Harold Altman

Disturbing behavior: a study of incident reports

Over 5,000 incident reports from a large state hospital were factor-analyzed, and actuarial risk-rates were calculated for the resulting nine factors. Incident risk-rates are presented for sex, race, marital status, and diagnosis. Findings include: (1) young, single males with deferred diagnosis are high incident risk; and (2) schizophrenic incident rates, when corrected for length of stay, are relatively low.

Prediction of length of hospital stay

Abstract The Missouri standard system of psychiatry 1 is a statewide program for reporting uniform information on all patients admitted to the hospitals within the Missouri Division of Mental Health. Professional staff, technicians, clerks, patients, and relatives contribute precoded observations about patients. An electronic data-processing network stores, processes, and returns incoming data. The central aim of this system is to derive models of psychiatric disease states, of outcome according to a variety of parameters and responses, and of patients who respond to certain types of treatment. These models will provide standards for comparison with individual patients and for grouping patients into classes which will allow generalizations and probability statements to be generated about individuals from the groups. The probability statements so generated are promptly returned to the practicing clinician as suggestions to aid him in his decision making. There is considerable evidence 2,3 that such cookbook methods are adequate and that clinicians should have such results made available to them. This article reports our findings in a cross-validated study of length of hospital stay (LOS) and the significant items that were found to predict long and short stays. Information concerning LOS has an obvious utility in helping the clinician to plan more effectively for a patients care in the hospital as well as providing him a sound basis for counseling with relatives. We anticipated further dividends from the study, such as the emergence of factors that contribute to chronicity and perhaps the discovery of some clues relating to etiology.

Behavioral Effects of Drug Therapy on Psychogeriatric Inpatients. I. Chlorpromazine and Thioridazine

ABSTRACT: Psychogeriatric inpatients were treated for six weeks (after a six‐week clearance period) with one of three medication regimens involving chlorpromazine and thioridazine, to study the behavioral effects. (Total N = 132.) Although the treatments started simultaneously and proceeded concurrently, each treatment assignment was made at random and independently of the other two. The treatments were: 1) chlorpromazine vs. thioridazine, studied “double‐blind”; 2) a single bedtime dose of drug vs. fractional doses throughout the day; and 3) different total daily dosages (30, 60, 90 or 120 mg). Patients were rated on the MIBS, a new inpatient behavior form that utilizes 11 factored scales plus ratings of drug side effects. Schizophrenic and non‐schizophrenic subgroups were evaluated, as well as the total sample. Results were negative for treatments No. 1 and No. 2, but total dosage was significantly correlated with factor scale changes. The pattern of changes was different for the two diagnostic subgroups. The findings on side effects indicated that raters were confounding side effects and therapeutic effects.

Marijuana use and subsequent psychiatric symptoms: a replication

Abstract This work attempted to replicate a controversial report that marijuana use leads to ego decompensation and psychosis even in young people without predisposition. Subjects were drawn from first admissions, inpatient and out-patient, within the Missouri Division of Mental Health. There were 106 males and 49 females from 13 to 24 years old. A questionnaire and clinical records were used to identify 38 youths whose use of marijuana antedated psychiatric symptoms. Capsule histories showed instances of poor judgment, confusion, anxiety, depression, and apathy. However, ten other variables, which were also investigated, produced higher “hit rates” than did marijuana. They included masturbation, sex education, beer drinking, dancing, kissing, and late TV movies. The case history method was discussed from a methodological stand-point, and was shown to have inherent pitfalls.

Missouri Actuarial Report System (MARS)

INCE 1966, the Missouri Department of Mental Health (DMH), in collaboration with the University of Missouri, has been developing a comprehensive statewide computerized information system.‘.2 Ten major mental health facilities are connected via remote terminals with high-speed card-readers and line-printers to an IBM 370-155 computer in St. Louis. Approximately fifteen satellite facilities also process data through the terminals of these ten facilities via messenger service and telephone. The system currently processes about 1000 new patients per month, with over 180,000 patients on the data-base. More than 10,000 clinical reports and 30,000 outpatient contacts are processed monthly. Most of the basic clinical forms are automated, including face sheet, mental status checklist, community adjustment scales, psychologic screening tests, and others.” Early in the history of the project, there was considerable interest in the feasibility of classifying individual patients into clinically useful categories, utilizing the large DMH standardized data-base in establishing explicit rules. These rules usually took the form of equations derived by using multivariate statistical techniques. The term “actuarial” in the behavioral science literature has come to mean this process of delineating and using explicit rules to classify individuals or predict their behavior. In this paper, the terms “actuarial rule set” or “rule set” will refer to such rules or equations. The authors’ earliest attempt at actuarial classification involved a list of major diagnostic categories attached to the printout of a computerized mental status report.’ Associated with each category was a probability estimate of the patient’s belonging to that group.” Later, a separate report was developed concerning risks of short versus long length of hospital stay, unauthorized absence from the inpatient service, and harm to self or others.“PX Thereafter, a single report was designed to incorporate all of the above, plus type of psychotropic drug treatment most likely to be prescribed in the Missouri DMH. Entirely new actuarial rule sets were developed, using more sophisticated statistical techniques. After two years of development, the Missouri Actuarial Report System (MARS) became operational. and the creation of a MARS report was “triggered” automatically whenever an admission inpatient mental status report was processed by the computer.

