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<p>This study addresses differential diagnosis and treatment in psychiatry based on sex differences. It attempts to explain why women are diagnosed and treated differently from men, and to investigate the nature of psychiatric practice, in this regard.</p> <p>For the investigation, the thesis is in three parts. First, an analysis of the data on diagnosis and treatment of mental illness, so called. Secondly, and analysis of three theories which attempt to account for the phenomenon of psychiatric social control, i.e . the medical model of mental illness, labelling theory and feminism. Finally, a theoretical framework is presented which attempts to avoid the inadequacies of the other theoretical approaches to the problem.</p> <p>The fundamental argument in the thesis is that psychiatry acts to suppress those not directly involved in wage labour. It acts to redefine the social problems generated by capital as the indivudal problems of its victims.</p> / Master of Arts (MA)

Two related program evaluations of the mental health system in Puerto Rico are conducted. Initially, research is carried out in two state psychiatric hospitals involving an organizational analysis of relevant systems variables as they impinge upon effective institutional functioning. In this scheme hospital effectiveness is predicted by success in achieving formally prescribed goals and in the adequacy of resource utilization. The basic assumption is that the psychiatric hospital reflects the patterning of reciprocal and interdependent behaviors of individuals which form a larger all-important pattern. The hospitals are studied by means of a questionnaire administered to staff to ascertain perceptions of the work environment, communication and coordination processes, overall hospital organization, and the treatment environment. The results of organizational functioning are presented in a profile analysis plotting institutional means over ten functional dimensions. Individual component variables are converted into standard scores and broken down by staff sub-groups. Each institution and staff sub-group differs uniquely across the dimensions. Overall the results point to excessive staff frustration and disillusionment with the organization's functions, and a treatment environment limited in patient autonomy, socio-emotional interaction, and therapeutic content. The complementary study of first releases from these hospitals examines background and performance characteristics of a sample of patients in an effort to distinguish those who complied with aftercare referrals from those who did not, and those who were readmitted from those still in the community one year after release. Bivariate analysis of the relationship between each of the two dependent variables and the several demographic and treatment variables at each hospital reveals that the strongest differentiation of compliers from non-compliers is having been active in pre-hospital outpatient care, while the extent of use of aftercare was the strongest predictor of remaining in the community. Implications for policy and for further research in mental health service delivery are discussed.

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura's self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices for electronic health records (EHR) in a rural mental health facility, created policy and practice guidelines, and developed implementation and evaluation plans to guide the initiative as it moves forward. The team included physicians, psychiatrists, psychologists, nurse practitioners, nursing support staff, social workers, and substance abuse counselors. The team explored approaches for implementing EHR-based medication management based on research in the current literature and goals/objectives of each department. Team members identified major issues and proposed guideline changes based on evidence in their own fields. The team then collaborated to develop policies and practice guidelines in a series of meetings designed to build consensus for supporting a unified set of products to be accepted by all departments. The resulting policies and practice guidelines are accompanied by plans for implementation and evaluation that provide the institution with a comprehensive solution to polypharmacy in elderly patients. This project may improve overall quality of care by reducing medication and preventing health complications related to polypharmacy.

Magister Curationis - MCur / The frequent readmission of patients in psychiatric hospitals is caused by the relapse in their different psychiatric conditions. With a shortage of professional nurses, lack of resources, and an ever-increasing workload, the frequent readmission of psychiatric patients further worsens the situation.

This study examines effects of a hospital-based psychiatric day program on eight subjects over a six month period. Each subject underwent a semi-structured interview at admission to the Program, and then at three and sixth months or on discharge with concurrent Psychometric testing. Quantitative and qualitative data were compared with information from "significant others" and unit staff reports to determine changes in subjects' behaviours over the study period. To consider any effects of the Program on psychiatric re-admissions, relevant data dating back to 1980 from both regional admitting centres were examined for patients who were identified as having had multiple re-admission for psychiatric care as well as a minimum of twenty-four days attendance at the Day Program ( n = 73 ). The results indicated a trend towards improved quality of life, improvement in selfcare, social supports, ability to form relationships and in the quality of family relationships. Reduction in number and intensity of symptoms, and improvement in coping skills was reported for 88% of subjects. Subjects were found to agree in their perception of the most and least helpful elements of the Program. Re-admission data showed that the Program was most beneficial for number of admissions, rate of admissions, length of stay and rate of length of stay for the diagnostic group of Depressions and for the group as a whole. There were also positive effects in some of these areas for the diagnostic groups of Anxiety Disorders and Personality Disorders (confidence level of 95%).

Thesis (M. Arch.)--University of Hong Kong, 1999. / Includes special report study entitled: Architecture intervention in building conservation. Includes bibliographical references.

The purpose of this study was to explore the experiences of mental health nursing instructors and students regarding the one-to-one in mental health contexts. Using person-centered interviewing, nursing instructors and students were asked to share their views related to the one-to-one, the skills and techniques used to conduct the one-to-one, and the teaching and evaluation strategies used in clinical settings. Findings indicate ambiguity surrounding the one-to-one for both instructors and students. Students also feel anxious and uncertain without models to guide their one-to-ones, and instructors feel frustrated with how to teach and evaluate the one-to-one. Finally, findings indicate the need for further articulation of the one-to-one within nursing literature, and the development of guidelines to support student learning of the one-to-one in clinical settings. / vii, 117 leaves ; 29 cm