Glenn R. Yank

Abnormal diurnal weight gain among long-term patients with schizophrenic disorders

We found diurnal weight gain to be abnormal among 65 long-term patients with schizophrenic disorders. Patients were weighed at 7 a.m. and 4 p.m. serially and diurnal weight gain was normalized (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.2 +/- 1.5% for 47 male patients compared (P = 0.001) with 0.6 +/- 0.4% for 11 male controls. NDWG was 1.7 +/- 0.7% for 18 female patients compared (P less than 0.0001) with 0.5 +/- 0.3% for 14 female controls. We hypothesize that NDWG may be an index of both the severity and duration of the schizophrenic disorder.

Development of water dysregulation during arieti's third stage of schizophrenia?

We found abnormal diurnal weight gain among 25% of acutely psychotic patients with schizophrenia and 68% of chronically psychotic patients with schizophrenia. They were weighed at 7:00 AM and 4:00 PM weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7:00 AM weight from the 4:00 PM weight, multiplying the difference by 100, and dividing the result by the 7:00 AM weight, NDWG was 0.93% +/- 0.89% for the 36 acutely psychotic patients and 2.2% +/- 1.5% for the 68 chronically psychotic patients (F = 25.297, p less than 0.0001). Drugs did not explain this difference. Our data, though preliminary, suggest that water dysregulation, as manifested by abnormal diurnal weight gain, develops in schizophrenia as patients progress into Arietis third stage of this disorder. A longitudinal study design, rather than our cross-sectional one, would be necessary to assess developmental changes in schizophrenia.

Lithium, polyuria and abnormal diurnal weight gain in psychosis

We evaluated diurnal weight gain and polyuria among 31 institutionalized chronically psychotic patients receiving lithium and 42 controls not receiving this drug. The patients were weighed weekly for three weeks at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. Polyuria was assessed using mean urine creatinine concentration (MUCR). NDWG was abnormal among study patients (1.9 ± 1.2%) and controls (1.6 ± 1.5%) independent of lithium treatment. The variation in MUCR explained about 20% of the variation in NDWG in both groups.

Toward the Financial Integration of Public Mental Health Services

The public treatment of seriously mental ill patients continues to be frustrated by the lack of administrative and financial integration of state and community mental health services. Several states have initiated attempts to improve the costeffectiveness of public mental health services through mechanisms that create financial incentives fostering community-based alternatives to psychiatric hospitalization. Examples of such mechanisms include capitation financing systems, performance contracts, regional mental health authorities, utilization review, and bed-targets. This paper reviews evidence supporting the need for and success of these efforts, and also addresses their limitations.

The link between fluid intake and weight gain in psychosis

Diurnal weight gain was found to be abnormal among 44 of 77 institutionalized chronically psychotic patients. All patients were weighed and urine samples obtained weekly for 3 weeks at 7 A.M. and 4 P.M. Diurnal weight gain was normalized as a percentage by subtracting the 7 A.M. weight from the 4 P.M. weight, multiplying the difference by 100, and then dividing the result by the 7 A.M. weight. Normalized diurnal weight gain (NDWG) was 2.504 +/- 1.266% for the 44 study patients with abnormal findings, .631 +/- .405% for the 16 acutely psychotic controls, and .511 +/- .351% for 29 normals. Urine excretion was related (r = .476, p = .001) to NDWG in the subgroup of study patients with abnormal NDWG, consistent with the observation that their fluid intake exceeded fluid excretion in the afternoon.

The Galt Visiting Scholar in Public Mental Health: A review of a model of state-university collaboration

The Galt Visiting Scholar in Public Mental Health program was developed in Virginia to strengthen the relationships between the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services and the Commonwealths three medical schools. We describe the development and evolution of this program and its accomplishments to date. Despite significant accomplishments, many of the key recommendations of previous Galt Scholars have not been enacted. The Galt Scholar approach of a consultant model is discussed and analyzed structurally using consultation theory. This analysis demonstrates both the potentials and limits of consultant models of state-university collaboration.

Abnormal diurnal weight gain among chronically psychotic patients contrasted with acutely psychotic patients and normals

We found diurnal weight gain to be abnormal among 28 institutionalized chronically psychotic patients. They were weighed daily for 15 days at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.8 +/- 1.3% for the 28 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls, and 0.511 +/- 0.351% for 29 normals. Ninety-three per cent of the study sample had NDWG values above the upper limit of normal. Sex, diagnosis, smoking, baseline weight, blood pressure, and pulse did not explain these observations. NDWG related (N = 28, r = 0.552, P = 0.002) to antipsychotic drug dose. The implications of our findings are discussed.

Abnormal Diurnal Weight Gain in Chronic Psychosis without Seasonal Change

We found diurnal weight gain to be abnormal in chronic psychosis. Nineteen chronically psychotic patients were weighed daily at 7 a.m. and 4 p.m. for 1 year. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.714 +/- 0.824% for the 19 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls and 0.511 +/- 0.351% for 29 normals. All the study patients had NDWG values above the upper limit of normal. There were no seasonal differences (p less than 0.0001) in NDWG of the study sample. Sex, diagnoses, vital signs, and drugs did not explain our findings.

State-university collaboration: Role of the psychiatric hospital medical director

Medical directors are clinician-executives who provide leadership to advance state-university collaboration programs, and to facilitate recruiting and empowering a professional staff in the public sector. This article examines the medical directors role and tasks from the perspective of a “social systems clinician” who interacts with medical staff, hospitals, agencies, and university systems to meet oversight responsibilities and promote organizational development.