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  • 1
    ISSN: 1573-3238
    Keywords: readmission ; psychiatric hospital ; psychosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study examined clinical correlates of rapid readmission to a psychiatric inpatient service (less than 3 months after discharge) compared to delayed readmissions (3–12 months) in first-admission patients diagnosed with schizophrenia, bipolar disorder with psychosis, and major depression with psychosis. After reviewing the clinical records and research summaries of all patients who were readmitted within 1 year of discharge, we compared the two readmission groups with respect to demographic and clinical characteristics and subsequent clinical course. Rapid readmission was significantly associated with instability of clinical condition at first discharge (especially mood symptoms) and, to a lesser degree, with failure to prescribe specific medication for affective psychosis patients. Regardless of duration of community tenure, readmission was strongly associated with medication nonprescription or discontinuation. The results suggest that managed care protocols aimed at preventing rapid readmission may require specific symptom assessment and pharmacotherapeutic intervention during the initial hospitalization. Readmission can be used as a quality indicator of both clinical processes (hospital and outpatient care) so long as duration of community tenure prior to readmission is taken into account.
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  • 2
    ISSN: 1573-3238
    Keywords: Schizophrenia ; first-admission ; psychotic symptoms ; outcome ; negative symptoms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to determine whether clinical status at 6-month follow-up is a predictor of 2-year clinical status in first-admission schizophrenic patients. If short-term status is indeed a strong predictor of subsequent functioning, the relationship would support earlier initiation of aggressive interventions. An epidemiologically based sample of 162 first-admission schizophrenic patients was examined at index hospitalization and at 6- and 24-month follow-up, using a variety of diagnostic and clinical assessment instruments. Respondents were divided into three groups based on their 6-month clinical status: delusions or hallucinations present at 6-month follow-up with or without negative symptoms (n = 63); moderate to high levels of negative symptoms (but not positive symptoms) present (n = 42); neither positive nor negative symptoms present (n = 57). Differences in 24-month clinical functioning were evaluated (GAF scores, BPRS factors, role functioning, number of rehospitalizations, and illness course). No significant differences were found among the three groups on demographic characteristics, substance abuse history, or extent of treatment during the follow-up. At 24-month follow-up, respondents with positive psychotic symptoms at 6-month follow-up had the worst, and those with no positive or negative symptoms the best functioning, with the negative-symptom group intermediate on most indices. Thus, among schizophrenic patients, poor 6-month clinical status identified a patient subgroup at high risk for continued poor clinical status at 24 months, suggesting the need for earlier intensive intervention in an attempt to prevent this progression.
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  • 3
    ISSN: 1573-3238
    Keywords: Schizophrenia ; psychosis ; depression ; bipolar ; outcome ; epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Six-month outcome status was examined in 202 first-admission inpatients with DSM-III-R schizophrenia spectrum (N = 96), psychotic bipolar disorder (N = 64), and psychotic depression (N = 42) drawn from 10 facilities in Suffolk County, New York. Schizophrenics fared significantly worse on all outcome variables except rehospitalization, which ranged from 17.7 to 23.4%. Bipolars had good psychosocial outcomes regardless of clinical outcome, while the two outcome domains were uncorrelated among schizophrenics and psychotic depressed. Schizophreniform patients had significantly better outcome than those with schizophrenia or schizoaffective disorder. Posthospital treatment was generally unrelated to outcome except that fewer rehospitalized schizophrenics received continuous treatment, and patients with psychotic depression with poorer psychosocial outcome received medication less frequently. These findings highlight the different treatment needs of these diagnostic groups, especially as regards the provision of more intensive rehabilitation for schizophrenic patients and the “poor-outcome” psychotic depressed.
