Discharges against medical advice

Size: px
Start display at page:

Download "Discharges against medical advice"

Transcription

1 Predictors and Outcome of Discharge Against Medical Advice From the Psychiatric Units of a General Hospital Kenneth P. Pages, M.D. Joan E. Russo, Ph.D. Dane K. Wingerson, M.D. Richard K. Ries, M.D. Peter P. Roy-Byrne, M.D. Deborah S. Cowley, M.D. Objective: The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. Methods: A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSM-IV psychiatric and substance use diagnoses, and scores on an expanded 32- item version of the Psychiatric Symptom Assessment Scale were compared. Results: The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. Conclusions: The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended. (Psychiatric Services 49: , 1998) The authors are affiliated with the department of psychiatry and behavioral sciences at the University of Washington, Harborview Medical Center, Box , 325 Ninth Avenue, Seattle, Washington ( , kpages@earthlink.net). Dr. Pages is acting instructor, Dr. Russo is research associate professor, Dr. Wingerson is assistant professor, Dr. Ries is associate professor, and Dr. Roy-Byrne and Dr. Cowley are professors. Discharges against medical advice (AMA) are common for psychiatric inpatients, occurring in 6 to 35 percent of cases, with a mean rate of 16 percent (1 4). Even though AMA discharges require physicians time and can result in lack of discharge planning and scheduled outpatient follow-up, they have received little attention in the medical literature, especially in the post- DSM-III era. Although clinical wisdom suggests that patients discharged AMA are more psychiatrically ill, less likely to be engaged in treatment, and more likely to have a poor outcome, findings about these issues are inconsistent. The study of patients discharged AMA is of particular importance to the psychiatrist because patients on psychiatric units are more likely to leave against medical advice than patients on medical or surgical units (5). Patients with comorbid psychiatric conditions are more likely to have AMA discharges from medical or surgical units (6). The literature on AMA discharges from psychiatric inpatient units has suffered from small sample sizes and lack of a categorical diagnostic classification system. Most studies took place before managed care, when stays were longer. Finally, community support systems were not well established to provide continuing treatment for patients after discharge. Ten studies have examined characteristics of AMA discharges (3,7 15). Younger age (3,8, PSYCHIATRIC SERVICES September 1998 Vol. 49 No

2 10,12), personality pathology (3,8,12, 15), and substance abuse (3,10,13,14) have been the most consistent characteristics shared by patients discharged AMA. Socioeconomic status has been shown to be both higher (8,10) and lower (11) for patients with AMA discharges. One study found higher suicidality (8). Two studies were unable to find any differentiating characteristics of patients discharged AMA (7,16). In terms of outcome, the medical literature supports the commonly held view that patients discharged against medical advice have worse outcomes than patients without such discharges. Patients with AMA discharges respond poorly to inpatient treatment (9,16). In four of five studies, rehospitalization rates were higher among these patients (2,13,17,18). In summary, results of studies on AMA discharges are inconclusive and of varying generalizability. Some authors have been pessimistic about the ability to predict AMA discharges and implement interventions to improve outcomes for these patients (19). The study reported here explored the issue of AMA discharge in a large group of patients treated in an urban psychiatric inpatient service, using standardized diagnostic criteria and a standardized rating instrument. We hypothesized that substance abuse, male gender, and young age would be associated with a higher rate of AMA discharge. Furthermore, we believed patients discharged AMA would have worse outcomes, as measured by symptom ratings at discharge and rehospitalization. Methods Sample Subjects were 2,425 severely ill and largely indigent patients voluntarily admitted to three inpatient psychiatric units at a general hospital, Harborview Medical Center in Seattle, over a four-year period from April 1993 to April Because this study is based on data routinely collected as part of the clinical evaluation and care of all patients, no informed consent was obtained. Use of this routine data for research purposes is approved by the University of Washington human subjects committee. Women made up 40.9 percent of the sample. The mean±sd age of the sample was 36.6±11.6 years, with a range of 18 to 92 years. The sample was primarily Caucasian (70.8 percent), followed by African American (20.1 percent), Asian (3.5 percent), Latino (2.9 percent), Native American (1.7 percent), and other (.9 percent). Primary axis I psychiatric diagnoses were bipolar disorder, depressed phase (342 patients, or 14.1 percent); unipolar depression (1,144 patients, or 47.2 percent); schizophrenia and schizoaffective disorder (395 patients, or 16.3 percent); acute mania (141 patients, or 5.8 percent); and other diagnoses (403 patients, or 16.6 percent) mostly atypical psychotic, affective, and impulse control disorders. Of the 2,425 patients, 42.5 percent had a concurrent active DSM-IV diagnosis of substance abuse or dependence. The mean±sd length of stay was 11.1±8.8 days, with a range from 1 to 132 days. The median stay was nine days. Assessments All patients received standardized assessment batteries (20) administered by the attending psychiatrist within 24 hours of admission and discharge. The assessment elicited information about demographic characteristics and psychiatric history. DSM-IV psychiatric and substance use diagnoses (21) were obtained by using a checklist of symptoms. An expanded 32-item version of the Psychiatric Symptom Assessment Scale (PSAS) (22) was also used. Each PSAS item or subscale (for example, anxious mood) is rated on a 7-point scale, with 0 indicating not present and 6 indicating most severe. The assessment battery has been shown to be both reliable and valid for use with inpatients (20). The internal consistency reliability was.76 for both admission and discharge. Additional items on denial of psychiatric illness and substance abuse were also assessed. A patient s denial of psychiatric illness or understanding of illness was rated on a 7-point scale, with 0 indicating a full understanding and 6 indicating denial of problems or confabulation about the reason for hospitalization. An item on dysfunctional consequences of alcohol or drug use was rated by the attending psychiatrist on a 7-point scale, with 0 indicating no consequences and 5 or 6 indicating that the patient s use of substances shows dependence, such as compulsive use and loss of control. A variable measuring both frequency and quantity of current substance use was rated on a 7-point scale, with 0 indicating abstinence for more than 12 months and 6 indicating current use more often than weekly in a large quantity, such as consuming three or more drinks at a time or using multiple drugs. The Mini Mental State Examination (MMSE) (23) was administered at admission to assess cognitive functioning. The physician-rated Social and Occupational Functioning Assessment Scale (20), which is similar to the original Global Assessment of Functioning (21), was also administered at admission. The Lehman Quality of Life Interview (24,25) was administered at admission and discharge by the nursing staff using a structured interview procedure. This instrument has been shown to be reliable and valid for use with severely ill psychiatric inpatients (26). All irregular discharges were classified as against medical advice, including patients who were discharged by signing out against medical advice, were absent without leave, and were administratively discharged. Statistical analyses To compare characteristics of patients who left against medical advice and patients with regular discharges, chi square analyses were performed on categorical variables based on admission data. For continuous variables (except for age) at admission, analyses of covariance (ANCOVAs) were calculated between the groups, with age, gender, and ethnicity as covariates. Because of the number of tests, a Bonferroni adjustment of the significance level to.001 was made; values greater than.001 are presented only for descriptive purposes. To summarize admission differences between patients with AMA and regular discharges, variables that discriminated between the groups univariately (p<.05) were used as potential predictors in a stepwise logistic regression analysis. In this analysis, the dependent variable was AMA dis PSYCHIATRIC SERVICES September 1998 Vol. 49 No. 9

