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Biomedical subjects

F Cournos

Publications and source records attributed to F Cournos.

At least 37 records · Page 2Linked to original sources
PubMed1996

Illicit-drug injection among psychiatric patients without a primary substance use disorder.

OBJECTIVE: To increase understanding of HIV infection risk among patients with severe mental illness, the study sought to identify predictors of injection drug use among patients who did not have a primary substance use disorder. METHODS: A total of 192 patients recruited from inpatient and outpatient public psychiatric facilities were interviewed by trained mental health professionals using the Structured Clinical Interview for DSM-III-R (SCID), the Positive and Negative Syndrome Scale, and the Parenteral Drug Use High-Risk Questionnaire. RESULTS: Sixty percent of the sample met SCID criteria for lifetime substance abuse or dependence. Although only two patients reported drug injection in the past six months, 38 (20 percent) had injected drugs since 1978, the year that HIV began to spread in the U.S. A lifetime diagnosis of opioid abuse or dependence was a strong predictor of drug injection, but only 11 of the 38 patients with a recent history of injection drug use had either of these diagnoses. The likelihood of injecting drugs was four times greater among patients with a history of intranasal substance use compared with those without such use, three and a half times greater among African-American patients than among non-African-Americans, and five times greater among patients aged 36 or older compared with younger patients. CONCLUSIONS: In assessing HIV risk among patients with severe mental illness, it may be more important to identify the route of drug administration than the specific substances used because of the strong association between intranasal drug use and history of injection.

Adolescent↗
PubMed1996

The relative contributions of psychiatric symptoms and AIDS knowledge to HIV risk behaviors among people with severe mental illness.

BACKGROUND: This study was designed to determine whether psychiatric symptoms and acquired immunodeficiency syndrome (AIDS) knowledge predict human immunodeficiency virus (HIV) risk behavior among people with severe mental illness. METHOD: We interviewed 178 psychiatric patients to determine Axis I diagnosis, level of functioning, severity of psychiatric symptoms, knowledge about AIDS, sexual risk behaviors in the previous 6 months, and drug injection since 1978. Severity of psychiatric symptoms was rated on the Positive and Negative Syndrome Scale within the classification of positive, negative, cognitive, excited, and depressed/anxious symptoms. RESULTS: Ninety-two patients (51.7%) reported being sexually active in the previous 6 months. Of sexually active patients for whom data were available, 44 (47.8%) of 92 had multiple sex partners; 32 (35.2%) of 91 used drugs during sex; 27 (29.7%) of 91 traded sex for drugs, money, or other goods; and 50 (58.1%) of 86 never used condoms. Thirty-one patients (17.5%) had drug-injection histories. The median AIDS knowledge score was 23 (82.1%) of 28. Although AIDS knowledge was negatively correlated with cognitive and negative symptoms and positively correlated with excitement, knowledge alone did not predict any risk behavior. However, when AIDS knowledge was taken together with age and excited symptoms, the odds of being sexually active versus abstinent were three times higher among patients with better AIDS knowledge and twice higher among patients with greater excited symptoms. Having multiple sex partners was nearly three times as likely among patients with greater positive symptoms. Trading sex was more than three times as likely among patients with schizophrenia than among those with other diagnoses and more than five times as likely among those with more excitement symptoms. CONCLUSION: Patients, particularly those who were sexually active, were well informed about AIDS. Specific psychiatric conditions, including the presence of positive and excited symptoms and a diagnosis of schizophrenia, predicted certain sexual risk behaviors and must be the focus of innovative prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Characteristics of HIV-positive chronically mentally ill inpatients.

The growing population of chronically mentally ill persons who are HIV-positive or who have AIDS has not yet been adequately studied. We describe the entire population of known HIV-positive inpatients in a state psychiatric center in New York City. In this sample, the typical patient with known HIV infection is as likely to be a man as a woman and is a member of an ethnic minority group. HIV-positive patients had multiple risks for HIV infection including injecting drug use (IDU), sex with IDU partners, prostitution and male homosexual activity. Most patients were at a late stage of HIV-infection, typically with CD4+ cell counts of 400. Discharge plans were complicated by HIV illness and most HIV-positive patients had a longer length of hospital stay than non HIV-positive patients. We discuss the need to plan for the management of increasing numbers of HIV-positive patients in inpatient, outpatient, and residential facilities.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Risk factors for homelessness among women with schizophrenia.

