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The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March-December 2019 and March-December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality.
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COVID-19 , Intento de Suicidio , Humanos , Intento de Suicidio/psicología , Pandemias , Estudios Longitudinales , COVID-19/epidemiología , Control de Enfermedades TransmisiblesRESUMEN
Background: Cognitive dysfunctions represent a core feature of schizophrenia and a predictor for clinical outcomes. One possible mechanism for cognitive impairments could involve an impairment in the experience-dependent modifications of cortical networks. Methods: To address this issue, we employed magnetoencephalography (MEG) during a visual priming paradigm in a sample of chronic patients with schizophrenia (n = 14), and in a group of healthy controls (n = 14). We obtained MEG-recordings during the presentation of visual stimuli that were presented three times either consecutively or with intervening stimuli. MEG-data were analyzed for event-related fields as well as spectral power in the 1-200 Hz range to examine repetition suppression and repetition enhancement. We defined regions of interest in occipital and thalamic regions and obtained virtual-channel data. Results: Behavioral priming did not differ between groups. However, patients with schizophrenia showed prominently reduced oscillatory response to novel stimuli in the gamma-frequency band as well as significantly reduced repetition suppression of gamma-band activity and reduced repetition enhancement of beta-band power in occipital cortex to both consecutive repetitions as well as repetitions with intervening stimuli. Moreover, schizophrenia patients were characterized by a significant deficit in suppression of the C1m component in occipital cortex and thalamus as well as of the late positive component (LPC) in occipital cortex. Conclusions: These data provide novel evidence for impaired repetition suppression in cortical and subcortical circuits in schizophrenia. Although behavioral priming was preserved, patients with schizophrenia showed deficits in repetition suppression as well as repetition enhancement in thalamic and occipital regions, suggesting that experience-dependent modification of neural circuits is impaired in the disorder.
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We investigated the vividness of mental imagery and its possible relationship with the predisposition towards hallucinations in 52 schizophrenia (SZ) patients, 44 of their first-degree relatives (R) and two healthy control groups (high-schizotypy [CHS; n=24]; low-schizotypy [CLS; n=24]). We investigated phenomenological and cognitive trait markers of schizophrenia, including cognitive correlates of hallucinations and vividness of mental imagery, and the influence of individual psychopathology. Overall, scores on the mental imagery questionnaire (QMI [Sheehan, P.W., 1967. Reliability of a short test of imagery. Perceptual and Motor Skills 25, 744.]) suggested higher mental imagery vividness in first-degree relatives, high-schizotypy controls and patients, than in low-schizotypy controls. However, vividness of mental imagery was independent of predisposition towards hallucinations and cognitive test performance scores. These results suggest that vividness of mental imagery may be a trait marker across the schizophrenia spectrum. In addition we propose that imagery proneness is relatively independent of the individual psychopathology.
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Trastornos del Conocimiento , Familia/psicología , Imaginación , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adulto , Biomarcadores , Trastornos del Conocimiento/psicología , Femenino , Predisposición Genética a la Enfermedad , Alucinaciones/diagnóstico , Alucinaciones/genética , Humanos , Masculino , Pruebas Neuropsicológicas , Inventario de Personalidad , Esquizofrenia/genética , Trastorno de la Personalidad Esquizotípica/diagnóstico , Trastorno de la Personalidad Esquizotípica/psicologíaRESUMEN
Psychiatric diagnosis is invariably guided by self-report. When such self-report is questioned, reliance on formalized testing predominates. The situation is less certain, however, when such methods and clinical "feel", or intuition, conflict. While many argue for the supremacy of actuarial methods, fields such as Management have increasingly emphasized the importance of intuition; Psychiatry, although with few objective tests and reliance on the clinical encounter, offers surprisingly few answers. We explore here the use of intuition in decision-making through a case example and suggest that it is not inferior to other diagnostic methods: intuition should be used to suggest, guide, and modify psychiatric diagnosis. Mostly, there is a need for greater discussion among Psychiatrists including consideration to the clinical, legal, and ethical implications of the use of intuition in psychiatric decision-making.
