The promise and peril of involuntary outpatient commitment.

Over the last 20 years, involuntary outpatient commitment has periodically been proposed as a possible strategy for providing mental health services to chronic mental patients. Under this approach, patients meeting certain criteria of dangerousness or need for treatment could be compelled by the courts to take part in treatment programs in the community. This article examines the available literature regarding this policy and the arguments for and against it. The final section outlines implementation issues that should be considered in designing any such policy so that it could be both legally acceptable and clinically sound. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mechanisms of involuntary attention.

We tested 3 mechanisms of involuntary attention: (1) a perceptual enhancement mechanism, (2) a response-decision mechanism, and (3) a serial-search mechanism. Experiment 1 used a response deadline technique to compare the perceptual enhancement and the decision mechanisms and found evidence consistent with the decision mechanism. Experiment 2 used a multiple-targets paradigm to compare the decision and serial-search mechanisms. The results favored the decision mechanism. Experiment 3, which varied the display size and whether distractors were present in the display, found that when locating the target was easy, the results conformed to the decision mechanism. However, when locating the target was difficult, the serial-search mechanism was favored. Thus, there appears to be at least 2 mechanisms of involuntary attention. The serial-search mechanism accounts for involuntary attention when the target is difficult to locate, whereas the decision mechanism accounts for results when the target is easy to locate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical depression: Comparative efficacy of outpatient treatments.

178 moderately clinically depressed clients were given 10 wks of psychotherapy, behavior therapy, drug therapy, or relaxation therapy (treatment control condition). Tests administered included the Depression Adjective Check List, the Beck Depression Inventory, and the Eysenck Personality Questionnaire. 55 normal Ss were evaluated for comparison purposes but were not part of the data analyses. In addition to showing differential treatment drop-out rates, results showed behavior therapy to be superior on 9 of 10 measures at the end of treatment and marginally superior at the 3-mo follow-up. Psychotherapy performed most poorly on most outcome measures at both evaluation periods, and there were no significant differences between drug therapy and relaxation therapy on any outcome measure. Neither therapist experience nor client cluster type interacted with treatment. There was an overall significant difference between high and low treatment responders, but discriminant function classification predicted treatment response correctly in only 68% of the cases. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laminectomy and the treatment of lower-back pain in Massachusetts

During 1984-85, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.     

The treatment effectiveness of outpatient substance misuse treatment organizations between court-mandated and voluntary clients

Do outpatient substance misuse treatment organizations have different outcomes for court-mandated and voluntary clients depending on the mix of those clients? Do client characteristics, organizational factors, and treatment practices predict organizational treatment outcome rates? A nationally representative sample of 330 nonmethadone outpatient substance misuse treatment organizations was surveyed in 1990. Sixty-four of the organizations had 75% or more court-mandated clients; 122 of the organizations had 25% or less court-mandated clients. Organizations with 75% or greater court-mandated clients had a greater rate of clients failing to comply with their treatment plan than organizations with 25% or less court-mandated clients, but there were no differences in clients meeting the goals of their treatment. Client characteristics, organizational factors, and treatment practices are evaluated through multivariate regression to determine their impact on organizational rates of treatment success and failure among clients.     

Patient-treatment matching improves compliance of alcoholics in outpatient treatment

In chronic medical disorders, patient compliance is very poor and often less than 50%. The purpose of this investigation was to determine whether the proper matching of patient, treatment, and therapist would improve patient compliance in the outpatient treatment of alcoholics. We randomly placed 119 alcoholics who had commenced protracted outpatient treatment for alcoholism in either low or high structured treatments. These 119 patients were offered 12 months of individual treatment. Interruption of this treatment was recorded as noncompliance. The treatment courses were expressed in survival curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38% compliance among mismatched patients. Twenty-four months after the initiation of treatment, patients in the compliance group had a significantly higher level of function than those in the noncompliance group. Our investigation of alcoholics involved in outpatient treatment shows that the correct matching of patients and treatment structure improves compliance and long-term prognosis. It is hoped that the present investigation will generate interest in future research on correct matching to gain improved compliance in patients with a chronic medical disorder.     

Awareness of illness in schizophrenia and outpatient treatment adherence

We present a brief measure of awareness of illness in schizophrenia and test whether awareness is related to perceived need for and adherence to outpatient psychiatric treatment. A prospective design assessed treatment adherence, awareness of the signs and symptoms of schizophrenia, symptoms, neurocognitive status, and substance abuse at baseline and 6-month follow-up in 89 persons with schizophrenia. Results indicate that persons with greater awareness perceived greater need for outpatient treatment and evidenced better adherence to outpatient treatment when adherence and awareness were measured concurrently. Awareness was not related to adherence at 6-month follow-up. In addition, neurocognitive impairment was associated with lower overall adherence to treatment when reported by collaterals at baseline and 6-month follow-up. Neurocognitive impairment was, however, associated with higher self-reported adherence to medication, which suggests that neurocognitive status may bias adherence reporting in persons with schizophrenia.     

Ceftriaxone and outpatient treatment of infective endocarditis

There are a total of 8000 cases of infective endocarditis yearly in the United States. Central nervous system metastatic infections are not uncommon in infective endocarditis. Because ceftriaxone is highly bound to serum proteins, there is concern that the drug is highly bound to serum proteins, there is concern that the drug might not penetrate well in the core of an infected vegetation. To date, there are two published studies on the treatment of nonenterococcal streptococcal endocarditis by ceftriaxone in humans. Ceftriaxone appears to be an attractive alternative antibiotic therapy to conventional regimens in the treatment of streptococcal endocarditis.     

Relapse prevention strategies in outpatient substance abuse treatment.

Reviews the use of relapse prevention (RP) strategies in the treatment of substance abuse disorders. The work of G. A. Marlatt and J. R. Gordon (1980, 1985) provided the cognitive-behavioral base of RP models and numerous techniques. Specific protocols for the treatment of alcoholism, cocaine abuse, marijuana abuse, and heroin addiction are described. This body of knowledge has given the drug-free outpatient treatment of substance abuse a clear focus and direction. The techniques used in the RP include 7 groups of strategies: psychoeducation, identification of high-risk situations for relapse, development of coping skills, development of new-life behaviors, increased self-efficacy, dealing with relapse and avoiding the abstinence violation effect, and drug and alcohol monitoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors affecting engagement of dual diagnosis patients in outpatient treatment

This study examined factors associated with engagement in outpatient treatment of patients with dual diagnoses of psychiatric disorder and substance use disorder. The charts of all 57 patients referred to a dual diagnosis treatment program during a six-month period were reviewed, and data on patients' substance use diagnosis, psychiatric diagnosis, sex, ethnicity, and referral source were collected. Patients referred from inpatient treatment were more likely to attend three or more appointments at the dual diagnosis program than those referred from outpatient treatment. Substance of abuse interacted with both referral source and sex in predicting engagement.     

The efficacy of the combined conservative therapy of patients with chronic obliterating arterial diseases of the extremities in outpatient practice

The paper provides the results of multimodality conservative therapy in 527 patients with chronic obliterating diseases of extremity arteries, which was performed in the outpatient setting. Factors influencing its efficiency were analyzed. The paper emphasizes the value of this direction of treatment whose underestimation sharply aggravates the prognosis of these diseases, including the results of their surgical management. Having obtained positive results in 84.5% of patients, the authors note the efficiency of treatment to be decreased with severe arterial insufficiency of lower extremities (5% of negative results in Stage IIa, 23% in Stage IIb, and 40% in Stage III), in patients with prior surgical interventions, and in elderly patients with atherosclerosis obliterans and younger patients with non-specific aortoarteritis.     

Measuring the quality of outpatient treatment for schizophrenia

OBJECTIVE: Usually it is not possible to study the initial systemic response in patients with acute pancreatitis in the first hours after onset of the disease. We used postendoscopic retrograde pancreatography (ERP) pancreatitis as a model to study cytokine and anticytokine release in the early phase of human acute pancreatitis. METHODS: Post-ERP pancreatitis was defined as a threefold increase in serum amylase and at least two of the following clinical symptoms: abdominal pain, nausea, vomiting or peritonism 24 h after ERP. Serum levels of pro-inflammatory cytokines interleukin-1beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8), tumour necrosis factor alpha (TNF), as well as endogenous antagonistic mediators of the systemic inflammatory response such as soluble tumour necrosis factor alpha receptors p55 (TNFR p55) and p75 (TNFR p75), and IL-1-receptor antagonist (IL-1-RA) and interleukin-2-receptor (IL-2R) as indicators of lymphocyte activation were measured before and 0, 1, 4, 12, 24 and 48 h after ERP. In nine patients with acute post-ERP pancreatitis, these parameters were monitored daily until C-reactive protein (CRP) was within normal ranges and were compared to patients without pancreatitis after ERP. RESULTS: IL-1beta was not detectable in five patients with and four patients without post-ERP pancreatitis. The values of the remaining patients in both groups were lower than 3.9 pg/ml. IL-8 and IL-1-RA serum concentrations peaked 12 h after ERP (132.9 and 3245.0 pg/ml respectively) compared to patients without post-ERP pancreatitis (25.8 and 389.9 pg/ml respectively). The IL-6 concentration increased to 81.6 pg/ml (8.0 pg/ml in control patients) 24 h after ERP, while the peak values for CRP were measured 72 h after ERP (164.0 versus 7.7 mg/l). IL-2R content was maximally elevated 144 h after ERP (688.8 versus 255.9 U/ml), while concentrations of TNF and its receptors showed no significant change over time. CONCLUSION: The initial response of the cytokine network to damage of the human pancreas leading to acute pancreatitis includes the release of IL-8 and the IL-1 antagonist IL-1-RA, while IL-1beta is not found in the systemic circulation. The TNF system does not seem to be involved as indicated by the lack of detectable changes in TNF and the soluble TNFR p55 and p75 serum concentrations. Lymphocyte activation as indicated by elevated IL-2R levels occurred days after the initial trauma. Even mild post-ERP pancreatitis leads to significant systemic release of cytokines and their biological counterparts.     

The new-generation laser surgical apparatus Doktor in the combined treatment of stomatological disease in an outpatient setting

Presents the design, technological characteristics (wavelength 10.6 mu cm, power up to 7 W, permanent mode) of a new-generation surgical laser Doktor and its use in the treatment of dental and maxillofacial diseases (diseases of the periodontium and buccal mucosa, pericoronitis, trophic ulcers, retention cysts, furuncles and carbuncles of the skin of the neck and face, odontogenic inflammatory processes, injuries, tumors) and in reconstructive, plastic, and cosmetologic surgery.