General Psychiatric Population Research Articles

The customer is always right: patients' perceptions of psychiatric nursing actions.

In this age of consumerism, consideration should be given to patients' perceptions of interactions with the health care provider as a factor in assessing the quality of care provided. This article describes a study of 100 psychiatric inpatients in a large urban medical center who evaluated 50 commonly used psychiatric nursing actions. Significant differences were found between the general psychiatric patient population and the substance abuse population in perception of helpfulness and frequency of performance with 7 of the 50 nursing actions. As the consumer's perception of the effectiveness of nursing actions is determined, emphasis can be given to those interventions when planning patient care.

1, 000 Forensic Outpatients: A Descriptive Study

The case notes and court reports of 1,000 consecutive outpatient referrals to a regional forensic outpatient service were studied retrospectively. Socio-demographic, psychiatric and forensic information was collected. The sample was predominantly male, Caucasian and relatively young in comparison with a general psychiatric population. The commonest source of referral was from defense solicitors and the commonest reason for referral was for a court report. A wide range of diagnoses and offences were noted. A number of differences were found in the frequency of gender, ethnicity and diagnosis according to the source of, and reason for, referral.

The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: a comparison of eating disordered and psychiatric inpatients.

The authors compared rates of physical and sexual abuse in women with eating disorders (N = 102) and general psychiatric disorders (N = 49). Relationships between sexual abuse and severity of eating disordered and psychiatric symptoms were also examined. While high rates of sexual abuse were found in the eating disordered sample, these rates were not significantly higher than those found in the general psychiatric population. No relationship between a history of sexual abuse and severity of eating disordered symptoms was found. However, within the eating disordered group, sexually abuse subjects reported more severe psychiatric disturbances of an obsessive and phobic nature than nonabused subjects. These findings suggest that while sexually abusive experiences may be related to increased psychological distress, they do not serve to increase eating disordered symptomatology.

Recognition of Alcohol Abuse in Psychiatric Outpatients and Its Effect on Treatment

Previous studies of detection of alcoholism by primary medical care-givers have found discovery rates to be at best 50 percent (2-6). In this study, mental health clinicians-in-training recognized alcohol-related symptoms in almost 70 percent of patients. However, alcohol abuse was unrecognized in nearly a third of patients identified as probable alcohol abusers. Significant differences between therapists' ratings of the success of treatment of alcohol abusers and the success of treatment of nonabusers were found. Patients in whom alcohol abuse was recognized tended to be rated as more enjoyable to work with and as having a more successful treatment than patients whose alcohol problems were unrecognized, although this difference was not significant. This trend is consistent with clinical impressions that clinicians' failure to recognize patients' alcohol-related symptoms may produce miscommunication that can result in the clinicians' experiencing a sense of frustration and futility and the patients' experiencing a sense of being less well understood. The short form of the MAST, although less sensitive than the trainees' judgments, was quite accurate in predicting which patients were alcohol abusers. Our experience indicates that brief screening scales like the MAST could be valuable and easily administered adjuncts to the evaluation of general psychiatric outpatient populations. Routine use of such scales might reduce the frequency of nonrecognition of a variety of substance abuse problems as well as raise the consciousness of providers working in settings that do not offer specialized substance abuse treatment services.

Evaluation of the Modified Mini-Mental State Examination in a General Psychiatric Population

Studies of clinical cognitive screening tests began in the 1960s, and ten instruments have been reported in the English literature. In this study, we have compared the widely used Mini-Mental State Examination developed by Folstein with a reportedly enhanced version, the Modified Mini-Mental State Examination devised by Teng, using a sample of 250 patients (inpatients, outpatients, emergency). We have come to the conclusion that the modifications brought about by Teng result in a minor improvement of the validity of the Mini-Mental State Examination in a psychiatric patients in a general hospital.

Clinical assessment of psychiatric consultations in a medical long‐term care facility: Interrater reliability for DSM‐III diagnostic groups

AbstractThe reliability of the DSM‐III diagnostic system was assessed in a medical long‐term care facility population that was recently seen in psychiatric consultation. Six standard rating scales were used to determine interrater agreement for perceiving psychopathology prior to selecting diagnoses. The findings were that six major diagnostic groups could be accurately distinguished from one another: no disorder; organic mental disorders; affective disorders; paranoid disorders; schizophrenia and psychotic disorders not elsewhere classified; and a mixed group of other diagnoses that occurred in low frequency in this study population. The interrater reliability (kappa = 0.64–0.70) was comparable to that found in the general psychiatric population.

