Reuben Margolis

Decision to admit in an inner-city psychiatric emergency room: Beyond diagnosis—The psychosocial factors

A one week sample of all patients who presented to the psychiatric emergency room of a large general municipal hospial in an inner-city area were studied. Demographic make-up, clinical picture, nature of coping styles, support systems, social, work, and family adjustment were studied as they related to admission status. Diagnosis, psychiatric history, and clinical status predicted admission as well as the nature of the patients social functioning, coping style, and community supports. The implications of the socioeconomics of mental health for treatment planning were discussed.

Predicting psychiatric admission from an emergency room. Psychiatric, psychosocial, and methodological factors.

The determinants of psychiatric hospitalization, especially nonspecific issues, have been studied extensively. The methodological problem of correlational non-cross-validated findings are seen as contributing to our uncertainties about the critical issues involved in the decision to admit. A cross-validated multiple regression analysis of determinants of hospitalization in an inner-city municipal hospital revealed two determinants of hospitalization: severity of schizophrenic symptoms and active suicidal and/or homicidal ideation. They accounted for one third of the variance without shrinkage. Quasi-experimental designs may be the most efficient means of studying the remaining unexplained variance.

A Single-Blind Evaluation of Thiothixene with Outpatient Schizophrenic Children.

The results of a single-blind study assessing the effectiveness of thiothixene in a group of severely ill, outpatient schizophrenic children are presented with details pertaining to procedure and side effects. The subjects, 17 boys and one girl, ranged in age from 5 to 13 years. Thiothixene proved effective in all of the 18 schizophrenic children, as indicated by the psychiatrists global impressions. Further evaluation of behavioral change, using a 23-item psychiatric rating scale, indicated significant improvement in motor activity, stereotyped behavior, coordination, sleeping, affect, exploratory behavior, concentration, eating habits, and range of communication. Despite relatively high dosages (10 to 24 mg per day) few side effects were noted during the course of the treatment period. It is suggested that thiothixene is a safe and effective antipsychotic agent for the treatment of schizophrenic children on an outpatient basis.

The hospitalization proneness scale as a predictor of response to phenothiazine treatment. II. Delay of psychiatric hospitalization.

To further explore the influence of personality factors on response to phenothiazine treatment, we examined the relationship between the hospitalization proneness scale (HPS) and the effectiveness of phenothiazine treatment in delaying hospitalization for those patients hospitalized during the course of their clinic treatment. The 129 hospitalized patients were part of a larger cohort of 446 chronic schizophrenic outpatients randomly assigned to placebo, promazine, and chlorpromazine and treated under double blind conditions. The patients in this sample were hospitalized after from 1 to 114 months of continuous outpatient treatment. The patients were divided into hospitalization prone and nonprone groups on the basis of the HPS. The HPS consists of measures of the patients effectiveness in social interactions, cognitive performance, and social attainment assessed at intake. The findings indicate that the number of months the patient was able to remain in outpatient treatment prior to hospitalization is the result of an interaction between the specific drug received and level of HPS score (p < .01). A multiple range test indicated that among prone patients, those treated with either chlorpromazine or promazine remained in treatment for a significantly longer period of time than comparable placebo-treated patients (p < .05). On the other hand, nonprone patients treated with chlorpromazine were hospitalized after a significantly shorter period of time than nonprone patients treated with either placebo or promazine (p < .05). In addition, chlorpromazine-treated nonprone patients were hospitalized significantly earlier than chlorpromazine-treated prone patients (p < .01). The results were discussed in terms of the relationship between the personality attributes measured and the sedative characteristics of the drugs employed. The implications of the findings to drug treatment and future research were also discussed.