Hospital & community psychiatry最新文献

Data from archival sources were used to determine the kinds of patients treated at the St. Louis City (later St. Louis County) Insane Asylum, the treatments they received, activities of daily life in the asylum, and political factors affecting operation of the asylum in the late 19th and early 20th centuries. Data from patient records, journal and newspaper articles, and annual reports of asylum superintendents from the period were analyzed. The authors conclude that although much has changed in the operation of public psychiatric hospitals in the past 100 years, some themes, including inappropriate referrals of forensic cases to psychiatric hospitals, problems of discharging long-stay patients, and the media's tendency to sensationalize events and conditions in hospitals, remain the same.

In the 19th century, when bleeding and purging were widely used in mainstream medicine, homeopathy was warmly embraced by some U.S. practitioners as a more humane alternative. Developed by the German physician Samuel Hahnemann, homeopathy sought to cure symptoms of disease by use of drugs that induced similar symptoms and restored the patient's "vital force." This paper describes the general principles of homeopathy and recounts specific treatments of mental illness from the homeopathic literature. It also describes the application of homeopathic principles to the institutional care of mental illness, using New York's Middletown Homeopathic Asylum for the Insane as an example.

Objective: The author reviewed the history of American psychiatry for the first 150 years of the American Psychiatric Association's existence (1844-1994) as reflected in remarks of the association's presidents.

Methods: Presidential addresses or remarks from alternative sources were located for the 120 presidents who served the association between 1844 and 1994.

Results: The presidents' remarks on six topics-psychiatric practice, etiology of mental illness, public mental hospitals, alternatives to state hospitals (deinstitutionalization), biologic treatments, and fiscal issues were sampled and arranged chronologically.

Conclusions: American psychiatry's history--its innovations, cyclical repetitions, and self-assessments-can be gleaned from this form of data. The presidents' remarks appear to refute the claim that organized American psychiatry has been negligent in criticizing itself.

Psychiatric rehabilitation, which is aimed at helping persons who have long-term mental illness to develop their capacities to the fullest possible extent, has been an integral part of psychiatric treatment in the U.S. since the beginnings of moral treatment in the early 19th century. The author outlines broad historical developments and prominent current modalities and models of psychiatric rehabilitation, including the introduction of family care, the day hospital, social skills training, psychoeducation, and the Fountain House model. He discusses the conceptual underpinnings of the field, such as the need to work with the healthy part of the patient and changes in views on vocational rehabilitation. Current concerns include the possibility of overselling rehabilitation and of misusing the term "recovery."

Objectives: The authors examined the extent to which health maintenance organizations (HMOs) enroll and provide services to people with severe mental illness.

Methods: The automated pharmacy system of a large HMO identified members who had received a prescription for an antipsychotic drug or lithium during the two-year study period (1986 and 1987). These data, combined with data from a 2 percent random sample of HMO members and from medical records, were used to identify members who satisfied DSM-III-R criteria for schizophrenia and bipolar disorder. Treated prevalence rates derived from these data were compared with estimated treated prevalence data obtained in the National Institute of Mental Health's Epidemiologic Catchment Area (ECA) survey.

Results: Although methodological complications and small sample sizes precluded a detailed comparison, the study found a significantly lower treated prevalence rate of schizophrenia among HMO members than in the ECA survey. The treated prevalence rate of bipolar disorder was also lower than the ECA rate, but the difference was not significant.

Conclusions: The differences in treated prevalence rates seemed to be the result of different study methodologies and factors influencing HMO membership. The results underscore the need for a comprehensive study of the course of severe mental illness among HMO members.