Thomas Grande - Academia.edu (original) (raw)

Papers by Thomas Grande

The effects of outpatient civil com-mitment on community tenure and functioning were studied in a... more The effects of outpatient civil com-mitment on community tenure and functioning were studied in a group of 20 patients with a history of recur-rent hospitalizations, noncompliance with outpatient treatment, and good response to treatment. During the first 12 months of outpatient corn-mitrnent, patients experienced sig-nificant reductions in visits to the psychiatric emergency service, hos-pital admissions, and lengths of stay compared with the 12 months before commitment. They significantly in-creased the number of appointments kept with their psychiatrist. It ap-pears that when used judiciously, outpatient civil commitment is a helpful tool in maintaining hospital recidivists in the community. (Psy-chiatric Services 47:1251-1253, 1996) U se of oritpatient civil coti)niit-ment has been advocated as a nicans to redrice the rehospitahization rate for a group of seveicly mentally ill reciclivists. However, its Potential pitfalls have also h)een well described, Dr.?wIunetz is chief clin...

New Directions for Mental Health Services, 1997

A Statistical Evaluation of the Literature Regarding the Associations Among Alcoholism, Drug Abuse, and Antisocial Personality Disorder

Substance Use & Misuse, 1988

Prior literature suggested an association among alcoholism, drug abuse, and antisocial personalit... more Prior literature suggested an association among alcoholism, drug abuse, and antisocial personality disorder. A meta-analysis of inferential studies bearing on these associations was performed on 40 studies. Results demonstrated that each diagnosis in the triad had a significant positive association with each of the other two. Possible common etiologies of the diagnoses were discussed. Presence of one of the three diagnoses suggests that consideration of the other two is advisable. Finally, interrelationships among the diagnoses may explain treatment results common to several of the diagnoses.

Associations Among Alcoholism, Drug Abuse, and Antisocial Personality: A Review of Literature

Psychological Reports, 1984

Current practice through both diagnostic systems and clinical approaches tends to view alcoholism... more Current practice through both diagnostic systems and clinical approaches tends to view alcoholism, drug abuse, and antisocial personality as completely distinct systems. In the course of research with other goals, the authors noted the apparent associations of each pair within this triad. As prior reviews of the literature on associations among these did not deal with implications of frequent association, this literature was re-evaluated with a more comprehensive assessment of the studies and reports bearing on these associations. After a broad search, studies were examined that reponed statistics indicating an association or none between one or more of the pairs of the triad. About 75% to 80% of the studies meeting the criteria showed positive associations between pairs. Also, a common etiological matrix may predispose one to behaviors diagnostic of each aspect of the triad: alcoholism, drug abuse, and antisocial personality. Although many studies contained methodological difficult...

The Use of the MacAndrew Alcoholism Scale in Detecting Substance Abuse and Antisocial Personality

Journal of Personality Assessment, 1990

We evaluated the hypothesis that characterological factors, particularly antisocial personality, ... more We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.

Associations among major psychiatric diagnoses

Journal of Consulting and Clinical Psychology, 1988

Abstract 1. The frequency and associations of multiple diagnoses were examined in 205 psychiatric... more Abstract 1. The frequency and associations of multiple diagnoses were examined in 205 psychiatric inpatients. The Washington University research criteria assessed past and current episodes of illness. Over half the sample received more than one diagnosis. ...

Archives of Psychiatric Nursing, 2012

Critics of outpatient commitment (OPC) suggest that African Americans with severe and persistent ... more Critics of outpatient commitment (OPC) suggest that African Americans with severe and persistent mental illness may be more frequently subjected to coercive treatment. This study examines the frequency of use of OPC and assertive community treatment and compares their influence on the perceptions of procedural justice/choice and coercion/negative pressure on African Americans and Whites. No significant differences were found in the rate at which OPC was applied to African Americans or in the use of assertive community treatment. Although procedural justice/choice does contribute significantly to the perception of coercion/negative pressure in both groups, its influence is diminished in African Americans.

Economic evaluation of risperidone in an outpatient population

Annals of Pharmacotherapy, 1999

To study the impact of risperidone use on the cost of services provided to severely mentally disa... more To study the impact of risperidone use on the cost of services provided to severely mentally disabled outpatients and on hospital avoidance, and to analyze patterns in the use of concomitant medications as a surrogate marker of changes in adverse effects or patient well-being. The patients were 31 clients of community mental health centers who had received risperidone for at least three months and for whom there were at least three months of available data on medication use and costs prior to risperidone treatment. The actual average monthly costs of community mental health services obtained from a county mental health board were compared with service costs prior to use of risperidone, using the patients as their own controls, and compared with a control group. Compared with the pre-risperidone period, the average cost per month of providing mental health services increased by 73.7% during the risperidone treatment period. Compared with the pre-risperidone period, the average total cost of treatment (including medications) increased by 113.3% during the risperidone treatment period. The average total cost of medication increased by 422.8% during the risperidone treatment period compared with the pre-risperidone treatment period. From the perspective of the community mental health board, risperidone treatment did not reduce the cost of services provided to these clients, but substantially and significantly increased total costs, including medication.

Community Mental Health Journal, 2001

This study examines the extent to which severely mentally disabled (SMD) patients in one county m... more This study examines the extent to which severely mentally disabled (SMD) patients in one county mental health system were incarcerated in the local jail and examines characteristics of a sample (N = 30) of such individuals. We found that in the study year, 7.9% of known SMD patients had at least one incarceration in the county jail. Diagnoses were predominantly