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Biomedical subjects

D L Cutler

Publications and source records attributed to D L Cutler.

51 records · Page 3Linked to original sources
PubMed1989

Social networks and negative versus positive symptoms of schizophrenia.

The social networks of people with schizophrenia are less functional than those of nonpsychiatric populations. In this study, positive versus negative symptoms were examined in relation to social networks. Thirty-nine patients with chronic schizophrenia were assessed for positive and negative symptoms and for size and quality of social network. Patients with more negative symptoms had significantly smaller social networks. Their networks were similarly more dysfunctional on a variety of measures. Positive symptoms did not correlate significantly with any network variable.

Adult↗
PubMed1989

A basic residency curriculum concerning the chronically mentally ill.

In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision, didactics and seminars, and evaluation mechanisms. Recommendations are also made concerning changes in the Accreditation Council for Graduate Medical Education's Special Requirements for Residency Training in Psychiatry, which would require residency programs to place more emphasis on training to meet the needs of the chronically mentally ill. Obstacles to the implementation of the proposed recommendations are presented and possible solutions are discussed.

Accreditation↗
PubMed1988

Characteristics of state hospital patients who are hard to place.

As a result of deinstitutionalization, acute care beds in state hospitals have become blocked by patients who lack access to appropriate community placements but who have derived maximum benefit from hospital care. To help plan community services for these patients, this study identified and described patients at an Oregon state hospital who were hospitalized longer than therapeutically necessary because no community facility could treat them. A total of 146 patients were identified during a three-month period, and 81 were described; 65 percent were men, 70 percent were schizophrenic, and 90 percent presented a risk to themselves or others. The patients exhibited few strengths, and one-third had a substance abuse problem, at least one counter-therapeutic attitude, or a need for medical monitoring. The authors describe how new community residential facilities can meet the needs of these difficult patients.

Adult↗
PubMed1987

A comparison of schizophrenic patients in different community support treatment approaches.

Recent advances in the care of the chronically mentally ill in the community have resulted in a "community support system" approach to maintaining chronically mentally ill persons outside the hospital. Yet, very little is known of what a community support system actually is for the chronic mental patient. This paper looks at three different sorts of community support programs and compares a sample of patients within them with respect to network variables, role performance, and demographic variables. Implications regarding the use of network oriented approaches are discussed and directions for further research are explored.

Aftercare↗
PubMed1987

Academic, community and state mental health program collaboration: the Oregon experience.

The authors review the relationship that has evolved over the years between the Department of Psychiatry at Oregon Health Sciences University and Oregon's community and state mental health programs. They describe the compatibility that exists between the basic requirements of academic psychiatry departments and public mental health programs and demonstrate how these organizations have been able to fulfill one another's needs in Oregon. Specific examples of successful collaborations in the areas of education, administration, research, and service are presented to illustrate how relationships that have been designed to meet specific requirements of one organization can fulfill many requirements of both. Suggestions are provided for those organizations contemplating similar collaborative endeavors.

Community Mental Health Centers↗
PubMed1986

Community residential options for the chronically mentally ill.

We have discussed the problems of the new young chronic patients, deinstitutionalized old chronic patients now living in the community, and some of the groups of hard to place patients. We have talked about problems with community barriers, staff training, a spectrum of facilities, and we have looked at what new sorts of facilities may need to be developed. It seems clear that we have not yet developed a spectrum which can deal with all varieties of the chronically mentally ill. Pepper (1985) has suggested a different, more ideal spectrum of housing particularly suited to the young adult chronic patient. These include crisis residences, supervised 14-bed residences, growth house for 14 beds; support house for 14 beds; supervised apartments (satellite apartments), 14 beds; supportive apartments, 14 beds; (these have less intensive staffing than supervised ones); open community living; and residential congregate care for adults (RCCAs). These RCCAs are large facilities located either in old state hospitals or nursing homes which are primarily oriented towards the homeless mentally ill. According to Pepper, if a program can plan a spectrum of housing situations in the immediate catchment area, it can then actually meet the specific needs of each patient with a specific sort of residential facility. The challenge for community residences is certainly much greater than a decade ago and, with the homeless mentally ill population continuing to grow (Bachrach, 1985), one might be tempted to regard our present situation as one of crisis proportions. Clearly, there is little doubt that a need exists for a wide spectrum of living situations to be made available to the deinstitutionalized or never institutionalized young adult chronic patient. Yet very few incentives exist for those who would try to meet this challenge. To do this effectively will undoubtedly require the development of sizeable amounts of public funding through existing and new channels to provide support for a variety of new types of community living arrangements with varying degrees of structure and treatment. There is also a great need for continued educating of the community about the realities of treating chronic mental patients in tailored facilities who must be protected from harming themselves or others. Finally, we in the field need better continuing education for ourselves and for those staff working in the residential area. Most of us don't ever learn about how to operate outside of our offices.(ABSTRACT TRUNCATED AT 400 WORDS)

