Hospital & community psychiatry
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Hosp Community Psychiatry · Nov 1993
Comorbid substance abuse and recovery from acute psychiatric relapse.
The study investigated whether chronic mentally ill patients whose psychiatric relapse was complicated by active substance abuse recovered from relapse at a different rate than similar patients with no comorbid substance abuse. ⋯ Results suggest that use of a urine toxicology screen and the BPRS early in treatment may aid in assessing the acute course of several psychiatric disorders and the effect of comorbidity.
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Hosp Community Psychiatry · Oct 1993
Comparative StudyQuality and cost of services for seriously mentally ill individuals in British Columbia and the United States.
To better understand the strengths and weaknesses of systems of services for seriously mentally ill individuals in Canada and the United States, the quality and cost of services in the province of British Columbia (population 3.2 million) were compared with those of services in the 50 states. ⋯ Probable reasons for the superior services for seriously mentally ill individuals in British Columbia include single-source funding, a strong mandate to treat such individuals, and a comprehensive approach to providing services. The Canadian health system, as implemented in British Columbia, has definite advantages for individuals with serious mental illnesses.
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Hosp Community Psychiatry · Jul 1993
Case ReportsRespecting the autonomy of chronic mentally ill women in decisions about contraception.
Treatment of women patients with chronic mental illness who are at risk of unwanted pregnancies presents ethical challenges to the clinician who wishes to respect the patient's autonomy while also helping her avert the potential adverse consequences of unwanted pregnancy. The clinician who simply allows the patient to continue at risk or coerces her into using contraception may not have adequately considered the variable nature of the patient's autonomy. The authors suggest that the clinician should assess and treat conditions underlying the patient's variable impairment of autonomy to maximize her ability to participate in family planning decisions. Case examples are used to illustrate assessment of patients' decision-making capacity, development of family planning approaches that respect patients' autonomy, and use of a newly available contraceptive implant.
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Hosp Community Psychiatry · Jul 1993
Childhood abuse and neglect among women outpatients with chronic mental illness.
The purposes of the study were to determine the prevalence of childhood sexual abuse, physical abuse, and neglect among women outpatients with severe and persistent mental illness; to examine patterns of co-occurrence of the various types of abuse; and to explore the relationships between childhood abuse and adult psychiatric symptomatology. ⋯ Chronic mentally ill women seem to experience higher rates of abuse and more types of abuse than the general population. Clinicians should try to determine whether chronic mentally ill women have histories of abuse and to develop interventions to meet their special needs.