3 charge (0=regular discharge and 1=AMA discharge). The model was examined for outliers, which were removed if necessary and the model refit. Odds ratios and their 95 percent confidence intervals were calculated for the significant predictors. A risk index of significant predictors of discharge status was created. Differences in length of stay between the discharge groups were analyzed using an ANCOVA with gender, age, and ethnicity as covariates. Chi square analyses were used to determine group differences in rates of rehospitalization after the index stay. We also determined group differences at discharge on continuous variables measuring outcome. For these analyses we used ANCOVAs, with age, gender, ethnicity, symptom ratings at admission, and length of stay as covariates. Length of stay was used as a covariate because we were interested in determining if differences in outcomes existed independently of differences due to the typically shorter stays of patients with AMA discharges. Because of the number of tests, a Bonferroni adjustment of the significance level to.001 was made. Results Demographic characteristics Of the 2,425 patients in the sample, only 195 (8 percent) had AMA discharges. Table 1 presents information about demographic characteristics, functional impairment, and level of care for the groups. Compared with patients discharged regularly, patients with AMA discharges were significantly less likely to be Caucasian and to have been on the locked unit. They were more likely to be men and to be currently unemployed, and they were less functionally impaired by current physical illness; however, these differences were significant only at the trend level. Characteristics at admission Table 2 presents information about psychiatric status and substance abuse. The discharge groups did not differ in primary psychiatric diagnoses. Although almost twice as many patients with AMA discharges had personality disorders, the difference was significant only at the trend level Table 1 Characteristics of psychiatric inpatients with discharges against medical advice (AMA) and regular discharges AMA discharge (N=195) (p<.01). Trend-level differences also indicated that patients with AMA discharges were more likely to have two or more lifetime psychiatric inpatient admissions and to be self-referred to treatment. As Table 2 shows, patients with AMA discharges were significantly more likely to have a current DSM-IV substance use diagnosis. More than half of the patients with AMA discharges had a current substance use diagnosis, compared with about 40 percent of the patients with regular discharges. No significant differences were found in the proportions of patients with a substance-induced mood disorder. Patients with AMA discharges had a significantly greater frequency and quantity of substance use. No significant differences at admission were found in any measures of psychiatric symptoms, current functioning, or quality of life. Trend-level differences in suicidality, hostility, and dysfunctional consequences of substance use were noted. Patients who were discharged AMA tended to be less suicidal and more hostile and to have more dysfunctional consequences of substance use than regularly discharged patients as measured at admission. Predictors of AMA discharge Logistic regression was performed to predict discharge status from the admission variables. Fifteen variables Regular discharge (N=2,230) Characteristic N % N % χ 2 Male , Caucasian , Living alone , Currently unemployed , History of assault Functional impairment Hospitalized on locked unit df=1 p<.05 p<.01 p<.001 were allowed stepwise entry into the equation: age, gender, employment status, ethnicity, residence (living alone versus with others), current functional impairment, previous inpatient psychiatric hospitalization (lifetime and past 12 months), previous substance abuse treatment, current substance abuse diagnosis, the dysfunctional consequences of substance use, the quantity and frequency of current use, suicidality, and hostility. Self-referral and personality pathology were not used because of missing data. However, a second model including these variables was tested on a reduced sample (N=652), and the results were similar. To facilitate the interpretation of the odds ratios, the continuous variables measuring substance abuse were dichotomized into low or high use and mild or severe consequences. The overall model was significant (χ 2 =62.34, df=6, p<.001) and contained six significant predictors of AMA discharge, all of which increased risk by a factor of 1 to 2. The predictors were use of a large quantity of the substance or substances abused (odds ratio=1.92, p<.001, 95 percent confidence interval=1.61 to 2.23), more than two previous inpatient psychiatric hospitalizations (OR=1.73, p<.001, CI=1.44 to 2.02), ethnicity other than Caucasian (OR= 1.86, p<.001, CI=1.45 to 2.19), absence of functional impairment due to physical illness (OR=1.47, p<.03, CI=1.12 to 1.82), PSYCHIATRIC SERVICES September 1998 Vol. 49 No

4 Table 2 Diagnostic and substance abuse characteristics on admission of psychiatric inpatients with discharges against medical advice (AMA) and regular discharges male gender (OR=1.38, p<.05, CI=1.07 to 1.69), and mild to no suicidality at admission (OR=1.59, p<.003, CI=1.30 to 1.88). The risk index created from the six predictors was significantly related to discharge status (χ 2 =53.67, df=6, p<.001); scores ranged from 0 (having no risk factors) to 6 (having all the risk factors). Patients with regular discharges were nearly three times as likely as patients with an AMA discharge to have no risk factor or only one risk factor (20.4 percent versus 7.7 percent). In contrast, patients with AMA discharges were more likely than patients with regular discharges to have four to six risk factors (25.6 percent versus 16.8 percent). Outcomes The patients with AMA discharges had a mean±sd length of stay of 6.41±6.01 days, compared with 11.37± AMA discharge (N=195) Regular discharge (N=2,230) Characteristic N % N % χ 2 Diagnosis Bipolar disorder Schizophrenia Mania Other Personality pathology Previous inpatient psychiatric hospitalization Two or more Admission in past 12 months Substance abuse treatment history No treatment Previous treatment Treatment indicated or recommended but refused Current substance abuse DSM-IV substance abuse diagnosis Diagnosis of substance-induced mood disorder Other psychiatric status variables More than two emergency room visits in the past Self-referred No previous suicide attempt N=61 for AMA discharge; N=591 for regular discharge df=4 for comparisons of psychiatric diagnosis; df=2 for all other comparisons p<.05 p<.01 p< for the patients with regular discharges. Adjusted mean scores for the total PSAS and for five of its subscales that differentiated between the two discharge groups are shown in Table 3. Rehospitalization rates within one month of the index hospitalization were significantly greater for patients with AMA discharges (χ 2 =18.32, df=1, p<.001). Twelve percent of patients with AMA discharges were readmitted within one month compared with only 5 percent of the regularly discharged patients. When the analysis controlled for ethnicity, gender, age, admission levels of symptoms, and length of stay, the cumulative global measure of psychiatric symptoms at discharge, as well as measures of some individual symptoms, was significantly different between the groups. Patients with AMA discharges had higher overall PSAS scores at discharge and were more suicidal, anxious, and hostileaggressive at discharge. Not surprisingly, they were rated as four times more uncooperative than patients with regular discharges, even after the analysis controlled for level of uncooperativeness at admission. Although the groups did not differ in the quality of their denial about their illness at admission, patients with regular discharges had significantly less denial at discharge. Although quality-of-life variables did not differ significantly between the groups, two trend-level differences were found. Patients with AMA discharges reported more satisfaction at discharge with their living arrangements and personal safety than did regularly discharged patients. Discussion This study measured predictors of discharge against medical advice from an inpatient psychiatric service and outcomes of patients discharged AMA. We identified six significant predictors of AMA discharge. They were use of a large quantity of a substance or substances, more than two previous inpatient admissions, ethnicity other than Caucasian, absence of functional impairment due to medical illness, male gender, and mild or no suicidality at admission. We found patients discharged AMA to have significantly worse outcomes at discharge, with higher PSAS scores, greater suicidality, and more anxiety and hostility-aggression. They were also more uncooperative and had poorer insight into their illness than patients with regular discharges. Our study was a replication of previous studies showing an association between substance abuse and AMA discharge status. We add to this literature by showing that a greater current quantity and frequency of substance use, not merely a diagnosis of substance abuse or dependence, independently increases the risk of leaving the hospital against medical advice. We found that this high level of substance use placed patients at a two-times-greater risk of leaving AMA than patients with a lower level of substance use before admission. Two previous studies found pa PSYCHIATRIC SERVICES September 1998 Vol. 49 No. 9