A study of risk factors for homelessness among the severely mentally ill was extended to include women, and a case-control study of 100 indigent women with schizophrenia meeting criteria for literal homelessness and 100 such women with no history of homelessness was conducted. Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder. Homeless women also had less adequate family support.

Adult↗
PubMed1994

HIV-1 infection at two public psychiatric hospitals in New York City.

Seroprevalence for HIV-1 was anonymously evaluated between November 1989 and July 1991 among severely mentally ill patients at two public psychiatric hospitals in New York City. The study population consisted of new admissions and long-stay patients aged 18-59. Of 1116 eligible patients, usable samples were obtained from routine blood drawings on 971 (87%). Seroprevalence was comparable among men (5.2%) and women (5.3%). Age did not predict seropositivity. Men with a recorded history of homosexual behaviour or injection drug use were, respectively, 1.8 and 2.0 times more likely to be seropositive than men without these histories. Women with a recorded history of injection drug use were 4.0 times more likely to be seropositive than women without such a history. Ethnicity was not predictive for men, but Black women were 2.4 times more likely to be HIV-1 positive than non-Black women. Severely mentally ill inpatients had a substantial rate of HIV-1 seropositivity, indicating a need for additional testing, education and counselling efforts for this population.

Adolescent↗
PubMed1994

Sexual activity and risk of HIV infection among patients with schizophrenia.

OBJECTIVE: This study sought to determine the frequency and types of sexual behavior among patients with schizophrenia and to assess the behavior with respect to risk of HIV infection. METHOD: Ninety-five inpatients and outpatients with a research diagnosis of schizophrenia underwent a series of face-to-face interviews to determine their sexual activity and correlate it with demographic characteristics, psychopathology, and medication side effects. RESULTS: Forty-four percent of the patients had been sexually active in the preceding 6 months, and 62% of these had had multiple partners. Sexual activity was associated with greater general psychopathology. Having multiple sexual partners was associated with younger age, a lower level of functioning, the presence of delusions, and more positive symptoms. Of the sexually active patients, 12% reported at least one partner who was HIV positive or injected drugs, or both, and 50% had exchanged sex for money or goods. Ten percent of the patients had engaged in homosexual activity in the preceding 6 months and 22% during their lifetime; the frequency was similar among men and women. Consistent condom use was uncommon. CONCLUSIONS: A substantial proportion of schizophrenic patients had recent histories of sexual abstinence, but an almost equal number were sexually active. Sexual activity was usually accompanied by behavior related to HIV risk. Sexual activity and having multiple partners were associated with certain measures of more severe illness. Younger patients were more likely to have multiple partners but were also more likely to use condoms. There is a need for aggressive prevention strategies with this population.

Adolescent↗
PubMed1993

Do psychiatric patients need greater protection than medical patients when they consent to treatment?

It is commonly assumed that psychiatric patients require greater protection than medical patients when they make health care decisions. A review of the literature reveals that there is meager evidence for this belief and that both groups have significant capacity problems. Many factors other than psychiatric illness have been shown to impede understanding of informed consent information in health care settings. These include powerful emotional states, lack of a high school education, the presence of a severe medical illness, and increasing age. Clinicians can help patients become more adequate decision makers by taking such steps as providing adequate disclosure and inquiring about patient understanding. Even then, setting a realistically lenient standard of capacity seems the most practical approach. If screening for capacity is important for a specific health care decision, all vulnerable groups should be targeted.

Attitude to Health↗
PubMed1993

HIV seroprevalence among homeless patients admitted to a psychiatric inpatient unit.

OBJECTIVE: This study was conducted to determine the seroprevalence of HIV-1 antibodies among hospitalized homeless mentally ill patients. METHOD: From December 1989 through May 1991 the authors collected discard blood samples from patients consecutively admitted to a psychiatric unit designated for the care of severely mentally ill persons removed from the streets of New York City. The blood samples were tested for HIV-1 antibodies, and the results were analyzed for associations with age, gender, ethnicity, male homosexual activity, and use of injected drugs. RESULTS: The HIV seroprevalence was 6.4% (13 of 203 samples). Patients between ages 18 and 39 accounted for 51.2% of the admissions and 84.6% of the 13 positive results, a seroprevalence of 10.6% for this subsample. Patients under age 40 were more than six times as likely to test positive for HIV antibodies as those 40 or over. Ethnicity did not predict seropositivity. Women were as likely as men to be infected. Although clinicians had noted high-risk behavior on the charts for only three (23.1%) of the 13 positive cases, a recorded history of use of injected drugs was associated with a 6.5-fold greater risk of HIV seropositivity. CONCLUSIONS: One in every 16 patients admitted to the special unit was HIV positive. Age under 40 and use of injected drugs were strongly associated with seropositivity. Because information on high-risk behavior was infrequent, the reasons for younger patients' greater risk are unclear. The homeless mentally ill require outreach efforts to reduce the risk of acquiring or transmitting HIV.

