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Biomedical subjects

R R Bootzin

Publications and source records attributed to R R Bootzin.

36 records · Page 2Linked to original sources
PubMed1986

Psychiatric episodes in general hospitals without psychiatric units.

Forty percent of inpatient psychiatric episodes are treated in general hospitals without psychiatric units, but little is known about these patients and their treatment. A survey of medical records personnel at 452 hospitals without psychiatric units revealed that the hospitals' psychiatric patients typically lived at home, were admitted through the emergency room because of a substance abuse disorder, received active medical treatment, were discharged back home after about four days, and paid with private insurance. The hospitals that treated primarily substance abusers provided a significantly different mix of treatments than did those that treated primarily patients with traditional diagnoses. The data suggest that general hospitals without psychiatric units may provide appropriate treatment for psychiatric patients, especially those with a substance abuse disorder.

Hospitals, General↗
PubMed1985

The subjective well-being of mental patients in nursing homes.

This article reports a survey of self-reports of well-being by chronic mental patients in nursing homes. Patients reported lower levels of well-being than the general population, but not lower than other socially disadvantaged groups including urban renewal blacks. Nursing home mental patients reported levels of well-being that were generally similar to mental patients in other settings, including day hospital patients, participants in an innovative community care program, and patients receiving traditional hospital and follow-up care. These reports were mostly unrelated to levels of symptomatology or social integration, but were strongly related to patient perceptions of the quality of the environment. Results have important implications concerning the justifications for community care goals like noninstitutional care, reduction of symptomatology, and the fostering of social integration.

Chronic Disease↗
PubMed1984

The social integration of psychiatric patients in nursing homes.

The authors explored self-reports of the social integration of 163 chronically ill psychiatric patients who were admitted to 12 nursing homes over a 1-year period. Results suggest that nursing home care for psychiatric patients is custodial and institutional in character and that the social integration of such patients is generally low. Nursing home patients had lower scores than outpatients but not inpatients on a measure of social participation; they were similar to both these groups on measures of spending and employment. Levels of social integration changed little over 1 year, either for better or for worse.

Adolescent↗
PubMed1984

Mental patients in nursing homes: their characteristics and treatment.

Nursing homes have become a primary care site for chronic mental patients. The present study reports an empirical investigation of the characteristics of 163 mental patients in nursing homes in a large midwestern city and of the treatment they receive. These mental patients tended to be chronic schizophrenics with an established history of poor social coping. Their average age was 48 years, and they had no obvious physical ailments that would account for their nursing-home placements. These patients received an average of three or four medications each, a figure that tended to increase over a 1-year period. Conversely, relatively little psychosocial treatment is provided these patients, and such treatment tends to decrease over a year. Results are discussed in terms of the relative emphasis in nursing homes on custodial care versus active psychosocial treatment.

Custodial Care↗
PubMed1984

Nursing homes: the new total institution in mental-health policy.

Recent opinion suggests that the facto mental-health policy in this country is institutionalization, rhetoric to the contrary notwithstanding. The nursing-home industry is the center of that policy. More patients with chronic psychiatric disorders may reside in, and more mental-health money may go to, nursing homes than to any other mental-health setting. Starting from Goffman's classic definition of the central feature of a total institution, the present study documents, through a random sample of mental-health facilities, that nursing homes are virtually indistinguishable from hospitals on some characteristics that define a total institution and that both hospitals and nursing homes are clearly distinguishable from a variety of outpatient mental-health settings. In view of the magnitude of the role played by nursing homes in the care of mental patients, it is concluded that the nursing home is the new total institution of mental-health policy.

Health Policy↗
PubMed1982

Criteria for success in deinstitutionalization: perceptions of nursing homes by different interest groups.

Studies of deinstitutionalization often use a limited set of criteria by which to judge success. Social integration and recidivism, for example, are particularly popular criteria. Yet such criteria may not reflect the diverse settings in which community care occurs, nor the diverse views of success held by different interest groups. The present study presents a methodology for developing more comprehensive criteria for evaluating social programs, including deinstitutionalization. The methodology is illustrated by analyzing the perceptions of different interest groups about the nature of successful care for mental patients in nursing homes.

Attitude of Health Personnel↗
PubMed1981

Nursing home care for mental patients: descriptive data and some propositions.

Nursing homes play an important role in the community-based care of chronic mental patients, yet there is little research in that setting. The present study gathered and analyzed descriptive data on 20 nursing homes in a large urban area, including data about structure, staffing, policy, treatment, residents, discharge, psychosocial climate, and neighborhood characteristics. Results suggested a clear difference between skilled nursing versus intermediate care facilities, with the latter playing a larger role in caring for mental patients. More important, data suggested such facilities play primarily a custodial rather than treatment role, and that managers expect patients in nursing homes to stay indefinitely. In view of this, our justifications for community care, such as social integration, need to be examined anew.

