Faculty Bibliography

In a sample of 1,032 psychiatric inpatients studied for 1 year, chronic patients (more than 6 months' inpatient stay) represented 17.4%, almost half of whom were discharged during a 2-year follow-up; an additional 19.4% died. The incidence of "new" long-stay patients was 8.6/100,000 population, which, if constant over time, would result in a net increase of long-stay patients. Most chronic long-stay patients had a diagnosis of schizophrenia or organic brain syndrome. The two diagnostic groups had strikingly different patterns of deinstitutionalization. Alcoholic patients and those with "other" diagnoses demonstrated chronic dependence on the hospital, characterized by short inpatient stays and high readmission rates.

Thirty clinical studies involving more than 10,000 patients conducted during the last 20 years have been analyzed to assess the value of caffeine as an analgesic adjuvant. Although most studies included patients with postpartum uterine cramping or episiotomy pain, some involved patients with pain from oral surgery or headache. In 21 of 26 studies, the relative potency estimates of an analgesic with caffeine to an analgesic without caffeine is greater than one. The pooled relative potency estimates in each of several major categories of combination analgesics are significantly greater than one. The overall pooled relative potency estimate is 1.41, with 95% confidence limits of 1.23 to 1.63; that is, to obtain the same amount of response from an analgesic without caffeine requires a dose that is approximately 40% greater than one with caffeine.

The authors examined the 3 1/2-year mortality rate of 1,033 psychiatric patients who had received inpatient treatment during a 1-year period, using standardized mortality ratios to identify heightened risk. Deaths due to accidents or suicides and pneumonia occurred more frequently than expected. Deaths due to cancer occurred primarily among alcoholics; nonalcoholic patients had a significantly lower cancer mortality risk. The risk associated with age was greatest for young patients in general, but male schizophrenic patients and female alcoholics died at particularly young ages. The highest mortality risk associated with diagnosis was for male patients with affective disorders. The authors discuss the implications of these findings.

This study relates inpatient-treated prevalence of the three mental illnesses most often requiring inpatient treatment--schizophrenia, alcoholism, and affective disorders--to social class in a suburban area. Rates were developed for the total population, including those living in domiciliary care, for those living in households only, and for first-admission patients living in households. Log-linear models supported the finding that low socioeconomic status was related to a high prevalence of alcoholism and affective disorders. In contrast, socioeconomic status was not related to the prevalence of schizophrenia among those living in households or among first-admission patients living in households.

A computerized drug-review system both reviews drug orders and notifies clinicians of orders that are considered exceptions to some clinical guidelines. The impact of this system in a psychiatric center in which it has been used since December 1975 is examined in terms of the reduction of the percentage of orders of psychotropic drugs that involve polypharmacy or dose-range exceptions. The results show a substantial reduction in orders in exception since the implementation of the system

An approach for developing quantitative care norms for outpatient acute psychiatric patients is presented. Both the methodological concept of the norming procedure and its application to the needs of Medicaid in Rockland County, New York are given. The methodology is totally general in that it could be applied to concerns related to characterization of services rendered in a wide variety of applications ranging from planning to utilization review. The norms developed relate both to monthly quantity of services rendered and length of active treatment period. Further, the impact of a review rule is discussed in terms of its implication to number of cases reviewed

This paper reports on an analysis of psychiatric population. 55 female patients with breast cancer were matched with non-cancer patients on age, year of admission, psychiatric diagnosis, race, and religion. Reserpine use was examined for yearly use by each year preceding the diagnosis of breast cancer, by cumulative yearly use, and by other defined time periods. Regardless of the definition of reserpine user, there were no significant increased relative risks of breast cancer for those women on reserpine. There was a fairly low proportion of patients from each group who were on the drug in any given year, and a fairly wide range of total dosage received. Over half of the women used reserpine at some time during their hospital stay