A survey of New Zealand psychiatrists' clinical experience with the Mental Health (Compulsory Assessment and Treatment) Act of 1992

AIMS: This study examines the clinical experience of New Zealand psychiatrists with the Mental Health (and Compulsory Assessment and Treatment) Act of 1992. METHODS: A survey was distributed to all psychiatric specialists residing in New Zealand who were registered with the Medical Council of New Zealand (n = 232). The survey examined the extent of practitioners' use of the Mental Health Act, perceived strengths and weaknesses of the Mental Health Act, and experiences with the family court system. RESULTS: Psychiatrists estimated that almost half (46.4%) of patients retained under the Mental Health Act were released within 3 weeks. Inpatient consultants reported dedicating 18.6% of their working time to Mental Health Act related activities. A majority of respondents indicated that: the Mental Health Act requires major revision (55.6%), the Mental Health Act results in the inappropriate release of some psychiatric patients into the community (70.9%), and that compulsory treatment orders are a useful tool for promoting community treatment of the mentally ill (69.2%). While a majority (81.5%) indicate that individual judges are consistent in their interpretation of the Mental Health Act across cases, only 26.5% of respondents agree that the law is interpreted uniformly by different judges. CONCLUSIONS: The Mental Health Act is perceived as time-consuming and cumbersome to administer. However, compulsory treatment orders do facilitate community treatment, an explicit goal of the Mental Health Act. Proposed areas for refinement of the Mental Health Act are discussed. Further examination of the interface between psychiatrists and the family court system would be useful.     

Drug Abuse Treatment Outcome Study (DATOS): Treatment Evaluation Research in the United States.

Much of what is known about typical drug abuse treatment outcomes comes from a series of large-scale national prospective longitudinal treatment evaluation studies supported by the National Institute on Drug Abuse over the past 3 decades. An overview of the historical context, research design, and findings from the Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) is presented. The Drug Abuse Treatment Outcome Study (DATOS), a multisite cooperative agreement, is the latest and most advanced in this research designed to understand drug abuse treatment. DATOS investigators are conducting analyses in 4 thematic areas: health services research, retention and engagement in treatment, the life course of treated addicts, and policy-relevant treatment outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue: The National Institute on Drug Abuse's (NIDA's) Drug Abuse Treatment Outcome Study (DATOS).

Seven of the articles in this special issue of Psychology & Addictive Behaviors compose the 1st comprehensive look at an important collaborative research endeavor of the National Inst on Drug Abuse (NIDA), the Drug Abuse Treatment Outcome Study (DATOS). This introduction highlights some of the key findings of DATOS that are reported in this special issue. Also highlighted are areas that future DATOS studies should help illuminate about the effectiveness of drug abuse treatment as it is typically practiced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical experience with methohexital-nitrous oxide anaesthesia (author's transl)

The effects of methohexital, given as a 0.1% intravenous drip in combination with nitrous oxide were studied in 159 persons who had various types of surgical operations. The depth of anaesthesia was easily controlled, the circulation remained unaffected and the combination was well tolerated. There were no difficulties concerning either induction or recovery. The combination of i.v. methohexital and nitrous oxide proved very satisfactory for maintaining prolonged anaesthesia in elderly persons and patients in poor general health.     

Twenty-two year's experience with intraocular lenses (author's transl)

The employment of the intraocular lens is an acceptable procedure in selected cases. It has great optical and practical advantages over conventional treatment. In the evaluation of suitable cases, clinical considerations, indications and contraindications are of major importance. The extraction of the opaque cataractous lens from the human eye is an eternally new, ever exciting operation which always has challenged the skill of the ophthalmic surgeon. It is not easy and it always involves a risk. The additional demands of technique incurrent in the insertion of the intraocular pupillary lens render the operation still more difficult and increase the risks. The results presented and the advantages achieved justify, in my opinion, the use of an intraocular lens in selected cases of cataract extraction.     

Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS).

Program and client data from the Drug Abuse Treatment Outcome Study (DATOS) were used to examine program structural and treatment characteristics in 1991–1993. Similar data from the Treatment Outcome Prospective Study were used to compare the characteristics of DATOS programs with those in 1979–1981. Drug abuse treatment typically consisted of supportive therapy delivered primarily in groups, emphasizing abstinence from all illicit substances, including alcohol, buttressed by relapse prevention and urine monitoring during treatment. Secondary treatment emphases reflected each modality's unique orientations. Over the 2 eras, comprehensive services declined while many core elements of treatment strengthened, including client awareness of treatment plans and posttreatment involvement in 12-step groups. Some programs began to experience structural changes resulting from cost containment and managed care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).

