Airway obstruction due to arytenoid prolapse in a child

Outcomes of clients with severe mental illness in a psychosocial and vocational rehabilitation program modeled after the Program for Assertive Community Treatment were tracked through record review to determine if clients' employment gains were sustained while they were in the program. A total of 184 clients participated in the program between December 1984 and February 1994, of whom 34 percent remained for one to four years and 33 percent remained for longer than four years. Sixty-four percent of the clients who stayed in the program a year or longer attained employment. The program maintained an average employment rate of 33 percent of all participating clients. More than half of the clients who held jobs worked part time and were employed more than half of the time that they were in the program.     

Perceived social support and community adaptation in schizophrenia

Prompted by the continuing transition to community care, mental health nurses are considering the role of social support in community adaptation. This article demonstrates the importance of distinguishing between kinds of social support and presents findings from the first round data of a longitudinal study of community adaptation in 156 people with schizophrenia conducted in Brisbane, Australia. All clients were interviewed using the relevant subscales of the Diagnostic Interview Schedule to confirm a primary diagnosis of schizophrenia. The study set out to investigate the relationship between community adaptation and social support. Community adaptation was measured with the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP) and measures of dissatisfaction with life and problems in daily living developed by the authors. Social support was measured with the Arizona Social Support Interview Schedule (ASSIS). The BPRS and ASSIS were incorporated into a client interview conducted by trained interviewers. The LSP was completed on each client by an informal carer (parent, relative or friend) or a professional carer (case manager or other health professional) nominated by the client. Hierarchical regression analysis was used to examine the relationship between community adaptation and four sets of social support variables. Given the order in which variables were entered in regression equations, a set of perceived social support variables was found to account for the largest unique variance of four measures of community adaptation in 96 people with schizophrenia for whom complete data are available from the first round of the three-wave longitudinal study. A set of the subjective experiences of the clients accounted for the largest unique variance in measures of symptomatology, life skills, dissatisfaction with life, and problems in daily living. Sets of community support, household support and functional variables accounted for less variance. Implications for mental health nursing practice are considered.     

Amelioration of methotrexate-induced malabsorption by vitamin A

Since the early 1960s the Brief Psychiatric Rating Scale (BPRS) has been one of the most frequently used standardized methods in international psychiatric research. The BPRS is used mainly for the rating of psychopathological symptoms of schizophrenic subjects. According to the results of factorial analyses, the original version of the BPRS is divided into five subscales, which have been preserved in the German translation. The validity of this original scale structure for the German BPRS version has not been investigated, however. A principal-components analysis of the 18 BPRS items carried out on the data of 301 schizophrenics yielded four factors that are comparable with four of the original subscales: Thought disturbance, Hostility/suspiciousness, Anxiety/depression, and Anergia. These results are compared with earlier findings and similarities and differences are discussed.     

Outcome analysis of work-hardening programs

The competitive marketplace and the demand for accountability by health care payers are strongly influencing the need for work hardening programs to participate in program evaluation and produce outcome data. This study compiled program performance data on 22 work programs in Wisconsin over an 11-month period. Client data related to demographics of gender, age, occupation, insurance coverage, diagnosis, services clients received, patterns of attendance, and outcomes upon discharge were collected. Results described the majority of the clients treated in the work hardening programs to be men, aged 26 to 46 years, with occupations classified in the miscellaneous category according to the Dictionary of Occupational Titles. The reimbursement source for the majority of work program clients was worker's compensation. The most frequent condition treated was injury to the lumbar spine. Most clients were treated and discharged within a 3-week period. More than half of the clients served returned to their usual and customary jobs.     

A preliminary study of partial hospital management of severe obsessive-compulsive disorder

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.     

Meta-analysis of the Brief Psychiatric Rating Scale factor structure.

A meta-analysis (N=17,620; k=26) of factor analyses of the Brief Psychiatric Rating Scale (BPRS) was conducted. Analysis of the 12 items from Overall et al.'s (J. E. Overall, L. E. Hollister, & P. Pichot, 1974) 4 subscales found support for his 4 subscales. Analysis of all 18 BPRS items found 4 components similar to those of Overall et al. In a 5-component solution, a 5th activation component emerged but was best supported among samples of schizophrenic patients. The first 4 components appear to form the core of the BPRS factor structure. Results of the meta-analysis suggest 5 subscales (with items in parentheses): Affect (anxiety, guilt, depression, somatic); Positive Symptoms (thought content, conceptual disorganization, hallucinatory behavior, grandiosity); Negative Symptoms (blunted affect, emotional withdrawal, motor retardation); Resistance (hostility, uncooperativeness, suspiciousness); and Activation (excitement, tension, mannerisms-posturing). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speech outcomes of a prolonged-speech treatment for stuttering