5 Table 3 Adjusted mean scores on the Psychiatric Symptom Assessment Scale (PSAS) and five of its subscales that differentiated at discharge between psychiatric inpatients with discharges against medical advice (AMA) and regular discharges 1 Regular dis- charge (N=2,230) AMA discharge (N=195) Scale or subscale N % N % F PSAS Suicidality Anxious mood Hostility-aggression Uncooperativeness Insight about psychiatric illness Higher scores indicate greater severity of symptoms. The means are adjusted for covariates of age, gender, ethnicity, symptom severity on admission, and length of stay. df=1, 2,430 p<.001 tients with AMA discharges to be more likely to have a history of substance abuse than patients who were discharged regularly. In one study, 61 percent of patients with AMA discharges had a history of substance abuse, compared with 47 percent of those discharged regularly (27). In another, patients with AMA discharges were statistically more likely to have a history of alcoholism and to have been admitted for treatment of alcohol-related problems (14). Only one other study, on a dual disorders unit, examined the relationship between quantity of substance use and AMA discharge and found no correlation (15). The discrepancy between that study and ours can be explained by the difference in case mix. Our sample was drawn from general psychiatric units rather than from a dual diagnosis unit, where the rate of substance use disorders was high. Patients with multiple previous psychiatric hospitalizations were at a higher risk for AMA discharge. Hospitalization may be a way to deal with an immediate stressor. Once the stressful situation is resolved to the patient s satisfaction, the patient may request a discharge that seems premature to the psychiatrist (9,13). Perhaps these patients are not adequately treated during admission and come back repeatedly for episodes of partial treatment. Although we did not collect data on patients history of AMA discharges, studies suggest that patients leave against medical advice repeatedly (13,18,28). In our sample, being other than Caucasian increased the risk of AMA discharge. Only four previous studies examined race three found that it was not a significant predictor (1,2,9), and one found African-American patients to be almost twice as likely as Caucasians to leave AMA (29). It is unclear whether the association with race represents an independent contribution or reflects the known association between lower socioeconomic status and AMA discharge (5,30). Patients who were functionally impaired by physical illness left against medical advice less frequently than those who were not impaired, probably because patients who can easily walk out of the hospital are at an obvious advantage to do so compared with those who are in a wheelchair, for example. Patients with greater functional impairment may have limited ability to care for themselves independently. Finally, patients living alone were more likely to have an AMA discharge. Some studies have suggested that more isolated patients are at greater risk for leaving AMA than patients with stronger social ties (11). It is possible that patients living alone do not have support available from family and friends to continue hospitalization until treatment is complete. Our study adds to the previous literature showing that patients who leave the hospital AMA have worse outcomes than those with regular discharges. Their response to inpatient treatment was worse in that they did not improve at the same rate. This finding is similar to results of a previous study showing that although treatment response of patients discharged AMA increases with length of stay, it still falls short of that of regularly discharged patients (16). In other words, the poorer outcome of these patients is not entirely due to leaving the hospital in fewer days. One study found qualified support for the hypothesis that patients discharged AMA would have poorer outcomes than regularly discharged patients (27). On two scales and at two of six follow-up points at one year on the Health-Sickness Rating Scale and at two years on the Historical Information Form the regularly discharged patients did significantly better than the patients who were discharged AMA. A second study found no difference in follow-up variables between patients with AMA discharges and matched controls (7). In addition, patients with AMA discharges are rehospitalized more often than regularly discharged patients. This result has been found in four of five studies addressing this issue (4,13,18,30). Two studies have attempted to assess the dangerousness of patients discharged AMA. One study found higher mortality among these patients (14). The other concluded they were no more dangerous than patients discharged regularly because no casualties occurred in the group with AMA discharges (30). Our data showed a higher level of suicidality at discharge among patients discharged AMA, which suggests a potential for greater dangerousness. This finding is consistent with other measures indicating that these patients do not improve to the same degree as regularly discharged patients. This issue is important because one reason that physicians ask patients to sign discharge papers when they leave the hospital against medical advice is their concern that patients will suffer excessive morbidity and mortality by not continuing their inpatient treatment. The relative strengths of our study include a large sample size and the use PSYCHIATRIC SERVICES September 1998 Vol. 49 No

6 of a standardized psychiatric assessment form to make diagnoses based on DSM-IV criteria. In addition, use of the Psychiatric Symptom Assessment Scale allowed us to collect information from each patient about a large number of symptoms, as well as a range of information about substance use and outcomes. The sample is representative of patients and lengths of stay encountered in an urban general hospital s inpatient psychiatric units. We recognize a number of limitations of our study. The data were collected as part of routine patient care at a busy urban general hospital and not as part of a controlled prospective study. To directly measure outcome, previous studies in this area have attempted to locate patients with AMA discharges after they left the hospital, which we did not do. An important issue is whether we can intervene to improve the outcome of patients discharged AMA even though they do not complete their hospitalization. This high-risk group (31) must be identified early so that discharge planning can begin immediately. Perhaps a more permissive approach to these patients should be taken, because it is clear they have multiple hospitalizations. It would probably be in their best interest for clinicians to facilitate a transition to outpatient treatment regardless of their discharge status. In an effort to facilitate this transition, Targum and associates (32) attempted to design an intervention to reduce the rate of AMA discharges. Anticipating that such patients were more likely to be inadequately prepared for admission, to have negative preconceptions about hospitalization, and to expect hospital staff to be of no help, these authors instituted a patient advocate system to intervene when a patient asked to leave against medical advice. AMA discharges were reduced from 11.6 percent to 7.6 percent. More attention should be paid to risk factors for AMA discharge, and we can focus future work on patients with four to six of the risk factors. Interventions should either deter patients from leaving or improve their chances of successfully following up with outpatient treatments. In this way patients may be more likely to complete treatment and less likely to repeatedly use high-cost inpatient services for crisis management. References 1. Akhtar S, Halfrinch J, Mestayer R: AMA discharge from a psychiatric inpatient unit. International Journal of Social Psychiatry 27: , Siegel RL, Chester TK, Price DB: Irregular discharges from psychiatric wards in a VA medical center. Hospital and Community Psychiatry 33:54 56, Planansky K, Johnston R: A survey of patients leaving a mental hospital against medical advice. Hospital and Community Psychiatry 27: , Dalrymple AJ, Fata M: Cross-validating factors associated with discharges against medical advice. Canadian Journal of Psychiatry 38: , Smith DB, Telles LJ: Discharges against medical advice at regional acute care hospitals. American Journal of Public Health 81: , Fulop G: Anxiety disorders in the general hospital setting. Psychiatric Medicine 8: , Scheer N, Barton GM: A comparison of patients discharged against medical advice with a matched control group. American Journal of Psychiatry 131: , Kecmanovic D: Patients discharged against medical advice from a lock and key psychiatric institution. International Journal of Social Psychiatry 21: , Steinglass P, Grantham CE, Hertzman M: Predicting which patients will be discharged against medical advice: a pilot study. American Journal of Psychiatry 137: , Harper DW, Elliott-Harper C, Weinerman R, et al: A comparison of AMA and non- AMA patients on a short-term crisis unit. Hospital and Community Psychiatry 33: 46 48, Heinssen RK, McGlashan TH: Predicting hospital discharge status for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder. Archives of General Psychiatry 45: , Crowe DB, Rosse RB, Sheridan MJ, et al: Substance use diagnoses and discharge patterns among psychiatric inpatients. Hospital and Community Psychiatry 42: , Chandrasena R, Miller WC: Discharges AMA and AWOL: a new revolving door syndrome. Psychiatric Journal of the University of Ottawa 13: , Corley MC, Link K: Men patients who leave a general hospital against medical advice: mortality rate within six months. Journal of Studies on Alcohol 42: , Greenberg WM, Otero J, Villaneuva L: Irregular discharges from a dual diagnosis unit. American Journal of Drug and Alcohol Abuse 20: , Miles JE, Adlersberg M, Reith G, et al: Discharges against medical advice from voluntary psychiatric units. Hospital and Community Psychiatry 27: , Booth BM, Cook CAL, Blow FC: Comorbid mental disorders in patients with AMA discharges from alcoholism treatment. Hospital and Community Psychiatry 31: , Louks J, Mason J, Backus F: AMA discharges: prediction and treatment outcome. Hospital and Community Psychiatry 40: , LaWall JS, Jones R: Discharges from a ward against medical advice: search for a profile. Hospital and Community Psychiatry 31: , Roy-Byrne P, Dagadakis C, Ries R, et al: A psychiatrist-rated battery of measures for assessing the clinical status of psychiatric inpatients. Psychiatric Services 46: , Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, Bigelow LB, Berthot BD: The Psychiatric Symptom Assessment Scale. Psychopharmacology Bulletin 25: , Folstein MF, Folstein SE, McHugh PR: Mini-Mental State : a practical method for grading the cognitive state of patients for clinicians. Journal of Psychiatric Research 12: , Lehman AF: A quality of life interview for the chronically mentally ill. Evaluation and Program Planning 11:51 62, Lehman AF: The well-being of chronic mental patients: assessing quality of life. Archives of General Psychiatry 40: , Russo J, Roy-Byrne P, Reeder D, et al: Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. Journal of Nervous and Mental Disease 185: , Glick ID, Braff DL, Johnson G, et al: Outcome of irregularly discharged psychiatric patients. American Journal of Psychiatry 138: , Jeremiah J, O Sullivan P, Stein MD: Who leaves against medical advice? Journal of General Internal Medicine 10: , Moy E, Bartman BA: Race and hospital discharge against medical advice. Journal of the National Medical Association 88: , Krakowski AJ: Patients who sign against medical advice. Psychiatric Journal of the University of Ottawa 10: , Pages KP, Russo JE, Roy-Byrne PP, et al: Determinants of suicidal ideation: the role of substance use disorders. Journal of Clinical Psychiatry 58: , Targum SD, Capodanno AE, Hoffman HA, et al: An intervention to reduce the rate of hospital discharges against medical advice. American Journal of Psychiatry 139: , PSYCHIATRIC SERVICES September 1998 Vol. 49 No. 9

