Gender and schizophrenia outcome: a clinical trial of an inpatient family intervention

Several studies document sex differences in premorbid and intermorbid role functioning, showing less functional deficit among females. The specific nature of sex differences in role functioning is still poorly understood. The purpose of the present study was to investigate sex differences in symptomatology and role functioning in a sample of 92 inpatients hospitalized for an episode of DSM-III-diagnosed schizophrenic disorder. Patients were randomized at hospital admission to either of two treatment conditions: (1) multimodal hospital treatment with the addition of an inpatient family intervention (IFI) or (2) multimodal hospital treatment without IFI. Results indicated (1) sex differences in levels of substance abuse and antisocial behavior (worse for males both at admission and followup)--dimensions of psychopathology unrelated to the core features of schizophrenia; (2) superior family and occupational functioning in females at followup; and (3) superior clinical response of females to IFI. Data on family response to IFI suggest some ameliorative effects of IFI on critical family attitudes toward female patients as well as greater family compliance with IFI treatment among the families of females. Sex differences in intermorbid family and occupational functioning and response to a family-based psychosocial intervention are discussed in light of data on rejecting family attitudes toward the patient and sex differences in symptomatology. The possible influence of sex-differentiated social role demands on response to IFI is also discussed.

Between patient and doctor. Improving the quality of care for serious mental illness

The quality of care typically rendered to seriously mentally ill patients in this country does not reflect the extraordinary expansion and refinement in recent decades of scientifically based psychiatric diagnostic and therapeutic capacities. In this paper, the authors examine reasons for the disparity between the quality of the scientific base and the quality of care, citing recent historical influences and contemporary obstacles, and then propose strategies for change.

Psychiatric aspects of basketball

This article presents a theory of the psychology of basketball from three perspectives: individual psychodynamics, family systems interactions and athlete-community relationships. It focuses on the differences between functional and dysfunctional individual and team performance. Maximal individual performance usually requires relatively high levels of cognitive and physical skills, while team performance depends on having individuals with the interpersonal skills necessary to create the chemistry mandatory for the shared decision making called teamwork.

A randomized clinical trial of inpatient family intervention, III: Effects at 6-month and 18-month follow-ups

This paper focuses on the follow-up results of a randomized clinical trial of inpatient family intervention (IFI) that emphasized psychoeducation. Results for the sample of 169 psychiatric patients suggested that adding family treatment to standard hospital treatment was effective; however, the statistical interactions indicated that this therapeutic effect was restricted to female patients with schizophrenia or major affective disorder. The effect of family treatment on male patients with these diagnoses was minimal or slightly negative. In a group of patients with other diagnoses, the Treatment by Sex effect was reversed: male patients did better with the family treatment.

Bipolar affective disorder and creativity: implications and clinical management

Research on the relationship between creativity and mental illness is summarized, and studies documenting a relationship in writers between creativity and affective illness (particularly bipolar illness) are described. Writers have a high prevalence of affective illness, and both affective illness and creativity have increased frequency in their first-degree relatives. The clinical management of the creative individual is challenging. In general, creative individuals are most productive when their affective symptoms are under good control.

The clinical significance of thought disorder across time in psychiatric patients

The occurrence and clinical significance of thought disorder, as measured by general abstraction ability and idiosyncratic abstractions, remains a complex and ambiguous area of inquiry. We studied 49 subjects in a longitudinal design in which the effects of general psychopathology and depression on abstraction function were assessed. Results indicate that a) depressive patients have a generalized abstraction dysfunction not limited to specific content areas, b) some depressive patients have a residual abstraction deficit on discharge from the hospital, c) idiosyncratic abstractions are a characteristic but not pathognomonic marker for schizophrenia, and d) across all subjects, abstraction difficulties represent a seemingly state-dependent "final common pathway" that significantly correlates with general psychopathological impairment rather than level of depression.

An interdisciplinary psychoeducation program for schizophrenic patients and their families in an acute care setting

A psychoeducation program in an acute care inpatient psychiatric setting involves schizophrenic patients and their families in a range of educational interventions that are responsive to their particular strengths and vulnerabilities. Patients receive one-on-one instruction about their illness from a psychiatrist and the nursing staff and learn community living skills in classes and tutorials conducted by occupational therapists. Families discuss ways of coping with the patients' illness in a series of meetings with a social worker, and they attend workshops led by a team of clinicians and an administrator, who advise them of current perspectives on the illness and its management and about how to negotiate the mental health system. A mental health library keeps staff, family, and patients abreast of recent literature about schizophrenia. The authors believe the program prepares patients to live in the community better than do programs whose goals are limited to symptom reduction or crisis intervention.

Inpatient family intervention: a randomized clinical trial. II. Results at hospital discharge

Although family intervention is practiced in most psychiatric hospitals, to our knowledge, no adequately controlled studies of its efficacy exist. This study was designed to answer, in part, the question of the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients (1) with major psychiatric disorders, (2) in need of hospital treatment, and (3) for whom both treatments are judged clinically feasible. This article compares treatment results at the time of hospital discharge for 169 patients randomly assigned to the inpatient Family Intervention or comparison conditions. Inpatient Family Intervention had greater efficacy than the comparison treatment, mostly attributable to its effect on female patients, especially those patients (and their families) with affective disorder.