It has been shown that people who stutter can speak with greatly reduced stuttering after treatments that use variations of Goldiamond's (1965) prolonged-speech (PS). However, outcome research to date has not taken account of several important issues. In particular, speech outcome measures in that research have been insufficient to show that lasting relief from stuttering has been achieved by clients outside the clinic for meaningful periods. The present study used extensive speech outcome measures across a variety of situations in evaluating the outcome of an intensive PS treatment (Ingham, 1987). The speech of 12 clients in this treatment was assessed on three occasions prior to treatment and frequently-on eight occasions-after discharge from the residential setting. For 7 clients, a further assessment occurred at 3 years posttreatment. Concurrent dependent measures were percent syllables stuttered, syllables per minute, and speech naturalness. The dependent measures were collected in many speaking situations within and beyond the clinic. Dependent measures were based on speech samples of substantive duration, and covert assessments were included in the study. Detailed data were presented for individual subjects. Results showed that 12 subjects who remained with the entire 2-3-year program achieved zero or near-zero stuttering. The majority of subjects did not show a regression trend in %SS or speech naturalness scores during the posttreatment period, either within or beyond the clinic. Some subjects showed higher posttreatment %SS scores during covert assessment than during overt assessment. Results also showed that stuttering was eliminated without using unusually slow and unnatural speech patterns. This treatment program does not specify a target speech rate range, and many clients maintained stutter-free speech using speech rates that were higher than the range typically specified in intensive PS programs. A significant correlation was found between speech rate and perceived posttreatment speech naturalness.     

Responsiveness of Health-Related Quality of Life Outcome Measures in Cardiac Rehabilitation: Comparison of Cardiac Rehabilitation Outcome Measures.

Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each battery was completed by cardiac rehabilitation and comparison participants at 2 time points (411 and 375 participants in total, respectively). There was a high degree of variability in the responsiveness of instrument subscales. The positive affect subscale of the Global Mood Scale (J. Denollet, 1993a) was the most responsive (SRM = 0.62). Further information on the comparative responsiveness of psychosocial scales is important to optimize instrument selection for outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of high- and low-dose corticotropin tests in the diagnosis of secondary adrenal insufficiency

Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60-89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms ). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

Emergency care avoidance: ethnic matching and participation in minority-serving programs

Using data from a county level mental health service system, relationships were examined between ethnic matching, program involvement and emergency service use. When clients were matched with an ethnically similar clinician who was also proficient in their preferred language, they had fewer emergency service visits than did clients who were unmatched on the basis of ethnicity and language. Equally if not more significant than ethnicity or language matching was the client's program and the proportion of minority clients it served. Clients in programs serving a relatively large proportion of minority clients had fewer emergency service visits than those in programs serving a smaller proportion of minority clients. More research is needed to document the impact of matching along with greater attention to minority oriented programs.     

An integrated medical and psychosocial treatment program for psychotic disorders: patient characteristics and outcome

OBJECTIVES: To provide an overview of a comprehensive and integrated case-management program that incorporates principles of assertive community treatment and combines effective medical and psychosocial interventions and to present the results of a process and outcome evaluation of the program, with particular emphasis on its impact on service utilization and consumer satisfaction. METHOD: Data on demographic, clinical, and several outcome measures were collected on all patients who received care in the program for a minimum of 6 months. For process evaluation we assessed the extent to which the program adhered to its goals and satisfied the patients, their families, and community-service agencies. Outcome-evaluation data on the number and length of hospital admissions were compared for each subject with individual historical data for a period equal to the time spent in the program. In addition, relapses of psychotic symptoms that did not result in hospital admissions were calculated for each patient while in the program. RESULTS: Demographic, clinical, and treatment characteristics of clients show that the program has succeeded in maintaining its focus on providing services to relatively chronically ill patients with psychotic disorders over a mean period of 3 years. The process-evaluation data indicated a high level of satisfaction by patients, families, and other service agencies with the services received. Information on outcome variable showed that the program achieved significantly lower rates of hospital admissions and relapse of psychosis than expected. There was a highly significant reduction achieved in the utilization of inpatient hospital resources for patients receiving care in the program. Most of the inpatient service utilization was attributed to patients either who were resistant to treatment with antipsychotic agents or who refused to accept or comply with medication. CONCLUSIONS: It is possible to provide effective continuity of care from inpatient treatment to community adjustment for most individuals with psychotic disorders across the spectrum by blending hospital and community resources within an integrated case-management model of care.     