Frequent Rehospitalization and Noncompliance With Treatment

The relationship between frequent rehospitalization and compliance with treatment (medication and aftercare) was examined in a retrospective chart review of patients treated at an urban community mental health center over an 18-month period. Twenty-five patients who had been hospitalized three or more times during the study period were compared with a matched group of 25 patients who had been hospitalized less than three times and with the total group of 698 patients active at the center throughout that period. The study found a highly significant correlation between noncompliance with medication and frequent rehospitalization. Compared with the general psychiatric patient population, frequently hospitalized patients tended to be younger and to have a chronic psychiatric illness, particularly one with an affective component, that featured at least intermittent psychosis. The author recommends study of outpatient commitment to treatment as a means of reducing noncompliance.

Comparison of the MCMI and MMPI-168 as psychiatric inpatient screening inventories.

The Millon Clinical Multiaxial Inventory (MCMI) has been recently developed as an alternative to the Minnesota Multiphasic Personality Inventory (MMPI) and shares some of its psychometric advantages and disadvantages with the MMPI-168, a short form of the MMPI. The current study compared the structure and utility of the MCMI and MMPI-168 for a general hospital inpatient psychiatric population. Overall, the two instruments were highly correlated and found to have conceptually similar factor structures. Empirical comparison of the factor structures indicated that construct validity is greatest for neurotic traits. Both instruments demonstrated a similar utility in predicting discharge diagnosis.

Portal-systemic encephalopathy: neuropsychiatric manifestations.

Portal-systemic encephalopathy, which occurs as a consequence of cirrhosis of the liver, is associated with a variety of neuropsychiatric symptoms. Problems related to the differential diagnosis and medical management of portal-systemic encephalopathy, as compared to other more usual psychiatric disorders, are discussed. Also addressed are issues of particular concern to psychiatry, such as the use of pharmacotherapeutics and the rehabilitation of alcoholism, which are commonly seen in individuals with portal-systemic encephalopathy and liver disease, as well as in the general psychiatric patient population.

The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit.

Factor analysis of symptom ratings recorded on the Brief Psychiatric Rating Scale (BPRS) for a sample of 87 geropsychiatry inpatients resulted in five relatively independent factors. The factor structure differed in two important respects from that previously observed in numerous analyses of BPRS ratings of patients from the general adult psychiatric population. The symptom of depressive mood combined with emotional withdrawal and motor retardation to define a withdrawn depression factor, whereas depressive mood has routinely evidenced greater affinity for anxiety and tension in younger adults. In addition, the unitary thinking disturbance factor that has been observed routinely in data from the younger adult psychiatric population split into separate factors of cognitive dysfunction and psychotic distortion. Construct validity of the cognitive dysfunction factor was examined with reference to an objective mental status questionnaire.

The treatment requests of alcoholics.

Two hundred and thirty-four alcoholic patients at a general hospital outpatient clinic were administered a questionnaire to ascertain their treatment requests. One year later information characterizing the patients and their treatment outcomes was obtained by chart review and therapists' ratings. The alcoholics' treatment requests were similar to those obtained previously with general psychiatric populations. The most frequent requests were for psychological treatments: 'clarification of issues' or 'psychodynamic insight' while requests for administrative help or social intervention were least frequent. Requesting psychological treatments did not significantly predict engaging in psychotherapy or change during therapy. Requesting help with the complications of drinking only and not psychological help predicted early drop out. Medical, administrative and social intervention requests predicted poor improvement in drinking behavior during therapy.

Norms, reliability, and item analysis of the Hopelessness Scale in general psychiatric, forensic psychiatric, and college populations.

Administered the Hopelessness Scale to 99 criminal psychiatric inpatients, 118 general psychiatric inpatients, and 197 upper-level college students. Normative data were reported for each group. Both of the psychiatric groups endorsed significantly more items in the hopeless direction than did the college student sample. The scale was found to be more reliable with the psychiatric patients than with the college students. The difference in reliability may reflect the restriction of range of hopelessness scores among college students. An item analysis of the Hopelessness Scale for each of the three groups was presented. These data suggest that three items (4, 5, 13) were not measuring hopelessness as reflected in the other items. Suggestions for further research with the Hopelessness Scale to clarify the components of hopelessness in nonpsychiatric populations were presented.

Motion sickness susceptibility: population profiles in a general psychiatric population and in heroin addicts and alcoholics.

Motion sickness susceptibility: population profiles in a general psychiatric population and in heroin addicts and alcoholics.

Modern diagnosis schizophrenia in hospitalized psychiatric patients.

The authors applied modern criteria to the diagnosis of 254 patients admitted to the psychiatric wards of an urban hospital. They found that only 16 (6.3%) met the St. Louis criteria for schizophrenia. Other studies using similar criteria also reported a consistently low prevalence of schizophrenia in general psychiatric inpatient populations. However, 30 "undiagnosed" patients (12%) in this study narrowly missed the definite diagnosis of schizophrenia because of the presence of affective disorder and/or insufficient duration of symptoms. The authors discuss the clinical and research implications of these findings.

Chronic illness behavior in psychiatric patients: an attempt at behavioral validation.

