Carlos E. Climent

Development of an alternative, efficient, low cost mental health delivery system in Cali, Colombia

SummaryA new program was developed for the delivery of mental health services in Cali, Colombia utilizing auxiliary nurses who were given special training and supervision. In order to evaluate this program, equivalent groups of 30 patients each, who came to the psychiatric emergency room, were treated over a three-month period by the auxiliary nurses or by the “traditional” service which relies mostly on interns and residents. It was found that the experimental program produced a greater decrease in symptoms as measured by psychiatric ratings and by a self-report scale. A questionnaire completed by family members also revealed a similar difference. No differences were found between the two systems on patients attitudes toward services, on a self-esteem scale, or on a social adjustment scale. The cost of the new program was somewhat less than the traditional one. The results suggest that the new system should continue to be used and evaluated.

Prediction of Risk for Drug Use in High School Students

On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent-child relationships. This 53 item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent-child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed.

Factors Related to Imprisonment in Female Heroin Addicts

Heroin addiction is a phenomenon which effects males approximately four times more frequently than females as measured by requests for treatment. Probably bacause of this, heroin addiction in females has received little attention in the literature. In 1966 Ellinwood et al. reported characteristics of 30 women in the USPHS narcotics hospital in Lexington. From clinical impressions it would appear that the natural history of addiction in women is similar to that in men, i.e., recurrent physical illnesses, arrests, incarcerations, overdoses, and high age specific mortality rates. Imprisonment is a major and not infrequent occurrence in an addicts life. However, not all addicts find their way into the prison system. While little is known about the female addict, even less is known about those factors which protect female addicts against incarceration. This study is an attempt to compare two populations of female addicts, one currently in prison and the other never having suffered imprisonment. Variables rela...

Lunar Madness: An Empirical Study

HAT THE PHASES of the moon influence the appearance of mental illness is a belief that has survived the passage of centuries. In a review of the historical literature, Oliven” has pointed out that various sources, from the Old Testament to the 18th century medical literature, express a belief in the influence of the moon on mental illness, not only psychosis, but also epilepsy, suicide, alcoholism, and pyromania. Despite these beliefs, relatively little effort has been made to test these hypotheses. The results of published studies have been inconsistent, and in some cases, questionable because of methodological problems. The following brief review of the literature will attempt to illustrate these points. Bauer and Hornick’ tabulated the number of visits to a psychiatric emergency room at a large municipal hospital during the 24 hours of each lunar period. Data were obtained over a two year period. Comparisons made showed that there were no differences in the number of visits during the different moon periods. There are, however, several problems regarding the design of the study. First, the data collection was limited to a 24 hour period of each lunar phase; this ignored the fact that a psychiatric patient does not necessarily reach a hospital on the same day as his crisis. Second, these authors considered the total number of patients regardless of illness and did not, for example, distinguish between psychosis and neurosis. Third, the study was limited to two years, a rather short period, since only 24 observations for each lunar phase were possible. Fourth, many people who experienced a psychiatric episode did not attend this particular ER clinic since many other psychiatric facilities were available in the municipal area. The sample obtained in this manner represents, therefore, just a fraction, and not a random one, of a specific geographic area. Finally, they did not consider the problem of sex or diagnostic differences. These problems reoccur, to a greater or lesser degree, in almost all earlier studies of this problem. In contrast to the findings of the previous study, are those of Blackman and Catalina.” These authors compared the number of patients seen at a municipal psychiatric emergency room during the full moon, with the number of patients seen at other times of the month. Data were obtained for a 12 month period. They reported a slight tendency for more patients to be seen on the day of the full moon in contrast to the preceding 10 day period, but not in contrast to the succeeding IO day period. Unfortunately, no chi-square analysis for frequencies was used, but

Extension of Mental Health Services Through Training of Primary Health Workers

One of the greatest concerns in the health field today is to contribute to the well-being of people by bringing health to the entire population but specially to those of scarce resources. To reach that goal, it is necessary to design effective systems. Unfortunately, in the psychiatric field progress in that direction has been slow; despite the fact that 40 million men, women and children suffer from mental disorders in the developing countries and 90% of them can not receive treatment because of lack of resources (WHO, 1975).

Use of a discharge potential scale as a monitoring technique for psychiatric patients

SummaryAn instrument to evaluate the readiness of a psychiatric inpatient to be discharged from the Hospital is presented. The basic assumption is that patients ready for discharge show changes on the different items of this instrument as treatment goes on. The study sample of 52 patients consisted of first admissions to the psychiatric Hospital in Call, Colombia. All ratings were made by auxiliary nurses supervised by psychiatric nurses, based on observed behavior. The results of a five week follop-up, show that patients get discharged from the Hospital when the scores are around 60 or above, but the major score change occurs within two weeks of admission. The findings imply that sistematic monitoring of patients progress avoid unnecessarily long hospitalizations. This instrument because of its simplicity and coverage, appears to be a useful device to assist in the process of monitoring the progress of psychiatric inpatients.