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Toma de Decisiones , Trastornos Fingidos/diagnóstico , Intuición , Trastornos Mentales/psicología , Psiquiatría/métodos , Inconsciente en Psicología , Adulto , Trastornos Fingidos/psicología , Femenino , HumanosRESUMEN
INTRODUCTION: The aim of this study was to investigate to what extent pathological creatine kinase (CK) levels are associated with aggressive behavior in patients admitted to psychiatric facilities. It is based on the assumption that CK activity increases prior to a rise in motor activity and aggressive behavior. It should be noted that this assumption requires additional confirmation in more extended studies. METHOD: Over a period of 3 months, the CK levels of 317 psychiatric inpatients were assessed immediately following admission to a secure ward. During the course of the patients' stay (mean: approximately 11 days), their aggressive behavior was independently assessed using the Staff Observation Aggression Scale (SOAS-R). RESULTS: A receiver operating characteristic (ROC) analysis estimated an area under the curve (AUC) for subsequent aggressive behavior of 70.7% with a sensitivity of 70.1% and a specificity of 71.2%. When the variables involuntarily admission, lifetime history of aggression and absence of suicide attempts were also taken into account, the AUC was higher at 78.2%. CONCLUSION: Despite some methodological shortcomings in the collection of data, the study indicates that it could be useful to measure CK levels at the time of admission because elevated levels may indicate an increased risk of successive aggressive behavior for patients on secure psychiatric wards.
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Agresión/fisiología , Creatina Quinasa/sangre , Trastornos Mentales/enzimología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Internamiento Obligatorio del Enfermo Mental , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Admisión del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Medición de Riesgo , Adulto JovenRESUMEN
As aggressive behavior has a negative impact in general psychiatry, its influence specifically from a gender-related point of view in an in-patient population of a psychiatric clinic was assessed at the time of admission. A group of 521 successively admitted psychiatric in-patients was investigated at admission with the help of the "Social Dysfunction and Aggression Scale". A slightly higher frequency and intensity of "verbal aggressive behavior" was observed in males. Within the other categories of aggressive behavior ("tension", "physical violence to things", and "assaults"), however, the percentages and intensities of gender-related aggressive behavior did not differ significantly. Furthermore, under the covarying impact of various psychiatric diagnoses, the gender-related differences concerning the intensity of "verbal aggressive behavior" disappeared. When comparing male and female subgroups, it was notable that male schizophrenic patients were younger than female patients when displaying comparable risks of showing at least one kind of aggressive behavior. In addition, in the female subgroup, "self-injurious behavior" was more strongly correlated to the category "tension" than in the male subgroup. Although there are some methodological shortcomings, the present results show that there are small qualitative differences in gender-related aggressive behavior in addition to minimal quantitative differences in the frequency and intensity of "verbal aggressive behavior" at admission.
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Agresión , Hospitales Psiquiátricos , Pacientes Internos , Caracteres Sexuales , Femenino , Alemania , Humanos , Masculino , Conducta Autodestructiva/epidemiología , ViolenciaRESUMEN
BACKGROUND: Gamma-band oscillations are prominently impaired in schizophrenia, but the nature of the deficit and relationship to perceptual processes is unclear. METHODS: 16 patients with chronic schizophrenia (ScZ) and 16 age-matched healthy controls completed a visual paradigm while magnetoencephalographic (MEG) data was recorded. Participants had to detect randomly occurring stimulus acceleration while viewing a concentric moving grating. MEG data were analyzed for spectral power (1-100Hz) at sensor- and source-level to examine the brain regions involved in aberrant rhythmic activity, and for contribution of differences in baseline activity towards the generation of low- and high-frequency power. RESULTS: Our data show reduced gamma-band power at sensor level in schizophrenia patients during stimulus processing while alpha-band and baseline spectrum were intact. Differences in oscillatory activity correlated with reduced behavioral detection rates in the schizophrenia group and higher scores on the "Cognitive Factor" of the Positive and Negative Syndrome Scale. Source reconstruction revealed that extra-striate (fusiform/lingual gyrus), but not striate (cuneus), visual cortices contributed towards the reduced activity observed at sensor-level in ScZ patients. Importantly, differences in stimulus-related activity were not due to differences in baseline activity. CONCLUSIONS: Our findings highlight that MEG-measured high-frequency oscillations during visual processing can be robustly identified in ScZ. Our data further suggest impairments that involve dysfunctions in ventral stream processing and a failure to increase gamma-band activity in a task-context. Implications of these findings are discussed in the context of current theories of cortical-subcortical circuit dysfunctions and perceptual processing in ScZ.
