Cost-effectiveness of providing insurance benefits for posthospital psychiatric halfway house stays

A model insurance benefit package of post hospitalization psychiatric halfway house care was developed and administered to 32 hospitalized mentally ill persons. The therapeutic and cost effectiveness of providing a 120-day benefit package was examined over a 14-month post-hospitalization period. This was compared with the effectiveness of hospitalization benefits alone for the same patients over the 42 months prior to halfway house admission. In terms of therapeutic efficacy, there was no significant deterioration after hospitalization release in either the symptom or behavioral coping scales, except for an increase in somatization. Yearly hospital recidivism rates fell from 79% to 29%, and the average yearly length of hospital stay per patient fell from 83 days to 18 days. In terms of cost-effectiveness, halfway house benefits saved the insurers 59% of their hospitalization costs. The implications of these findings are discussed.     

Co-leader termination in an outpatient alcohol treatment group

The termination of a co-leader from a long-term therapy group for alcoholic outpatients is described over a seven-week period from the initial termination announcement to the first week following the co-leader's departure. The authors highlight salient themes and defensive maneuvers that appear as the group struggles with the difficult task of termination. Attempting initially to flee from the impending loss, the group defends with pseudomature responses and veiled hostility. These are followed by themes of abandonment and loss. The group leaders' initial collusion with the group's denial of loss is described, along with leader tactics to facilitate the group's termination work. Finally, the meaning of a group farewell gift is discussed in terms of both its implicit communications and as a form of resistance.     

Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.     

Agonistic onset marks emotional changes and dispersal propensity in wild house mouse males (Mus domesticus)

The authors investigated implications of agonistic onset for anxiety and dispersive motivation in maturing wild house mouse males (Mus domesticus). Laboratory-kept fraternal pairs either developed agonistic dominance or stayed amicable during their first 2 months of life, when the authors assessed open-field behavior and dispersal propensity. State anxiety was lower in amicable than agonistic males and higher in subordinate than dominant ones. During subsequent dispersal trials, 1 dominant and 1 amicable male from 2 fraternal pairs were concomitantly introduced into seminatural enclosures containing 3 females. One male invariably became territorial. The defeated males, if previously dominant, dispersed at significantly higher rates than if previously amicable. The authors conclude that agonistic onset during development represents an adaptive behavioral switch from a submissive-philopatric to agonistic-dispersive coping strategy.     

Drinking without thinking: an implicit measure of alcohol motivation predicts failure to control alcohol use

Addiction is characterized by dyscontrol - substance use despite intentions to restrain. Using a sample of at-risk drinkers, the present study examined whether an implicit measure of alcohol motivation (the Implicit Association Test [IAT]; Greenwald, A.G., McGhee, D.E., & Schwartz, J.L.K. (1998). Measuring individual differences in implicit cognition: the Implicit Association Test. Journal of Personality and Social Psychology, 74, 1464-1480) would predict dyscontrol of alcohol use. Participants completed an IAT and, to elicit motivation to restrain alcohol use, were instructed that greater consumption in a taste test would impair performance on a later task for which they could win a prize. All participants viewed aversive slides and then completed a thought-listing task. Participants either exerted self-control by suppressing negative affect and thoughts regarding the slides or did not exert self-control. Post-manipulation, the groups did not differ in mood, urge to drink or motivation to restrain consumption. During the subsequent taste test, participants whose self-control resources were depleted consumed more alcohol than did those in the control group. Additionally, the IAT, but not an explicit measure of alcohol motivation, more strongly predicted alcohol use when self-control resources were depleted. The results indicate that the IAT may have utility in predicting dyscontrolled alcohol use.     

Counsellors' perspectives on the use of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) in an alcohol counselling setting

As part of a randomised controlled trial to investigate the feasibility of using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) within an alcohol counselling setting, counsellors' views of using the tool were sought. Data about the service users' use of SEIQoL were collected during the counselling session, and focus groups and questionnaires were used to collect data on counsellor perceptions and experiences of using the tool. SEIQoL was easy and quick to use and provided users with a graphic, visual and dynamic means to identify important areas that contributed to their quality of life; it appeared to enhance the reflective process early on in counselling. Counsellors reported that service users requested the tool be used more frequently during the counselling process and they felt it could be a useful review tool.     

