RESUMEN
A 50-year-old male presented for a Whipple's procedure to excise a pancreatic lesion. Massive transfusion of packed cells and fresh frozen plasma was required. Towards the end of the procedure, the patient developed sudden onset of frank pulmonary oedema and hypotension. A presumptive diagnosis of transfusion related lung injury was made after prompt investigations excluded circulatory overload or cardiogenic shock as the cause. This case report describes an increasingly common and life-threatening sequela of blood product transfusion, the management of which is complicated by the current lack of specific diagnostic tests.
Asunto(s)
Hipotensión/etiología , Complicaciones Intraoperatorias/etiología , Plasma , Edema Pulmonar/etiología , Síndrome de Dificultad Respiratoria/etiología , Reacción a la Transfusión , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The use of mental health indicators to compare provider performance requires that comparisons be fair. Fair provider comparisons mean that scores are risk adjusted for client characteristics that influence scores and that are beyond provider control. Data for the study are collected from 336 outpatients receiving publicly funded mental health services in Washington State. The study compares alternative specifications of multiple regression-based risk-adjustment models to argue that the particular form of the model will lead to different conclusions about comparative treatment agency performance. In order to evaluate performance fairly it is necessary to not only incorporate risk adjustment, but also identify the most correct form that the risk-adjustment model should take. Future research is needed to specify; test, and validate the mental health risk-adjustment models best suited to particular treatment populations and performance indicators.
Asunto(s)
Servicios Comunitarios de Salud Mental/normas , Trastornos Mentales/epidemiología , Indicadores de Calidad de la Atención de Salud , Ajuste de Riesgo , Adulto , Benchmarking , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Modelos Estadísticos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Análisis de Regresión , Muestreo , Washingtón/epidemiologíaRESUMEN
Participants were 54 clients with serious psychiatric disorders and 21 clinical case managers. Clients' serious psychiatric disorders included Axis I diagnoses, such as schizophrenia and bipolar disorder. This study examined how attachment states of mind of both clients and case managers influenced the effectiveness of therapeutic relationships and client functioning. Client and case manager attachment states of mind interacted in predicting the working alliance and client functioning. Specifically, clients who were more deactivating with respect to attachment had better alliances and functioned better with less deactivating case managers, whereas clients who were less deactivating worked better with more deactivating case managers. These findings highlight the importance of clinicians and clients being matched in ways that balance their interpersonal and emotional strategies.
Asunto(s)
Manejo de Caso/normas , Trastornos Mentales/terapia , Apego a Objetos , Relaciones Profesional-Paciente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia/normas , Análisis de Regresión , Resultado del TratamientoRESUMEN
OBJECTIVE: The study examined the association between fidelity of programs to the assertive community treatment model and client outcomes in dual disorders programs. METHODS: Assertive community treatment programs in the New Hampshire dual disorders study were classified as low-fidelity programs (three programs) or high-fidelity programs (four programs) based on extensive longitudinal process data. The study included 87 clients with a dual diagnosis of severe mental illness and a comorbid substance use disorder. Sixty-one clients were in the high-fidelity programs, and 26 were in the low-fidelity programs. Client outcomes were examined in the domains of substance abuse, housing, psychiatric symptoms, functional status, and quality of life, based on interviews conducted every six months for three years. RESULTS: Clients in the high-fidelity assertive community treatment programs showed greater reductions in alcohol and drug use and attained higher rates of remission from substance use disorders than clients in the low-fidelity programs. Clients in high-fidelity programs had higher rates of retention in treatment and fewer hospital admissions than those in low-fidelity programs. No differences between groups were found in length of hospital stays and other residential measures, psychiatric symptoms, family and social relations, satisfaction with services, and overall life satisfaction. CONCLUSIONS: Faithful implementation of, and adherence to, the assertive community treatment model for persons with dual disorders was associated with superior outcomes in the substance use domain. The findings underscore the value of measures of model fidelity, and they suggest that local modifications of the assertive community treatment model or failure to comply with it may jeopardize program success.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Servicios Comunitarios de Salud Mental/organización & administración , Diagnóstico Dual (Psiquiatría) , Abuso de Marihuana/complicaciones , Esquizofrenia/complicaciones , Resultado del Tratamiento , Adulto , Trastornos Relacionados con Cocaína/diagnóstico , Femenino , Humanos , Masculino , Abuso de Marihuana/diagnóstico , New Hampshire , Cooperación del Paciente , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , Esquizofrenia/diagnósticoRESUMEN
OBJECTIVE: To determine the cost-effectiveness of Assertive Community Treatment (ACT) in comparison to Standard Case Management (SCM) for persons with severe mental illness and substance use disorders. DATA SOURCES AND STUDY SETTING: Original data on the effectiveness and social costs of ACT and SCM that were collected between 1989 and 1995. Seven community mental health centers in New Hampshire provided both types of treatment. STUDY DESIGN: Persons with schizophrenia, schizoaffective disorder, or bipolar disorder and a concurrent substance use disorder were randomly assigned to ACT or SCM and followed for three years. The primary variables assessed were substance use, psychiatric symptoms, functioning, quality of life, and social costs. DATA COLLECTION METHODS: Effectiveness data were obtained from interviews at six-month intervals with persons enrolled in treatment and with their service providers. Social cost and service utilization data came from client reports; interviews with informal caregivers; provider information systems and Medicaid claims; law enforcement agencies; courts; and community service providers. PRINCIPAL FINDINGS: Participants in both groups showed significant reductions in substance use over time. Focusing on quality of life and substance use outcomes, ACT and SCM were not significantly different in cost-effectiveness over the entire three-year study period. Longitudinal analyses showed that SCM tended to be more efficient during the first two years but that ACT was significantly more efficient than SCM during the final year of the study. CONCLUSIONS: In an adequately funded system, ACT is not more cost-effective than SCM. However, ACT efficiency appears to improve over time.