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Encéfalo/fisiopatología , Ritmo Gamma , Magnetoencefalografía , Percepción de Movimiento/fisiología , Esquizofrenia/fisiopatología , Adulto , Ritmo alfa , Enfermedad Crónica , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Tiempo de Reacción , Procesamiento de Señales Asistido por ComputadorRESUMEN
OBJECTIVE: Due to their importance frequency and quality of intimate partner violence were recorded in a group of 89 severely mentally ill women in an exploratory investigation. METHODS: With the help of the "Partner Violence Screen" (PVS) and the "Index of Spouse Abuse" (ISA) frequency and severity of intimate partner violence were quantified. Due to data structure nonparametric statistical methods were used for hypothesis testing. RESULTS: The rate of in intimate-partner violence was approximately 67â% in both instruments. Based on the ISA sum-scores intimate partner violence showed associations with lower educational, occupational, and social levels, main-diagnoses of addiction and schizophrenia, longer course of the illness, a higher number of children, and own experience of violence in adolescence. CONCLUSION: Despite methodological limitations - such as missing control group, highly selected group, and non-involvement of the male partners - the results show the importance of intimate partner violence in severely mentally ill women. The findings presented indicate that intimate partner violence should be taken into consideration in each individual case.
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Maltrato a los Niños , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Adulto , Anciano , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Niño , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Estudios Transversales , Femenino , Alemania , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Estadísticas no Paramétricas , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto JovenRESUMEN
The aim of this study was to investigate the association of compulsory measures (CM) with pathological Creatine Kinase (CK) levels in 317 patients admitted to a secure psychiatric ward. The assumptions is that CK-activity is increased prior to administration of CM because increases in CK-levels may represent aggressive behaviour as precursors of a higher chance of administrating CM. The CK-levels were assessed immediately following admission. During the course of the patients' stay the frequency of different CM was assessed by the use of the Staff Observation Aggression Scale. In a CHAID analysis pathological CK-levels were associated with subsequent administration of CM. Lifetime aggression and main diagnosis were associated with administration of CM as well. In a ROC analysis concerning pathological CK-activity the AUC for subsequent administration of CM was 70.5â% with a sensitivity of 73.5â% and a specifity of 67.5â%. Despite some methodological shortcomings the study indicates that it could be useful to measure CK-activity at the time of admission because pathological levels may indicate an increased probability of administration of CM subsequent to aggressive behaviour.
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Agresión/fisiología , Agresión/psicología , Nivel de Alerta/fisiología , Coerción , Internamiento Obligatorio del Enfermo Mental , Creatina Quinasa/sangre , Trastornos Mentales/enzimología , Trastornos Mentales/terapia , Psicotrópicos/administración & dosificación , Restricción Física , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Humanos , Tiempo de Internación , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Factores de Riesgo , Medidas de Seguridad , Medio Social , Adulto JovenRESUMEN
Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by liaison psychiatrists. The data were assessed using the Staff Observation Aggression Scale (SOAS-R) and Psycho-Oncological Basic Documentation (PO-BADO); the quality of psychiatric disturbances was measured with a three-level rating according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria. Nineteen of 388 patients (4.9%) displayed violent behavior. The variable "cognitive limitations" was clearly associated with aggressive behavior. The interaction factor "constantly bedfast, nonterminal phase, and strong feelings of helplessness or subjection," was associated with aggressive behavior as a trend statistically. Eight of 19 inpatients showing aggressive behavior were prematurely released from the treatment facility. In a multivariate model the association of the variable "aggressive behavior" to premature interruption of treatment with unfinished diagnosis and therapy was weighted rather strong. Despite their methodological limitations, these results suggest that members of oncological teams should be able to identify violent behavior and its precursors at an early stage as important factors, which may decrease patient cooperation.
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Agresión/psicología , Neoplasias/psicología , Violencia/psicología , Adulto , Anciano , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Neoplasias/terapia , Cooperación del PacienteRESUMEN
OBJECTIVE: Contrary to current theoretical debates on father roll and collective father representations, only few empirical studies have so far been done on the topic of fatherhood of psychiatric patients. The study at hand investigates the paternity rate, the frequency by which fathers actually live together with their children and other aspects commonly associated with fatherhood, of a cohort consisting of men who had been under psychiatric treatment. METHODS: 222-male patients who had been under psychiatric treatment in the first quarter of 2005 were recruited for a survey on variables relevant to paternity. In addition to a descriptive statistical analysis a subgroup classification of fatherhood-variables associated with other independent variables, i. e. primary diagnosis, severity of disease, migration background, relationship status and age was performed using the multivariate statistical methods of Exhaustive CHAID-analysis. RESULTS: In total, of the 222 Patients we recruited for this study 74 (33,3 %) were fathers. Of these, 44 were fathers to an underage child. 31 of these men actually lived in the same household as their child. The Exhaustive CHAID analysis was able to display different associations between the independent variables and the varied dependent aspects of fatherhood. Here, the independent variables "relationship status", "primary diagnosis" and "migration background" showed to be important. CONCLUSION: A paternity rate of approximately one third demonstrates the relevance of this subject matter. Specific options for treatment, support and therapy, which include the mothers of the patient's children and, where applicable, take their migrant background into consideration, need to be established.
