Involuntary admissions in a Canadian province: the influence of geographic and population factors.
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Commitment of Persons with Psychiatric Disorders↗
Biomedical subjects
A Malla
Publications and source records attributed to A Malla.
Symptom patterns of alcoholism in a northern Ontario population.
Alcoholism is noted to be a common problem in Canada and particularly in native populations. We report here a survey of the frequency of evidence of alcoholism over a period of four months in a relatively isolated Northern Ontario population in which more than 80% were either status Indians or of partly Indian origin. Using questionnaire methods, "definite" alcoholism was found to affect 27% of adults seen at a clinic and probable alcoholism affected another 20%. This gives a minimum prevalence of 14.6% of the local adult population over a four month period on the basis merely of examination of less than one third of the adults in the community. Blackouts, tremors, bad temper, chest pain, unsteadiness, loss of appetite, vomiting, sadness and stomach pain occurred significantly more often in the alcoholic patients. Stomach pain, loss of appetite and vomiting were less prominent with alcoholism in this population than in a Southern population. The findings indicate the importance in general practice of looking for alcoholism, the ease with which this may be undertaken with a few very simple short questions and the importance of some characteristic patterns, especially blackouts, shakiness and unsteadiness as one pattern and stomach pain and other gastro-intestinal symptoms as another pattern.
Adult↗
An outcome study comparing refusers and acceptors of treatment for alcoholism.
Fifteen matched pairs of alcoholics who had either refused or completed day treatment were reassessed sixteen months after the initial assessment. The treated group had improved significantly more than the untreated group on measures related directly to alcohol abuse, in their utilization of inpatient psychiatric services, and the use of family physician's services. The treated group had also used disulfiram for significantly longer periods of time. The treatment refusers had nonetheless achieved statistically significant, albeit modest, reduction in their consumption of alcohol compared to their pre-assessment levels. Both groups showed equal amount of change on a number of psychosocial measures, such as employment, use of minor tranquilizers and non-prescription drugs, legal problems and symptoms of depression. These findings are discussed in the context of the effectiveness of a day program, the use of disulfiram and certain pretreatment characteristics of the patient.
Adult↗
Factors associated with involuntary admission to psychiatric facilities in Newfoundland.
To assess what factors determine the involuntary status of psychiatric patients, we reviewed the case records of 5729 patients consecutively admitted to one of four inpatient psychiatric facilities, including a mental hospital, in St. John's between October 1975 and October 1978. Of the 5729 patients 5005 (87.4%) were voluntary and 724 (12.6%) involuntary. Involuntary patients were more likely than voluntary patients to be male, single and unemployed and to have been referred by police or transferred from another facility to the mental hospital, where most of the involuntary admissions occurred. They had higher rates of previous admissions to a psychiatric facility and of suicidal and violent behaviour, were more likely to have a diagnosis of schizophrenia or mania and were less likely to be suffering from depression or a neurotic disorder. In correspondence with differences in diagnosis, involuntary patients stayed in hospital more than twice as long as voluntary patients, were less likely to receive electroconvulsive therapy, minor tranquillizers and antidepressants, and were more likely to receive neuroleptics and lithium carbonate. Stepwise logistic regression analysis revealed that only the source of referral and a diagnosis of neurotic disorder had an independent effect on admission status. The findings are discussed in the context of the controversy over the parens patriae approach v. the legal approach to involuntary admission of psychiatric patients.
Adult↗
Attitudes towards mental illness: the influence of education and experience.
Female nursing students who had completed an instructional and experiential training program were compared on their perception, beliefs and opinions about mental illness with students who had just entered the same program. The results showed that students who had completed their training were better able to perceive the presence and severity of mental illness. Both groups favoured psychosocial etiology and psychosocial forms of treatment. There was no difference in their attitudes towards the mentally ill and both groups shared an overall optimism about prognosis. The implications of the lack of sophisticated knowledge about psychiatric disorders among mental health professionals are discussed.
Adult↗
Screening for alcoholism in family practice.
