Janet Lavelle

The Suffolk County Mental Health Project: demographic, pre-morbid and clinical correlates of 6-month outcome

The diagnostic specificity and predictive utility of the classical prognostic indicators in schizophrenia were examined in psychotic patients enrolled in the Suffolk County Mental Health Project. First-admission psychotic patients with schizophrenia (N = 96), major depression (N = 42), and bipolar disorder (N = 64) drawn from 10 facilities in Suffolk County, New York, were assessed during their initial hospitalization and at 6-month follow-up. Longitudinal consensus diagnoses were determined after the 6-month interview. The diagnostic groups shared similar background characteristics, but schizophrenics had poorer pre-morbid adjustment, longer periods of psychosis before hospitalization and more negative symptoms initially. Except for rehospitalization, schizophrenics had the worst and bipolars the best functioning at follow-up. Among the classical prognostic indicators, the best predictor of 6-month outcome for each diagnostic group was premorbid functioning.

Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization

BACKGROUND It is now well documented that both black and white patients with severe mental illness are likely to use different types of treatment facilities, have different lengths of hospital stays, and receive different types and dosages of psychotropic medications. It is still uncertain, however, whether these differences exist at the early stages of treatment. METHOD We examined treatment patterns for a countywide sample of patients with psychotic disorders recruited at their initial psychiatric hospitalization. Illness characteristics, prior treatment histories, admission conditions, and psychotropic medication use during this hospitalization were compared for both black and white patients. RESULTS Black patients were less likely to have had out-patient treatment prior to their first hospitalization and were more likely to be hospitalized in public than in community psychiatric units than were white patients. Black patients were also more likely to be hospitalized primarily for a behavioral disturbance and escorted to the hospital by the emergency medical services or police, while white patients were more often hospitalized primarily for subjective suffering. These patterns were particularly significant for those with a non-schizophrenia diagnosis. However, there were few statistically significant differences between black and white patients on psychotropic medication use during the first hospitalization. CONCLUSIONS Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization.

Eliciting psychotic symptoms using a semi-structured diagnostic interview. The importance of collateral sources of information in a first-admission sample.

This study addressed the importance of medical record information in determining the presence of psychotic symptoms in first-admission patients. A sample of 232 first-admission inpatients screened for psychotic symptoms by facility personnel was administered the Structured Clinical Interview for DSM-3-R (SCID) followed by a medical record review and interview with a significant other. Medical records were unavailable for sixteen patients. These patients were more often female, married, and more suspicious than patients whose records were reviewed. Of those having interviews and record reviews, 49 showed no clear evidence of psychosis. The remainder were divided into three groups: 97 subjects who revealed all of their psychotic symptoms during the interview (SCID-ALL); 61 who revealed only some of their delusions or hallucinations during the interview (SCID-PART); and 25 who revealed none of this information during the interview but whose records clearly described psychosis (SCID-NONE). The three groups were reasonably similar demographically and with respect to clinical history. Clinically, at the time of interview, SCID-NONE subjects were less often still psychotic, were rated on the Brief Psychiatric Rating Scale as less depressed, more withdrawn, less cooperative and less severely ill, and had poorer insight ratings on the Hamilton Depression Scale.