Cues of disability and treatment continuation of chronic schizophrenics

Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention

The current study examined the feasibility and acceptability of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared with Goal-Focused Supportive Contact (SC) in a pilot randomized controlled trial for people with schizophrenia with high negative symptom severity. The sample included 55 participants from five community settings; masters-level study clinicians delivered interventions on-site. Participants completed assessments of cognitive, functional, and psychiatric symptoms at baseline, mid-treatment, post-treatment (12.5 weeks), and 6-month follow-up. Enrollment goals were not initially met, necessitating the addition of a fifth site; however, all groups and assessments were completed on-site. Study procedures were acceptable, as evidenced by 100% enrollment and completion of baseline assessments following informed consent; however, over 1/3rd of participants dropped out. No modifications were necessary to the intervention procedures and CBSST-CCT fidelity ratings were acceptable. The intervention was deemed acceptable among participants who attended ≥1 session, as evidenced by similar attendance rates in CBSST-CCT compared to SC. Among CBSST-CCT participants, lower positive symptoms were significantly associated with better attendance. Overall, we found mixed evidence for the feasibility and acceptability of the CBSST-CCT protocol in people with schizophrenia with high negative symptoms. Challenges are highlighted and recommendations for future investigations are provided.

Dropping out of care: inappropriate terminations of contact with community-based psychiatric services

BACKGROUND

Few studies have investigated factors which predict inappropriate terminations (drop-out) of clinical contact with mental health services.

AIMS

To identify patient and treatment characteristics associated with dropping out of contact with community-based psychiatric services (CPS).

METHOD

A 3-month cohort of patients attending the CPS was followed up for 2 years, to identify drop-outs.

RESULTS

We identified 495 patients who had had at least one psychiatric contact of whom 261 had complete ratings for the Global Assessment of Functioning and the Verona Service Satisfaction Scale. In the year after the index contact, 70 terminated contact with the CPS; of these, 44 were rated as having inappropriate terminations (the "drop-out" group) and 26 had appropriate terminations of contact. Drop-outs were younger, less likely to be married and their previous length of contact with services was shorter. No drop-outs had a diagnosis of schizophrenia. Multivariate analysis revealed predictors of dropping out.

CONCLUSIONS

In a CPS targeted to patients with severe mental illnesses, those who drop out of care are younger patients without psychoses who are generally satisfied with their treatment.

Dropping out of psychiatric treatment: a prospective study of a first-admission cohort

This study examined patient and treatment variables associated with patients dropping out of psychiatric treatment, drop-outs' reasons for terminating treatment, and the relationship between drop-out and patient satisfaction. The term "drop-out' was defined as termination of treatment despite therapeutic need. In a cohort of 131 first-admission psychiatric patients, 26% of these subjects dropped out of treatment during the first year. Multivariate analysis showed that dropping out was predicted by (a) living alone, (b) unemployment, (c) young age and (d) change of treatment service within the last month demanded by the patient against medical advice. Variables such as gender, diagnosis, mode of admission, type of hospital ward, level of treatment, transfer in accordance with treatment needs and inappropriate transfer caused by the treatment system were all non-significant. The drop-outs were markedly less satisfied with both the outcome and various aspects of the treatment process than those who did not drop out. The most common reasons given by the drop-outs for terminating treatment were dissatisfaction with care (44%) and no need for further treatment (20%). Greater knowledge of the factors related to drop-out might increase the likelihood of keeping patients in treatment.

Stigma, biomedical efficacy, and institutional control

This paper explores the role of biomedical efficacy in the rehabilitation of the disabled. Ethnographic data are presented from two studies, one concerned with the prevocationally blind, the other with the institutionalized chronically mentally ill. A comparison of rehabilitation for these two groups suggests that when disabilities do not respond well to biomedical interventions, inconsistent and contradictory interpretations and policies about etiology, therapy, and post-treatment prognosis are likely to flourish. These conflicts may, in turn, increase pressure on rehabilitation institutions to maintain control over their clients. This paper addresses these issues in order to stimulate discussion about the relationship of different kinds of disability to stigma and rehabilitation.

Retention of Hispanics in public sector mental health services

Hispanic underutilization of mental health facilities extends to lowered retention rates among the chronically mentally ill. A theoretical model of retention was developed with four domains of variables: personal traits, accessibility of social support, treatment characteristics, and facility characteristics. Using data collected from CMHC clinical charts in 1983 and 1984, the model was tested using multiple regression and commonality analysis. The model was tenable (R = .59). However, the commonality analysis suggested that most of the unique variance was contributed by the treatment domain. The social support domain made negligible unique contribution. Implications of the model are discussed.