Integrating forensically and civilly committed adult inpatients in a treatment mall program at a state hospital.

Objective: This brief report presents outcome data from a 350-bed state psychiatric hospital that integrated its adult forensically and civilly committed inpatient populations within one rehabilitative program.

Methods: Dorothea Dix Hospital, located in Raleigh, North Carolina, used the "treatment mall" model to offer all of its resources to all adult patients in a centralized setting. Program participation of 100 patients from two long-term civil units was compared with program participation of 94 patients from the hospital's medium- and maximum-security forensic units.

Benefits of psychosocial rehabilitation programming in a treatment mall.

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals.

Early recognition of clozapine-induced myocarditis.

Recently, there has been an increased recognition of the association of clozapine with myocarditis and myocardiopathy. Commonly used diagnostic tests have very limited sensitivity in diagnosing this potentially life-threatening complication. We present 3 case reports of clozapine-induced myocarditis/cardiomyopathy that illustrate the development of a combined approach involving a clinical questionnaire and diagnostic testing at our hospital.

Predicting sex offender treatment entry among individuals convicted of sexual offense crimes.

This study examined what factors were predictive of who volunteers for sex offender treatment (self-selection) as well as who enters treatment after volunteering (administration selection). Research participants included 404 treatment volunteers and 387 nonvolunteers to treatment who were convicted of a sexual offense involving minors within the federal prison system. Maximum likelihood probit estimation procedures indicated that when compared with nonvolunteers, treatment volunteers were more likely to be recommended by a judge to receive treatment at the time of sentencing, had received prior treatment for sexually deviant behavior, reported higher levels of motivation to change their sexually deviant behavior, and had lower rates of a substance use disorder in the year prior to incarceration.

Turning the tables: inpatients as decision makers in the treatment mall program at a state hospital.

Professionals have traditionally accomplished rehabilitative program development at public inpatient psychiatric facilities with limited input from program users. This report describes initial results and observations associated with the introduction of a user-controlled decision-making council built into the program development design of an evolving treatment mall at a state facility. Participant productivity and the satisfaction expressed by participants with regards to this approach captured the attention of staff facilitators and clinical managers, providing a sound basis for future impact studies.

Implementing a smoking ban in an acute psychiatric admissions unit.

In contrast to general medical hospitals, psychiatric hospitals often allow patients to smoke cigarettes. In addition to obvious health concerns, smoking can also interfere with clinical assessments and therapeutic activities, Implementation of a smoking ban on an acute male admissions unit did not result in any increase in aggressive behaviors. In addition, staff attitudes following the ban improved, and most staff members believed the ban was both ethical and beneficial to patients.

Secretin for refractory schizophrenia.

In preliminary uncontrolled studies, intravenous injection of the gastrointestinal peptide secretin produced improvements in the symptoms of autism. Because of the phenotypic overlap between autism and some aspects of schizophrenia, we performed a pilot study of secretin for treatment refractory schizophrenia. Twenty-two patients were randomized to a single intravenous dose of porcine secretin or placebo.

Medical management of the patient with cardiovascular disease.

Cigarette smoking, hypertension, hypercholesterolemia, and periodontal disease have been established as major risk factors for cardiovascular disease. Dentists and physicians should work aggressively to educate periodontitis patients about this relationship in an effort to improve the quality of health and contribute to their long-term survival. Blood pressure should be checked at the initial dental visit and at each subsequent visit in patients whose blood pressure is found to be high and/or has a history of hypertension.

Reliability of drug utilization evaluation as an assessment of medication appropriateness.

Objective: To test the reliability of drug utilization evaluation (DUE) applied to medications commonly used by the ambulatory elderly.

Methods: A DUE model was developed for four domains: (1) justification for use, (2) critical process indicators, (3) complications, and (4) clinical outcomes. DUE criteria specific to use in the elderly were developed for angiotensin-converting enzyme (ACE) inhibitors and histamine2 (H2)-antagonists, and consensus was reached by an external expert panel.