Recent literature has focused on chronic illness behavior as a final common pathway for many patients with psychosomatic disorders and learning theory has been used to explain the behaviors of these patients. The present study evaluated psychiatric patients in a variety of treatment settings using the methodology of Wooley and Blackwell (1). Blank forms were used as "do it yourself" tokens and rewarded behaviors were categorized as care-taking, sociability, achievement, communication, or other. A multivariate analysis of variance revealed that psychiatric patients did not differentially reward care-taking, as a chronic illness model would have anticipated; rather, they most frequently rewarded socialization and achievement. In addition, we found that patients without disability compensation rewarded socialization more frequently and achievement less frequently than did those patients with compensation. Treatment setting was not related to the types of behaviors that were rewarded. This study does not support a behavioral theory of chronic illness behavior in a general psychiatric population. The results are discussed with respect to the implications for psychiatry and psychosomatic medicine.

Breast Cancer and Treatment With Neuroleptics-Reply

<h3>In Reply—</h3> The comments by Thompson and Weissman seem fair enough. Real data are difficult to come by and data concerning the possible etiologic effects of neuroleptic drugs on human breast cancer are scarce indeed. Although recognizing the importance of statistical tests, it seemed to me to be clinically relevant to report that, of some 3,278 women who were treated for schizophrenia in the University of Texas Medical Branch (Galveston) hospitals over a 15-year period, only six returned during the last decade of that period for diagnosis and/or treatment of breast cancer. The ratio of prior diagnosis of schizophrenia to all prior psychiatric diagnoses<i>among women who were treated for breast cancer</i>was almost identical to the ratio of schizophrenia to all psychiatric diagnoses in the general psychiatric population of the hospital during the period studied. Thus, patients who were previously treated for schizophrenia were not overly represented relative to other

Interpersonal Attractiveness and Clinical Decisions in Alcoholism Treatment

The authors investigated the interactive contribution of patient characteristics and staff perceptions of the patient to decisions concerning the provision of continued alcoholism treatment following an initial 2-week evaluation period. Staff perceptions contributed significantly more to an individual's acceptance or rejection than did patient characteristics. A high interpersonal attractiveness rating also led to a significantly more positive evaluation of the patients' level of intelligence, knowledge of current events, morality, and adjustment. The present results and research findings with general psychiatric populations are compared.

A study of 100 physician psychiatric inpatients.

The author reviewed the case records of 100 physician inpatients in a private psychiatric hospital. He found that these physicians were more likely to have diagnoses of affective disorder and drug abuse than the general psychiatric hospital population, that their peak susceptibility occurred in their late 40s, that general practitioners and psychiatrists were overrepresented, and that female physicians were almost four times more vulnerable to suicide than male physicians. He describes some critical aspects of engaging the disabled physician in psychiatric hospitalization.

Conceptual validity of a phenomenological classification of psychiatric patients

No SOONER were computers able to handle the data than did psychologists and psychiatrists interested in establishing a more objective and reliable classification of psychiatric patients begin to apply empirical classification methods to psychiatric phenomena. Methods of factor analysis, cluster analysis, Q-sorts and a variety of other techniques have been used. The objective has been to identify the distinct patterns that occur repeatedly in nature in highly similar form. From a simple classification point of view, such distinct homogeneous types should provide the basis for most reliable segregation of patients. Some investigators have reasoned further that syndromes, which are recognized by the coexistence of particular unique patterns, are often found to be associated with distinct disease processes. Others have been more pragmatic, being concerned only with objective, reliable, and useful descriptive classification. WITTENBORN et al.,’ were perhaps first to report extensive multivariate analyses of the phenomena of psychopathology in 1953. BECKY followed the next year with an application of Q-sort methodology that resulted in description of six distinct types of schizophrenia, and GRINKER et al.,3 followed shortly with the description of four sub-types of depression (which bear considerable similarity to those identified in our own work). LORR et al.,4 undertook extensive cluster analyses of symptom and behavior rating profiles for large samples of patients from the general inpatient psychiatric population and identified six major phenomenological types. It is not possible, in this brief introduction, to analyze in detail the similarities and differences in classification concepts that might be derived from these and other empirical investigations. We would note, however, that given certain tolerance for minor discrepancies (due probably to differences in observational techniques, data bases, and methods of analysis), a substantial thread of consistency emerges. Our own work, which was the direct basis for the investigation reported here, is in many particulars not inconsistent with the empirical results obtained by others using different data bases. The primary question left unresolved by all of the empirical classification research concerns whether the typologies have clinical meaning. One aspect of this question involves the extent to which the empirically derived types “ring true” in clinical experience. It is our impression that previous investigators have stopped short of considering this important question.

The psychiatric treatment of the geriatric patient.

The author demonstrates, through case examples, how geriatric patients can be integrated into a general hospital's intensive therapeutic milieu program. He points to the need for further investigation of the advisability of segregating these patients from the general psychiatric population, as is now commonly done; perhaps other approaches will prove more fruitful.