Privatization of psychiatric services.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

The decision to change the primary locus of care for chronically ill psychiatric patients from the state mental hospital to the community has often set off a chain reaction of consequences. Notably, reducing the role of institutions has frequently resulted in destroying needed sanctuary for some patients. The author discusses the relationship between deinstitutionalization and the function of asylum and examines the relevance of three planning principles--functional equivalence, cultural relevance, and potential trade-offs--to the need of chronically ill psychiatric patients for asylum.

The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms. Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States. Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large. These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.

Back to table of contents Previous article Next article ArticleNo AccessTHE SCOPE AND PRACTICE OF AN EARLY-ACCESS BRIEF TREATMENT PSYCHIATRIC CENTERG. F. JACOBSON, D. M. WILNER, W. E. MORLEY, S. SCHNEIDER, M. STRICKLER, and G. J. SOMMERG. F. JACOBSONSearch for more papers by this author, D. M. WILNERSearch for more papers by this author, W. E. MORLEYSearch for more papers by this author, S. SCHNEIDERSearch for more papers by this author, M. STRICKLERSearch for more papers by this author, and G. J. SOMMERSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.121.12.1176AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByLiteraturTraining for Crisis Counselling16 October 2007 | British Journal of Guidance & Counselling, Vol. 11, No. 2Customer Approach and Walk-in Clinic Drop-Out Phenomenon27 July 2016 | International Journal of Social Psychiatry, Vol. 29, No. 2Walk-in Clinic Drop-Outs27 July 2016 | International Journal of Social Psychiatry, Vol. 28, No. 3Crisis intervention with adultsNew Directions for Mental Health Services, Vol. 1980, No. 6Comprehensive Psychiatry, Vol. 20, No. 6Terapia breve em hospital fechadoArquivos de Neuro-Psiquiatria, Vol. 36, No. 3A HOSPITALIZATION CRITERIA CHECKLIST AS AN EVALUATION TOOL FOR AN EMERGENCY SERVICERobert Sherrill, Jr.1 April 2006 | Psychiatric Services, Vol. 28, No. 11Generic and Individual Approaches to Crisis InterventionConspiracy of silence: psychiatric counseling with students at high risk for academic failure1 April 2006 | American Journal of Psychiatry, Vol. 132, No. 11Evaluation Des Soins en Pedopsychiatrie26 April 2017 | Canadian Psychiatric Association Journal, Vol. 20, No. 3Crisis Intervention Counseling and Police Diversion from the Juvenile Justice System: A Review of the Literature14 July 2009 | Juvenile Justice, Vol. 25, No. 1Crisis intervention and social casework: Similarities and differences in problem-solvingClinical Social Work Journal, Vol. 2, No. 1Emergency services in community mental health: problems and promise.American Journal of Public Health, Vol. 64, No. 2Referral Failures: A One-Year Follow-UpWALTER A. CHAMEIDES, and JOE YAMAMOTO1 April 2006 | American Journal of Psychiatry, Vol. 130, No. 10Brief Hospitalization on a Crisis Service: A Study of Patient and Treatment VariablesW. RAY WALKER, LOWELL B. PARSONS, and W. DOUGLAS SKELTON1 April 2006 | American Journal of Psychiatry, Vol. 130, No. 8The relationship of interpersonal acting-out to the process of decompensationClinical Social Work Journal, Vol. 1, No. 1Crisis Intervention: Theoretical and Methodological Considerations26 June 2016 | Australian & New Zealand Journal of Psychiatry, Vol. 5, No. 3Emergency Services26 April 2017 | Canadian Psychiatric Association Journal, Vol. 16, No. 2Smith College Studies in Social Work, Vol. 41, No. 2Community Mental Health Journal, Vol. 6, No. 4An Outpatient Setting for Treating Chronically Ill Psychiatric PatientsRICHARD T. RADA, ROBERT S. DANIELS, and EDGAR DRAPER1 April 2006 | American Journal of Psychiatry, Vol. 126, No. 6Journal of the American Academy of Child Psychiatry, Vol. 8, No. 3Generic and individual approaches to crisis intervention.American Journal of Public Health and the Nations Health, Vol. 58, No. 2A Psychiatric Emergency Service and Some Treatment ConceptsWARREN B. MILLER1 April 2006 | American Journal of Psychiatry, Vol. 124, No. 7British Journal of Psychiatry, Vol. 114, No. 509A systematic approach to brief therapy for patients from a low socioeconomic communityCommunity Mental Health Journal, Vol. 3, No. 4Emergency Psychiatry: Referrals from a Personal Advisory Service26 June 2016 | Australian & New Zealand Journal of Psychiatry, Vol. 1, No. 2BRIEF PSYCHOTHERAPY: A PSYCHOANALYTIC VIEWROBERT D. GILLMAN1 April 2006 | American Journal of Psychiatry, Vol. 122, No. 6 Volume 121Issue 12 June 1965Pages 1176-1182 Metrics PDF download History Published online 1 April 2006 Published in print 1 June 1965

