Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.     

Behavioral assessment of psychiatric inpatients and normal controls across different environmental contexts

Objectively defined, publicly observable behaviors were time sampled for hospitalized psychiatric patients and normal controls in three distinct environmental contexts: lunch time, free time, and gym time. The behaviors sampled included body activity, extremity activity, proximity, social interactions, participation, visual scanning, laughing/smiling, and idiosyncratic behavior. Patient behaviors were recorded during both a drug-free baseline period and a subsequent medication period. The data suggest that consistent and reliable differences between patients and normals in most behaviors can be observed and that environmental context is an important determinant of these differences. Results are discussed in terms of their implications for assessment procedures and treatment decisions.These investigations were supported in part by State of Illinois Department of Mental Health and Developmental Disabilities Grants RD836-13 and RD622-02 to the first author. The cooperation of the Illinois State Psychiatric Institute staff is gratefully acknowledged.     

A ten-year prospective study of aggression in a special secure unit for dangerous patients

In a 10-year prospective study inpatient aggression was investigated in a Norwegian special secure unit covering a well-defined catchment area with a population of 240,000. The seven bed special secure unit receives dangerous, psychotic patients for long-term treatment. Only 19 patients were treated during the ten-year study lasting from 1 April 1987 to 1 April 1997. Incidents of aggressive behavior were recorded on the Report Form for Aggressive Episodes by the nursing staff. The study aimed to identify, classify and measure the occurrence of aggressive behavior, as well as the relative frequency of events preceding such behavior. A total of 2021 incidents of aggressive behavior were recorded. Seventy-five per cent of the aggressive acts were verbal or physical threats, while the remaining 25% were physical assaults directed at other persons. Four patients accounted for about 80% of the aggressive encounters. Nursing staff were victims in about 90% of the incidents. Serious physical injury was extremely rare. Situations pertaining to limit-setting and problems of communication accounted for approximately 90% of the precipitants of aggressive behavior. There were no sex differences regarding the occurrence of aggressive behavior.     

MULTIPLE-BASELINE ANALYSIS OF A TOKEN ECONOMY FOR PSYCHIATRIC INPATIENTS

Twelve behaviors selected for reinforcement among 16 chronic psychiatric inpatients were divided into four classes: (a) personal hygiene, (b) personal management, (c) ward work, and (d) social skills. A token economy program was introduced for each class in a sequential, cumulative, multiple-baseline format. Corrections were included for methodological deficiencies frequently encountered in past studies. Treatment variables were systematically monitored, and target behavior rates, levels of global individual functioning, general ward behavior, and off-ward behavior were assessed during baseline, implementation, and probe periods. Results indicated abrupt and substantial increases in performance of most target behaviors, significant improvements in global individual functioning (p < .025), positive changes in general ward behavior, and increases in social interaction during off-ward activities. The findings provide strong evidence for the efficacy of a token economy and indicate that the multiple-baseline design can be a useful method for evaluating token economy programs.     

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.     

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as mild (adjustment reaction only) or severe (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of clinically significant elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.     

Children and adolescents discharged from public psychiatric hospital: Evaluation of outcome in a continuum of care

Ninety children and adolescents admitted to two state-operated psychiatric hospitals were followed from the time of their admission through one year post discharge. Data were collected from the children and adolescents, their families and clinicians at three intervals (during hospitalization, three months post discharge, and one year post discharge) to identify demographic, clinical, and service history characteristics of the children and adolescents, as well as to track their placement and other dispositional status following discharge from the hospital. The data indicated that the children and adolescents were seriously emotionally and behaviorally disturbed, came from families which were economically disadvantaged, and did not typically live in two-parent families. While the majority of the children and adolescents received recommended aftercare services during the three months following discharge from the hospital, there was a decline in placement stability for the children at the one-year post discharge followup. The most important predictors of successful outcome at discharge were living with a family member at the time of hospitalization and the participation of the family in the treatment planning during hospitalization.     

Social problem-solving in dual diagnosis patients

Social problem-solving skills among dual-diagnosis patients were compared to two control groups: psychiatric patients without substance abuse problems and community volunteers. A standardized, behavioral role-play test consisting of four scenarios representing interpersonal problems yielded two reliable dependent variables: (a) specificity, or elaboration, of the problem-solving response and (b) overall effectiveness of the response. Analyses of covariance (using a measure of intellectual function as the covariate) indicated that both dual-diagnosis patients and psychiatric controls were significantly poorer problem-solvers than were community controls. The overall pattern of the results indicated that deficits observed in a dual-diagnosis sample are not necessarily compounded due to the presence of the coexisting disorders. Implications of these findings, strengths and limitations of this study, and suggestions for future research are discussed.This research was supported in part by Grant DA04593-01 from the National Institute on Drug Abuse.Portions of this article were presented at the 22nd Annual Meeting of the Association for the Advancement of Behavior Therapy during November 1988 in New York.     

Integrating systems of care in California for youth with severe emotional disturbance III: Answers that lead to questions about out-of-home placements and the AB377 evaluation project

This paper is the third in a series of reports on preliminary empirical findings from replications of an integrated system of care for youth suffering from serious emotional disturbance. The development of the innovative system of care was pioneered in Ventura County, California, and the replications in three other California counties were legislatively enabled through California legislation (Assembly Bill 377). This report presents results on the expenditure and utilization of foster homes, residential placements made through special education programs, and state hospitals. Evaluation results indicate that foster home and state hospital utilization and expenditures are lower for the counties replicating the innovative system of care than for the state of California as a whole. Expenditures for special education residential placements are either at the state rate or lower in one county. The cumulative evidence supports the conclusion that the replication counties are utilizing restrictive levels of care at lower rates than would be expected, given state-wide patterns. The results, in conjunction with prior findings, are discussed in the context of questions about the possible fates of youth who no longer live in publicly funded residential facilities.     

Le contrôle judiciaire des hospitalisations sans consentement et épidémie de Covid : la fin d’une procédure en trompe l’oeil ?

Since 2011, the judge of freedoms and detention (JLD) is competent to control care measures without consent. This control, although essential in order to avoid abusive deprivation of liberty, is incomplete. Faced with the health crisis, the shortcomings of this control are more noticeable in a context of violation of the rights of people hospitalized without detriment.