Relation of counselor identification of client problem description to continuance in a behavioral weight loss program.

I investigated the relation of counselor ability to articulate salient information to continuance in a weight loss program in two studies. In the first, clients (N?=?39) were asked questions regarding their weight loss problems, and counselors were asked to predict client responses. A higher proportion of accurate predictions occurred for clients who later completed the program than for those who dropped out. Within the completer group, there was greater weight loss in cases that had been accurately predicted than in those that had not. The second study was identical to the first except for program duration, which was eight sessions for the first and six sessions for the second (N?=?41 clients). The results of the second study replicated those of the first with regard to continuance but not outcome. I discuss the relevance of the results to similar research done with different client populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An agency-based representative payee program and improved community tenure of persons with mental illness

OBJECTIVE: Representative payee programs help severely mentally ill individuals manage money from their Social Security payments to cover expenses for necessities and to avoid homelessness and rehospitalization. This study examined a representative payee program operated by a community mental health center to determine the criteria used by clinicians and ease managers to refer clients to the program and to learn whether participation in the program was associated with reductions in hospitalization. METHODS: The retrospective study included 56 individuals with severe mental illness who were enrolled in the representative payee program at Community Counseling Centers of Chicago for one year and who also had received services from the agency for at least one year before enrollment. Criteria used to refer clients to the representative payee program were determined through chart reviews. Data on state hospitalizations before and after enrollment were available for the entire sample; additional data on Medicaid-funded private hospitalizations were available for a subset of 33 clients. RESULTS: The most common criteria for enrollment in the representative payee program were comorbid substance abuse or dependence (49 percent), a history of homelessness (33 percent), and frequent hospitalizations (32 percent). During the year of participation in the representative payee program, the mean number of days spent in state hospitals decreased markedly compared with the year before enrollment, from 68 days to seven days. A similar reduction was noted in the number of days spent in state and private hospitals, from 97 days to 15 days. CONCLUSIONS: Findings from this pre- and postintervention retrospective study are tentative in the absence of a more rigorous design. However, the results suggest that the representative payee program is quite effective in reducing hospital stays.     

Predictors of child psychological changes during family-based treatment for obesity

OBJECTIVE: To explore the influence of 1-year changes in child obesity and maternal psychopathology on changes in child psychological problems. DESIGN: Hierarchical regression models were used to predict child psychological change, with demographic variables, maternal psychological change, and child percentage overweight change as predictors. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Clinic sample of 116 obese 8- to 12-year-old children and their mothers. INTERVENTIONS: Family-based behavioral weight-control program. MAIN OUTCOME MEASURES: Child psychopathology was assessed via mother-reported Child Behavior Checklists and maternal psychopathology was determined by standardizing scores on the Cornell Medical Index and the Symptoms Checklist-90-Revised. RESULTS: Significant improvements were observed in child percentage overweight (-20.1% overweight), and child and maternal psychopathology. Improved maternal psychopathology accounted for a significant amount of variance in improvements in the Child Behavior Checklist total Problems Scale and internalizing and externalizing problems subscales. Decreased obesity accounted for a significant amount of variance in improvements in the Total Competence scale and, somatic complaints, social problems and social competence subscales of the Child Behavior Checklist. Significant interactions of child obesity change by sex were found for Total Problems and externalizing scores. The interactions were due to girls with greater obesity reduction showing greater improvement in Total Problems, whereas boys with greater obesity reduction showed less improvement in externalizing problems. CONCLUSIONS: These results highlight the multidimensional nature of psychosocial functioning in obese children and call attention to multiple avenues for intervention to improve their psychosocial functioning.     

Training clinical psychologists for work with older adults: A working model.

Describes the Geropsychological Services Program established as part of the program in clinical/community psychology at the University of Oregon. Problems that faced the development of this program, principles that were established to govern its implementation, and the merger of didactic and experiential training are discussed. The major service aspects of the program involve reciprocal communication with community agencies and comprehensive psychosocial evaluations and treatment for elderly clients and their concerned caregivers. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of systematic group counseling on work adjustment clients.

