A controlled study of transitional day care for non-chronically-ill patients.

The authors randomly assigned 79 inpatients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called "transitional treatment" or a control treatment--weekly clinically believed to require intensive posthospital treatment to make the transition to the community. Although initially there was a significantly higher dropout rate from the control condition, at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome. Direct costs for the transitional treatment, however, were much higher.

A pilot survey of social work services in pediatric primary care programs in urban teaching hospitals.

OBJECTIVE: To determine the current status of social work presence in pediatric primary care clinics in urban teaching hospitals. DESIGN: Survey instrument mailed to the medical directors of outpatient pediatrics in the major pediatric teaching hospital of approved residency programs in the 100 largest metropolitan areas in the United States. RESULTS: Sixty responses (60%) were received. Eighty percent of practices reported having on-site social work services, with a median of 14,805 annual clinic visits per social work full-time equivalent. Ninety-five percent of respondents considered on-site social work services in pediatric primary care to be important, whereas half of respondents considered social work services "less than adequate" at their site, and most of these felt this inadequacy had led to additional hospital visits or other adverse outcomes. There were no significant associations of reported adequacy of social work services with any characteristics of hospital, practice, or population. CONCLUSION: Pediatric primary care clinicians at teaching hospitals consider on-site social work services to be important, but most report these services are less than adequate in their practices, and for many, adequacy has declined.

From paternalism to partnership: family and professional collaboration in children's mental health.

A survey of 455 caregivers of children with severe emotional disorders identified four empirically distinct dimensions of collaboration between mental health professionals and the children's family members. Characteristics of families, professionals, and the service delivery process associated with the dimensions are examined, as is the relationship between collaboration and family satisfaction.

Children of psychiatric patients: rarely seen or heard.

A survey of inpatient psychiatric social workers and a review of inpatient charts indicate that while social workers believe the inclusion of the patients' children in their practice is important, their documentation rarely reflects such activity. The authors review relevant literature on the effect of parental psychiatric illness on children, discuss the apparent schism between theory and practice, and consider the clinical and policy implications of these findings.

Patient-therapist mismatch: we would rather switch than fight.

The authors studied 21 psychiatric outpatients who were granted a change in therapist at their request. The study sample did not differ significantly from other outpatients in demographic characteristics or diagnosis. Results indicated that the great majority of requests for a change in therapists resulted from patient-therapist mismatch, and the majority of patients who changed therapists remained in treatment with the new therapist and reported being satisfied with the change. The authors believe that a flexible policy regarding changes in therapists will enhance treatment effectiveness, and they offer suggestions on how to manage transfers.

Is neuroleptic dysphoria a healthy response?

We examined the relationship between neuroleptic-induced extrapyramidal effects, subjective neuroleptic dysphoria, and clinical outcome in acutely psychotic inpatients. Thirteen of 50 consecutively admitted patients experienced severe neuroleptic dysphoria. Dysphoric patients were less likely to comply with neuroleptic, but nine did complete neuroleptic trials. The compliant dysphoric inpatients received significantly lower neuroleptic doses compared with nondysphoric patients, and yet had equivalent overall improvement of psychotic symptoms and less severe extrapyramidal effects. Despite having fewer physical signs of akinesia, dysphoric patients were significantly more distressed from akinesia than nondysphoric. We conclude that while some neuroleptic dysphoric patients become noncompliant, others benefit from dysphoria by negotiating for lower, less toxic, and yet effective neuroleptic dosages.