Agrowing number of states and. Use of Psychiatric Emergency Services and Enrollment Status in a Public Managed Mental Health Care Plan

Agrowing number of states and. Use of Psychiatric Emergency Services and Enrollment Status in a Public Managed Mental Health Care Plan Use of Psychiatric Emergency Services and Enrollment Status in a Public Managed Mental Health Care Plan Dane Wingerson, M.D. Joan Russo, Ph.D. Richard Ries, M.D. Christos Dagadakis, M.D. Peter Roy-Byrne,

More information

Clinical experience suggests. Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Clinical experience suggests. Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders Susanne Hörz, Dipl.-Psych., Ph.D. Mary C. Zanarini, Ed.D. Frances R. Frankenburg,

More information

Condensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia

Condensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia Condensed Clinical Practice Guideline Treatment Of Patients With Schizophrenia I. Key Points a. Schizophrenia is a chronic illness affecting all aspects of person s life i. Treatment Planning Goals 1.

More information

RISK FACTORS FOR PSYCHIATRIC HOSPITALIZATION AMONG ADOLESCENTS

RISK FACTORS FOR PSYCHIATRIC HOSPITALIZATION AMONG ADOLESCENTS SILBERMAN S C H O O L of S O C I A L W O R K RISK FACTORS FOR PSYCHIATRIC HOSPITALIZATION AMONG ADOLESCENTS Jonathan D. Prince, Ph.D Marina Lalayants, Ph.D. Child Welfare in the U.S. and Russia May 30

More information

A Clinical Translation of the Research Article Titled Antisocial Behavioral Syndromes and. Additional Psychiatric Comorbidity in Posttraumatic Stress

A Clinical Translation of the Research Article Titled Antisocial Behavioral Syndromes and. Additional Psychiatric Comorbidity in Posttraumatic Stress 1 A Clinical Translation of the Research Article Titled Antisocial Behavioral Syndromes and Additional Psychiatric Comorbidity in Posttraumatic Stress Disorder among US Adults: Results from Wave 2 of the

More information

Chapter V Depression and Women with Spinal Cord Injury

Chapter V Depression and Women with Spinal Cord Injury 1 Chapter V Depression and Women with Spinal Cord Injury L ike all women with disabilities, women with spinal cord injury (SCI) may be at an elevated risk for depression due to the double jeopardy of being

More information

Because of the many changes in

Because of the many changes in Hospitalization and Pharmacotherapy for Borderline Personality Disorder in a Psychiatric Emergency Service Juan C. Pascual, M.D. David Córcoles, M.D. Juan Castaño, M.D. Jose M. Ginés, M.D. Alfredo Gurrea,

More information

Prospective assessment of treatment use by patients with personality disorders

Prospective assessment of treatment use by patients with personality disorders Wesleyan University From the SelectedWorks of Charles A. Sanislow, Ph.D. February, 2006 Prospective assessment of treatment use by Donna S. Bender Andrew E. Skodol Maria E. Pagano Ingrid R. Dyck Carlos

More information

Allen County Community Corrections. Modified Therapeutic Community. Report for Calendar Years

Allen County Community Corrections. Modified Therapeutic Community. Report for Calendar Years Allen County Community Corrections Modified Therapeutic Community Report for Calendar Years 2011-2013 Joseph Hansel, Ph.D., Jacqueline Wall, Ph.D., & Aaron Kivisto, Ph.D. Allen County Community Corrections

More information

State of Iowa Outcomes Monitoring System

State of Iowa Outcomes Monitoring System State of Iowa Outcomes Monitoring System THE IOWA CONSORTIUM FOR SUBSTANCE ABUSE RESEARCH AND EVALUATION Year 17 Annual Outcome Evaluation Trend Report November 2015 With Funds Provided By: Iowa Department

More information

Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications

Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications MWSUG 2017 - Paper DG02 Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications ABSTRACT Deanna Naomi Schreiber-Gregory, Henry M Jackson

More information

State of Iowa Outcomes Monitoring System

State of Iowa Outcomes Monitoring System State of Iowa Outcomes Monitoring System THE IOWA CONSORTIUM FOR SUBSTANCE ABUSE RESEARCH AND EVALUATION Year 16 Annual Outcome Evaluation Trend Report November 2014 With Funds Provided By: Iowa Department

More information

OUR TEAM OUR SPECIALIZED PROGRAMS

OUR TEAM OUR SPECIALIZED PROGRAMS OUR TEAM Gracie Square Hospital offers a multidisciplinary approach to care for patients with psychiatric disorders who can benefit from inpatient hospitalization. Our treatment programs are provided by

More information

The traditional approach to. Requiring Sobriety at Program Entry: Impact on Outcomes in Supported Transitional Housing for Homeless Veterans

The traditional approach to. Requiring Sobriety at Program Entry: Impact on Outcomes in Supported Transitional Housing for Homeless Veterans Requiring Sobriety at Program Entry: Impact on Outcomes in Supported Transitional Housing for Homeless Veterans John A. Schinka, Ph.D. Roger J. Casey, Ph.D., M.S.W. Wesley Kasprow, Ph.D., M.P.H. Robert

More information

Appointment attendance in patients with schizophrenia

Appointment attendance in patients with schizophrenia Appointment attendance in patients with schizophrenia Practice points Appointment attendance in patients with schizophrenia is a significant and understudied issue. A sizable percentage of patients with

More information

Predictors of Severity of Alcohol Withdrawal in Hospitalized Patients

Predictors of Severity of Alcohol Withdrawal in Hospitalized Patients Elmer Original Article ress Predictors of Severity of Alcohol Withdrawal in Hospitalized Patients Radhames Ramos a, Thierry Mallet b, Anthony DiVittis c b, d, e, Ronny Cohen Abstract Background: Alcohol

More information

Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample

Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample Available online at www.sciencedirect.com Drug and Alcohol Dependence 96 (2008) 187 191 Short communication Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample Lara A.