Developed initially to enable motivated physically handicapped clients to return to work, rehabilitation is now encountering more clients who, due to psychological deficiencies, believe themselves no longer capable of productive work. To help clients build key psychosocial skills, a systematic group counseling approach, Personal Achievement Skills (PAS), was introduced and tested in a work adjustment setting in a comprehensive rehabilitation center. When compared with a group of 23 clients who had received work adjustment services and a placebo treatment (personal hygiene training), 20 experimental clients given Personal Achievement Skills and work adjustment services reported greater gains on self-ratings of life perspective (optimism), work-related attitudes, and goal attainment. Further research is needed to determine whether such psychological changes contribute to employment and job retention. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance in occupational therapy as a predictor of successful prevocational training

Scores on three subtests of the Minnesota Follow-up Scale (MFS) were related to client outcomes in a prevocational training program in a study of 26 clients who were referred from an adult psychiatric day treatment unit. The results of the study agreed with a prediction that successful performance in occupational therapy in the day treatment unit, as measured by subtest 1, would be significantly related to successful client outcomes. the results regarding predictions for two other subtests were less conclusive because clients received high scores. Age and sex distributions showed that the younger male clients were most likely to be referred for prevocational training. The staff of the prevocational training program accepted the results of the study and also agreed that performance in occupational therapy (in the day treatment unit) should receive greater recognition by staff members as an important indicator of work potential when evaluating clients for referral to a vocational training program. It is planned to continue the use of the MFS in the day treatment unit as an aid for evaluating clients for referral purposes. Scores will continue to be related to client outcomes in the prevocational training program. Further study is also planned concerning the relationship of age and sex and sources to which clients are discharged or referred from the day treatment unit.     

Sensitivity to change of the Brief Psychiatric Rating Scale-Extended (BPRS-E): An item and subscale analysis.

The Brief Psychiatric Rating Scale (BPRS) is the most commonly used outcome measure for the severely and persistently mentally ill (SPMI) population, possessing good interrater reliability, concurrent validity, and a strong factor structure. However, psychometric study of the extended version of the BPRS (the BPRS-E) is limited when compared with earlier versions (BPRS and BPRS-A). This study examined the item, factor, and diagnosis-specific sensitivity to change of the BPRS-E, the most recent version of this popular scale. Assessments were conducted at 90-day intervals with 201 adult psychiatric inpatients at the Utah State Hospital, yielding 786 symptom ratings. Of note was that ratings were conducted by independent assessors who were unaware of patients' treatment status. All but 2 of the 24 BPRS-E items, all 4 factors, and the total score were found to be sensitive to change when comparing patients' admission and discharge scores. Patient diagnosis was not associated with item, factor, or total score sensitivity to change. These findings extend the psychometric support for the BPRS-E and have implications for assessing outcome with the SPMI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The brief admission unit in emergency psychiatry

The study evaluates a Brief Admission Unit for clients of an emergency service located within a comprehensive community psychiatric program. Eighty-five clients completed the Brief Symptom inventory and a structured interview. Substance abuse disorder (n = 29) and major depression (n = 24) were the most common Axis I diagnoses, of which 30 subjects had two or more. Sixty subjects had an Axis II diagnosis. Mean duration of admission was 3.9 days, compared with the average in other acute units of 11.5 days. At discharge, half the subjects were rated as moderately to greatly improved and client satisfaction was high. The unit was crucial to the psychiatric emergency service and had a key role in relieving pressure on beds elsewhere within the system.     

Contraceptive practice after clinic discontinuation

A follow-up study was conducted of clients who stopped attending 4 family planning clinics in Washington County, Oregon, a predominantly white, middle-class suburban community. Clients had enrolled in the program between 1971-74, and dropped out by April 1975. 29% of the women (746) who were overdue for a return visit by more than 3 months (i.e. inactive clients) were contacted by phone and mail. No significant social or demographic differences were found between active and inactive clients or between dropouts who were contacted and those who were not. 71% of all program enrollees dropped out by the end of 3 years. However, 90% of the sample were either using contraception or not at risk of an unwanted pregnancy for a variety of reasons. The remaining 10% were either unprotected or already pregnant with an unplanned pregnancy (2%). The women at risk and not using contraception were more likely to be young, poorly educated, single, and recent enrollees in the family planning program. No other social or economic differences affected the comparison of the 2 groups. Most users continued to use the same method of contraception they had used before. However, a significantly smaller proportion of women were using the pill, a slightly larger proportion were using IUD and 6% more clients were sterilized. The most common reasons for leaving the program were the decision to use a private physician and relocation. Among women at risk, the most common reason was worry about the contraceptive method, especially the pill. New sources of care included private physicians (71%, but 1/3 of these women were disatisfied with their doctors' care or fees), public health clinic not part of the family planning program (21%) and drugstores. A very few women reported no alternate source of care.