An in-patient behavioural psychotherapy unit: description and audit

Article Abstract:

An in-patient behavioral psychology clinic which provides treatment for patients with long-standing severe disabilities is described. All the clinic patients had failed to respond to previous treatment regimens. The program encouraged self-treatment, self-monitoring, and a minimal amount of medication. Close relatives were trained to serve as co-therapists. The absence of night duty nurses gave patients a sense of self-sufficiency and cut nurse-treatment costs by 40 percent. Patients were taught coping strategies and were encouraged to take leaves to practice newly-acquired living skills in their home environment. Fifty-six patients were admitted between October 1987 and September 1988. They ranged in age from 18 to 50 years; 34 were women, and all were Caucasian. Forty-two were diagnosed with obsessive-compulsive disorder, five were agoraphobic, two had social phobias, and the others had varying diagnoses. The average number of face-to-face hours clinicians invested in treating patients and their families was 16. A six-month follow-up after discharge demonstrated significant improvements on all measures of clinical and social functions. Improvements in ratings of the patient's ability to manage a home, social functioning, and work capacity were supported by reports from the patients, family members, friends and referring agents. Most patients overcame the most crucial aspects of their handicap and developed living strategies which endured over time. It is suggested that similar cost-effective treatment units could be developed and run as community hostels attached to psychiatric care units. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Behavior therapy, Obsessive-compulsive disorder, Obsessive compulsive disorder, Psychiatric hospital patients, Self-management (Psychology), Self management (Psychology)

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Deinstitutionalisation - from hospital closure to service development

Article Abstract:

A review of the literature related to the closure of large psychiatric institutions and the expansion of community-based programs in England, the US, and Italy is presented. Since the mid-1950s, deinstitutionalization patterns in England and the US have been similar. In 1954, there were 558,900 psychiatric in-patients in the US; by 1980, there were 132,164. In Italy, no new psychiatric admissions to large state hospitals have been allowed since 1982. Rationales for deinstitutionalization are rooted in sociological, psychological, financial, administrative, pharmacological, and legal trends. Evaluations of community services have demonstrated great variations among centers, although the majority of deinstitutionalized patients desperately require continuing support. In the US, a 'club-house' model of day-care has been developed so that chronically ill psychiatric patients can drop in daily for social activities, meals, counseling, support, and vocational training. However, the US National Coalition for the Homeless has suggested that at least 30 percent of the 2.5 million American homeless suffer from chronic mental illness. In the US, psychiatric teams now tend to rely on a case manager approach in which a staff member serves as an advocate for the patients and acts as a liaison between the patients and the agencies they deal with (e.g., welfare). Unfortunately, financial surveys have shown that community care is no less expensive than institutional care and that discharged patients face isolation, poverty and inefficient, inadequate services. (Consumer Summary produced by Reliance Medical Information, Inc.)

Italy, Usage, Evaluation, Psychiatric services, Mental health services, Mentally disabled persons, Psychiatric hospitals, Great Britain, Psychiatry, Transcultural, Transcultural psychiatry

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Cannabis and psychosis: is there epidemiological evidence for an association?

Article Abstract:

While a link between use of cannabis drugs (marijuana, hashish, etc.) and insanity has been proclaimed since the year 1235, a distinct diagnostic category of ''cannabis psychosis'' remains to be convincingly established. The author undertakes a review of the literature concerning the relationship between cannabis and psychosis, and analyzes the findings in terms of the following epidemiological criteria: strength of association; consistency (agreement); specificity; temporal order; plausibility and coherence; and experimental evidence (methodology). On the basis of the review, certain conclusions may be reached: cannabis can cause a brief psychotic reaction; heavier use can lead to psychotic symptoms; and heavy users appear to have a higher risk of developing schizophrenia (although this finding has not been replicated to date). Analyses of existing studies reveal a number of methodological flaws, including lack of controls, failure to account for confounding factors, and small scale. These findings suggest that, although there is a definite link between the drug and the psychotic nature of some of its behavioral effects, use of the diagnostic category cannabis psychosis is unwarranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Causes of, Demographic aspects, Dosage and administration, Cannabis, Hamamelidae, Psychoses, Psychotic disorders

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