Profiles of recreational activities of daily living (RADL) in patients with mental disorders.

BACKGROUND: Activities of daily living, play a key role in the measurement of functional health as defined by the International Classification of Functioning, Disability and Health (ICF) and in prevention and treatment of mental or somatic illnesses. From a clinical context it is important to discriminate between basic "activities of daily living, ADL", "intentional activities of daily living, IADL", and "recreational activities of daily living, RADL". While ADL and IADL have gained much attention in dementia, the elderly, or severe somatic illnesses, there is a lack of research on RADL, which are important in depression, anxiety, or other neurotic disorders. SUBJECTS AND METHODS: 154 unselected inpatients of a department of behavioral and psychosomatic medicine filled in the "Check List of Recreational Activities" to assess the rates and profiles of RADL. RESULTS: Patients reported on average 19.3 (s.d. 7.0) activities (range 4 - 40), i.e. males 21.3 (s.d. 6.5, 9 - 34) and females 18.9 (s.d. 7.1, 4 - 40). Most frequent RADL were passive and unspecific activities like "watching tv" (93.4%). Least frequent were activities which need special skills or preparation like "horse back riding" (0.7%). Low rates were also found for activities which are in the centre of inpatient occupational therapy like "ceramics" (4.7%) or "silk-painting" (2.6%). There are differences between sexes but not in respect to age (18 to 60), sick leave and unemployment, or diagnostic status. When patients were asked what they would like to do in the future, the same activity profile emerged as when looking at what they had done in the last month CONCLUSION: The data give a reference profile for recreational activities, help to define what can be considered a normal frequency and spectrum of RADL, and, by this, can guide therapeutic interventions.

Short vs long hospitalization: a prospective controlled study. VII. Two-year follow-up results for nonschizophrenics.

A controlled, prospective study examined the relative effectiveness of short-term versus long-term psychiatric hospitalization. Results of a two-year follow-up of a sample of 74 nonschizophrenic subjects are reported here. Two years after admission there were no statistically reliable differences in functioning between short-term and long-term subjects with diagnoses of either affective disorders, or neurosis and personality disorders (including hysterical personality disorder). The findings reported do not support extended hospitalization for patients with these diagnoses. Caution regarding these findings is suggested by an anecdotal impression that short-term hospitalization may not have allowed for proper diagnosis and treatment for some persons in the affective disorder group.

A comparative trial of home and hospital psychiatric care. One-year follow-up.

The effectiveness of community-based treatment stressing home care was compared with hospital-based psychiatric care. One hundred and fifty-five patients destined for inpatient psychiatric care were randomly assigned to Home Care (76 patients) and to Hospital Care (79 patients). Symptoms, role functioning, and psychosocial burden on the family were similar at admission, one month, three months, six months, and one year. The mean in-hospital stay of Hospital Care patients was 41.7 days compared with a mean stay of 14.5 days for Home Care patients. The difference in the amount of ambulatory care received by patients in the two groups was not significant. The evidence is consistent: community-based psychiatric care is an effective alternative to hospital-based care for many but not all severely disabled patients. The active ingredients of successful community treatment are known, yet the lag in implementing these programs persists.

A description and evaluation of an outpatient intensive psychotherapy center.

The intensive psychotherapy center described and evaluated in this paper is unique because of its intensity and the fact that available treatment modalities are integrated into the program. Pateints are literally immersed in therapy on a full-time basis for an average of 3 weeks. Assessment of the program through the use of questionnaires completed by 335 patients at the time of discharge showed significant improvement in their presenting symptoms, interpersonal relationships, ability to work, and general level of comfort. An 8-month follow-up study of 171 patients revealed that this improvement was retained.

Research on the results of psychotherapy: a summary of evidence.

The authors present a basic overview of recent research on the outcome of psychotherapy, considering different types of therapy and different diagnostic categories separately. In some studies psychotherapy was more efficacious than spontaneous remission or placebo effects, especially in cases of anxiety and in nonpsychotic depression. As an adjunct to drugs and/or ECT, psychotherapy was effective in lowering the relapse rate of schizophrenic outpatients. Psychotherapy appeared to be more effective when focusing on realistic, relevant issues and when teaching social skills. Family therapy may be the most robust mode in terms of consistent positive results with different problems. Although results continue to be mixed, methodological progress is apparent and optimism for continued progress is warranted.