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Hijo de Padres Discapacitados/psicología , Padre/psicología , Trastornos Mentales/psicología , Responsabilidad Parental/psicología , Adolescente , Adulto , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Alcoholismo/etnología , Alcoholismo/psicología , Niño , Preescolar , Estudios Transversales , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Relaciones Padre-Hijo/etnología , Padre/estadística & datos numéricos , Femenino , Alemania , Humanos , Lactante , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/etnología , Persona de Mediana Edad , Responsabilidad Parental/etnología , Paternidad , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/etnología , Trastornos Psicóticos/psicología , Padres Solteros/psicología , Padres Solteros/estadística & datos numéricos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etnología , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
OBJECTIVE: To assess the frequency of compulsory admissions to psychiatric hospitals in immigrants and members of ethnic minorities compared to German patients. METHODS: The rates and quotas of compulsory admissions were assessed in the city of Frankfurt / Main during one year (2005). The data were compared to the epidemiological data of the inhabitants of the catchment area of the clinic (control group). RESULTS: The findings show a lower rate of admission to the psychiatric hospital in immigrants and members of ethnic minorities. The QUOTA of compulsory admissions compared to the total rate of admissions to the psychiatric hospital was higher in immigrants and members of ethnic minorities. The RATE of compulsory admissions out of 100 000 population in immigrants and members of ethnic minorities was similar to the rate of compulsory admissions in German population. CONCLUSIONS: Although some methodological limitations exist the findings are in line with results from other European and non-European countries.
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Internamiento Obligatorio del Enfermo Mental/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Trastornos Mentales/etnología , Grupos Minoritarios/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Emigrantes e Inmigrantes/psicología , Femenino , Alemania , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Grupos Minoritarios/psicología , Adulto JovenRESUMEN
OBJECTIVE: The evaluation of local mental health and complementary psychosocial care remains a difficult venture. For this reason systematic development of appropriate services is barely possible. The present study aimed to get reliable data of psychiatric in- and out-patient treatment as well as of complementary psychosocial care. METHODS: In the city of Frankfurt/Main the PISA project was initiated by the municipal mental health Mo-Ruservice. 677 involuntary hospitalizations were examined in the psychiatric clinics of the city of Frankfurt/Main with regard to diagnoses, socio-demographic data, complementary psychosocial outpatient care and circumstances of hospitalization. RESULTS: Any complementary psychosocial care was missing in more than seventy percent of patients. Only 10 percent of involuntarily admitted patients were examined by a physician before reaching the hospital and in only 1.3 percent the municipal mental health service had been consulted. CONCLUSIONS: Results show that a systematic improvement of precautionary complementary psychosocial care for risk patients is needed as well as the obligation of psychiatric emergency consultation before involuntary hospitalization.
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Internamiento Obligatorio del Enfermo Mental/estadística & datos numéricos , Sistemas de Información en Hospital/estadística & datos numéricos , Trastornos Mentales/epidemiología , Programas Nacionales de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Servicios Comunitarios de Salud Mental/legislación & jurisprudencia , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Estudios Transversales , Recolección de Datos/estadística & datos numéricos , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Femenino , Alemania , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Programas Nacionales de Salud/legislación & jurisprudencia , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Derivación y Consulta/legislación & jurisprudencia , Derivación y Consulta/estadística & datos numéricos , Medición de RiesgoRESUMEN
UNLABELLED: OBJECTIVE, METHODS: To estimate the impact of various independent variables on "parenthood", "number of off-springs", "living together with off-springs" information from 438 patients was gathered. RESULTS: 193 patients were parents of 375 off-springs. "Living alone", "schizophrenia", "organic psychiatric syndrome" decreased, "being an immigrant", "older age", and "female gender" (as a trend) increased the chance of "parenthood". "Being an immigrant" and "cohabitating relationship" increased whereas "schizophrenia" decreased the number of off-springs. 184 children lived together with 103 patients. "Cohabitating relationship", "being an immigrant", "child-care support" and "affective disorder" increased, "addiction" decreased the chance of "living together with children". "Being an immigrant" and "affective disorder" increased the number of children living together with their mentally ill parents. In families with schizophrenic fathers who live together with their children, the age of the first and second child was rather low. In contrast the child-care services were used only by 10.7 %. CONCLUSIONS: Our data show the relevance of parenthood and associated therapeutic issues.