491 consecutive adult patients who consulted their family physician for routine medical problems completed a five item screening questionnaire for alcoholism and a checklist of 12 commonly occurring symptoms. More than 11% showed definite evidence of alcoholism while another 6% showed probable evidence. Review of the medical record for that visit revealed that a large proportion of the alcoholics detected through this method were not diagnosed as such nor was alcohol charted as a significant factor in their medical problems. Patients who reported common symptoms such as blackouts, tremors, temper outbursts, chest pain, unsteadiness, loss of appetite, vomiting, sadness and "stomach pain" had significantly higher rates of alcoholism than those who did not report these symptoms. In order to detect alcoholism in family practice, it may be useful to routinely ask a few inoffensive questions to increase significantly the detection rate.
Adolescent↗
An epidemiological study of electroconvulsive therapy: rate and diagnosis.
Five thousand, seven hundred and twenty-nine consecutive admissions to the three general hospitals and the mental hospital in St. John's, Newfoundland, Canada, were examined retrospectively for the use of electroconvulsive therapy (ECT). The proportion of patients admitted who received ECT (rate), and the number of treatments per admission were recorded. Rate of ECT, expressed as percentage of patients admitted, was assessed for all hospitals separately and compared on legal status and diagnosis. One thousand, two hundred and thirty-six (21.5%) patients admitted, received ECT with little variation over a three year period. The rate was higher for the general hospitals and for voluntary patients. ECT was used in a very high proportion of patients with diagnoses of depression (50%), mania (20%), schizophrenia (36%), and neurotic disorders (20%). These findings are discussed in the context of the overall trend of a low utilization of ECT elsewhere, and the previous research evidence of limited indications for ECT.
Acute Disease↗
A comparison of disulfiram acceptors and refusers on selected demographic and clinical characteristics.
Male problem drinkers who accepted a treatment recommendation to take disulfiram were compared to those who refused the drug therapy. Subjects were drawn from a clinical population presenting to an outpatient alcoholism assessment service over a 3-year period. Both univariate and multivariate analyses were employed to investigate which client variables were associated with compliance to the disulfiram recommendation. The most important variable that distinguished the two groups was the percentage of other treatment recommendations adhered to by the client with the disulfiram acceptors being more likely to accept the other treatment recommendations. In addition, clients agreeing to take disulfiram were slightly younger and had higher scores on the Michigan Alcoholism Screening Test (MAST). Variables such as socio-economic status, previous treatment history, other drug use and drinking pattern were not associated with agreement to take disulfiram. The implications of these findings are discussed, particularly their relevance to research on the therapeutic effectiveness of disulfiram.
Adult↗
Differences in suicide rates: an examination of under-reporting.
A search of death certificates in the Registrar of Births and Deaths in Newfoundland was conducted covering the period of 1974 to 1978. In addition to 103 cases of suicide recorded on the certificates, in 104 cases no cause of death was recorded. The latter were further investigated through records of the forensic pathologist to determine the causes of death. Out of these, 14 cases were found to be unequivocal suicides and in 58 cases, cause of death was undetermined, or not investigated. These were added to the reported suicides (103) to provide a maximum possible correction for under-reporting. The suicide rate in Newfoundland still remains less than half the national rate in spite of the correction for underreporting. Implications of these findings are discussed in the light of reported research literature in this field, and social factors in the province.
Canada↗
Suicide in Newfoundland and Labrador.
The present investigation was undertaken to explore the special factors associated with low suicide rates in Newfoundland and covered the ten year period of 1964 to 1973. The data were collected from death certificates. Comparisons were made with figures for Canada as a whole, as reported in the official statistics. Apart from a constant overall low rate of suicide in Newfoundland, women and young people (aged 15 to 29) failed to show an increase in the suicide rates such as has been observed in other parts of Canada and throughout the western world. In Newfoundland, age specific suicide rates, choice of method, variations in the rates for different religious denominations and seasonal variations in suicide rates were different from those observed elsewhere. Generally, suicide in Newfoundland shows a much older pattern and does not involve the new high-risk groups seen in more urbanized societies. Possible explanations for the special demographic characteristics of suicide in Newfoundland are offered, mainly on social, cultural and geographical grounds.
Adolescent↗