Outpatient commitment for "revolving door" patients: compliance and treatment

Article Abstract:

Outpatient commitment (OPC) is a less restrictive alternative to the involuntary hospitalization of mentally ill patients who are ordered by the courts to seek treatment. It is based on the philosophy that while a mentally ill person may be determined dangerous and need treatment, he may not need inpatient care. Inpatient care has been the usual treatment, and often the only choice for those committed. In theory, OPC provides all the components of inpatient commitment, yet affords greater freedom. It is also an answer to the 'revolving door syndrome', which has resulted from shortened hospital stays. The revolving door syndrome refers to the fact that many chronically mentally ill patients are released after a short stay in the hospital, only to relapse and be readmitted due to noncompliance with aftercare. OPC, by providing mandatory outpatient care and monitoring, may help to eliminate this problem for many people. Ninety-seven patients hospitalized pending civil commitment hearings were followed for six months after they were released, mandated to OPC, or involuntarily hospitalized. About 54 percent were male and 94 percent were under 60 years old. Seventy-eight percent were diagnosed as schizophrenic and 58 percent had more than two prior hospitalizations. About half had a history of at least three episodes of dangerous behavior. Thirty-one were referred to OPC, the rest were either hospitalized involuntarily or released with the recommendation that they seek outpatient care. Those attending OPC were significantly more likely to attend outpatient care after discharge from the hospital than those who were not; they were also less likely to be noncompliant. Most remained in treatment after the end of the six-month study period, despite the fact that their mandate had expired three months earlier. The two who left treatment were rehospitalized by the sixth month. Based on these results, outpatient commitment is an effective tool by which to encourage compliance with all aspects of mental health care and treatment maintenance. This can effectively reduce the tendency for patients to get caught in the revolving door syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Civil commitment, Mentally ill persons, Patient compliance, Mentally ill, Recidivists

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Assessment and treatment of torture victims: a critical review

Article Abstract:

A review of treatment and assessment modalities for torture victims and the psychological and physical consequences of torture is presented. Psychological treatment and assessment of victims is typically organized by criteria for posttraumatic stress disorder (PTSD). PTSD basically consists of four symptom clusters: denial, avoidance and psychic numbing; reexperiencing the trauma; hyperarousal; and depression, which leads to withdrawal, detachment and guilt. Methods of torture, often politically motivated, are both physical and psychological, relying on fear and deprivation. Women often report suffering, sexual abuse and persecution from family members, and sexual assaults from political tormenters. Children tend to be verbally silent about issues related to brutal treatment or the witnessing of violence and death. Treatment of Holocaust survivors and Vietnam veterans with PTSD has been based on a cognitive and supportive approach which includes the establishment of trust between patient and therapist, mourning the loss of loved ones, country or culture, and dealing with denial and avoidance, survivor guilt, shame and humiliation. However, PTSD-related therapy has been criticized as being too narrow when it comes to political violence, since it reduces a cultural, historical and political problem to an individual psychological level. In many countries, psychiatrists must face politico-ethical issues when treating victims. Medical treatment can be traumatic for victims who fear surgical instruments and vulnerability. Research with Vietnam veterans has led to a basis for the biological treatment of psychological symptoms related to chronic sympathetic hyperarousal, reexperiencing trauma, and depression. Ultimately, however, recovery requires therapy, the support of family and friends, and a climate that can provide a growing sense of security. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Post-traumatic stress disorder, Aggressiveness (Psychology), Torture victims, Torture

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Treatment of bulimia nervosa with lithium carbonate: a controlled study

Article Abstract:

In the West, approximately two percent to four percent of young women are affected by bulimia nervosa, a potentially life-threatening disease characterized by food binging and/or purging, which can lead to severe weight loss and malnutrition. Some reports have shown that antidepressant medications are useful in the short-term treatment of bulimia nervosa whether the patient is depressed or not. The present paper reports the results of a study of 91 female bulimics with an average age of 25.4 years who received 600 milligrams (mg) to 1,200 mg of lithium carbonate or placebo over an eight-week period. Patients were separated into depressed and nondepressed subgroups; 30 women were depressed and 61 were not. For the 68 patients who completed the study, binging behavior significantly diminished whether they took lithium carbonate or placebo, as assessed by the Eating Disorder Inventory. Depression, as measured by the Hamilton Depression Rating Scale and the Beck Depression Inventory, decreased as well but seemed to be related to improvement in bulimic behavior rather than to the medication. Overall, therefore, the short-term improvement in the bulimic behavior of these patients was related to regular attendance at the eating disorder clinic rather than to a specific intervention, and improvement in mood was related to improvement in behavior. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Research, Bulimia, Psychopharmacology, Lithium carbonate

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