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.

Clinical and demographic variables related to "fitness to stand trial" assessments in Manitoba.

OBJECTIVE: To assess the extent to which clinical and nonclinical variables have been used by mental health professionals in Manitoba to determine fitness to stand trial. Researchers at a forensic setting in another province have suggested that demographic variables account for as much of the variance in predicting the outcome of these assessments as clinical variables. METHOD: These variables were assessed by the examination of 100 fitness assessments conducted at Winnipeg's Forensic Services unit during a 2-year period. RESULTS: Contrary to findings reported in Ontario, the variance in fitness evaluations in Manitoba was primarily accounted for by clinical rather than demographic variables. CONCLUSION: Since Manitoba's forensic clinicians were using standardized criteria that were very similar to 1992 Criminal Code revisions of fitness, the findings attest to the usefulness of these criteria.

A nongenetic basis of cycle frequency in bipolar disorder: study of a monozygotic twin pair.

The authors describe a pair of monozygotic twins with bipolar disorder but with a different course of the illness including age of onset, sequence of episodes, and cycle length. Based on these findings, the clinical course of bipolar illness does not appear to be genetically determined.

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.

Identification of nasal morphologic features that indicate susceptibility to nasal tip deflection with the LeFort I osteotomy.

The goal of this investigation was to identify and quantify nasal morphologic features which predispose to the nasal tip deflection associated with the LeFort I osteotomy. Fifty patients who had undergone LeFort I osteotomies were studied retrospectively from presurgical and postsurgical cephalograms and facial photographs. The magnitude of hard tissue change was measured in the vertical and horizontal planes, and soft tissue nasal change was measured in the vertical plane at two points on the outline of the soft tissue nose. Additional parameters were tested as potential predictors of nasal tip deflection, including the Deflection Resistance Index (DRI), which is a quantitative measure of nasal morphologic features. Data were subjected to a hierarchical multiple regression analysis allowing for multivariate prediction capability. At the supra nasal tip (SNt), magnitude of advancement, magnitude of impaction, and the DRI were all significant predictors (multiple R = 0.86). At the anterior nasal tip (ANt), magnitude of advancement, preoperative columellar angle, magnitude of impaction, the DRI, the interactions of advancement and DRI, and columellar angle and DRI were the significant predictors (multiple R = 0.89). It is concluded that the vertical deflection of the nasal tip resulting from the LeFort I osteotomy is influenced not only by the hard tissue movements but also by nasal structure. The DRI is a quantitative measure that can be used clinically to improve the predictability of vertical nasal tip deflection.

Selective attention and clinical depression: performance on a deployment-of-attention task.

Clinically depressed and nondepressed individuals completed a deployment-of-attention task developed by I. H. Gotlib, A. L. McLachlan, and A. N. Katz (1988). Results indicated that the clinically depressed individuals perform the task in an unbiased fashion, attending equally to positive-, negative-, and neutral-content stimuli. In contrast, the nondepressed individuals demonstrated a "protective" bias against the perception of negative stimuli by avoiding such material in favor of positive or neutral stimuli. Overall, the results of this study suggest that clinically depressed individuals do not show an attentional bias toward negative information, but rather, fail to demonstrate the positive or protective bias that is evident in nondepressed individuals.