Clients in the national Drug Abuse Treatment Outcome Study reported significant overall improvements in drug use and related measures during a 12-month follow-up period. A quasi-experimental design was used to examine the relationship of treatment duration with outcomes in each of the 3 major modalities represented. Client subsamples with longer retention in long-term residential programs and in outpatient methadone treatment had significantly better outcomes than those with shorter lengths of stay (results were inconclusive for outpatient drug-free programs because of sample limitations). This study used several methodological enhancements and showed general continuity of findings on retention effects from previous national evaluations of treatment effectiveness. It supports the need for more careful study of treatment process in relation to outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug addiction and treatment careers among clients in the Drug Abuse Treatment Outcome Study (DATOS).

Considerable heterogeneity in patterns of addiction and treatment career histories was observed among the 10,010 clients participating in the Drug Abuse Treatment Outcome Study (DATOS). For half of the clients, DATOS was their first treatment episode; for the other half, their mean number of prior treatment episodes was 3.5. Type of treatment and cumulative length of treatment exposure reflected the interaction of clients' drug use patterns and the historical availability of different treatment approaches. Regression analyses showed that a higher level of prior treatment use was associated with more severe addiction career characteristics, injection drug use, and criminal activities. Effective and cost-effective approaches to treatment need to include more strategic interventions that consider clients' diverse treatment histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of human leptospira infections with semicillin (ampicillin) or with amoxil (amoxycillin)

Ampicillin (Semicillin) and Amoxycillin (Amoxil) have a strong leptospirocidal effect in vitro and also in vivo. We have tested these drugs on 28 patients suffering from Leptospira infection. The patients generally received per os 3 g Ampicillin (Semicillin) or 2 g Amoxycillin (Amoxil) per day over a period of 6 days. In the groups treated with Ampicillin and Amoxycillin the average durations of fever during the treatment were 1.6 and 1.2 days, respectively. In the first group (Ampicillin) a 'second wave of fever' occurred in one case (5%) and in the second group (Amoxycillin), in 0% (as compared to 22% after treatment with benzylpenicillin). On the basis of our experiences, Ampicillin and Amoxycillin are strongly recommended for the treatment of human Leptospira infections.     

Treatment of newly diagnosed acute promyelocytic leukemia (APL) by all transretinoic acid (ATRA) combined with chemotherapy: The European experience. European APL Group

All transretinoic acid (ATRA) gives complete remission (CR) rates of 80 to 90% in newly diagnosed acute promyelocytic leukemia (APL). However, it has two major drawbacks (1) a rapid rise in WBC in some patients, with potentially fatal ATRA syndrome (2) rapid relapse with maintenance therapy using ATRA alone or low dose chemotherapy. The French APL group therefore designed a treatment approach with ATRA followed by intensive chemotherapy. The latter was administered after CR achievement with ATRA, or was rapidly added to ATRA in case of rapid rise in leukocyte counts. This combined approach, in a pilot study and in a randomized trial, proved superior to intensive chemotherapy alone, by slightly increasing the CR rate but more importantly by reducing the relapse rate. These results were confirmed by the Chinese, Japanese and New York groups. Our group (and other European groups) are now testing in a new randomized trial the better timing of ATRA and chemotherapy administration (ATRA followed by chemotherapy or ATRA plus chemotherapy) and the role (after an intensive consolidation) of maintenance treatment with intermittent ATRA, continuous low dose chemotherapy or both.     

Treatment of photodermatoses with carotinoids (author's transl)

39 patients were treated with carotinoids (beta-carotene alone or combined with canthaxanthine) with an oral dose of 50-150 mg/d, some of them for a period of several years. 23 of these were patients with porphyria (erythropoietic protoporphyria [EPP] 20, congenital erythropoietic porphyria 2, erythropoietic coproporphyria 1); 16 patients were suffering from various photodermatoses (solar urticaria 6, actinic reticuloid 5, UV-A intolerance 1, unclassified photodermatoses 4). Tolerance of the carotinoids was very good; no side effects were seen except for a yellow discoloration of the skin. In 19 of 20 EPP patients the result of the treatment was good, whereas no improvement was seen in the other kinds of porphyria. Of the 16 cases of photodermatoses not caused by porphyrinopathy, 6 responded to the therapy (solar urticaria 2, actinic reticuloid 2, UV-A intolerance 1, unclassified photodermatosis 1). Some cases showed great improvement as a result of the treatment.