Asunto(s)
Manejo de Caso/economía , Centros Comunitarios de Salud Mental/economía , Grupo de Atención al Paciente/economía , Trastornos Psicóticos/economía , Trastornos Relacionados con Sustancias/economía , Adolescente , Adulto , Comorbilidad , Costo de Enfermedad , Análisis Costo-Beneficio , Diagnóstico Dual (Psiquiatría) , Femenino , Estudios de Seguimiento , Humanos , Masculino , Medicaid/economía , Persona de Mediana Edad , New Hampshire , Trastornos Psicóticos/rehabilitación , Calidad de Vida , Trastornos Relacionados con Sustancias/rehabilitación , Resultado del Tratamiento , Estados UnidosRESUMEN
OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.
Asunto(s)
Manejo de Caso/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Personas con Mala Vivienda , Trastornos Mentales/terapia , Vivienda Popular/normas , Adulto , Femenino , Estudios de Seguimiento , Investigación sobre Servicios de Salud , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.
Asunto(s)
Servicios Comunitarios de Salud Mental , Desinstitucionalización , Trastornos Psicóticos/rehabilitación , Humanos , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud , InvestigaciónRESUMEN
Integrated mental health and substance abuse treatment within an assertive community treatment (ACT) approach was compared to that within a standard case management approach for 223 patients with dual disorders over three years. ACT patients showed greater improvements on some measures of substance abuse and quality of life, but the groups were equivalent on most measures, including stable community days, hospital days, psychiatric symptoms, and remission of substance use disorder.
Asunto(s)
Servicios Comunitarios de Salud Mental , Desinstitucionalización , Trastornos Psicóticos/rehabilitación , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Comorbilidad , Prestación Integrada de Atención de Salud , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Masculino , Persona de Mediana Edad , New Hampshire , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente , Calidad de Vida , Resultado del TratamientoRESUMEN
Health care report cards have been endorsed as a mechanism for efficiently comparing key quantifiable aspects of performance across a range of health systems or plans. There are challenges in determining what to measure; how to gather and analyze data; and how to report, interpret, and use findings. Mental health has received little attention, and a consumer perspective is typically not included. The proposed MHSIP mental health report card (MMHRC) addresses these concerns. General issues for report cards are discussed, and the MMHRC is described in terms of content, data sources and quality, and analysis and reporting.