More information

Douglas County s Mental Health Diversion Program

Douglas County s Mental Health Diversion Program Douglas County s Mental Health Diversion Program Cynthia A. Boganowski The incarceration of people with serious mental illness is of growing interest and concern nationally. Because jails and prisons are

More information

Supplementary Methods

Supplementary Methods Supplementary Materials for Suicidal Behavior During Lithium and Valproate Medication: A Withinindividual Eight Year Prospective Study of 50,000 Patients With Bipolar Disorder Supplementary Methods We

More information

*IN10 BIOPSYCHOSOCIAL ASSESSMENT*

*IN10 BIOPSYCHOSOCIAL ASSESSMENT* BIOPSYCHOSOCIAL ASSESSMENT 224-008B page 1 of 5 / 06-14 Please complete this questionnaire and give it to your counselor on your first visit. This information will help your clinician gain an understanding

More information

The Diagnostic Stability of DSM-IV Diagnoses: An Examination of Major Depressive Disorder, Bipolar I Disorder, and Schizophrenia in Korean Patients

The Diagnostic Stability of DSM-IV Diagnoses: An Examination of Major Depressive Disorder, Bipolar I Disorder, and Schizophrenia in Korean Patients Original Article pissn 1738-1088 / eissn 2093-4327 Clinical Psychopharmacology and Neuroscience 2011;9(3):117-121 Copyrightc 2011, Korean College of Neuropsychopharmacology The Diagnostic Stability of

More information

Office of Health Equity Advisory Committee Meeting

Office of Health Equity Advisory Committee Meeting Office of Health Equity Advisory Committee Meeting Disparities in Mental Health Status and Care Sergio Aguilar-Gaxiola, MD, PhD Professor of Clinical Internal Medicine Director, Center for Reducing Health

More information

Suicide Risk and Melancholic Features of Major Depressive Disorder: A Diagnostic Imperative

Suicide Risk and Melancholic Features of Major Depressive Disorder: A Diagnostic Imperative Suicide Risk and Melancholic Features of Major Depressive Disorder: A Diagnostic Imperative Robert I. Simon, M.D.* Suicide risk is increased in patients with Major Depressive Disorder with Melancholic

More information

Suicide Risk Assessment Self-Test

Suicide Risk Assessment Self-Test Suicide Risk Assessment Self-Test The 30 item true or false self-test is designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors. This self-test

More information

SUD Requirements. Proprietary

SUD Requirements. Proprietary SUD Requirements Triage screening to determine eligibility and appropriateness (proper member placement) for admission and referral. A comprehensive bio-psychosocial evaluation must be completed prior

More information

The Spanish Model of ACT: Methodology and Results. Alberto Durán Rivas. Psychiatrist. ACT Ferrol

The Spanish Model of ACT: Methodology and Results. Alberto Durán Rivas. Psychiatrist. ACT Ferrol The Spanish Model of ACT: Methodology and Results Alberto Durán Rivas. Psychiatrist. ACT Ferrol The Spanish Model of ACT: Methodology Spanish Model of ACT ACT Spanish Model try to be a faithfull version

More information

4th Quarter, FY 09/10 Telecare and Orange (TAO) Demographic Data

4th Quarter, FY 09/10 Telecare and Orange (TAO) Demographic Data Age Range 7 3% 12 5% 26 92% Transitional Age Youth, 16-25 Adult, 26-59 Older Adult, 6+ Graph A The Telecare and Orange (TAO) program is a Full Service Partnership (FSP) adult program designed to help awaken

More information

SUBSTANCE ABUSE A Quick Reference Handout by Lindsey Long

SUBSTANCE ABUSE A Quick Reference Handout by Lindsey Long Substance Abuse 1 SUBSTANCE ABUSE A Quick Reference Handout by Lindsey Long Diagnostic Criteria (APA, 2004) Within a 12 month period, a pattern of substance use leading to significant impairment or distress

More information

Assertive Community Treatment Team

Assertive Community Treatment Team Assertive Community Treatment Team Badri Daneshamouz December, 2014 About CMHA Founded in 1918, CMHA is one of the oldest voluntary health organizations National office, provincial divisions, local branches

More information

BroadcastMed Bipolar, Borderline, Both? Diagnostic/Formulation Issues in Mood and Personality Disorders

BroadcastMed Bipolar, Borderline, Both? Diagnostic/Formulation Issues in Mood and Personality Disorders BroadcastMed Bipolar, Borderline, Both? Diagnostic/Formulation Issues in Mood and Personality Disorders BRIAN PALMER: Hi. My name is Brian Palmer. I'm a psychiatrist here at Mayo Clinic. Today, we'd like

More information

Setting Non-profit psychiatric hospital. The economic analysis was carried out in the USA.

Setting Non-profit psychiatric hospital. The economic analysis was carried out in the USA. Inpatient alcohol treatment in a private healthcare setting: which patients benefit and at what cost? Pettinati H M, Meyers K, Evans B D, Ruetsch C R, Kaplan F N, Jensen J M, Hadley T R Record Status This

More information

Kaiser Telecare Program for Intensive Community Support Intensive Case Management Exclusively for Members within a Managed Care System

Kaiser Telecare Program for Intensive Community Support Intensive Case Management Exclusively for Members within a Managed Care System Kaiser Telecare Program for Intensive Community Support Intensive Case Management Exclusively for Members within a Managed Care System 12-Month Customer Report, January to December, 2007 We exist to help

More information

Hospital Length of Stay and Readmission for Individuals Diagnosed With Schizophrenia: Are They Related?

Hospital Length of Stay and Readmission for Individuals Diagnosed With Schizophrenia: Are They Related? April 17, 2008 Hospital Length of Stay and Readmission for Individuals Diagnosed With Schizophrenia: Are They Related? Summary Pan-Canadian data show relatively high rates of readmission and declining

More information

Comorbidity With Substance Abuse P a g e 1

Comorbidity With Substance Abuse P a g e 1 Comorbidity With Substance Abuse P a g e 1 Comorbidity With Substance Abuse Introduction This interesting session provided an overview of recent findings in the diagnosis and treatment of several psychiatric

More information

HEDIS Initiation and Engagement Quality Measures of Substance Use Disorder Care: Impact of Setting and Health Care Specialty

HEDIS Initiation and Engagement Quality Measures of Substance Use Disorder Care: Impact of Setting and Health Care Specialty POPULATION HEALTH MANAGEMENT Volume 12, Number 4, 2009 ª Mary Ann Liebert, Inc. DOI: 10.1089=pop.2008.0028 Original Article HEDIS and Engagement Quality Measures of Substance Use Disorder Care: Impact

More information

Legal 2000 and the Mental Health Crisis in Clark County. Lesley R. Dickson, M.D. Executive Director, Nevada Psychiatric Association

Legal 2000 and the Mental Health Crisis in Clark County. Lesley R. Dickson, M.D. Executive Director, Nevada Psychiatric Association Legal 2000 and the Mental Health Crisis in Clark County Lesley R. Dickson, M.D. Executive Director, Nevada Psychiatric Association Civil action: Civil Commitment Definition a legal action to recover money

More information

Psychotropic Medication

Psychotropic Medication FOM 802-1 1 of 10 OVERVIEW The use of psychotropic medication as part of a child s comprehensive mental health treatment plan may be beneficial and should include consideration of all alternative interventions.