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  • 4
    ISSN: 1433-9285
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The present study examines rates of mental health service utilization among depressed individuals in a large white collar cohort. Clinical and psychosocial features of a recent depressive episode, as well as preexisting psychiatric and psychosocial characteristics, are examined for their ability to distinguish between individuals who (a) did and did not seek help during their episode and (b) chose to consult one professional source rather than another. Results showed that approximately one-third of the sample sought professional help. Respondents consulting mental health specialists were more clinically impaired and had poorer work performance and fewer psychosocial assets than both those consulting nonpsychiatric physicians and those seeking no help. Respondents in the latter two groups were indistinguishable from one another on many of the assessed variables.
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  • 5
    ISSN: 1433-8491
    Keywords: Negative symptoms ; Psychotic disorders ; Stability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Negative symptoms were examined in 150 primarily first-admission patients diagnosed with schizophrenia, schizoaffective disorder, psychotic depression, psychotic bipolar disorder, and ‘other’ psychoses. The analysis focused on patients who were rated on the Scale for the Assessment of Negative Symptoms (SANS) within 45 days of admission and at follow-up 6 months later. Significantly more schizophrenics had moderate to severe negative symptoms at each time point compared with other psychotic patients. The SANS scores were found to be relatively stable over time in all five diagnostic groups. Although the DSM-IV includes alogia, effective flattening, and avolition in the A criterion for schizophrenia, only alogia and affective flattening were found to be specific to this disorder. Our results point to the existence and enduring quality of negative symptoms in the early phase of psychosis and its specificity to schizophrenia even at this early stage.
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  • 6
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1469-7610
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Abstract— The effects of maternal mental health and familial stress on child behavior were evaluated in a community sample of 691 preschoolers. Presence of behavior problems was determined using the Behavior Screening Questionnaire (BSQ) at age 3, and using the Conners Parent Rating Scale at age 4. In multivariate analyses, the development of disturbance was predicted by higher BSQ score, maternal role competition and maternal hostility assessed at both interviews; persistence was predicted by initial BSQ score and initial maternal hostility only. These results underscore the complexity of the relationships among maternal, familial and childhood variables
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  • 8
    ISSN: 1469-7610
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Abstract The Behavior Screening Questionnaire (BSQ) was used to determine whether 21/2–31/2 yr old children living near the TMI nuclear reactor were more disturbed than children living near another nuclear plant or near a fossil-fuel facility in Pennsylvania when assessed 21/2 yr later. The prevalence of behavior problems was 11%. Differences among the sites in overall rates and individual symptoms were small. Perceptions of environmental stress among the TMI sample of mothers were unrelated to BSQ scores, whereas in the comparison sites, where unemployment was rising, economic concerns were meaningfully related to the BSQ.
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  • 9
    ISSN: 1469-7610
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: This paper examines the cognitive and neuropsychological functioning of children who were in utero to age 15 months at the time of the Chornobyl disaster and were evacuated to Kyiv from the 30-kilometer zone surrounding the plant. Specifically, we compared 300 evacuee children at ages 10–12 with 300 non-evacuee Kyiv classmates on objective and subjective measures of attention, memory, and school performance. The evacuee children were not significantly different from their classmates on the objective measures (grades; Symbolic Relations subtest of the Detroit Test; forms 1 and 2 of the Visual Search and Attention Test; Benton Form A; Trails A; Underline the Words Test) or on most of the subjective measures (the attention subscale of the Child Behavior Checklist completed by mothers; the attention items of the Iowa Conners Teacher's Rating Scale; mother and child perceptions of school performance). The one exception was that 31.3% of evacuee mothers compared to 7.4 %of classmate mothers indicated that their child had a memory problem. However, this subjective measure of memory problems was not significantly related to neuropsychological or school performance. No significant differences were found in comparisons of evacuees and classmates who were in utero at the time of the explosion, children from Pripyat vs. other villages in the 30-kilometer zone, and children manifesting greater generalized anxiety. For both groups, children with greater Chornobyl-focused anxiety performed significantly worse than children with less Chornobyl-focused anxiety on measures of attention. The results thus fail to confirm two previous reports that relatively more children from areas contaminated by radiation had cognitive deficits compared to controls. Possible reasons for the differences in findings among the studies are discussed.
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