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Crisis-oriented residential treatment as an alternative to hospitalization.

The La Posada program, a short-term alternative to hospitalization for acutely disturbed chronic patients, combines crisis intervention techniques with techniques developed in halfway houses to enhance independent functioning and counteract regressive, dependent behavior. Highly structured days involving a variety of approaches including group and individual therapy, therapeutic activities, expectations of appropriate behavior, and responsibility for ongoing treatment enable most clients to leave the program within nine days and to begin outpatient and day treatment before discharge. The program has proved to be a cost-effective and readily reproducible way of reducing hospital utilization by diverting patients directly or allowing early discharge to La Posada.

Adjustment Disorders↗

The long-term psychiatric consequences of accidental injury. A longitudinal study of 107 adults.

One hundred and seven accidentally injured adults were studied while in hospital and assessed prospectively twice more in a mean period of 28 months. The patients were studied by means of taped clinical interviews, including the Comprehensive Psychopathological Rating Scale (which includes the Montgomery-Asberg Depression Rating Scale), and several self-report measures of distress (Schedule of Recent Life Events, General Health Questionnaire, Impact of Event Scale and State Anxiety Inventory) at the three assessments. The total incidence of psychiatric disorders considered to be caused by the accident during the follow-up period was 22.4%. The incidence of non-organic psychiatric disorders caused by the accident was 16.8% at the first follow-up and 9.3% at the final follow-up. Depressive disorders of different severity were most often seen. Only one patient suffered from a post-traumatic stress disorder during the follow-up, and none at the final follow-up (DSM-III). Organic mental disorders were diagnosed in 9.3% of the patients. In 5.6% of the patients this was the only disorder.

Accidents↗

[Psychosocial aspect and personality characteristics of patients with hemophilia].

The paper is concerned with the results of a study of the personality, of the intellectual development and psychosocial status in 137 patients aged 5 to 50 years suffering from hemophilia. As compared to the control group, insufficient social and labour adaptation of adult patients was established in spite of the positive characteristics of the personality and higher mentality in the patients at preschool and school ages. It is concluded that the problem requires further study with the use of the data obtained in psychosocial rehabilitation of this patients' group.

Adjustment Disorders↗

[Solitary confinement as risk factor for psychiatric hospitalization].

The subjects of this study are prisoners who were hospitalized from custody in a psychiatric clinic. All of such patients of one psychiatric clinic during the period from 1976 till 1978 were compared with a random sample of other psychiatric patients using case reports and other data. Differences were found concerning social, personal, psychiatric, and criminal history as well as psychopathological state and diagnosis. Compared to the complete population of prisoners of the area, prisoners from solitary confinement (mostly remanding custody) were overrepresented. Other risk factors for psychiatric hospitalization of prisoners are described. The results are discussed from prophylactic, therapeutic, and humanitarian points of view.

Adjustment Disorders↗

[Patterns of service utilization of mental health outpatients].

In light of the forthcoming implementation of national health reform, it is important to review and analyze data regarding the degree and pattern of outpatient, mental-health service utilization in Israel. The main questions this study addressed were: to identify the main groups of users of mental health care, and to determine the utilization patterns of these groups (by length, frequency, and type of treatment) and the profession of the caregivers. This study is based on the findings of the national survey of all adult users of ambulatory mental health services in 1 week in May 1986, and of a 1-week survey in 1994 of similar data from 7 mental health clinics. When patients were grouped into 2 main clinical categories according to the severity of their psychopathology (psychotic, major affective and organic disorders, vs. neurotic, adjustment and personality disorders) they showed different patterns of service utilization. The pattern of the first group was associated with the severity of the psychopathology, whereas the pattern of utilization of the second group was also associated with sociodemographic factors, which may reflect awareness of psychological problems and readiness to turn to mental health services. These factors may also affect the willingness of the caregiver to treat them.

Adult↗

A longitudinal follow-up of the effect of occlusal adjustment in patients with craniomandibular disorders.

The aim of this study was to evaluate the effect of occlusal adjustment in a prospective longitudinal study. Fifty selected patients with craniomandibular disorders (CMD) including headaches were randomly assigned to a treatment (T) or a control (C) group. Both groups received counselling and occlusal adjustment was performed in T group. Subjective symptoms and clinical findings were registered before and 2 years after treatment. At a follow-up 48% in the T group and 84% in the C group had demanded rescue treatment. Eleven patients in the T group (48%) and 3 patients in the C group (13%) without rescue treatment, reported overall subjective improvement. No difference was found between the groups regarding overall intensity of pain expressed by the visual analogue scale. When all kinds of treatment were taken into account, 70% and 79% of the patients in the T and C group reported overall subjective improvement at follow-up. The conclusions from this study were that in a two-year perspective only single patients improved from counselling alone. A few more patients improved if one more kind of treatment, for example occlusal adjustment, was added to the initial counselling, but the majority of the patients required a comprehensive treatment program.

Adolescent↗