More information

Final Report of Activity February 21 st, 2006 to April 30 th, 2006 CHEO Grant 052

Final Report of Activity February 21 st, 2006 to April 30 th, 2006 CHEO Grant 052 Final Report of Activity February 21 st, 2006 to April 30 th, 2006 CHEO Grant 052 1- Title of Study: The prevalence of neuropsychiatric disorders in children and adolescents on an inpatient treatment unit:

More information

BRIEF REPORT FACTORS ASSOCIATED WITH UNTREATED REMISSIONS FROM ALCOHOL ABUSE OR DEPENDENCE

BRIEF REPORT FACTORS ASSOCIATED WITH UNTREATED REMISSIONS FROM ALCOHOL ABUSE OR DEPENDENCE Pergamon Addictive Behaviors, Vol. 25, No. 2, pp. 317 321, 2000 Copyright 2000 Elsevier Science Ltd. Printed in the USA. All rights reserved 0306-4603/00/$ see front matter PII S0306-4603(98)00130-0 BRIEF

More information

Adult Mental Health Services applicable to Members in the State of Connecticut subject to state law SB1160

Adult Mental Health Services applicable to Members in the State of Connecticut subject to state law SB1160 Adult Mental Health Services Comparison Create and maintain a document in an easily accessible location on such health carrier's Internet web site that (i) (ii) compares each aspect of such clinical review

More information

Mental health advocates, policy

Mental health advocates, policy Length of Stay, Referral to Aftercare, and Rehospitalization Among Psychiatric Inpatients Estina E. Thompson, Ph.D., M.P.H. Harold W. Neighbors, Ph.D. Cheryl Munday, Ph.D. Steve Trierweiler, Ph.D. Objective:

More information

DBT Modification/ Intervention

DBT Modification/ Intervention Table 2. Published Studies Examining Application of Inpatient DBT (alphabetical listing) Citation Inpatient Setting DBT Sample Comparison Sample DBT Modification/ Intervention Outcome Measures Results

More information

Incarceration of people with mental

Incarceration of people with mental Incarceration Among Adults Who Are in the Public Mental Health System: Rates, Risk Factors, and Short-Term Outcomes William B. Hawthorne, Ph.D. David P. Folsom, M.D. David H. Sommerfeld, Ph.D. Nicole M.

More information

County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT)

County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT) County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT) Annual Report January 1, 2012 to December 31, 2012 County of San Diego, Health and Human Services Agency

More information

The Science of PASRR Validated BH Instruments Let s Envision The Possibilities

The Science of PASRR Validated BH Instruments Let s Envision The Possibilities The Science of PASRR Validated BH Instruments Let s Envision The Possibilities Level I Screening: Where Are We? CFR provides limited guidance beyond identifying those who may have a MI/ID/RC Variability

More information

Summary ID#7029. Clinical Study Summary: Study F1D-MC-HGKQ

Summary ID#7029. Clinical Study Summary: Study F1D-MC-HGKQ CT Registry ID# 7029 Page 1 Summary ID#7029 Clinical Study Summary: Study F1D-MC-HGKQ Clinical Study Report: Versus Divalproex and Placebo in the Treatment of Mild to Moderate Mania Associated with Bipolar

More information

Estimates of the Reliability and Criterion Validity of the Adolescent SASSI-A2

Estimates of the Reliability and Criterion Validity of the Adolescent SASSI-A2 Estimates of the Reliability and Criterion Validity of the Adolescent SASSI-A 01 Camelot Lane Springville, IN 4746 800-76-056 www.sassi.com In 013, the SASSI Profile Sheets were updated to reflect changes

More information

With Mild and More Severe Intellectual Disabilities Referred to a Dual Diagnosis Service. Abstract. Authors

With Mild and More Severe Intellectual Disabilities Referred to a Dual Diagnosis Service. Abstract. Authors brief report: Comparison of Clients With Mild and More Severe Intellectual Disabilities Referred to a Dual Diagnosis Service Abstract Authors Jonny Elserafi, 1,2 Stacy E. White, 1 Yona Lunsky 1,2 1 Dual

More information

S P O U S A L R ES E M B L A N C E I N PSYCHOPATHOLOGY: A C O M PA R I SO N O F PA R E N T S O F C H I LD R E N W I T H A N D WITHOUT PSYCHOPATHOLOGY

S P O U S A L R ES E M B L A N C E I N PSYCHOPATHOLOGY: A C O M PA R I SO N O F PA R E N T S O F C H I LD R E N W I T H A N D WITHOUT PSYCHOPATHOLOGY Aggregation of psychopathology in a clinical sample of children and their parents S P O U S A L R ES E M B L A N C E I N PSYCHOPATHOLOGY: A C O M PA R I SO N O F PA R E N T S O F C H I LD R E N W I T H

More information

Appendix Table 1. Operationalization in the CIDI of criteria for DSM-IV eating disorders and related entities Criteria* Operationalization from CIDI

Appendix Table 1. Operationalization in the CIDI of criteria for DSM-IV eating disorders and related entities Criteria* Operationalization from CIDI Appendix Table 1. Operationalization in the CIDI of criteria for DSM-IV eating disorders and related entities Criteria* Operationalization from CIDI 1 Anorexia Nervosa A. A refusal to maintain body weight

More information

METHODS RESULTS. Supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC

METHODS RESULTS. Supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC PREDICTORS OF MEDICATION ADHERENCE AMONG PATIENTS WITH SCHIZOPHRENIC DISORDERS TREATED WITH TYPICAL AND ATYPICAL ANTIPSYCHOTICS IN A LARGE STATE MEDICAID PROGRAM S.P. Lee 1 ; K. Lang 2 ; J. Jackel 2 ;

More information

Screening for psychiatric morbidity in an accident and emergency department

Screening for psychiatric morbidity in an accident and emergency department Archives of Emergency Medicine, 1990, 7, 155-162 Screening for psychiatric morbidity in an accident and emergency department GARY BELL, NICK HINDLEY, GITENDRA RAJIYAH & RACHEL ROSSER Department of Psychiatry,

More information

Transitions To and From At-Risk Alcohol Use In Adults In the United States

Transitions To and From At-Risk Alcohol Use In Adults In the United States Transitions To and From At-Risk Alcohol Use In Adults In the United States Richard Saitz, Timothy C. Heeren, Wenxing Zha, Ralph Hingson Departments of Community Health Sciences and Biostatistics, Boston

More information

SUBJECT: Suicide Risk Screening and Assessment of Individuals in State Hospitals and State-Operated Crisis Stabilization Programs

SUBJECT: Suicide Risk Screening and Assessment of Individuals in State Hospitals and State-Operated Crisis Stabilization Programs DBHDD SUBJECT: Suicide Risk Screening and Assessment of Individuals in State Hospitals and State-Operated Crisis Stabilization Programs Policy: 03-504 Page 2 of 3 Hospital and CSP Staff Awareness regarding

More information

Dealing with Feelings: The Effectiveness of Cognitive Behavioural Group Treatment for Women in Secure Settings

Dealing with Feelings: The Effectiveness of Cognitive Behavioural Group Treatment for Women in Secure Settings Behavioural and Cognitive Psychotherapy, 2011, 39, 243 247 First published online 30 November 2010 doi:10.1017/s1352465810000573 Dealing with Feelings: The Effectiveness of Cognitive Behavioural Group

More information

OUTCOMES OF DICHOTOMIZING A CONTINUOUS VARIABLE IN THE PSYCHIATRIC EARLY READMISSION PREDICTION MODEL. Ng CG

OUTCOMES OF DICHOTOMIZING A CONTINUOUS VARIABLE IN THE PSYCHIATRIC EARLY READMISSION PREDICTION MODEL. Ng CG ORIGINAL PAPER OUTCOMES OF DICHOTOMIZING A CONTINUOUS VARIABLE IN THE PSYCHIATRIC EARLY READMISSION PREDICTION MODEL Ng CG Department of Psychological Medicine, Faculty of Medicine, University Malaya,

More information

JC Sunnybrook HEALTH SCIENCES CENTRE

JC Sunnybrook HEALTH SCIENCES CENTRE Dear Referring Provider: Thank you for referring your patient to the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences Centre. The attached form will assist us in determining

More information

Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete measure comprising 14 items

Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete measure comprising 14 items Online Supplement Data Supplement for Clement et al. (10.1176/appi.ps.201300448) Details of additional measures included in the analysis Questionnaire on Anticipated Discrimination (QUAD)(1): is a self-complete