A controlled study of transitional day care for non-chronically-ill patients

The authors randomly assigned 79 inpatients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called "transitional treatment" or a control treatment--weekly clinically believed to require intensive posthospital treatment to make the transition to the community. Although initially there was a significantly higher dropout rate from the control condition, at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome. Direct costs for the transitional treatment, however, were much higher.

The inpatient psychiatric unit as consultation service

In response to the changing role of the hospital in the mental health care system, the authors propose a new model for inpatient psychiatric units--that of consultants to outpatient therapists and community and mental health agencies. They discuss key aspects of an inpatient hospitalization that facilitate the tasks of expanded diagnostic evaluation and treatment assessment, and present several cases to illustrate how information and perspectives gleaned from the evaluation can be effectively conveyed to both patient and outpatient therapist, so that it optimizes care of the patient after discharge.

Psychobiology and psychopharmacology: issues in clinical research training

Although the scope of basic studies in psychopharmacology and psychobiology has been expanding steadily for about 30 years, relatively few clinical psychiatrists, psychologists, and psychopharmacologists now choose to become researchers or teachers in these disciplines. Such training is crucial to the future vitality of both academic and private-practice psychiatry, and in view of increasing constraints on training funds, student researchers may well be an endangered species. With these concerns in mind, at its 1984 meeting, the American College of Neuropsychopharmacology's Education and Training Committee organized a symposium of investigators, administrators, and former trainees to explore aspects of effective clinical research training in psychobiology and psychopharmacology. Aspects discussed included mentoring, settings and content of training, depth versus breadth of curriculum, and the effect of a critical mass of colleagues at various stages of professional development. Following a brief overview, selected panelists addressed the issues from their individual perspectives.

The inpatient care of the chronically mentally ill

The inpatient treatment of the chronically mentally ill as it has been practiced in the past, is practiced at the present, and may be practiced in the future is discussed. The reasons for admitting the chronically ill to inpatient services; the steps of such treatment and treatment modalities employed; and considerations for discharge are presented. In addition, the indications as well as pros and cons for long-term inpatient hospitalization are included.

Determination of chlorpromazine and its major metabolites by gas chromatography/mass spectrometry: application to biological fluids

A method for the quantitative determination of chlorpromazine and five of its major metabolites in a single sample of biological fluid in the ng/ml range has been developed utilizing gas chromatography/mass spectrometry with selected ion recording. The assay is highly specific and quantification is accomplished by an inverse stable isotope dilution technique, using deuterium-labeled variants of the compounds as internal standards. In this way the concentrations of chlorpromazine and five of its major metabolites (the sulfoxide, the N-oxide, the monodemethylated, the didemethylated, and the 7-hydroxylated compounds) can be determined in biological fluids. Levels in humans have been measured both in plasma and in red blood cells and are compared to those found in related in vitro studies.

A controlled evaluation of inpatient family intervention. I. Preliminary results of the six-month follow-up

Although family intervention is practiced in most psychiatric hospitals, there are no adequately controlled studies of its efficacy. This study was designed to answer, in part, the following question: What is the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients with major psychiatric disorders who are in need of hospital treatment and for whom both treatments are judged clinically feasible? This is our first report, presenting preliminary data on six-month follow-up for the first three quarters of the total sample of 144 patients (80 with schizophrenic disorder and 64 with major affective disorder).

Efficacy and feasibility of high dose tricyclic antidepressant treatment in elderly delusional depressives

It is unclear why delusional depressives respond poorly to usual doses of tricyclic antidepressants alone. Seventeen elderly, delusional depressives were treated with high doses of imipramine or desmethylimipramine while monitoring plasma levels in an open study. Four of seven patients who received an adequate trial responded, but over half of the total sample had to be dropped due to intolerable side effects or worsening clinical condition. Antidepressants in high doses may be effective for part of the delusional depression sample, but this potentially effective pharmacologic therapy is not feasible in a large percentage of elderly or agitated patients.

Marital and family therapy for troubled physicians and their families. A bridge over troubled waters

Because individual therapy for troubled physicians has been notoriously difficult and often ineffective, we report our experience using a treatment--marital therapy--newly applied to such problems in the medical community. The sample involved 13 male physicians and their spouses with emotional difficulties in themselves and/or their relationships. After marital treatment, there was substantial improvement in more than 92% (12/13) of the physicians, their spouses, and/or their marital relationships.

Use of joint consultations in inpatient psychiatry

The coexistence of medical and psychiatric problems in psychiatric inpatients often causes compliance difficulties, based on either irrational and distorted fears of medical treatment or more rational concerns that proposed psychiatric treatment could adversely affect a preexisting medical condition. The authors propose the use of joint consultations, in which both the psychiatrist and the other medical specialist meet together with the patient, as a way of ameliorating such distortions and conflicts and thereby improving compliance with both medical and psychiatric treatment.

Recent developments in family therapy: a review

Since its beginning some 25 years ago, family therapy has become a widely used madality. The field is developing its own theoretical foundations, training institutions, and body of outcome research; the authors review some of the changes, especially those of the last two or three years. One major development is the growing differentiation of family therapy models and techniques; related are increasing attempts to delineate selection criteria and to provide empirical data for special matches of problems and treatments. The field has moved from its early preoccupation with schizophrenia to concern with new target populations, such as families disrupted by divorce. Family therapy is also being used more often in the treatment of hospitalized patients and of substance abusers. The outcome research is growing in extent and sophistication; the positive results indicate a continuing prominent role for this modality.