Little attention outside the therapeutic setting has been given to specifying the aspects of social relationships that might be helpful for patients recovering from psychotic episodes. The authors studied 20 patients who had been hospitalized for a psychotic episode for 1 year following discharge to examine the role their social relationships played during this period. The data show that 12 functions of social relationships were important and that there were two phases of social needs--convalescence and rebuilding--over the recovery period. The authors discuss the theoretical and clinical implications of these findings.

Although not a new phenomenon, wife-beating has been largely ignored by mental health professionals. The author describes a context in which the physical abuse of women as wives can be understood and suggests alternative theoretical constructs to traditional theories of masochism as explanations of why women stay in violent marital relationships. She discusses the societal attitudes that normalize the use of family violence as well as attitudes about women, men, and sex roles that leave women vulnerable to assault; summarizes the research on abused wives; identifies a specific stress response syndrome caused by violent abuse; and elaborates on the problems posed for clinicians working with abused women.

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

Back to table of contents Previous article Next article ArticleNo AccessDr. Weintraub and Associates ReplyWALTER WEINTRAUB, HENRY T. HARBIN, JONATHAN BOOK, GARY W. NYMAN, ALP KARAHASAN, THOMAS KRAJEWSKI, and BRUCE L. REGANWALTER WEINTRAUBSearch for more papers by this author, HENRY T. HARBINSearch for more papers by this author, JONATHAN BOOKSearch for more papers by this author, GARY W. NYMANSearch for more papers by this author, ALP KARAHASANSearch for more papers by this author, THOMAS KRAJEWSKISearch for more papers by this author, and BRUCE L. REGANSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.141.9.1128-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Dr. Weintraub and Associates Reply." American Journal of Psychiatry, 141(9), pp. 1128-a–1129 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byResearch and Services Partnerships: The Practice Research Network: A Successful Collaboration in MarylandSandra J. Sundeen, M.S.N., Howard H. Goldman, M.D., Ph.D., Daniel J. Nieberding, M.S., L.C.P.C., Deborah A. Piez, M.S., L.P.C., and Robert W. Buchanan, M.D.1 May 2013 | Psychiatric Services, Vol. 64, No. 5Community Mental Health Journal, Vol. 41, No. 6A Three-Decade Perspective on Community and Public Psychiatry Training in OregonRupert Goetz, M.D., David L. Cutler, M.D., David Pollack, M.D., Neil Falk, M.D., Elizabeth Birecree, M.D., Bentson McFarland, M.D., Ph.D., George Keepers, M.D., and Dale Walker, M.D.1 September 1998 | Psychiatric Services, Vol. 49, No. 9Residency training in massachusetts: A new approach to state-university collaborationThe journal of mental health administration, Vol. 24, No. 1A Public-Academic Partnership to Train Psychiatric Residents in a Rural Mental Health ProgramDrew Bridges1 April 2006 | Psychiatric Services, Vol. 45, No. 1Academic Psychiatry, Vol. 16, No. 3The Program for Public Psychiatry: State-University Collaboration in ColoradoGordon Neligh, James H. Shore, James Scully, Haydee Kort, Brock Willett, Courtenay M. Harding, and George Kawamura1 April 2006 | Psychiatric Services, Vol. 42, No. 1The Maryland Plan: The Rest of the StoryWalter Weintraub, Gary Nyman, and Henry Harbin1 April 2006 | Psychiatric Services, Vol. 42, No. 1Community Mental Health Journal, Vol. 27, No. 6A basic residency curriculum concerning the chronically mentally ill1 April 2006 | American Journal of Psychiatry, Vol. 146, No. 10New Directions for Mental Health Services, Vol. 1989, No. 42New Directions for Mental Health Services, Vol. 1989, No. 44New Directions for Mental Health Services, Vol. 1989, No. 44Too Many Psychiatrists?WALTER WEINTRAUB1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 3Too Many Psychiatrists?ARTHUR S. MODE1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 3Accuracy of the diagnoses of affective disorders and schizophrenia in public hospitals1 April 2006 | American Journal of Psychiatry, Vol. 145, No. 2New Directions for Mental Health Services, Vol. 1988, No. 37Psychiatric Quarterly, Vol. 59, No. 2Psychiatric Quarterly, Vol. 59, No. 2Psychiatric Quarterly, Vol. 59, No. 2Academic, community and state mental health program collaboration: The Oregon experienceCommunity Mental Health Journal, Vol. 23, No. 4CMHC's: Relationships with academia and the stateCommunity Mental Health Journal, Vol. 23, No. 4Recruitment of Public Psychiatrists: The Impact of University and State Collaboration on FMGs in MarylandWalter Weintraub, and Jonathan Book1 April 2006 | Psychiatric Services, Vol. 37, No. 10Graduates of Foreign Medical Schools in American PsychiatryRodrigo A. Munoz, and Michael Madigan1 April 2006 | Psychiatric Services, Vol. 37, No. 10TEAMS: Teamwork Training for Interns, Residents, and NursesJohn P. Bair, and Brad K. Greenspan1 April 2006 | Psychiatric Services, Vol. 37, No. 6Public-Sector PsychiatristsWalter Weintraub, and Henry T. Harbin1 April 2006 | Psychiatric Services, Vol. 37, No. 6In ReplyKevin Leehey, and John Misiaszek1 April 2006 | Psychiatric Services, Vol. 37, No. 6 Volume 141Issue 9 September 1984Pages 1128-a-1129 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1984

