Gary J. Gerber

Drug-induced reinstatement of extinguished self-administration behavior in monkeys.

Responding was established in squirrel monkeys under a modified progressive ratio schedule of IV d-amphetamine or cocaine self-administration. Subsituation of saline for the drug solutions resulted in extinction of the self-administration behavior. IV injections of certain doses of d-amphetamine or cocaine, immediately prior to test sessions in which response-contingent saline infusions were delivered, reinstated the rate and pattern of responding observed during sessions in which drug was self-administered. Presession IV injections of several doses of pentobarbital or chlorpromazine failed to consistently reinstate responding. These results were interpreted in terms of the discriminative control of drug self-administration behavior by the current drug state of the subject.

PSYCHIATRIC REHABILITATION: EFFICACY OF FOUR MODELS

This paper is a critical review of four major rehabilitation programs: assertive community treatment, case management, vocational rehabilitation, and educational rehabilitation. Reported outcomes are reviewed in the context of study design, service characteristics, client characteristics, and operationalization of outcomes. Findings from the four programs are compared with one another. The authors concluded that clients are able to learn most of the skills taught, independently of the rehabilitation model. Furthermore, skills learned in one life domain generalized to a moderate extent to other areas. The four rehabilitation programs had varied effects on the outcome variables, and part of the variability in the findings appears to be related to client characteristics. Limitations of the studies reviewed are identified and a set of recommendations was suggested for the future practice of research into psychiatric rehabilitation.

Subjective well-being and community integration among clients of assertive community treatment.

AbstractThree aspects of community integration (i.e., physical, social, and psychological integration) were examined in relation to subjective well-being (SWB) in a sample of 92 persons with psychiatric disabilities receiving services from assertive community treatment (ACT) teams. Although two of the integration variables, namely physical and psychological integration, were related to SWB at the bivariate level, these relationships were not maintained following sequential multiple regression analysis. Findings support previously established relationships between SWB and psychiatric symptoms and between SWB and self-esteem. Results also emphasize the importance of client perceptions of social support that may be attributable, in part, to ACT services.

Measuring subjective quality of life in people with serious mental illness using the SEIqoL-DW.

In response to suggestions that available measures may not adequately reflect the idiosyncratic nature of subjective quality of life, the schedule for the evaluation of individual quality of life (SEIQoL) was developed to allow individuals first to select and define their own dimensions of quality of life, and then to assign a relative weight to each of the dimensions they have chosen. A simplified version of the instrument, the SEIQoL-direct weighting (SEIQoL-DW), can be used to elicit similar information from subjects with impaired cognitive functioning. The present study explored the feasibility of using this technique with a sample of 35 clients with serious mental illness served by assertive community treatment (ACT) teams. The SEIQoL-DW was well accepted by the study cohort. The SEIQoL-DWs global index was correlated with the satisfaction with life scale (SWLS), and with the quality of life inventory (QOLI). The SEIQoL-DW may have potential as a clinical planning tool that allows respondents to define personally relevant quality of life dimensions upon which attainable goals can be based.

Identifying the core competencies of community support providers working with people with psychiatric disabilities.

The study was intended to identify core competencies for community support providers working with people with psychiatric disabilities. Using multiple methods developed from previous research in the field of developmental disabilities, 18 consumers receiving services and 16 staff members from two mental health community support programs identified a list of 68 competencies that included personal attributes, knowledge, and skills. Based on a card sort task, 34 consumers receiving services and 34 support workers from six mental health community support programs rated 59 of the 68 competencies as being either absolutely necessary or desirable. Results of a second card sort task found that a majority of competencies identified as being needed pre-employment were personal attributes consistent with adopting a person-centered approach. Competencies categorized as to be learned on the job involved special knowledge and skills specific to working with people with psychiatric disabilities. The range of personal attributes, knowledge, skills represented in the identified competencies reflects the complexity of contemporary mental health community support. Findings are indicative of the need for specialized training and supervision that has not been typically available in the community mental health sector.

Adjustment, Integration, and Quality of Life Among Forensic Patients Receiving Community Outreach Services

To date, there is little information regarding the adjustment of forensic patients living in Canadian communities. The present study describes the extent of integration and quality of life among fifteen forensic patients on Disposition Orders specifying conditional discharge living in a small Ontario community. All the respondents were clients of the Forensic Outreach Service based at the Brockville Psychiatric Hospital. Measures administered in face-to-face interviews included quality of life, community Integration, self-esteem, coping, ratings of problem behaviors, and a client satisfaction questionnaire. Results suggest a fairly stable picture of life for the respondents. They report feeling a sense of belonging in their community and appear to be satisfied with the quality and frequency of their social contacts, in spite of limited social integration. The Forensic Outreach Service represents an advance toward providing services to forensic patients that are currently available to other persons with psychiatric disabilities living in Canadian communities.

Old long-stay psychiatric in-patients in Ontario, Canada

A survey identified old long-stay patients in Ontario provincial psychiatric hospitals (PPHs) who were admitted before age 65, and had been hospitalized continuously for more than 6 years. PPHs serving the sparsely populated north and the Toronto megalopolis were excluded. reported all old long-stay inpatients for September 1, 1993. population were considerably lower than a comparable study in Scotland where occupancy rates were 59 per 100,000. Possible reasons for this difference include rehabilitation programs in Ontario PPHs that address needs of old long-stay patients, and the introduction of community support programs. Occupancy rates of 4.93 per 100,000 Remaining hospitals