Hospital & community psychiatry
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Hosp Community Psychiatry · Aug 1986
Review Case ReportsUsing electroconvulsive therapy for patients with neurological disease.
In the United States electroconvulsive therapy (ECT) is not commonly used with patients who have conditions affecting the structure or function of the brain. Many clinicians may be unaware, therefore, that ECT has been used safely to treat patients with combined major depression and central nervous system disorders; patients with organic mental syndromes, particularly delirium; and patients who have psychiatric disorders that mimic or are distorted by brain disease. The author discusses the successful use of ECT with such patients as well as potential dangers of the treatment through a review of worldwide experience with ECT and presentation of case examples. He concludes by suggesting possible mechanisms through which ECT may benefit both depression and organic mental syndromes.
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Hosp Community Psychiatry · Aug 1986
The paradoxes of reform: reevaluating Italy's mental health law of 1978.
Recent data on Italy's mental health law of 1978 delineate a more complex picture of deinstitutionalization than that suggested by the first wave of enthusiastic writings on the law's implementation. In violation of the law's original intent, many Italian regions depend heavily on newly established hospital-based units, while development of community services has been uneven. Factors affecting implementation include both ambiguous and unenforceable provisions in the law and unwillingness at the national and local levels to fund necessary community alternatives. Recent proposals to "reform the reform" may move Italian psychiatry even further away from the legacy of successful deinstitutionalization in cities such as Trieste and Arezzo.
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The stigma associated with psychiatry is the most critical problem facing the profession, the author contends. He identifies the major sources of stigma as psychiatrists' internal conflicts over treatment ideologies and methods and the hostility between psychiatrists and other physicians that has led to disparagement of psychiatry as a medical specialty. To combat the stigma he recommends that highest priority be given to efforts to unify the profession and to increase psychiatry's participation in organized medicine. He also urges psychiatrists to limit self-revelation and self-exploration in the media, to emphasize the broad range of knowledge and skills that makes them uniquely suited to perform evaluative and triage functions, and to halt the current practices of shunting whole classes of patients off to other disciplines for care and of educating other disciplines in psychiatric techniques.
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The author reviews the status of the state mental hospital and the chronic mental patient within the psychiatric service system and then examines the hospital's evolution from a systems perspective. She predicts that the state mental hospital will survive as an integral part of the service system, that it will be one of several loci of care for the chronic mentally ill, and that it will continue to experience financial and identity crises in the near future. She considers it essential that the state mental hospital be seen not as a facility of last resort but as one of many agencies that meet the varied needs of the chronic mentally ill.
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Hosp Community Psychiatry · Mar 1986
Chronic mental patients in nursing homes: reexamining data from the National Nursing Home Survey.
A reanalysis of data from the 1977 National Nursing Home Survey, including data not available earlier, led to an estimate that 668,000 chronic mentally ill patients reside in nursing homes. Several subpopulations of nursing home residents were also identified and compared, which showed, for instance, that residents with only mental disorders were younger, were less likely to need the help of another person in daily activities, and were much less likely to be totally dependent than residents with only physical disorders. ⋯ Residents diagnosed as senile, with or without a physical disorder, more closely resembled the purely physically ill than the purely mentally ill patients. The data illustrate the wide range of needs of mentally ill nursing home residents and reinforce the importance of assessing and improving the appropriateness of care offered.