HIV seroprevalence and clinical characteristics of severe inpatient mentally Ill homeless
Tóm tắt
Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.
Tài liệu tham khảo
Bachrach, L. L. (1984). Research on services for the homeless mentally ill.Hospital and Community Psychiatry, 35, 901–913.
Ball, F. L. J., & Havassy, E. H. (1984). A survey of homeless consumers of acute psychiatric services.Hospital and Community Psychiatry, 35, 917–921.
Brickner, P. W., Filardo, T., Iseman, M.,etal. (1984). Medical aspects of homelessness. In H. R. Lamb (Ed.),The homeless mentally ill: A task force report of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association.
CDC (1987a). Centers for Disease Control, Division of Tuberculosis Control, Center for Prevention: Tuberculosis control among homeless populations.Morbidity and Mortality Weekly Report, 36, 257–260.
CDC (1987b). Centers for Disease Control,Morbidity and Mortality Weekly Report, 36, 509–515, August 14.
Cohen, N. L., Putnam, J. F., & Sullivan, A. M. (1984). The mentally ill homeless: Isolation and adaptation.Hospital and Community Psychiatry, 35, 922–924.
Cournos, F., Empfield, M., Horwath, E.,et al. (1990). HIV infection in state hospitals: Case reports and long-term management strategies.Hospital and Community Psychiatry, 41, 163–166.
Cournos, F., Empfield, M., Horwath, E.,et al. (1991). HIV seroprevalence among admissions at two psychiatric hospitals.American Journal of Psychiatry, 148, 1225–1230.
Drapkin, A. (1990). Medical problems of the homeless. In C. L. M. Caton (Ed.),Homeless in America. New York: Oxford University Press.
Eagle, P. F., & Caton, C. M. (1990). Homeless and mental illness. In C. M. Caton, (Ed.),Homeless in America. New York: Oxford University Press.
Empfield, M., Cournos, F., Mayers, M.,et al. (1990). HIV in state hospitals: Clinical/ethical dilemmas. Paper presented at the 143rd Annual Meeting of the American Psychiatric Association, New York, May 12–17.
Federal Task Force on Homelessness and Severe Mental Illness (1992).Outcasts on Main Street: Report of the Federal Task Force on Homelessness and Severe Mental Illness. Washington, D.C.: U.S. Department of Health and Human Services.
Friedland, G. H. (1990). Early treatment for HIV: The time has come.New England Journal of Medicine, 322, 1000–1002.
Froner, G. (1988). AIDS and homelessness.Journal of Psychoactive Drugs, 20, 197–202.
Gerwitz, G. R., Horwath, E., Cournos, F.,et al (1988). Patients at risk for HIV.Hospital and Community Psychiatry, 39, 1311–1312.
Grunberg, J., & Eagle, P. F. (1990). Shelterization: How the homeless adapt to shelter living.Hospital and Community Psychiatry, 41, 521–525.
Harris, M., & Bachrach, L. L. (1990). Perspectives on homeless mentally ill women.Hospital and Community Psychiatry, 41, 253–254.
Kelly, J. A., Murphy, D. A., Bahr, G. R.,et al. (1992). AIDS/HIV risk behavior among the chronic mentally ill.American Journal of Psychiatry, 149, 886–889.
Kolata, G. (1988). Many with AIDS said to live in shelters in New York City.The New York Times: April 4, p. B1.
Lovell, A., & Shern, D. (1989). Assessing mental health status among adults who are homeless. In J. P. Morrissey and D. L. Dennis (Eds.),Homeless and mental illness: Toward the next generation of research studies. Bethseda, Maryland: Proceedings of a NIMH-Supported Conference, February 21 and 22.
Nardell, E. A. (1989). Tuberculosis in homeless, residential care facilities, prisons, nursing homes, and other close communities.Seminars in Respiratory Infections, 4, 206–215.
NYC DOH (1990). New York City Department of Health, AIDS Surveillance Unit: AIDS surveillance update, March.
OPRR (1985). OPRR Reports: Regulation 45 CFR 46. 102 (f). Washington, D.C.: U.S. Department of Health and Human Services, Office of Protection from Research Risks.
Pincus, S. H., Schoenbaum, E. E., & Webber, M. (1990). Seroprevalence survey for human immunodeficiency virus antibodies in mentally retarded adults.NYS Journal of Medicine, 90, 139–142.
Sacks, M. H., Perry, S., Graver, R.,el al. (1990a). Self-reported HIV-related risk behavior in acute psychiatric inpatients: A pilot study.Hospital and Community Psychiatry, 41, 1253–1255.
Sacks, M. H., Silberstein, C., & Weiler, P. (1990b). HIV-related risk factors in acute psychiatric inpatients.Hospital and Community Psychiatry, 41, 449–451.
Sacks, M. H., Dermatis, H., Losser-Ott, S., & Perry, S. (1992). Seroprevalence of HIV and risk factors for AIDS in psychiatric inpatients.Hospital and Community Psychiatry, 43, 736–797.
Schrage, H. E., Silver, M. A., & Oldham, J. M. (in press). Disposition and discharge planning and the role of the state systems. In S. Katz and D. Nardacci (Eds.),Intensive treatments of the homeless mentally ill. Washington, D.C.: American Psychiatric Association Press.
Schrage, H. E., Silver, M., Meyer, I.,et al. (1990). HIV seroprevalence in the seriously mentally ill. Paper presented at the 143rd Annual Meeting of the American Psychiatric Association. New York, May 12–17.
Smith, P. A. (1989).Moving forward: A national agenda to address homelessness in 1990 and beyond, a status report on homelessness in America. New York: Partnership for the Homeless, Inc.
Stricof, R. L., Kennedy, J. T., Nattell, T. C.,et al. (1991). HIV seroprevalence in a facility for runaway and homeless adolescents.American Journal of Public Health, 81, 50–53.
Talbot, J. A., & Lamb H. R. (1984). Summary and recommendations. In R. H. Lamb (Ed.),The homeless mentally ill: A task force report of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association Press.
Tessler, R. (1989). What have we learned to date? Assessing the first generation of NIMH-supported research studies on the homeless mentally ill. In J. P. Morrissey and D. L. Dennis (Eds.),Homeless and mental illness; Toward the next generation of research studies: Bethseda, Maryland: Proceedings of a NIMH-Supported Conference, February 21 and 22.
Torres, R. A., Lefkowitz, P., Kales, C.,et al. (1987). Homelessness among hospitalized patients with the acquired immunodeficiency syndrome in New York City.Journal of the American Medical Association, 258, 779–780.
Ward, J. W., & Drotman, D. P. (1992). Epidemiology of HIV and AIDS. In G. P. Wormser (Ed.),AIDS and Other Manifestations of HIV infection, 2nd edition. New York: Raven Press.
Way, B. B., & Banks, S. M. (1990). Use of seclusion and restraint in public psychiatric hospitals: Patient characteristics and facility effects.Hospital and Community Psychiatry, 41, 75–81.
Weisfuse, I. B., Chiasson, M. A., Back, S.,et al. (1990). HIV-1 infection in New York City STD clinic patients: Evidence for stable seroprevalence 1987–1988.Abstracts: V International Conf AIDS, 89, Los Angeles: AMFAR.