More information

Clinical Trial Results Database Page 1

Clinical Trial Results Database Page 1 Clinical Trial Results Database Page 1 Sponsor Novartis Pharmaceuticals Corporation Generic Drug Name Therapeutic Area of Trial Major Depressive Disorder (MDD) Approved Indication Treatment of major depressive

More information

MEDICAL POLICY EFFECTIVE DATE: 04/28/11 REVISED DATE: 04/26/12, 04/25/13, 04/24/14, 06/25/15, 06/22/16, 06/22/17

MEDICAL POLICY EFFECTIVE DATE: 04/28/11 REVISED DATE: 04/26/12, 04/25/13, 04/24/14, 06/25/15, 06/22/16, 06/22/17 MEDICAL POLICY SUBJECT: STANDARD DIALECTICAL BEHAVIOR A nonprofit independent licensee of the BlueCross BlueShield Association PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered,

More information

Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC)

Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC) Community Mental Health Journal, Vol. 39, No. 6, December 2003 ( 2003) Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC) Mona Goldman,

More information

Everyday Problem Solving and Instrumental Activities of Daily Living: Support for Domain Specificity

Everyday Problem Solving and Instrumental Activities of Daily Living: Support for Domain Specificity Behav. Sci. 2013, 3, 170 191; doi:10.3390/bs3010170 Article OPEN ACCESS behavioral sciences ISSN 2076-328X www.mdpi.com/journal/behavsci Everyday Problem Solving and Instrumental Activities of Daily Living:

More information

Office Practice Coding Assistance - Overview

Office Practice Coding Assistance - Overview Office Practice Coding Assistance - Overview Three office coding assistance resources are provided in the STABLE Resource Toolkit. Depression & Bipolar Coding Reference: n Provides ICD9CM and DSM-IV-TR

More information

Prof. dr. Peter Goossens, MANP FEANS. A.W.M.M. Stevens, MD M.H.G. Groot lipman RN Msc

Prof. dr. Peter Goossens, MANP FEANS. A.W.M.M. Stevens, MD M.H.G. Groot lipman RN Msc Show Yourself : The development of an intervention to show professionals at an admission ward the patients euthymic being during severe mania or depression Prof. dr. Peter Goossens, MANP FEANS A.W.M.M.

More information

A Comparative Study of Socio Demographic and Clinical Profiles in Patient with Obsessive Compulsive Disorder and Depression

A Comparative Study of Socio Demographic and Clinical Profiles in Patient with Obsessive Compulsive Disorder and Depression American Journal of Psychiatry and Neuroscience 2018; 6(4): 99-103 http://www.sciencepublishinggroup.com/j/ajpn doi: 10.11648/j.ajpn.20180604.12 ISSN: 2330-4243 (Print); ISSN: 2330-426X (Online) A Comparative

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Subotnik KL, Casaus LR, Ventura J, et al. Long-acting injectable risperidone for relapse prevention and control of breakthrough symptoms after a recent first episode of schizophrenia:

More information

SUMMARY AND DISCUSSION

SUMMARY AND DISCUSSION Risk factors for the development and outcome of childhood psychopathology SUMMARY AND DISCUSSION Chapter 147 In this chapter I present a summary of the results of the studies described in this thesis followed

More information

Adherence in A Schizophrenia:

Adherence in A Schizophrenia: Understanding and Diagnosing Bipolar Disorder Treatment Promoting for Bipolar Treatment Disorder Adherence in A Schizophrenia: Resource for Providers Engagement Strategies for Health Care Providers, Case

More information

INDIANA CONSORTIUM FOR MENTAL HEALTH SERVICES RESEARCH DAWN PROJECT EVALUATION STUDY, PUBLIC BRIEFING, SEPTEMBER 2005

INDIANA CONSORTIUM FOR MENTAL HEALTH SERVICES RESEARCH DAWN PROJECT EVALUATION STUDY, PUBLIC BRIEFING, SEPTEMBER 2005 INDIANA CONSORTIUM FOR MENTAL HEALTH SERVICES RESEARCH DAWN PROJECT EVALUATION STUDY, PUBLIC BRIEFING, SEPTEMBER 2005 Introduction PREDICTING SUCCESS IN A SYSTEM OF CARE Eric R. Wright, Ph.D., Harold E.

More information

DESCRIPTION OF FOLLOW-UP SAMPLE AT INTAKE SECTION TWO

DESCRIPTION OF FOLLOW-UP SAMPLE AT INTAKE SECTION TWO SECTION TWO DESCRIPTION OF FOLLOW-UP SAMPLE AT INTAKE 7 2.1 DEMOGRAPHIC CHARACTERISTICS Table 2.1 presents demographic descriptive data at intake for those who were included in the follow-up study. Data

More information

Abstract. Comprehensive Psychiatry 48 (2007)

Abstract. Comprehensive Psychiatry 48 (2007) Comprehensive Psychiatry 48 (2007) 329 336 www.elsevier.com/locate/comppsych Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders,

More information

New Research in Depression and Anxiety

New Research in Depression and Anxiety New Research in Depression and Anxiety Robert Glassman Introduction Depression and anxiety are some of the most common disorders of childhood and adolescence. New research in these areas explores important

More information

Typical or Troubled? Teen Mental Health

Typical or Troubled? Teen Mental Health Typical or Troubled? Teen Mental Health Adolescence is a difficult time for many teens, but how does one know the difference between typical teen issues and behavior that might signal a more serious problem?

More information

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia Bani-Fatemi et al. BMC Psychiatry 2013, 13:252 RESEARCH ARTICLE Open Access Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia Ali Bani-Fatemi 1, Gina Polsinelli 1, James L Kennedy

More information

Comorbidity of Depression and Other Diseases

Comorbidity of Depression and Other Diseases Comorbidity of Depression and Other Diseases JMAJ 44(5): 225 229, 2001 Masaru MIMURA Associate Professor, Department of Psychiatry, Showa University, School of Medicine Abstract: This paper outlines the

More information

EMERGENCY ROOM AND PRIMARY CARE SERVICES UTILIZATION AND ASSOCIATED ALCOHOL AND DRUG USE IN THE UNITED STATES GENERAL POPULATION

EMERGENCY ROOM AND PRIMARY CARE SERVICES UTILIZATION AND ASSOCIATED ALCOHOL AND DRUG USE IN THE UNITED STATES GENERAL POPULATION Alcohol & Alcoholism Vol. 34, No. 4, pp. 581 589, 1999 EMERGENCY ROOM AND PRIMARY CARE SERVICES UTILIZATION AND ASSOCIATED ALCOHOL AND DRUG USE IN THE UNITED STATES GENERAL POPULATION CHERYL J. CHERPITEL

More information

Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders

Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders autism 2007 SAGE Publications and The National Autistic Society Vol 11(1) 9 17; 070987 1362-3613(200701)11:1

More information

Acute Stabilization In A Trauma Program: A Pilot Study. Colin A. Ross, MD. Sean Burns, MA, LLP

Acute Stabilization In A Trauma Program: A Pilot Study. Colin A. Ross, MD. Sean Burns, MA, LLP In Press, Psychological Trauma Acute Stabilization In A Trauma Program: A Pilot Study Colin A. Ross, MD Sean Burns, MA, LLP Address correspondence to: Colin A. Ross, MD, 1701 Gateway, Suite 349, Richardson,

More information

RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT

RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT 1 P age RACE-ETHNICITY DIFFERENCES IN ADOLESCENT SUICIDE IN THE 2009 DANE COUNTY YOUTH ASSESSMENT Andrew J. Supple, PhD Associate Professor Human Development & Family Studies The University of North Carolina

More information

In the general population, men are more physically aggressive

In the general population, men are more physically aggressive Article Gender Differences in Violent Behaviors: Relationship to Clinical Symptoms and Psychosocial Factors Menahem Krakowski, M.D., Ph.D. Pal Czobor, Ph.D. Objective: Men are more violent than women in