The evaluation and treatment of first-episode psychosis.

A first episode of psychosis is a traumatic experience for patients and families. At the time of initial evaluation, the differential diagnosis should include a broad range of neurological, general medical, and psychiatric conditions. Methodological advances in operationally defining illness onset, "offset," and remission have allowed more careful studies of treatment response in first-episode patients.

Methotrexate elimination in a patient with an orthotopic neobladder with and without a urethral catheter.

Placement of a urethral catheter has been recommended to ensure adequate methotrexate elimination in patients with a neobladder; however, the need for this and its impact on methotrexate elimination have not been determined. A 53-year-old man with a cecal continent urinary diversion received intravenous methotrexate 30 mg/m2 on two occasions, with and without urethral catheter drainage of the neobladder. Serum methotrexate concentrations declined at a rate that resulted in 24- and 48-hour values falling below the accepted toxic concentration threshold of 5-50 mumol/L, and 0.

The impact of changing from the MMPI to the MMPI-2 on profile configurations.

Fifty-three individuals under court review at a forensic unit of a state hospital were administered both the original Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) and the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) within an interval of a few days. The test-retest stability of the raw scores from each administration was determined by computing Pearson product-moment correlations for both the individual scales in the profile and for the pattern of scores on the two instruments for each subject. The stability of the T-score patterns was analyzed by means of total codes of the pairs of profiles, tabulations of the two-point high-point combinations, and correlations of the T-score profiles of each subject on the two instruments.

Evidence for normal feedback inhibition of triiodothyronine on the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) in abstinent male alcoholics.

Disturbances in the hypothalamic-pituitary-thyroid (HPT) axis have been reported in abstinent, noncirrhotic alcoholics, including a reduction in thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) and reductions in triiodothyronine (T3). Some evidence has suggested that a portion of alcoholics may also exhibit a disturbance in the feedback inhibition of thyroid hormone on TSH release. To evaluate the function of the HPT axis negative feedback system in abstinent, noncirrhotic alcoholic men we compared the TSH response with TRH before and after a standard suppressive dose of T3.

Dose-response studies with thyrotropin-releasing hormone (TRH) in abstinent male alcoholics: evidence for selective thyrotroph dysfunction?

A reduced thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) has been reported in subjects with a history of alcoholism whereas prolactin (PRL) responses have generally been normal. One hypothesis proposed to explain the reduced TSH response is down-regulation of pituitary TRH receptors. If this is correct, PRL response should also be diminished.

A pilot study for a structured, time-limited therapy group for sexually abused pre-adolescent children.

The critical role of specific types of mastery skill development in the treatment of sexually abused children is explored, and defense mechanisms of "invulnerable children," who function adequately despite trauma and stress, are described. The authors describe their development of structured group therapy techniques designed to foster these types of mastery skills with sexually abused children aged 6 to 8. These techniques include development of intellectualization defenses through original coloring books and therapeutic board games, cathartic exploration of feelings through structured art and storytelling exercises, cognitive relabeling and self-esteem building through role-play, "chants and cheers," homework shared with mothers, and other structured group procedures designed to develop specific coping skills.

Neurochemical and psychopharmacologic aspects of aggressive behavior.

The clinical treatment of violent behavior shows a remarkable congruence with preclinical research concerning the modulations of central neurotransmitter systems and their influence upon human aggressive behavior. Moreover, systematic alterations of central neurotransmitter activity in patients offer substantial promise of increasing the successful biological modification of violent behavior.

TSH response to TRH in depression with and without panic attacks.

Low thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) has been repeatedly described in approximately 25% of patients with major depression. Panic disorder appears related to depression along several dimensions, including prevalence of low TSH response to TRH. The authors divided 46 patients with primary unipolar depression by gender and by presence or absence of concurrent panic attacks and compared their TRH test results with those of 106 normal control subjects, controlling for confounding variables.