Behavioral Effects of Drug Therapy on Psychogeriatric Inpatients. II. Multivitamin Supplement

ABSTRACT: Psychogeriatric inpatients were treated with a B‐complex and C vitamin preparation (Albee with C) for six weeks in a double‐blind study. (Total N = 132.) They were rated on the MIBS, a new inpatient behavior form that involves 11 factored scales. One clinically and statistically significant finding emerged: there was a striking decrease in pathologic manifestations on the MIBS Excitement scale for a non‐schizophrenic subgroup of the vitamin‐treated sample compared to the placebo sample. Implications of this finding are discussed in terms of a detailed examination of the Excitement scale and in terms of a literature review of the effects of vitamin therapy on the behavior of psychogeriatric patients.

A Statewide Computerized Psychiatric System: Demographic, Diagnostic and Mental Status Data

IN 1966, the Missouri Division of Mental Diseases and the University of Missouri Department of Psychiatry in St. Louis, began an effort to standardize clinical psychiatric record data and convert it to a machine readable code. This program was undertaken with the belief 1) that if psychiatry is to progress as a scientific discipline, it is necessary to better define its terms and classify its observations, and 2) that the computer can be of help in the day-to-day practice of psychiatry if clinical data is coded and machine processable. Missouri has a total population of about five million people. The Division of Mental Diseases serves primarily the medically indigent. It has 10 major institutions across the State with an inpatient population of approximately 8,000. Approximately 12,000 new patients are admitted per year. The Department of Psychiatry in Saint Louis is an academic institution, a part of the University of Missouri. It is dedicated to research and training and has a strong interest in the care of major mental illness. These two institutions have joined forces in a major computer effort. Committees of professional staff have been set up to develop reporting instruments for each major area of clinical data gathering. These include systems to gather demographic data, mental status findings, psychiatric and social history, behavioral observations, psychological test data and others.

Demographic and mental status profiles. Patients with homicidal, assaultive, suicidal, persecutory and homosexual ideation. The Missouri Automated Standard System of Psychiatry.

SummaryUsing 87 demographic and mental status variables from the Missouri Division of Mental Diseases automated record file, equations to predict five clinically important types of ideation (i.e., homicidal, assaultive, suicidal, paranoid, and homosexual) were developed and cross-validated on 4,156 inpatients. The multiple correlations found ranged from .25 to .48 on cross validation and were all statistically significant. Zero-order correlations for the 10 strongest predictors of each type of ideation are presented and the clinical implications of the correlations are discussed. The prediction equations developed should make it possible for clinicians to improve the accuracy of their assessments of the true status of their patients for these five types of ideation.

Childhood and adolescent problems of adult psychiatric inpatients

Abstract The Missouri Standard System of Psychiatry (SSOP) is a computerized information system that gathers codable, objective data from all Missouri Department of Mental Health facilities. 1 This automated system is an attempt to create a more objective approach to psychiatry. There are many theories concerning what are important etiologic factors for psychiatric illnesses. Using automated information gathered from relatives and other community informants via the SSOPs Community Adjustment Profile System (CAPS), a 98-item questionnaire, 2 we have addressed ourselves to the question of what relationships childhood deprivation and maladjustment have to adult behavior patterns in psychiatric inpatients. The basic questions studied concerned early (before age 20) deprivation and maladjustment: 1. 1. Did the adult community behavior adjustment patterns and diagnoses of inpatients who suffered early deprivation differ from those of inpatients who did not? 2. 2. Did the adult adjustment patterns and diagnoses of inpatients who manifested early maladjustment differ from those inpatients who had not? 3. 3. Did the adult adjustment patterns and diagnoses of inpatients who manifested both early deprivation and early maladjustment differ from inpatients displaying neither pattern? 4. 4. If differences existed, did they form patterns that were clinically comprehensible?

An Iterative Program for Scale Building Based on Intra-Scale Consistency

an initial pool of items. The choice of the initial set of items depends upon the judgment of competent persons as to their suitability (face validity) for the purposes of the scale. The aim is to identify a subset of these items with high internal consistency. The computer program calculates and prints out the mean, variance, and standard deviation for each item in the initial pool. It also accomplishes the following iterative procedure: