ethnicity, housing, mental health tenure, and agency tenure. Conclusions: Our findings indicated incentives for employment may provide a better guide for correlations of and commitment to employment when compared to barriers. We discuss the implications for employment for individuals with psychiatric disabilities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychologists' roles and opportunities in rehabilitation and recovery for serious mental illness: A survey of Council of University Directors of Clinical Psychology (CUDCP) clinical psychology training and doctoral education.

The emergence of psychiatric rehabilitation and the recovery movement generate new and expanded roles for psychologists in services for people with serious mental illness (SMI). However, the proportion of psychologists working in SMI services today is substantially less than previous decades. This article reviews the roles of psychologists in various mental health systems and outlines the contributions that psychologists can make in implementing evidence based approaches for people with SMI. A survey of American Psychology Association (APA)-accredited Council of University Directors of Clinical Psychology (CUDCP) Clinical Psychology doctoral programs was conducted. The results of the survey indicate an increase, since the early 1990s, in clinical faculty with SMI interests, and suggest that many graduate programs provide opportunities for SMI-relevant research and practicum training. However, the survey also indicates a lack of coursework on topics relevant to SMI and a lack of coursework relevant to assuming administrative and leadership roles in the mental health system. Despite training opportunities in graduate school, production of new PhDs who choose the SMI field is unlikely to meet the demand. According to the present study, the limiting factor is not availability of training, but student career choice. The opportunities and challenges that psychologists face in SMI recovery-oriented service delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laryngeal cancer: quality-of-life and cost-effectiveness

The purpose of this paper is to review the current literature in relation to mental illness and criminal behaviour. The material presented for discussion was selected from forensic and general psychiatric literature. However, a number of important publications, policy documents and independent reports were used to explore the debate surrounding this subject. Contemporary studies of prison populations in the UK and abroad illustrated the difficulty in relating mental illness to crime. Papers presenting research in the UK revealed important implications for mental health policy and the way in which the penal system deals with mentally disordered offenders. The literature reviewed provided arguments for and against an association between mental illness and criminal behaviour. Methodological problems associated with criminological and psychiatric research were addressed in relation to the exploration of whether people suffering from a mental illness are more dangerous or violent than other people. Research papers focusing on public reaction to mentally ill people living in the community provided important considerations when addressing mental illness and criminal behaviour in the context of care in the community policy. This paper will be of interest to a broad range of mental health professionals, particularly those working with individuals who have a history of mental illness and violent behaviour, or mental health professionals working with mentally disordered offenders.     

Predicting First Time Involvement in the Juvenile Justice System Among Emotionally Disturbed Youth Receiving Mental Health Services.

Rates of mental illness among youth in the juvenile justice system are exceptionally high, yet the understanding of the process by which some mentally ill youth end up in juvenile justice, whereas others stay in the mental health system is relatively undeveloped. The goal of the present study is to extend previous research findings by focusing prospectively on 659 youth between the ages of 8 and 17 years who were enrolled in Medicaid with a psychiatric diagnosis. Of those with no prior involvement with the juvenile justice system at baseline, 12% had contact with the juvenile justice system within 1 year. Those who were older, exhibited more externalizing behaviors, and came from minority backgrounds were more likely to come into contact with the juvenile justice system. Dual-system involvement was common, suggesting that a more integrated approach between these systems needs to be developed with a special emphasis on minority youth who exhibit externalizing disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Residual psychopathology in released psychiatric patients and its relation to readmission.

The degree and type of mental pathology reflected in MMPI scores was surveyed in 147 hospitalized psychiatric patients upon admission and release. Both statistical and clinical assessments of the profiles were made with analyses related to changes during hospitalization and to comparison with normal groups. Results vary depending on method of assessment. A substantial group of profile-pairs are judged as showing improvement at release (75%), while the remainder (25%) show more illness. Statistical analysis shows significant group improvement but exit profiles do not resemble those of normals. Psychotic profile types do not change to resemble neurotic ones with hospital treatment. MMPI change scores seem to anticipate rehospitalization better than evaluation of the patients' exit profile alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)