Requirement for and position of partial clinical treatment in the system of psychiatric care

Reference is made to the level of development of psychiatry in the USSR and the general principles of psychiatric care accepted in the country. Part of the development in the GDR is then described, followed by an argument in favour of day and night care for patients. This is an area where much remains to be done. This partial clinical treatment is to fill the gap between inpatient and outpatient facilities and should be available in the residential area of the patient.     

Computer-based instruction and the practical aspects of memory

This article examines the relationship between basic memory research and computer-based instruction (CBI). The results of basic memory research have helped determine the current directions of computer-assisted instruction (CAI) research and development. These directions have included examining the utility of such learning systems for facilitating memory outcomes and developing CBI systems based on cognitive instructional principles. Examples of such systems include the emerging generation of hypermedia and artificial tutoring systems. Inconclusive results, however, have been found regarding CBI's effects on memroy phenomena. The CBI literature has thus not established the utility of any memory theory for naturally occurring phenomena. Several plausible reasons for this “null finding” are discussed.     

The effectiveness and ethical justification of psychiatric outpatient commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.     

Child and parent perceptions of children's psychopathology in psychiatric outpatient children

This study investigated the clinical utility of multitrait-multimethod assessments of internalizing and externalizing symptoms in child psychiatric outpatients. Mothers tended to rate all symptoms of psychopathology at higher levels of severity than their children. In contrast to studies of inpatients, much stronger convergent validity of child and mother ratings was obtained. Overall, findings yielded little evidence of discriminant validity, although mothers appeared better able to discriminate between internal and external symptomatology than their children. Methodological and theoretical explanations of these findings are discussed.     

Clinical utility of new cut-off scores for the world health organization ADHD self-report scale among adolescents in psychiatric outpatient care

Previous analyses of the proposed cut-off score for the 18-item World Health Organization ADHD Self-Report Scale (ASRS-18) among psychiatrically referred adolescents have shown limited clinical utility. This prospective study examined the diagnostic accuracy and clinical utility of new cut-off scores of the ASRS-18 in a consecutive sample of 111 Swedish adolescent psychiatric outpatients. Using the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS) as the reference standard and based on predefined sensitivity and specificity criteria, multiple new general and sex-specific cut-off scores were evaluated. Results showed that clinical utility was greater for sex-specific cut-off scores than for general cut-off scores. The greatest change in pre-test to post-test probability of ADHD diagnosis was observed with a balanced, high-specificity diagnostic cut-off score for girls, where the probability of ADHD increased from 40% pre-test to 82% post-test. The proposed new cut-off levels for the ASRS-18 are useful for the detection and identification of ADHD among adolescents in general psychiatric outpatient settings.     

Some aspects of verbal conditioning in psychiatric patients

Using a modification of a verbal conditioning technique reported by Tafiel (1955) it was found that only schizophrenics and normals showed evidence of conditioning, neurotics and depressives showing changes not differing from chance. There was greater evidence of conditioning among Ss aware of the contingency between response and reinforcement, and some tentative evidence for relationships of anxiety and extraversion with verbal conditioning.     

Pastoral care of the discharged psychiatric patient

Pastoral Psychology -     

Differences in the severity of disturbance of behaviors in children receiving inpatient and outpatient psychiatric treatment.

This study was conducted to determine if there are differences in the severity of disturbance of behaviors exhibited by children receiving inpatient psychiatric treatment and those receiving outpatient psychiatric treatment based on their parents' judgments of the frequency of occurrence of those behaviors. The same behaviors were found to exist in both treatment groups, but the severity of disturbance of those behaviors in the inpatient sample was significantly greater than in the outpatient sample. The scale used in this study was found to be a valid and useful instrument for predicting inpatient and outpatient status of children. Pratice and research implications of this study are also discussed.