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Continuity of care by means of psycho-educational therapy
Longitudinal Course and Treatment Outcome
BIOL PSYCHIATRY 1992;31:61A-252A
87A
changes in the variable r provide a model of distinct illness phases and the sometimes abrupt transitions from one phase to the next. We used an auto regression time series least squares technique to obtain r values for illness phases in five patients who have seque~ttiallyprogressed from discrete intormittent episodes to ultra-rapid continuous cycling. Increases or waxing and waning of r models each of the:~e five patients. Using this formula, we have also generated 'theoret'cal' life charts resembling the actual life charts of course of illness. This ch~r~os-derivedmathematical ~,o,~,el, and the definitions of phases of the illness derived from it, can aid in under~tanding and classifying the longitudinal course of affective illness. It suggests that alterations in a single vmiable could account for both the progressive increases in cycle frequency and other patterns of observed illness evolution and the impact of treatment on disease progression.
59
CONTINUITY OF CARE BY MEANS OF PSYCHO-EDUCATIONAL YHERAPY Avner Elizur t, Enav Karniel-Layer, t Henry Szor, Shula Livne, 2 Shimon Spiro2 IAbarbanel Mental Health Center, Sackler School of Medicine, Tel-Aviv Uniw~rsity; 2School of Socia! Work, Tel-Aviv University, l~rael. The presont study evaluated the effectiveness of short-term group intervention compared with the traditional method of continuity of care from hospitalization to outpatient care. This transition is crucial in promoting reintegration into community life and preventing early relapse. Two matched groups of chronic schizophrenic patients hospitalized in two wards in our center were compare: One ward discharged its patients to the Bat-Yam Community Center, using a short-term group based on psycho-educational principles. The other ward discharged its patients to another regional community center, using the traditionat method of referral. The~ was a follow-up period of 1 year after discharge. Outcome evaluation wa,,~based on relapse rate, compliance to outpatient treatment, knowledge and attitudes towards mental illness, and medication. The psycho-educational group had a significantly smaller relapse rate and higher scoring on compliance to outpatient treatment. The patients had better knowledge and more realistic and adequate attitudes towards their illness. A short-term, group intervention framework based on psycho-educational principles is more effective then the traditional referal mode in facilitating an effective transitiort of chronic schizophrenic patients from hospital care to community out-patient treatment ensuring continuity of care,
60
MEDICAL AND PSYCHIATRIC DISORDERS IN THE DEVELOPMENT OF THE CATATONIC SYNDROME Brendan T. Carroll The Ohio State University, Columbus, OH 43210. Catatonia is a syndrome of neurological and psychiatric signs that is observed in schizophrenia, affective di:~orders, and other psychiatric conditions. It also occurs secondary to medical conditions. In a recent review of "organic" catatonia from cases in the literature, Afinson an, 1 Carroll demonstrated that some medical conditions were clearly associated with the development of c~,tatonia. In this study 36 patients admitted to a medical psychiatric unit or psychiatric unit over a 5-year period were retrospectively evaluated, and met one or both sets of proposed criteria for the catatonic syndrome. The patient's diagnosis was made by an independent staff psychiatrist. Family history was recorded foT:each patient. Finally, medical and psychiatric conditions were evaluated for their synergistic effect on the development of catatonia. Twentythree patients had one or more medical conditions reported to be associated with catatonia. The psychiatric diagnoses included schizophrenia, catatonic type (9), schizophrenia, other types (4), schizoaffective disorder (4), bipolar disorder (12), major depression (4), and secondary to medical conditions (3). In 15 cases, conditions such as dementia, movement disorders, and epilepsy were believed to be the primary etiologic factors. When the 53 episodes of catatonia were examined individually, patients were exposed to neuroleptics prior to 31 of the episodes and not exposed in 22 of the episodes. Neuroleptic exposure may have been a factor, but there were no clear cases of neuroleptic-induced or substance-induced catatonia. Family history
BIOL PSYCHIATRY 1992;31:61A-252A
87A
changes in the variable r provide a model of distinct illness phases and the sometimes abrupt transitions from one phase to the next. We used an auto regression time series least squares technique to obtain r values for illness phases in five patients who have seque~ttiallyprogressed from discrete intormittent episodes to ultra-rapid continuous cycling. Increases or waxing and waning of r models each of the:~e five patients. Using this formula, we have also generated 'theoret'cal' life charts resembling the actual life charts of course of illness. This ch~r~os-derivedmathematical ~,o,~,el, and the definitions of phases of the illness derived from it, can aid in under~tanding and classifying the longitudinal course of affective illness. It suggests that alterations in a single vmiable could account for both the progressive increases in cycle frequency and other patterns of observed illness evolution and the impact of treatment on disease progression.
59
CONTINUITY OF CARE BY MEANS OF PSYCHO-EDUCATIONAL YHERAPY Avner Elizur t, Enav Karniel-Layer, t Henry Szor, Shula Livne, 2 Shimon Spiro2 IAbarbanel Mental Health Center, Sackler School of Medicine, Tel-Aviv Uniw~rsity; 2School of Socia! Work, Tel-Aviv University, l~rael. The presont study evaluated the effectiveness of short-term group intervention compared with the traditional method of continuity of care from hospitalization to outpatient care. This transition is crucial in promoting reintegration into community life and preventing early relapse. Two matched groups of chronic schizophrenic patients hospitalized in two wards in our center were compare: One ward discharged its patients to the Bat-Yam Community Center, using a short-term group based on psycho-educational principles. The other ward discharged its patients to another regional community center, using the traditionat method of referral. The~ was a follow-up period of 1 year after discharge. Outcome evaluation wa,,~based on relapse rate, compliance to outpatient treatment, knowledge and attitudes towards mental illness, and medication. The psycho-educational group had a significantly smaller relapse rate and higher scoring on compliance to outpatient treatment. The patients had better knowledge and more realistic and adequate attitudes towards their illness. A short-term, group intervention framework based on psycho-educational principles is more effective then the traditional referal mode in facilitating an effective transitiort of chronic schizophrenic patients from hospital care to community out-patient treatment ensuring continuity of care,
60
MEDICAL AND PSYCHIATRIC DISORDERS IN THE DEVELOPMENT OF THE CATATONIC SYNDROME Brendan T. Carroll The Ohio State University, Columbus, OH 43210. Catatonia is a syndrome of neurological and psychiatric signs that is observed in schizophrenia, affective di:~orders, and other psychiatric conditions. It also occurs secondary to medical conditions. In a recent review of "organic" catatonia from cases in the literature, Afinson an, 1 Carroll demonstrated that some medical conditions were clearly associated with the development of c~,tatonia. In this study 36 patients admitted to a medical psychiatric unit or psychiatric unit over a 5-year period were retrospectively evaluated, and met one or both sets of proposed criteria for the catatonic syndrome. The patient's diagnosis was made by an independent staff psychiatrist. Family history was recorded foT:each patient. Finally, medical and psychiatric conditions were evaluated for their synergistic effect on the development of catatonia. Twentythree patients had one or more medical conditions reported to be associated with catatonia. The psychiatric diagnoses included schizophrenia, catatonic type (9), schizophrenia, other types (4), schizoaffective disorder (4), bipolar disorder (12), major depression (4), and secondary to medical conditions (3). In 15 cases, conditions such as dementia, movement disorders, and epilepsy were believed to be the primary etiologic factors. When the 53 episodes of catatonia were examined individually, patients were exposed to neuroleptics prior to 31 of the episodes and not exposed in 22 of the episodes. Neuroleptic exposure may have been a factor, but there were no clear cases of neuroleptic-induced or substance-induced catatonia. Family history