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Cuidado del Niño/estadística & datos numéricos , Composición Familiar , Trastornos Mentales/epidemiología , Padres/psicología , Adolescente , Adulto , Niño , Crianza del Niño , Protección a la Infancia/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Civil , Trastornos Mentales/psicología , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Trastornos del Humor/psicología , Trastornos Neurocognitivos/epidemiología , Trastornos Neurocognitivos/psicología , Esquizofrenia/epidemiología , Psicología del EsquizofrénicoRESUMEN
OBJECTIVE: To investigate the impact of psychiatric illness, aggression, and other covarying variables on the compliance and coping potential of cancer patients treated in liaison-consultation psychiatry. METHODS: The study involves 270 cancer patients who were admitted to the oncology ward for diagnosis and treatment. Each patient took part in a psychiatric consultation. We used the Transplant Evaluation Rating Scale (TERS), which provides a system for differentially recording the patient's compliance and coping potential (total score for the TERS items 3-10). Following standardization using the basic psychooncological documentation (PO-BADO), the demographic variables were recorded. We also identified the internal processes which each patient used to deal with the disease using criteria established by Kübler-Ross as well as the phases of cancer experience according to Fawzy. RESULTS: Twenty-three variables were checked for their relationship to the coping and compliance potential. For 13 of these, the Mann-Whitney U-test or Spearmann-Rank correlation calculated exceeded the required Bonferroni-adjusted significance level. The calculation of an ordinal regression model containing these significant single variables showed that the following variables are associated with a lower compliance and coping potential according to their estimate (Beta-value): aggression as the dominant form of dealing internally with cancer (Kübler-Ross), pre-existing DSM IV Axis 1 psychiatric disorders, carcinoma-induced psychiatric disorders, necessity of treatment with neuroleptics and male gender. Acceptance as the dominant form of dealing internally with cancer (Kübler-Ross) is strongly associated with a higher compliance and coping potential. CONCLUSION: The results show that the compliance and coping potential of oncological in-patients can be comprehensively described by the Transplant Evaluation Rating Scale. The instruments of measurement used in the study are also useful for describing risk factors associated with low levels of compliance and coping potential.
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Adaptación Psicológica , Neoplasias/psicología , Cooperación del Paciente/psicología , Psiquiatría , Derivación y Consulta , Rol del Enfermo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Agresión/psicología , Antipsicóticos/uso terapéutico , Comorbilidad , Femenino , Humanos , Control Interno-Externo , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/terapiaRESUMEN
BACKGROUND: The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named 'praecox feeling' by the Dutch psychiatrist Rümke in 1941. SAMPLING AND METHODS: To evaluate the diagnostic quality of this kind of intuitive clinical approach we investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the 'praecox feeling' was rated in four degrees: not present--mild--moderate--high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. RESULTS: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of 'praecox feeling'. The single variable 'affective disturbances' had the highest impact on the intensity of 'praecox feeling' in an ordinal regression analysis. Furthermore a high intensity of 'praecox feeling' strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of 'praecox feeling'. CONCLUSION: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent.