Asunto(s)
Participación de la Comunidad/métodos , Servicios de Salud Mental/normas , Calidad de la Atención de Salud/organización & administración , Atención a la Salud/normas , Humanos , Servicios de Salud Mental/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud/métodos , Sociedades Médicas , Estados UnidosRESUMEN
STUDY OBJECTIVE: Human papillomavirus (HPV) infections may be the most common sexually transmitted disease (STD) among adolescents and young adults. A strong association exists for certain "high-risk" HPV-type cervical infections and subsequent evolution of cervical cancer and its precursor lesions. The objective of this study was to detect HPV in cervical biopsies of reserve officer training corps (ROTC) cadets attending a regional summer camp who had abnormal screening Papanicolaou (Pap) smears and to better define the spectrum of HPV oncogenic risk types for this population. It was hypothesized that HPV would be detected in the majority of cervical biopsies in keeping with the evolving concept of cervical cancer and its precursors as an STD and the central role of HPV in its development. DESIGN: On arrival for summer military camp training, college women cadets underwent physical examinations that included pelvic examinations for Pap smears. Study participants completed confidential questionnaires after informed consent was obtained. Subjects, who had abnormal Pap smears as defined by reports of atypical squamous cells of undetermined significance (ASCUS) or low- or high-grade squamous intra-epithelial lesions (LGSIL or HGSIL), underwent colposcopic evaluations with cervical biopsies. Subsequently, biopsies were processed for detection of HPV-specific DNA by gel electrophoresis, chemiluminescent oligonucleotide probing, and DNA-RNA hybridization methods after polymerase chain reaction (PCR) amplification. PARTICIPANTS: All female summer camp enrollees presented to the Madigan Army Medical Center Gynecology Clinic for complete physicals before the onset of the training program and were solicited for study inclusion. MAIN OUTCOME MEASURES: All colposcopic biopsy specimens were evaluated for the presence of HPV DNA and subtyped if positive. RESULTS: Representing 42 states, 95% (332) of eligible subjects participated. Mean age was 21.9 years. Racial composition included 70% white, 16% black, 4% Hispanic, 4% Asian, and 6% "other." Eighty-five percent had a history of hetero-sexual activity, with 17.7 years as the mean age at onset. Of the subjects, 12.6% reported a previous diagnosis of a sexually transmitted disease, and 7.8% (26 of 332) had abnormal Pap smears. Of these, colposcopic biopsy results were available for 25 of the 26 abnormal Pap smears. Ninety-six percent (24 of 25) of the colpobiopsies had detectable HPV. Eighty-eight percent (22 of 25) of the subjects with abnormal Pap smears had concurrent abnormal biopsy results. All of these had detectable HPV, confirmed by three different methods, and 29% had dual HPV infection. Sixty percent had "intermediate" or "high-risk" types identified by specific genotyping, 8% had "low-risk" types, and 28% had nontypable HPV. CONCLUSIONS: The data confirm that abnormal Pap smears in this young adult college population are almost always associated with HPV infection, a significant proportion of it being other than low-risk types. The prognostic significance of type-specific cervical HPV infection still needs to be better defined in relation to potential cofactors and host immune response. However, clinicians who provide primary gynecologic care to adolescents and young adults should be aware of the high correlation between abnormal Pap smears and HPV cervical infection and should follow up the patient with the potential risk in mind.
Asunto(s)
Cuello del Útero/virología , Personal Militar , Prueba de Papanicolaou , Papillomaviridae/aislamiento & purificación , Frotis Vaginal , Adolescente , Adulto , Biopsia , Cuello del Útero/patología , Colposcopía , ADN Viral/análisis , Femenino , Humanos , Papillomaviridae/genética , PronósticoRESUMEN
The surgical management of empyema consists of (1) aggressive therapy with thoracotomy and decortication or (2) conservative treatment with chest tube drainage and intravenous antibiotics. Recently, Kern and Rodgers introduced thoracoscopic debridement as an adjunct to the management of children with empyema, with promising results. Hence, the authors report their experience with thoracoscopy in the management of pediatric patients with empyema. In the last years, 10 children have undergone thoracoscopic debridement (TD) for empyema. The average age was 6.9 years (range, 2 to 16). Children underwent TD an average of 14 days (range, 8 to 16) after initial presentation and 4 days (range, 2 to 6) after admission to the authors' hospital. Indications for TD were persistent requirement of supplemental oxygen and failure of conservative medical management that consisted of antibiotics and tube thoracostomy. Three children had positive pleural fluid cultures for Streptococcus pneumoniae. In all cases, preoperative ultrasound or chest computed tomography examination showed dense pleural fluid with septation. During surgery, TD allowed for lung expansion and precise chest tube placement in all patients except one who required conversion to minithoracotomy and decortication for persistent encasement with a thick pleural peel. There were no postoperative complications related to the procedure. After TD, all children had prompt clinical improvement. The patients were weaned from supplemental oxygen by postoperative day 2, and following early chest tube removal, nine children were discharged home by postoperative day 7 (range, 3 to 10). One child required further hospitalization for underlying renal failure. In the authors' hands, TD was effective in producing prompt clinical improvement in children with empyema.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Empiema Pleural/cirugía , Endoscopía , Toracoscopía , Adolescente , Antibacterianos/uso terapéutico , Tubos Torácicos , Niño , Preescolar , Desbridamiento , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/microbiología , Empiema Pleural/terapia , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Admisión del Paciente , Alta del Paciente , Pleura/cirugía , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/microbiología , Neumonía Neumocócica/diagnóstico por imagen , Neumonía Neumocócica/cirugía , Atelectasia Pulmonar/cirugía , Estudios Retrospectivos , Streptococcus pneumoniae/aislamiento & purificación , Toracostomía/instrumentación , Toracotomía , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: Continuous treatment teams serving persons with co-occurring severe mental disorders and substance abuse disorders at seven sites in New Hampshire were evaluated to determine their fidelity to a model based on the Program for Assertive Community Treatment. METHODS: Continuous treatment teams and standard case management programs at the seven sites were evaluated on 13 criteria for fidelity to the continuous treatment team model over a 27-month period. Data sources included clinicians' activity logs, agencies' management information systems, interviews, observation of staff activity and practices, and clinical records and other documents. RESULTS: The continuous treatment teams scored significantly higher than the case management programs on ten of the 13 criteria. The teams were more effective than the case management programs in implementing substance abuse treatment. CONCLUSIONS: Evaluation of the programs' fidelity to the model criteria allowed differentiation of successfully implemented continuous treatment teams from standard case management and from an unsuccessfully implemented team. The results confirm the need for careful measurement of model implementation and for investigation of organizational issues such as administrative support and clarity of program mission.