Adolescent↗
PubMed1993

Reliability of sexual risk behavior interviews with psychiatric patients.

Test-retest interviews examining recent sexual activity were administered to 27 severely ill psychiatric patients after stabilization. Three reports were judged to be questionable. For the 16 sexually active patients among the remaining 24, high test-retest reliability was found for number of sexual partners, frequency of episodes, and proportions of episodes involving vaginal intercourse and use of condoms. The interviews did not exacerbate psychiatric symptoms.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV prevention among psychiatric inpatients: a pilot risk reduction study.

An HIV prevention program was piloted on an acute inpatient admission ward. Patients who volunteered to participate had significantly higher rates of histories of substance use than non-participants, suggesting that patients participated based on rational concerns about past HIV risk behavior. The program consisted of 75 minute sessions once a week for seven weeks and was co-led by an HIV counselor and the ward's social worker. Each session focused on a specific topic and included a short presentation of informational material, viewing of an educational videotape, a discussion, and role play and other educational games. In spite of a wide range in functioning among the participants, discussion was lively and participation was good. The pilot program demonstrates that chronic mentally ill patients can engage in, and benefit from, risk reduction programs and that frank and explicit discussion of sexual issues is well tolerated. Recommendations for improvement in the program are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Outcome of involuntary medication in a state hospital system.

OBJECTIVE: The purpose of the study was to examine the course of involuntarily administered medication in a state hospital population. METHOD: The authors retrospectively examined the records of all 51 involuntarily medicated patients in six state hospitals in New York City in a single calendar year. Clinical course was recorded for the period of involuntary medication and for 12 months thereafter. These patients were compared to 51 patients on the same wards who accepted medication. RESULTS: Clinicians assessed involuntarily medicated patients as more dangerous to themselves or others and less delusional after treatment than the comparison patients. Long-acting intramuscular antipsychotics were prescribed more frequently for involuntarily medicated patients. No differences were observed in rates of discharge, outpatient cooperation, or rehospitalization. Half of the patients in both groups remained continuously institutionalized, and of those who left the hospital, only 30% of the involuntarily medicated group and 40% of the comparison group took medication as outpatients. CONCLUSIONS: For these chronically severely ill patients, involuntary medication did not appear to enhance insight or cooperation or result in rapid return to the community. Involuntary medication is often a necessary short-term, in-hospital management strategy, but it does not replace the need to develop comprehensive, long-term inpatient and community-based approaches to the management of treatment refusal.

Adult↗
PubMed1991

HIV seroprevalence among patients admitted to two psychiatric hospitals.

OBJECTIVE: The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. METHOD: Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. RESULTS: Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. CONCLUSIONS: One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.

Adolescent↗
PubMed1990

HIV infection in state hospitals: case reports and long-term management strategies.

Issues facing state psychiatric hospitals as a result of the epidemic of human immunodeficiency virus (HIV) are illustrated by five cases. These issues include use of universal precautions to prevent transmission of HIV, medical diagnosis and management of HIV-infected patients, management of threatening behavior by infected patients, management of patients' sexual behavior, and discharge planning. The authors suggest that institutions will be required to ensure that sexual behavior between patients does not occur or to offer patients condoms or other means to protect themselves from infection. They recommend upgrading the medical capabilities of state hospitals so that they can competently provide long-term combined medical and psychiatric care to HIV-infected patients.

Adult↗
PubMed1990

Mental health policy for the 1990s: tinkering in the interstices.

That public policy has abysmally failed the chronically mentally ill seems beyond genuine dispute. Successive reforms have foundered on the familiar shoals of overblown expectations and insufficient resources. In this paper, we review current policies affecting the chronic and disabled mentally ill, and we consider some approaches to reform. We begin by trying to identify and characterize the chronically mentally ill and their disabilities. Next, we consider the chaotic patchwork of federal and state programs that has come to replace the asylum. We then criticize several competing models of reform that we believe fail to make an empathic connection with the mentally ill. Finally, we urge a strategy of limited reform consistent with available empirical data about program effectiveness and sensitive to the likely economic, political, and legal constraints of the 1990s.

Chronic Disease↗