Preferred terms for users of mental health services among service providers and recipients.

OBJECTIVE: The terms used to refer to recipients of psychiatric services continue to be controversial. Terms in current use include "patient," "client," "consumer," and "survivor." In this study mental health service recipients and providers were surveyed about their preferences among these terms, and responses were analyzed to identify factors associated with various preferences. METHODS: A total of 550 service providers and 427 recipients at four sites in Ontario-two provincial psychiatric hospitals, a private mental health center, and a psychiatric unit of a general hospital-participated in a brief anonymous survey. RESULTS: Among service providers, 68.4 percent preferred the term "patient," 26.5 percent preferred "client," and.5 percent preferred "consumer." Logistic regression analysis showed that service providers' preferences were associated with age and gender. Among service recipients, 54.8 percent preferred the term "patient," 28.8 percent preferred "client," 7 percent preferred "survivor," and 2.8 percent preferred "consumer." Service recipients' preferences were associated with site, self-reported diagnosis, and employment status. CONCLUSION: The study results indicate lack of universality in preferences for terms for users of mental health services and suggest the need for dialogue about preferred terms between service providers and recipients.

Physician satisfaction with review boards: the provincial psychiatric hospital perspective.

OBJECTIVES: To assess the level of satisfaction of physicians in provincial psychiatric hospitals with Review Boards (RBs) regarding Civil Commitment Certificates (CCCs), Certificates of Incompetence (COIs), and Treatment Orders (TOs). METHOD: A total of 200 survey questionnaires were distributed to physicians in provincial psychiatric hospitals. Ninety surveys (completed by 25 females, 45 males, and 20 unknown gender) were returned, representing a 45% return rate. Because of their assignments (for example, outpatient department), not all physicians were involved with RBs, and the return rate is likely to have been influenced by this factor. RESULTS: Physician satisfaction rates of 58.2% for CCCs, 66.7% for COIs, and 70.0% for TOs were obtained. Stepwise multiple regression analysis showed that the level of physician satisfaction with RBs for CCCs was predicted best (44.7% of variance) by physician level of comfort with certification and years of institutional affiliation. Qualitative physician responses revealed 3 major themes: patient-related issues, physician-related issues, and RB structure- and process-related issues. CONCLUSIONS: Strategies that increase physician comfort level with RBs and changes in the medicolegal structure and process are discussed. A similar survey of patients and RB members is recommended.

Assessment of service needs of adult psychiatric inpatients: a systematic approach.

In this study, a systematic needs-assessment approach to evaluating the institutional and community service requirements of adult psychiatric inpatients is reported. The Community Placement Questionnaire (CPQ) was completed by professional staff on all patients between the ages of 18-65 residing in a publicly-funded psychiatric hospital. Of the 105 patients surveyed, 65.7% were considered potentially hard to place in the community (6.7% were nominated for permanent placement in the institution), and 34.3% were considered easy to place. The findings indicate that successful planning for community-based mental health services requires the four essential elements of the protected hospital environment, treatment, augmentation in psychosocial rehabilitation programming and availability of supports and services in the community. Specific strategies for transition from institutional-based care to community care are discussed.

A brief method of assessing adult inpatients' level of need for community support systems.

The study examined the usefulness of the Level of Community Support Systems (LOCSS) scale in rating psychiatric inpatients' need for community supports after discharge. The scale was compared with two other instruments, the Community Placement Questionnaire (CPQ) and the Community Supports and Services Checklist (CSSC) in assessing 105 inpatients. LOCSS scale ratings were related to service utilization indicators, to items on the CPQ measuring community functioning ability, and to the CSSC score. The LOCSS scale correctly classified the level of difficulty of community placement for 69 percent of patients, indicating its usefulness as a screening tool in planning community-based psychosocial rehabilitation services.

Predictive validity of the Level of Expressed Emotion (LEE) Scale: readmission follow-up data for 1, 2, and 5-year periods.

The predictive validity of the Level of Expressed Emotion (LEE) Scale in a group of schizophrenic patients was examined. Forty-six patients with DSM-III diagnoses of schizophrenic disorders were administered the perceived expressed emotion measure (LEE) and followed up for a 5-year period. Patients' ratings of their social environments were related to rehospitalization 1 year, 2 years (p < .02) and 5 years (p < .01) after initial assessment. These results supported the utility of the LEE in identifying schizophrenic patients at high risk for rehospitalization.

Psychiatric assessment of patients with life-threatening cardiac arrhythmias.