Asunto(s)
Manejo de Caso , Servicios Comunitarios de Salud Mental/normas , Trastornos Mentales/rehabilitación , Grupo de Atención al Paciente , Trastornos Relacionados con Sustancias/rehabilitación , Adulto , Continuidad de la Atención al Paciente , Diagnóstico Dual (Psiquiatría) , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Trastornos Mentales/psicología , New Hampshire , Evaluación de Programas y Proyectos de Salud , Trastornos Relacionados con Sustancias/psicología , Resultado del TratamientoRESUMEN
Obstructive sleep apnea in children may result in hypoxia, right-sided heart failure, and sudden death. Children with craniofacial deformities and/or cerebral palsy are at high risk for the development of obstructive sleep apnea. Prompted by the excellent results obtained in adults when sleep apnea was managed by an aggressive surgical approach, we undertook a similar treatment philosophy in children. Twenty-eight patients representing four diagnostic groups were evaluated and operated on for severe upper airway obstruction: Down syndrome (n = 5), cerebral palsy (n = 12), Goldenhar syndrome (n = 4), and a mixed apnea group (n = 7). Tracheostomy was avoided in 25 of 28 patients (89 percent), with a marked decrease in apnea (median 90 percent) and hypopnea (median 87 percent) episodes. Tongue hyoid suspension and skeletal expansion procedures, which were the mainstay of treatment, were applied for the first time in children and adolescents with obstructive sleep apnea.
Asunto(s)
Síndromes de la Apnea del Sueño/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Métodos , Cuidados Posoperatorios , Síndromes de la Apnea del Sueño/etiologíaRESUMEN
BACKGROUND: The use of alcohol by persons with schizophrenia is common and has been associated with increased severity of psychiatric symptoms, multiple psychosocial problems, abuse of other drugs, and poor treatment outcomes. Most of the previous research in this area has been with urban patients. METHOD: The authors examined the correlates and outcomes of alcohol use in a rural sample of 75 DSM-III-R outpatients with schizophrenia. Based on multiple measures, 25% (N = 19) of 75 rural patients with schizophrenia were diagnosed with current co-occurring alcohol use disorders. Clinicians' ratings and self-reported symptoms were used to examine correlates of alcohol use, and the study group was followed prospectively for 1 year to identify all episodes of rehospitalization, incarceration, or literal homelessness. RESULTS: Alcohol use disorder was statistically significantly associated with unstable housing, conceptual disorganization, denial of mental illness, and rehospitalization during 1-year follow-up. Several trends suggested that alcohol use was also related to positive symptoms of psychosis. CONCLUSION: Among rural patients with schizophrenia, alcohol use appears to play a significant role in destabilizing psychosocial adjustment. These results replicate similar findings in urban settings.
Asunto(s)
Alcoholismo/epidemiología , Atención Ambulatoria , Esquizofrenia/epidemiología , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Población Rural , Psicología del Esquizofrénico , Resultado del TratamientoRESUMEN
Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement.
Asunto(s)
Costo de Enfermedad , Trastornos Mentales/economía , Servicios de Salud Mental/economía , Revisión de Utilización de Recursos/métodos , Análisis Costo-Beneficio , Recolección de Datos , Investigación sobre Servicios de Salud/métodos , Humanos , Servicios de Salud Mental/estadística & datos numéricos , Reproducibilidad de los Resultados , Valores Sociales , Estados Unidos , Revisión de Utilización de Recursos/economíaRESUMEN
Substance abuse is the most common comorbid complication of severe mental illness. Current clinical research converges on several emerging principles of treatment that address the scope, pace, intensity, and structure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatment, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse and mental health interventions in the same program, d) comprehensive, broad-based services to address other problems of adjustment, e) safe and protective living environments, f) flexibility of clinicians and programs, g) stage-wise treatment to ensure the appropriate timing of interventions, h) a longitudinal perspective that is congruent with the chronicity of dual disorders, and i) optimism.