The author compared the arrest rates of 301 former state mental hospital patients with those of the local county population and selected U.S. cities. He found that the patients had a markedly higher incidence of arrests for criminal behavior, including violent offenses, than either of the comparison groups. Patients who were female, aged 20-30, and nonwhite had higher arrest rates for violent offenses than the rest of the study group. These findings are at variance with those of earlier studies but are in general agreement with more recent studies. The author suggests the need for further research in order to more completely identify those factors which explain the high crime rate among the mentally ill.

Back to table of contents Previous article Next article ArticleNo AccessDr. Donlon RepliesPATRICK T. DONLONPATRICK T. DONLONSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.136.9.1232-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Dr. Donlon Replies." American Journal of Psychiatry, 136(9), pp. 1232-a–1232 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byEvidence for Onset of Antipsychotic Effects Within the First 24 Hours of TreatmentShitij Kapur, M.D., Ph.D., Tamara Arenovich, M.S., Ofer Agid, M.D., Robert Zipursky, M.D., Stacy Lindborg, Ph.D., and Barry Jones, M.D.1 May 2005 | American Journal of Psychiatry, Vol. 162, No. 5First-Episode Psychosis: Influences of Culture and Medical ComorbidityHarvard Review of Psychiatry, Vol. 12, No. 5Journal of Psychiatric Practice, Vol. 9, No. 1Pediatric Emergency Care, Vol. 16, No. 5Anesthesia & Analgesia, Vol. 85, No. 1Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services1 April 2006 | Psychiatric Services, Vol. 47, No. 3New Directions for Mental Health Services, Vol. 1965, No. 3Acta Psychiatrica Scandinavica, Vol. 90, No. 5, Vol. 121Changing patterns of neuroleptic dosage over a decade1 April 2006 | American Journal of Psychiatry, Vol. 146, No. 6Efficacy of Adjunctive Carbamazepine in the Treatment of Chronic Schizophrenia13 February 2017 | Drug Intelligence & Clinical Pharmacy, Vol. 21, No. 4, Vol. 7Treatment of intractable hiccups with intramuscular haloperidol1 April 2006 | American Journal of Psychiatry, Vol. 142, No. 11The Intensive Care Unit Syndrome: Causes, Treatment, and Prevention30 August 2016 | Drug Intelligence & Clinical Pharmacy, Vol. 19, No. 1The Violent Patient: A Strategy for Management and DiagnosisJoe P. Tupin1 April 2006 | Psychiatric Services, Vol. 34, No. 1Training Personnel in the Prevention and Management of Violent BehaviorLaurent S. Lehmann, Maria Padilla, Shawn Clark, and Sandra Loucks1 April 2006 | Psychiatric Services, Vol. 34, No. 1Efficacy and side effects of haloperidol in psychotic patients: oral versus intravenous administration1 April 2006 | American Journal of Psychiatry, Vol. 139, No. 12Overview: clinical applications of the Amytal interview in psychiatric emergency settings1 April 2006 | American Journal of Psychiatry, Vol. 139, No. 5Clinical use of the antipsychotics1 April 2006 | American Journal of Psychiatry, Vol. 138, No. 2New England Journal of Medicine, Vol. 305, No. 19Neuroleptic-Induced Depression?FRED WEINSTEIN1 April 2006 | American Journal of Psychiatry, Vol. 137, No. 2Pseudomonas aeruginosa in hemodialysates from schizophrenic patients1 April 2006 | American Journal of Psychiatry, Vol. 137, No. 2Neuroleptic-induced depression?1 April 2006 | American Journal of Psychiatry, Vol. 137, No. 2Cancer, Vol. 46, No. S4Cardiac arrhythmia and haloperidol1 April 2006 | American Journal of Psychiatry, Vol. 136, No. 11 Volume 136Issue 9 September 1979Pages 1232-a-1232 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1979

Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings. Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments. The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder. These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.

Pathological gambling was officially defined as a psychiatric illness by APA in 1980. The authors report on the results of a state-wide study in New York that indicated significant differences between problem gamblers in the general population and pathological gamblers entering publicly funded treatment programs. These results, based on telephone interviews using standardized assessment instruments with 1,000 persons, raise serious clinical and programmatic issues regarding the development and organization of appropriate services for pathological gamblers. They also point to the fact that large segments of the general population are not receiving needed services.

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

The authors evaluated characteristics of patients whom clinicians accurately assessed as being at high or low risk for violence and patients for whom clinicians overestimated or underestimated the risk. At admission, physicians estimated the probability that each of 226 psychiatric inpatients would physically attack someone during the first week of hospitalization. Nurses rated assaultive behavior in the hospital with the Overt Aggression Scale. Acute symptoms were rated with the Brief Psychiatric Rating Scale. For the group as a whole, assessed levels of risk were substantially related to later physical aggression (sensitivity = 67%, specificity = 69%). Multinomial logit analysis showed that patients with psychotic disorders such as schizophrenia, organic psychotic conditions, and mania were more likely to be accurately assessed by clinicians as being at high risk (true positives) than to be true negatives or false positives. A recent history of violence was associated with higher estimated risk but did not distinguish true positives from false positives. An admission mental status characterized by low levels of hostility, uncooperativeness, and suspiciousness and high levels of depression, guilt, and anxiety differentiated true negative patients from others, but symptom profiles did not differ among true positives, false positives, and false negatives. Clinical judgments emphasizing gender and race/ethnicity were associated with predictive errors: nonwhite and male patients tended to be false positives. While clinicians can accurately classify the potential for violence in the majority of patients at admission, systematic errors characterize inaccurate assessments of the risk. Awareness of these patterns may help improve assessment of the risk of violence in clinical practice.

The goal of this study was to determine whether self-mutilators with personality disorders differ from nonmutilators with personality disorders in impulsivity, aggression, and other psychopathology and whether serotonergic dysfunction contributes to self-mutilation. Twenty-six self-mutilators with personality disorders were matched to 26 control subjects with personality disorders for gender, age, education, axis I diagnosis of affective disorder, and axis II diagnosis of personality disorder. Numerous indexes of psychopathology as well as CSF 5-hydroxyindoleacetic acid (5-HIAA) levels and platelet imipramine binding sites (Bmax) and affinity (Kd) were determined. Self-mutilators had significantly more severe character pathology, had greater lifetime aggression, and were more antisocial than the control subjects. The self-mutilators scored higher on the Hamilton Rating Scale for Depression but not on the Beck Depression Inventory or the Beck Hopelessness Scale. The two groups did not differ on the Buss-Durkee Hostility and Guilt Inventory or on the Sensation Seeking Scale. The degree of self-mutilation was significantly correlated with impulsivity, chronic anger, and somatic anxiety. Both self-mutilation and impulsivity showed significant negative correlations with Bmax, although the two groups did not differ in CSF 5-HIAA levels or in platelet imipramine binding. The results demonstrate the contribution of severe character pathology, aggression, impulsivity, anxiety, and anger to self-mutilation and provide preliminary support for the hypothesis of underlying serotonergic dysfunction facilitating self-mutilation.