OBJECTIVE: This article describes the development of a protocol specifically designed for the psychiatric assessment of patients with life-threatening ventricular arrhythmias. METHOD: Psychiatric assessment occurs in the context of a team approach in which the cardiologist has a pivotal role. Initial findings and one-year follow-up data on the first twenty-five patients evaluated psychiatrically are presented. RESULTS: Findings tend to confirm that psychiatric complaints are common on initial assessment and suggest that patients with life-threatening ventricular arrhythmias who do not use the psychological mechanism of denial and volunteer psychological complaints may constitute a subgroup of patients who would be more amenable to psychiatric intervention compared to those denying psychological complaints at initial psychiatric interview. CONCLUSION: Psychiatrists and associated professionals should become more involved with patients with life-threatening cardiac arrhythmias.

Abnormal eating attitudes among a group of Nigerian youths: I. Bulimic behaviour.

The prevalence of bulimic behaviour, a form of abnormal attitude to eating, was investigated among three different samples of Nigerian youths. Using the Binge-Eating questionnaire, a total of 649 females comprising high-school (n = 196), university undergraduate (n = 333) and college of education (n = 120) students were surveyed. A significant proportion of the total student population engaged in bulimic behaviours of bingle-eating (21.16%) and vomiting (22.20%). The various weight control methods they used include diet pills (4.70%), diuretics (6.60%), laxatives (19.50%) and vomiting (26.20%). These findings suggested that bulimic behaviour may be as much a non-western phenomenon as it is a western phenomenon.

Abnormal eating attitudes among a group of Nigerian youths: II. Anorexic behaviour.

A survey of a total of 644 female Nigerian high-school, college and university undergraduate students was conducted to examine abnormal eating attitudes associated with anorexic behaviour. Using a cut-off score of 20 on the Eating Attitudes Test-26 (EAT-26), overall prevalence of disordered eating attitudes was found to be 14.1%. Prevalence figures for the high-school, university, and college samples were 18.6%, 9.1% and 21.7% respectively. These findings are comparable to those from western countries and suggests that nowadays abnormal eating attitudes associated with anorexia behaviour may be a universal phenomenon that transcends cultural boundaries, contrary to the earlier notion that they were restricted to western countries.

Psychiatric emergency services in a Canadian city: I. Prevalence and patterns of use.

The patterns of use of psychiatric emergency services in Saskatoon, Saskatchewan were studied. A total of 576 patients who had received psychiatric emergency care from any of the four major health care facilities in Saskatoon during a three month period were included in the study. Visits for psychiatric emergency services during the study period represented 2.32% of the total number of visits to emergency facilities. Most patients with psychiatric emergencies went to hospitals with psychiatric units. The characteristics of patients served by the four facilities and those who visited the psychiatric emergency services on more than one occasion during the study period are reported. The implications of these findings for health care planning are discussed.

Psychiatric emergency services in a Canadian city: II. Clinical characteristics and patients' disposition.

The clinical characteristics of patients seen at the psychiatric emergency facilities in a Canadian city and the determinants of decisions regarding their treatment were investigated. A total of 544 patients who sought psychiatric emergency services from the three hospitals in Saskatoon during a three month period were studied. Cognitive disturbance, past psychiatric history, previous psychiatric hospitalization and diagnoses of substance use disorders, affective disorders, anxiety disorders and schizophrenic disorders were associated with psychiatric emergencies. Psychiatric diagnoses and availability of social support were significantly associated with disposition. The implications of these findings for psychiatric emergency services are discussed.

The measurement of expressed emotion: a review.

Expressed emotion refers to the affective attitudes and behaviours (i.e., criticism, hostility and emotional overinvolvement) of relatives toward a family member with a psychiatric illness. In this article, the Camberwell Family Interview, the standard method used to assess expressed emotion, and alternative approaches to the measurement of expressed emotion are reviewed. While there is a reasonable correspondence between ratings derived from the Camberwell interview and the less arduous alternative methods, the association is not perfect. In addition, the conceptual similarities and prognostic utility of these measures require replication and further exploration. Of the alternative assessment methods available, the use of the Five Minute Speech Sample or the Level of Expressed Emotion Scale as screening devices is recommended.

Validation of the five minute speech sample in measuring expressed emotion.

The relationship of the Five Minute Speech Sample (FMSS) to the Camberwell Family Interview and its coding system were evaluated. The Camberwell Family Interview and the FMSS were administered to twenty-three relatives of patients diagnosed with schizophrenia. Overall, the results supported the utility of the FMSS and its coding system as a brief screening device for measuring expressed emotion.

Prognostic validity of clinical and psychometric variables in psychogeriatric inpatients.

The prognostic validity of both clinical and psychometric variables in a sample of psychogeriatric inpatients was evaluated. Elderly patients were divided into three outcome groups (nondischarged, n = 29; discharged-readmitted, n = 38; and discharged-nonreadmitted, n = 67), and comparisons were made on the clinical and psychometric variables. Results were cross-validated on a new sample of patients. Discriminant analysis yielded two predictive functions, which appeared to represent physical status and behavioral disturbance. Results suggest that a combination of clinical and psychometric variables yields the best level of prediction.