Asunto(s)
Trastornos Mentales/complicaciones , Trastornos Relacionados con Sustancias/terapia , Actividades Cotidianas , Antipsicóticos/uso terapéutico , Actitud del Personal de Salud , Enfermedad Crónica , Terapia Combinada , Servicios Comunitarios de Salud Mental , Comorbilidad , Atención Integral de Salud , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/rehabilitación , Grupo de Atención al Paciente , Psicoterapia , Recurrencia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
Utilization and cost of institutional and outpatient services were prospectively measured over 1 year for three groups of schizophrenic patients: current substance abusers, past substance abusers, and those without a history of substance abuse. Current abusers had significantly greater utilization and cost of institutional (hospital and jail) services. Current abusers also had greater utilization of emergency services. There were no significant differences between the groups in utilization and cost of other services, including psychosocial rehabilitation, outpatient treatment (case management, psychotherapy, and psychiatric visits), and housing supports. The implications for developing cost-effective treatments for dually diagnosed individuals are discussed.
Asunto(s)
Servicios Comunitarios de Salud Mental/economía , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Esquizofrenia/terapia , Trastornos Relacionados con Sustancias/terapia , Adulto , Alcoholismo/complicaciones , Alcoholismo/economía , Alcoholismo/terapia , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Análisis Costo-Beneficio , Costos y Análisis de Costo , Femenino , Hospitalización/economía , Vivienda/economía , Humanos , Institucionalización/economía , Institucionalización/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Esquizofrenia/complicaciones , Esquizofrenia/economía , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/economíaRESUMEN
Comorbid alcohol use disorders are common in schizophrenia. Although a variety of explanatory hypotheses involving self-medication have been proposed, few data available regarding schizophrenic patients' subjective experiences while using alcohol. We report interview data from 75 DSM-III-R schizophrenic outpatients regarding their subjective responses to alcohol. Over half of our sample reported that alcohol improved social anxiety, tension, dysphoria, apathy, anhedonia, and sleep difficulties. Other nonpsychotic experiences were frequently improved as well. In contrast, no more than 15% of subjects reported that alcohol relieved any specific psychotic symptom; similar proportions of subjects reported that alcohol aggravated psychotic symptoms. Reporting that alcohol had a positive effect on nonpsychotic experiences was associated with having lifetime alcohol use disorders. Reporting that alcohol relieved psychotic symptoms was associated both with having lifetime alcohol use disorders and with the number of psychotic symptoms reported. We discuss the implications of these findings for understanding alcohol abuse and dependence among schizophrenics.
Asunto(s)
Alcoholismo/psicología , Etanol/farmacología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Adulto , Consumo de Bebidas Alcohólicas , Alcoholismo/complicaciones , Atención Ambulatoria , Emociones/efectos de los fármacos , Femenino , Humanos , Entrevista Psicológica , Masculino , Inventario de Personalidad , AutomedicaciónRESUMEN
OBJECTIVE: The authors examined housing instability among treated schizophrenic patients in a rural area and compared the findings with those from their previous study of urban patients. METHOD: Seventy-five patients with schizophrenia or schizoaffective disorder who were treated in a rural mental health center were assessed with research interviews and ratings by their clinical case managers. The patients were followed for 1 year to identify episodes of psychiatric hospitalization, incarceration, and literal homelessness. RESULTS: Of the 75 patients, 19 (25%) had housing situations characterized as unstable by their case managers. For the majority, housing instability signified tenuousness of living arrangements rather than literal homelessness. Noncompliance with medications, alcohol use, and negative symptoms accounted for 30% of the variance in unstable housing. During follow-up, the unstably housed patients, compared to those in stable living situations, were no more likely to be rehospitalized but were somewhat more likely to be jailed and significantly more likely to be literally homeless. CONCLUSIONS: In the authors' previous study of urban psychiatric patients, unstably housed patients were more likely to be literally homeless, highly symptomatic, and rehospitalized during follow-up than the rural patients with unstable housing. Better outcomes in the rural area appeared to be related to the greater availability of housing alternatives and to intensive case management. For patients with unstable housing in both settings, noncompliance with medications and substance abuse, as well as housing arrangements, should be assertively addressed.