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Intuición , Esquizofrenia/diagnóstico , Adolescente , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: In psychiatry and psychotherapy, dealing with aggressiveness and autoaggressiveness is of great importance. Our aim was to find a link between overt aggressive and autoaggressive behaviour, which could be readily observed. SAMPLING AND METHODS: We investigated the frequency, type and intensity of aggressive, suicidal and self-injurious behaviour exhibited by 521 successively admitted psychiatric patients at the time of admission with the help of a standardised instrument (Social Dysfunction and Aggression Scale). The Social Dysfunction and Aggression Scale enables the investigation of 9 different types of overt aggressive behaviour and 2 different types of autoaggressive behaviour (suicidal vs. self-injurious behaviour). After calculating correlations between single variables, we attempted to estimate the predictive value of the different types of aggressive behaviour for suicidal and self-injurious behaviour by using ordinal regression models. In addition, the categorical information of our data was evaluated by loglinear analyses. RESULTS: Our study showed that all degrees of aggressiveness (low, moderate, high), which are exhibited in different types of aggressive behaviour, were linked to an increased risk of self-injurious behaviour. No correlation was found, however, between overt aggressive behaviour and suicidal behaviour. Only in the subgroup of depressive disorders did we establish that the risk of aggressive behaviour was decreased and the risk of suicidal behaviour was increased at the time of admission. CONCLUSIONS: The strong relationship between aggressive behaviour and self-injurious behaviour has previously been described in specific diagnostic subgroups, but not yet in a heterogeneous population of psychiatric in-patients from a defined catchment area. We, therefore, conclude that the link between aggressive and self-injurious behaviour could be a general one. Exhibiting aggressive behaviour and self-injurious behaviour within a short time span may be the result of an increased or disinhibited aggressive potential, which is independent of a specific diagnosis. As such, it possibly represents the general consequence of a highly altered state of mind and does not seem to be linked to a specific diagnostic subgroup. In psychiatric emergency situations, the previously described close relationship between aggressive and self-injurious behaviour should be taken into account.
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Agresión/psicología , Conducta Autodestructiva/psicología , Intento de Suicidio/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Psiquiátricos , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Factores de RiesgoRESUMEN
Tolerance of ambiguity means the ability to tolerate contradictory and incalculable informations. There is the hypothesis that a high degree of tolerance of ambiguity correlates with creativity. It is unclear how various psychiatric illnesses and psychopathological conditions affect tolerance of ambiguity. Therefore we carried out a study concerning the tolerance of ambiguity: 154 persons were systematically investigated with a standardized questionnaire (31 schizophrenic in-patients, 41 neurotic in-patients, 49 members of the staff as control group, 33 artists as control group). In addition we examined the degree of depression in the neurotic group, the anancasm score and the well-being in general. In the schizophrenic group we assessed psychotic symptoms, the positive and negative symptoms, medication, anancasm and depression. Tolerance of ambiguity decreased in the following sequence: artists - members of the staff - neurotic in-patients - schizophrenic in-patients. It became evident that in the schizophrenic group negative symptoms negatively correlates with tolerance of ambiguity. The results seem to confirm the hypothesis that there is a positive correlation between tolerance of ambiguity and creativity. In addition, the higher degree of intolerance of ambiguity in schizophrenic patients may represent a protective mechanism. Intolerance of ambiguity possibly protects from too many contradictory informations. Furthermore the necessity is confirmed that creative therapy methods should be carefully chosen to avoid irritation on the one hand and not to neglect the required training of creative basic functions on the other hand. Although our results weaken the thesis that psychiatric illness is generally associated with an increase of creativity they don't exclude that highly creative performances in some individuals are possible who are especially talented in spite of or even because of their emotional suffering.
Asunto(s)
Trastornos de Ansiedad/terapia , Disonancia Cognitiva , Creatividad , Trastorno Depresivo/terapia , Trastornos Neuróticos/terapia , Aceptación de la Atención de Salud/psicología , Psicoterapia , Esquizofrenia/terapia , Psicología del Esquizofrénico , Adulto , Anciano , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Arteterapia , Mecanismos de Defensa , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Neuróticos/diagnóstico , Trastornos Neuróticos/psicología , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/terapia , Inventario de Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Esquizofrenia/diagnósticoRESUMEN
Highly aggressive behaviour of psychiatric in-patients often provokes intense emotional reactions and countertransference-feelings in staff especially when it is necessary to control aggression in psychiatric emergency units. We investigated the emotional reactions immediately after the manifestation of a patient's aggressive behaviour in a group of 53 staff members. The amount of aggression was measured with the help of the "Modified Overt Aggression Scale" (MOAS). The type and intensity of the staff-emotions can be adequately described by using a special self-rating questionnaire: "Eigenschaftswörterliste" (EWL 60 S). Using principal component analysis, three factors were differentiated: experience of stress, experience of sovereignty and experience of calmness. Several independent variables were identified as selectively increasing the probability of priority of each emotional factor mentioned above. In addition, a subgroup of staff members who have a raised risk of stress experience compared to the other staff members was compiled by cluster analysis. Based on an aggressiveness sequence model, useful strategies were discussed which directly aim to improve the coping abilities of staff members dealing with their emotional over involvement.