Predicting clinically signficant change in an inpatient program for people with severe mental illness

Objective: The first aim of this study was to assess the proportion of patients who achieved reliable and clinically significant change over the course of treatment in an inpatient psychosocial rehabilitation program. The second aim was to determine whether age, gender, length of stay, and diagnosis and co-morbid diagnosis predicted those who were classified as improved or not improved, using clinical significance criteria. Method: Three hundred and thirty-seven patients from inpatient units at Bloomfield Hospital, Orange, New South Wales, Australia were assessed at admission, 3-month reviews and discharge using the expanded Brief Psychiatric Rating Scale, the Health of the Nation Outcome Scales and the Kessler 10. Results: Reliable and clinically significant improvement was found for 32.4% of inpatients on psychiatric symptomatology, 19.5% on psychosocial functioning and 20.2% on psychological distress. Logistic regression analyses found that the predictor variables collectively predicted those who made reliable and clinically significant improvement on psychiatric symptomatology, but not on psychosocial functioning or psychological distress. Those with a primary diagnosis of schizoaffective disorder had higher rates of improvement in psychiatric symptomatology compared to those with a diagnosis of schizophrenia. Those with co-morbid substance abuse disorders showed a trend towards greater improvement. Conclusions: Inpatient treatment is associated with clinically significant improvements for some patients with a severe mental illness. Patients with schizo-affective disorders are proportionally more likely to make improvement

Benchmarking across sectors: Comparisons of residential dual diagnosis and mental health programs

[extract] A Question to Ponder: How does your service compare to other similar services in the industry? How would knowing this help your organisation

Executive function deficits, rumination and late-onset depressive symptoms in older adults

Empirical evidence indicates that late-onset depression (i.e., age of onset > 60 years) is associated with executive function decline. This relationship suggests the possibility that executive dysfunction (ED) may contribute to depressive symptoms because it leads to decreased ability to inhibit ruminative thinking. This hypothesis was tested in a sample of 44 older adults reporting depressive symptoms with onset either late in adulthood or earlier in life. Consistent with hypotheses, older adults suffering from late onset, but not early onset, depressive symptoms showed an association between ED and depressive symptomatology. Furthermore, this selective relationship between ED and depressive symptomatology was mediated by ruminative tendencies. These results suggest that executive function deficits may contribute to late-onset of depressive symptoms by interfering with the ability to control ruminative thoughts