The effects of an expectancy state on the fate of applications and psychotherapy in an outpatient setting.

This study describes an attempt to influence the outcome of outpatient psychotherapy by offering pretherapy information to application. The sample consisted of more than 1,300 applicants; the pretherapy information, in the form of a printed leaflet, was included with the application blank for alternate cases. The results suggest that the pretherapy information tended to discourage the completing of application blanks. Among those patients who eventually participated in psychotherapy, pretherapy information had no effect on the duration of treatment or on treatment outcomes as rated by the therapists. Incidentally, the data indicate that having health insurance has a strong, positive effect on the number of treatment interviews.

Prospective study of course of illness in schizophrenia: Part I. Outcome at 1 year.

In a prospective study involving 161 patients discharged from inpatient psychiatric treatment, outcome data were obtained for 93 percent of the patients 1 year after clinic discharge. Sixty-seven percent of the patients were directly interviewed for the followup examination. Outcome data for symptomatology, relapses, employment, and social contacts did not differ significantly for patients with schizophrenic psychoses as compared to those with affective psychoses, neuroses, and other psychiatric diagnoses (predominantly alcohol dependency). A discrepancy between self-ratings and observer-ratings was particularly striking in the group of neuroses at discharge from inpatient treatment. These patients also had comparatively more prominent depressive symptomatology at followup. These findings raise questions about the influence of possibly different levels of intensity in outpatient followup treatment, and about outcome predictors independent of diagnosis. These questions are pursued in Parts II and III.

Contributors to cardiac invalidism after acute myocardial infarction.

Cardiac invalidism is a term used repeatedly in the literature during the past few decades, but little attention has been given to studying the variables contributing to this phenomenon. Data were collected from 111 patients with first acute myocardial infarction. Patients were visited at home 1 month and 4 months after hospital discharge. Social support, self-esteem, health perceptions, emotional distress, interpersonal dependency, and neuroticism were measured using standardized instruments. Illness severity was determined using the Coronary Prognostic Index, the Specific Activity Survey, and treadmill testing results. Neuroticism and social support were significant predictors of cardiac invalidism 4 months after myocardial infarction. Illness severity was not a significant predictor of cardiac invalidism or return to work. The only significant predictor of return to work was health perception. Patients receiving more support than desired experienced less cardiac invalidism after acute myocardial infarction. Physicians are encouraged not to assume that patients with large infarcts will become cardiac invalids. Psychologic recovery may require more than 4 months for many patients, but positive messages regarding patient health can influence such outcomes. Families and friends should be taught to provide appropriate types and amounts of support. The amount of support typically thought to be adequate may not be sufficient. Patients who initially receive more support than desired experience the best psychologic outcomes. High levels of support need not continue indefinitely.

Interational group therapy with alcoholics.

The techniques used and problems encountered in interactional group therapy with alcoholics are descussed.

The practice of behaviour therapy in West Africa: the case of Ghana.

The purpose of this report is to discuss the role of behavior therapy as an additional treatment model in the field of mental health in Ghana. The problems and achievements in its pioneer stage have been discussed. Ghanaian neurotics' concept of etiology of illness is profoundly rooted in cultural beliefs such as evil machination and cosmic forces. The profound role played by the traditional healers' definition of "mysterious illness" and treatment of neurotic symptoms has been modified since the introduction of behaviour therapy and this serves as a threat to the "healers". Analysing the findings so far one can recommend that behaviour therapy be included and emphasized in the future training of African psychiatrists and other mental health professionals in Africa in general and in Ghana in particular.

Psychiatric disability of Air Force fliers.