Identifying two potential mechanisms for changes in alcohol use among college-attending and non-college-attending emerging adults

This study tested whether pro-alcohol peer influences and prosocial involvement account for increases in drinking during the transition into emerging adulthood and whether these mechanisms differ depending on college attendance and/or moving away from home. The authors used structural equation modeling of prospective data from 825 young men and women. For 4 groups defined by college and residential status, more drinking in the spring of 12th grade predicted more pro-alcohol peer influences the following fall, and more pro-alcohol peer influences in the fall predicted increases in drinking the following spring. Going to college while living at home was a protective factor against increases in drinking and selection of pro-alcohol peer involvements. Prosocial involvement (measured by involvement in religious activities and volunteer work) was not significantly related to post-high school drinking except among college students living away from home. Prevention efforts should focus on (a) reducing opportunities for heavy drinking for college and noncollege emerging adults as they leave home and (b) increasing prosocial involvement among college students not living at home.     

Stem cell research: an ethical evaluation of policy options

In February 2004, South Korean researchers became the first in the world to successfully harvest stem cells and establish a stem cell line from a cloned human embryo. This is just one of eight possible policy options concerning human embryonic stem cell research. In practice, every kind of stem cell research can be done in one country or another. This paper evaluates the eight policy options concerning human embryonic stem cell research in light of the arguments and decisions behind them.     

Development of an institutional policy on artificial hydration and nutrition

The issues involved in deciding whether to use artificial methods of delivering hydration and nutrition are often very difficult for patients, families, and health care providers. Once private and personal matters, these decisions now frequently involve the judicial system. Five years ago, Hospice of Washington recognized the need for a written policy and wrote the one published here. Its goal is to respect individual preferences and family concerns while addressing the nutrition and hydration needs of dying patients. The policy sets parameters on the issue, provides basic information, and encourages crafting the most fitting resolution to each situation.     

The effects of alcohol consumption and expectancies in an experimental date rape analogue

This study examined the impact of perceived token resistance and the psychological and pharmacological effects of alcohol consumption on men's discrimination of when a female wants her partner to stop his sexual advances. In a 2 (alcohol vs. no alcohol) × 2 (expectancy vs. no expectancy) × 2 (perceived token resistance vs. no resistance) randomized factorial design, male college students were exposed to an audiotape of a date rape. Before listening, participants were told that on the previous date the woman did not resist sexual contact or that she initially objected to the contact but the man was able to obtain the level of intimacy he desired. Relative to participants assigned to the no-alcohol expectancy or no-alcohol consumption group, participants in the alcohol expectancy and alcohol consumption groups took significantly longer to determine that the man should refrain from attempting further sexual contact. The implications of the findings are discussed.This investigation was carried out by the first author under the supervision of the second author in partial fulfillment of the requirements for the degree of Doctor of Philosophy.     

Relations of perceived bodily changes with actual changes and changes in mood in obese women initiating an exercise and weight-loss program

Significant relationships were found between mean difference scores for body satisfaction and mood (rs = /.42 to .54/) for obese women (N = 50) beginning exercise programs for weight loss. No significant relationships were found between self-reported body satisfaction and measures of bodily changes. After replication, implications for theory and treatment were discussed.     

Evaluation of changes in mother-infant brief psychotherapy: A single case study

Representation-oriented brief psychotherapy with mother-infant dyads is used to examine correspondences between maternal behaviors and maternal representations of her infant. A single case study is presented to illustrate how one can objectify interactional variables that may correspond behaviorally to underlying maternal mental representations. This paper presents the results of a collaboration that focuses on the process of enacting fantasy via the domain of behavior. Attention is drawn to interacted themes that are enacted versions of representational themes. Enacted themes are pathogenic in behavioral terms for the infant. Five themes are identified in the case material. Changes in the mother's representations affect both the mother-infant relationship and the infant's functioning.     

Self-reported expected emotional changes as a function of alcohol intoxication by alcoholic men and women

80 alcoholic men and women registered for counseling at different Swedish outpatient units volunteered to complete semantic differential scales related to emotional expected effects of alcohol intoxication. Analyses indicated that alcoholics expect large doses of alcohol to increase pleasure, dominance, and arousal. These results were discussed in comparison with the results from previous related studies with nonalcoholic samples.