Chronic Disease↗
PubMed1981

Nursing homes and chronic mental patients.

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us recognize problems in the rationales for deinstitutionalization and community care. Problems with three concepts that were central to deinstitutionalization are examined--the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization--custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more constructive role in mental health policy.

Chronic Disease↗
PubMed1981

Long-term community care: mental health policy in the face of reality.

Nursing homes play an important role in the care of chronic mental patients, and they could be used as one base on which to build a better system of care. Carling, in his article "Nursing Homes and Chronic Mental Patients: A Second Opinion," appears to question aspects of this contention. His efforts in this regard are interesting but unconvincing, though his thoughtful comments usefully elaborate the problems inherent in trying to incorporate nursing homes into the mainstream of mental health care. He more successfully uses his article to describe the National Plan for the Chronically Mentally Ill, a recent policy proposal of great merit that may some day significantly benefit metal patients. Meanwhile, mental health policy must face the reality that nursing homes are providing useful services to many chronic mental patients who have been inadequately served by current community care programs. This is not likely to change in the foreseeable future. Policy advocates need to attend to practical alternatives, not just to idealized possibilities.

Chronic Disease↗
PubMed1976

The power of suggestion: another examination of misattribution and insomnia.

This experiment was conducted in an attempt to replicate and delimit the reverse placebo effect found by Storms and Nisbett in insomniacs. It was predicted that the reverse placebo effect would obtain when the pills' effects were described as affecting arousal (as in Storms and Nisbett's study) but that a direct suggestion effect would result when the pills were described as directly affecting sleep onset latency. Results indicated that direct suggestion effects obtained regardless of the focus of the instructions. The present study together with the findings of Kellogg and Baron call into question the reliability and clinical significance of the reverse placebo effect in the treatment of insomnia.

Adolescent↗
PubMedDate not supplied

Time-dependent sensitization of heart rate and blood pressure over multiple laboratory sessions in elderly individuals with chemical odor intolerance.

In this study, we tested the hypothesis that low-level chemical odor intolerance (i.e., "cacosmia") is a manifestation of heightened sensitizability to environmental stimuli. We examined supine heart rate and blood pressure of elderly individuals, who were classified as either having a higher degree of chemical odor intolerance (n = 12) or a lower degree of chemical odor intolerance (n = 13), upon awakening in a sleep research laboratory on 6 different days during an 8-wk protocol. During the 2 initial wk, they consumed a customary baseline diet (including ad lib milk and other dairy products), followed by 3 wk each of nondairy-containing and dairy-containing diets in randomly assigned, counterbalanced order. Measurements were made on 3 pairs of successive days, distributed over a 6-wk period, and on which different diets were consumed. The high-intolerance group had significantly higher mean supine systolic and diastolic blood pressures than did the low-intolerance group. Although subjects consumed milk products during both the initial baseline and subsequent dairy diet periods, the high-intolerance group had significantly higher heart rates and diastolic blood pressures later in the study than at baseline, especially when they were on the dairy diet. In contrast, the cardiovascular measures of the low-intolerance group lowered on average with time. The high-intolerance subjects had an increased mean diastolic blood pressure on the second days versus the first days in the laboratory (averaged across all diets). Collectively, the data suggest that elderly individuals with a high degree of chemical odor intolerance evidence (a) increased sympathetic tone in the cardiovascular system at rest over multiple measurements; and (b) greater sensitizability and/or lesser habituation of heart rate and diastolic blood pressure over time as a function, in part, of repeated environmental stressor exposures (i.e., a novel laboratory contextual setting and/or specific dietary constituents). Consistent with a sensitization model, the findings emphasize the need for two or more identical sessions at least 24 h apart in physiological studies of individuals with a high degree of intolerance for chemical odors versus normal individuals. The results of the blood pressure observations suggest that the possibility of abnormally labile autonomic function and cognitive sequelae in individuals with a high degree of intolerance for chemical odor increases with age.

Aged↗
PubMedDate not supplied

Intervention factors for promoting adjustment to nightwork and shiftwork.

This chapter reviews a broad range of factors that, if controlled, might promote adaptation to nightwork, shiftwork, and extended workshifts. Systematic study has begun in four of the areas reported here: work schedule design, napping, bright light stimulation, and drugs. Physical activity, ambient temperature, diet, and individual behaviors have been studied only superficially.

Adaptation, Physiological↗