Case reports of psychiatric disorders in flying personnel tend to be reported in diagnostic clusters. When viewed separately, these reports suggest specific patterns. When looked at collectively, psychiatric disorders in military aviators follow no specific pattern. A 5-year review of psychiatric evaluations done at the USAF School of Aerospace Medicine reveals a wide range of psychiatric diagnoses. Although aviators with psychiatric disabilities are seldom seen, a greater proportion of this group will be grounded compared to other medical referrals. In selected cases, psychiatric treatment is highly successful. In future work, greater emphasis should be given to the identification of life stress events for the purpose of deterrence, in addition to rehabilitation through treatment.

Post release adjustment of day and inpatients.

A comparison was made of the post-release adjustment of patients who were treated in the day hospital and those by the inpatient service. The patients diagnosed as schizophrenics, psychopaths and neurotics, living with their families, who were able to work prior to hospitalization were chosen for samples. In addition, the patients of the two samples were matched with regard to age, the number of hospitalizations and the length of the last one. The day hospital sample consisted of 85 patients and the inpatient sample of 92. Four aspects of social adjustment during the 18 months after discharge were particularly stressed: rehospitalization, working ability, interpersonal relations and role functioning in the family. No significant difference between day and full-time patients with regard to these aspects of post-release adjustment were revealed.

Psychiatric foster care for adult patients: results of a study in The Netherlands.

Since the 1920s psychiatric foster care has been considered as an important alternative to psychiatric hospitalization in the Netherlands. About one percent of the mental hospital patients are actually living with contracted families. These patients have their meals with their foster families, and stay there at night and at the weekends. Foster families can obtain support from hospital staff. Day-programmes, treatment and work rehabilitation, however, are usually undertaken in the grounds of the mental hospital. Some data will be presented on the characteristics, skills, social integration and consumer satisfaction of all 188 patients staying with 162 foster families. A comparison is made with a random-sample of hospital inpatients (N = 381), patients in sheltered homes (N = 179) and in day-centres (N = 86).

A two year follow up of new long-stay patients in an inner city district general hospital.

In 1967 Magnus described 'the new chronics', patients admitted to a psychiatric hospital who then stayed for more than one year. Since that time many studies have examined this patient group but the majority have focussed on psychiatric hospital populations. There is some doubt, however, as to whether the characteristics of new-long stay patients in District General Hospital (DGH) psychiatric in-patient units are comparable. The current paper describes a two year follow-up study of Medium and New-Long Stay patients identified within an inner-city DGH unit in 1986. Elderly patients with affective disorders and patients with organic brain syndromes were particularly highly represented. Length of stay at the time of the original survey, male sex, associated physical disability, and the presence of a secondary diagnosis were particularly associated with poor outcome. The results are discussed in relation to service provision.

Severely and persistently mentally ill patients in Italy: an overview of epidemiological and psychosocial findings.

The aim of this paper is to provide an overview of epidemiological, clinical and psychosocial characteristics of patients needing long-term treatment. The data concerned the following aspects: prevalence and incidence from the five best-established Italian psychiatric case registers; needs for care; psychosocial and clinical outcome as assessed by means of follow-up studies; social disability and relatives' perceived burden. The one-year prevalence rate of "long-term users" is consistent in Northern Italy, higher in Middle Italy and lower in Southern Italy. The incidence rate was found to be around 4 per 100,000. Even in a community oriented mental health service, users' needs for care are only partially met. A good psychosocial outcome was found associated with the use of social and/or vocational skills training, while the average number of days per year of hospitalization in a psychiatric department was found associated with poor outcome. A moderate degree of social disability was found among patients needing long-term treatment. The resulting family burden presented to a marked or very marked degree in more than 50% of the relatives.

Psychiatric disorders in opioid dependants.