Chronic Disease↗
PubMed1984

Productive activities for the chronic patient.

This paper examines the common characteristics of chronic psychiatric patients and the principles that should guide the development of any program of activities designed to promote their rehabilitation. A range of productive activities in each segment of a support network is described, and an example from Oregon is presented to illustrate how different levels of activities can be used to meet rehabilitation goals.

Activities of Daily Living↗
PubMed1984

Disseminating the principles of a community support program.

Oregon's Living in the Community (LINC) program for chronic patients succeeds because of effective collaboration between a state hospital and a community treatment and rehabilitation program. The authors trace the development of the LINC program from its beginning in the early 1970s as a progressive retraining project for Eastern Oregon State Hospital's "back ward" patients. They describe principles derived from the original project, such as the provision of training in the patient's natural environment, adoption of these principles into the Oregon community support program, and dissemination of LINC projects to other parts of the state. The authors conclude that such model programs can be transferred to urban and rural settings when supported by a statewide planning effort.

Chronic Disease↗
PubMed1982

The CMHC as a setting for residency education.

The authors review four approaches chairmen of departments of psychiatry have used to attempt to ensure quality resident education in CMHCs they do not control. Several examples are presented of administrative problems that may develop in this type of relationship. Based on this material and the author's experience, a four stage administrative process is presented which emphasized clear identification of goals and objectives, negotiation of a relationship that is beneficial to both the development and the CMHC, development of a written contract, and careful monitoring and evaluation of its progress. Designing a relationship in this fashion offers maximum opportunity for programmatic success.

Academic Medical Centers↗
PubMed1981

Training psychiatrists to work with community support systems for chronically mentally ill persons.

Community support programs are becoming a major priority in community mental health centers throughout the country. The authors present a training design that integrates principles and skills associated with this model into a 4-year residency training program. The aim of such programs is to keep young psychiatrists involved and in the forefront of the newer approaches to the treatment of chronically mentally ill persons.

Chronic Disease↗
PubMed1980

Community-family network therapy in a rural setting.

A model of family intervention with extended family members and significant community agency people is presented in an attempt to deal with the total social network surrounding a seriously dysfunctional family. They describe how this approach adapts itself well to a rural setting and seems to encompass most if not all of the significant helping systems in the family social sphere. The roles of the various team members are carefully outlined and the process of the therapeutic meeting is described. The authors believe that this approach has a facilitative effect to increase the functionality of already existing natural social systems on which the families are already quite dependent, but which prior to the network sessions were largely nonfunctional. The effect of all of this is to reduce drastically the amount of wasted time, energy, and effort that occurs when all the significant persons and agencies in the psychosocial sphere of a family are not working together in a coordinated manner.

Adolescent↗
PubMed1978

Life events and prisoners.

This study explores retrospectively the relationship of the accumulation of life events as it relates to prison incarceration and extends further the concept that coping with increasing environmental changes results in a variety of overt behaviors. The prison sample comprised 176 male inmates of a federal prison (McNeil Island, Washington) and a state penitentiary (Walla Walla, Washington). Life change scores were derived from the Schedule of Recent Experience (SRE). There was an escalation of annual life change scores of prisoners, indicating the mounting frequency of occurrence of life events prior to incarceration. The SRE may have value in the prediction of socially deviant behavior as with health changes. Variables seen as influencing life change scores were race, age, and education. Analyses of life event frequencies as compared to a normative group indicated that prisoners have evolved a coping life-style that reflects antisocial and criminal behavior.

Adult↗