More information

The Use of Collateral Reports for Patients with Bipolar and Substance Use Disorders

The Use of Collateral Reports for Patients with Bipolar and Substance Use Disorders AM. J. DRUG ALCOHOL ABUSE, 26(3), pp. 369 378 (2000) The Use of Collateral Reports for Patients with Bipolar and Substance Use Disorders Roger D. Weiss, M.D.* Shelly F. Greenfield, M.D., M.P.H. Margaret

More information

Running Head: THE EFFECT OF DENIAL OF CHILDHOOD TRAUMA 1

Running Head: THE EFFECT OF DENIAL OF CHILDHOOD TRAUMA 1 Running Head: THE EFFECT OF DENIAL OF CHILDHOOD TRAUMA 1 The Effect of Denial of Childhood Trauma on the Self-Report of Suicidality on Psychiatric Inpatients Dayna Kline Lehigh Valley Health Network: Research

More information

Unmanaged Behavioral Health Puts Your Company At Risk. Presented by: Dr. Sam Mayhugh Integrated Behavioral Health

Unmanaged Behavioral Health Puts Your Company At Risk. Presented by: Dr. Sam Mayhugh Integrated Behavioral Health Unmanaged Behavioral Health Puts Your Company At Risk Presented by: Dr. Sam Mayhugh Integrated Behavioral Health Behavioral Health Management Webinar Overview History of BH management Prevalence of behavioral

More information

Sponsor. Novartis Pharmaceuticals Corporation Generic Drug Name. Agomelatine Therapeutic Area of Trial. Major depressive disorder Approved Indication

Sponsor. Novartis Pharmaceuticals Corporation Generic Drug Name. Agomelatine Therapeutic Area of Trial. Major depressive disorder Approved Indication Clinical Trial Results Database Page 1 Sponsor Novartis Pharmaceuticals Corporation Generic Drug Name Therapeutic Area of Trial Major depressive disorder Approved Indication Investigational drug Study

More information

BEST in MH clinical question-answering service

BEST in MH clinical question-answering service 1 BEST.awp.nhs.uk Best Evidence Summaries of Topics in Mental Healthcare BEST in MH clinical question-answering service Question In adult patients experiencing a mental health crisis, which service model

More information

A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital

A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital Original Research Article A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital Maanasa T J 1*, Sivabackiya C 1, Srinivasan B

More information

Supplemental data for The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review

Supplemental data for The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review Data Supplement for Prins et al. (10.1176/appi.ps.201300166) Supplemental data for The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review Key differences between jails and prisons

More information

Violence by Patients Admitted to a Private Psychiatric Hospital

Violence by Patients Admitted to a Private Psychiatric Hospital TARDIFF, VIOLENCE Am J Psychiatry MARZUK, BY PATIENTS 154:1, LEON, January ET AL. 1997 Violence by Patients Admitted to a Private Psychiatric Hospital Kenneth Tardiff, M.D., M.P.H., Peter M. Marzuk, M.D.,

More information

Personality disorders as predictors of treatment outcome in a sample of alcohol dependent veterans with comorbid axis I disorders

Personality disorders as predictors of treatment outcome in a sample of alcohol dependent veterans with comorbid axis I disorders Washington University School of Medicine Digital Commons@Becker Posters 2005: Alcoholism and Comorbidity 2005 Personality disorders as predictors of treatment outcome in a sample of alcohol dependent veterans

More information

In the provision of mental health. Factors Associated With Involuntary Return to a Psychiatric Emergency Service Within 12 Months

In the provision of mental health. Factors Associated With Involuntary Return to a Psychiatric Emergency Service Within 12 Months Factors Associated With Involuntary Return to a Psychiatric Emergency Service Within 12 Months Steven P. Segal, Ph.D. Phillip D. Akutsu, Ph.D. Margaret A. Watson, D.S.W. Objective: This study examined

More information

To justify their expense, specialty

To justify their expense, specialty mcd1.qxd 12/13/01 12:34 PM Page 57 Severity of Children s Psychopathology and Impairment and Its Relationship to Treatment Setting Brett M. McDermott, M.B.B.S., F.R.A.N.Z.C.P. Robert McKelvey, M.D., F.R.A.N.Z.C.P.

More information

Voluntary Mental Health Treatment Laws for Minors & Length of Inpatient Stay. Tori Lallemont MPH Thesis: Maternal & Child Health June 6, 2007

Voluntary Mental Health Treatment Laws for Minors & Length of Inpatient Stay. Tori Lallemont MPH Thesis: Maternal & Child Health June 6, 2007 Voluntary Mental Health Treatment Laws for Minors & Length of Inpatient Stay Tori Lallemont MPH Thesis: Maternal & Child Health June 6, 2007 Introduction 1997: Nearly 300,000 children were admitted to

More information

APPENDIX 11: CASE IDENTIFICATION STUDY CHARACTERISTICS AND RISK OF BIAS TABLES

APPENDIX 11: CASE IDENTIFICATION STUDY CHARACTERISTICS AND RISK OF BIAS TABLES APPENDIX 11: CASE IDENTIFICATION STUDY CHARACTERISTICS AND RISK OF BIAS TABLES 1 Study characteristics table... 3 2 Methodology checklist: the QUADAS-2 tool for studies of diagnostic test accuracy... 4

More information

NOVEL INDICATIONS: Experiences from a Study in MDD with Mixed Features (Mixed Depression)

NOVEL INDICATIONS: Experiences from a Study in MDD with Mixed Features (Mixed Depression) NOVEL INDICATIONS: Experiences from a Study in MDD with Mixed Features (Mixed Depression) 11 APRIL 2013 Josephine Cucchiaro, PhD Vice President Clinical Operations & Project Management Sunovion Pharmaceuticals

More information

9/16/2016. I would feel comfortable dispensing/prescribing varenicline to a patient with a mental health disorder. Learning Objectives

9/16/2016. I would feel comfortable dispensing/prescribing varenicline to a patient with a mental health disorder. Learning Objectives The Smoking Gun: for Smoking Cessation in Patients with Mental Health Disorders BRENDON HOGAN, PHARMD PGY2 PSYCHIATRIC PHARMACY RESIDENT CTVHCS, TEMPLE, TX 09/23/2016 I would feel comfortable dispensing/prescribing

More information

Allen County Community Corrections. Home Detention-Day Reporting Program. Report for Calendar Years

Allen County Community Corrections. Home Detention-Day Reporting Program. Report for Calendar Years Allen County Community Corrections Home Detention-Day Reporting Program Report for Calendar Years 29-211 Joseph Hansel, Ph.D. and Jacqueline Wall, Ph.D. Allen County Community Corrections 21 W. Superior

More information

MICHAEL PRITCHARD. most of the high figures for psychiatric morbidity. assuming that a diagnosis of psychiatric disorder has

MICHAEL PRITCHARD. most of the high figures for psychiatric morbidity. assuming that a diagnosis of psychiatric disorder has Postgraduate Medical Journal (November 1972) 48, 645-651. Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital Summary A retrospective study was made of all

More information

Routine clinical measures in a newly commissioned Psychiatric Intensive Care Unit (PICU): Predictors of favourable outcomes.

Routine clinical measures in a newly commissioned Psychiatric Intensive Care Unit (PICU): Predictors of favourable outcomes. Routine clinical measures in a newly commissioned Psychiatric Intensive Care Unit (PICU): Predictors of favourable outcomes. Rebecca Carleton, 1 Matthew Cordiner, 1 Patrick Hughes, 1 Susan Cochrane, 1

More information

CALIFORNIA COUNTIES TREATMENT RECORD REQUIREMENTS

CALIFORNIA COUNTIES TREATMENT RECORD REQUIREMENTS CALIFORNIA COUNTIES TREATMENT RECORD REQUIREMENTS Every service provided is subject to Beacon Health Options, State of California and federal audits. All treatment records must include documentation of

More information