AIMS: Psychiatric disorders are common among substance dependants. The objectives of this study were to assess the rate of neurotic disorders among opioid addicts, and reassess the rate of those neurotic disorders two weeks after complete detoxification of the patients. MEASUREMENTS: Data were gathered from 500 (496 men and 4 women) opioid dependants, using DSM-IV criteria. The Middlesex Hospital Questionnaire (MHQ) was used to measure free-floating anxiety, depression, phobia, obsession, hysteria and somatization. RESULTS: Four hundred and ninety-six (99.2%) of the subjects were men of whom the majority (65.2%) were married, 26.4% single and the others were divorced or separated. Three hundred and thirty-four (66.8%) were in age range of 20 to 39 years. Of the subjects 154 (30.8) were self-employed, 116 (23.2%) were factory workers, 100 (20%) unemployed, 64 (12.8%) employees and 32 (6.4%) retailers. The majority, 322 (64.4%), reported elementary and high school as their level of education and only 20 (4%) were illiterate. The means for neurotic disorders (using the MHQ) before and two weeks after detoxification were 10.12 and 9.98 for anxiety, 7.54 and 7.41 for phobia, 10.10 and 9.76 for depression, 11.11 and 11.05 for obsession, 8.47 and 8.49 for hysteria and 9.82 and 9.46 for somatization, respectively. The mean difference was significant only for depression. CONCLUSIONS: Present findings indicated that the rate of neurotic disorders in opioid dependants is high and (except for depression) was not significantly different before detoxification and two weeks after detoxification. Opium was found to be the most prevalent form of opioid used. Also it can be concluded that during the last years some demographic characteristics of Iranian opioid addicts in this sample have changed. Cultural attitudes toward substance use quite likely affect the pattern of substance use. These findings can be considered when planning preventive and therapeutic programs.

Soviet approach to the causes of neuroses.

Some Soviet therapists admit the role of latent (that is, sexual) conflicts and childhood experiences in the origin of emotional disorders. They also attempt to utilize the influence of the social environment in the "readaptation" of neurotics. However, these attempts are limited by certain ideological as well as practical restrictions.

Personality, demographic, and intellectual variables associated with readiness for discharge from psychiatric treatment.

This study examined the relationship between staff rated discharge readiness and patient personality, demographic, and intellectual variables. Chi square and t test analyses were performed on data of 88 male and female adult patients of a short-term residential psychiatric treatment program. Patient diagnosis, trait anxiety level, marital status, age, and abstract intelligence scores assessed at admission were found to be significantly associated with staff ratings of patients' readiness for discharge following six weeks of treatment. Findings were discussed in terms of prior process and outcome literature and implications for future research.

[Analysis of the structure of admissions and the course of hospitalization of drug addicts treated at the I Clinic for Mental Diseases, Medical Academy, in Gdansk 1982-1988]. / Analiza struktury przyjec i przebiegu hospitalizacji toksykomanów leczonych w I Klinice Chorób Psychicznych AM w Gdansku w latach 1982-1988.

The structure of admissions and the course of hospitalization were evaluated in the group of 78 (48 men, 30 women) with diagnosis of psychoactive substance dependence hospitalized in the Ist Clinic of Psychiatry in Gdansk during the period of 1982-88. The mean duration of hospitalization lasted 24 days. The most numerous (59%) group of opioid dependent patients was characterized by the shortest time of hospitalization. The longest duration of the abstinence symptoms was observed in the group of multiple-substance+ dependent patients. 62% of them were taking the drugs during hospitalization. In the group of euphoria + there was a positive correlation between the period of abstinence symptoms and a duration of hospitalization. Half of the patients discontinued hospitalization before the end of therapy. The abstinence symptoms were treated with neuroleptics, clomethiazole and subcomatic insulin.

[Image therapy as a method of rehabilitation in neuroses and mental disorders]. / imagoterapiia kak metod reabilitatsii pri nevrozakh i psikhicheskikh zabolevaniiakh.

A new method of psychotherapy, imagotherapy, is offered. This method consists in restoring the capacity of many neurotic and psychotic patients to enter into an image adequate tao a given situation. Training of this capacity is of a substantial importance for rehabilitation treatment. The treatment forms are: story telling by the patient in a group, a fixed dialogue, an improvised dialogue, a combination of story telling with a dialogue, dramatization of a story. The conclusive stage of the imagotherapeutic process is conducted in a therapeutic theatrical studio. The therapeutic mechanism of the imagotherapy is based on activation of the second signal system, the regulating influence of which on the higher psychic activity is disclosed chiefly by Soviet neurologists and psychologists.