Seasonality in schizophrenia-An analysis of a nationwide registry with 110,735 hospital admissions.

BACKGROUND: Seasonal patterns in hospitalizations have been observed in various psychiatric disorders, however, it is unclear whether they also exist in schizophrenia. Previous studies found mixed results and those reporting the presence of seasonality differ regarding the characteristics of these patterns. Further, they are inconclusive whether sex is an influencing factor. The aim of this study was therefore to examine if seasonal patterns in hospitalizations can be found in schizophrenia, with special regard to a possible influence of sex, by using a large national dataset. METHODS: Data on all hospital admissions within Austria due to schizophrenia (F20.0-F20.6) for the time period of 2003-2016 were included. Age standardized monthly variation of hospitalization for women and men was analyzed and the level of significance adjusted for multiple testing. RESULTS: The database comprised of 110,735 admissions (59.6% men). Significant seasonal variations were found in the total sample with hospitalization peaks in January and June and a trough in December (p < 0.0001). No significant difference in these patterns was found between women and men with schizophrenia (p < 0.0001). CONCLUSION: Our study shows that schizophrenia-related hospitalizations follow a seasonal pattern in both men and women. The distribution of peaks might be influenced by photoperiod changes which trigger worsening of symptoms and lead to exacerbations in schizophrenia. Further research is necessary to identify underlying factors influencing seasonal patterns and to assess whether a subgroup of patients with schizophrenia is especially vulnerable to the impact of seasonal variations.

Power to the voice hearer - The German version of the voice power differential scale.

Voice power is an important concept in daily life of voice hearers and in the support and therapy for voice hearers who seek help. Therefore, the ability to examine voice power differentials between a voice and a voice hearer is essential. The present study aimed to collect data on voice power differentials and to further validate the Voice Power Differential Scale (VPD). 105 participants aged ≥ 18 with an ICD10 F2-diagnosis that included hearing voices were included in this study. Internal consistency was good (alpha = 0.792), as well as test-retest-reliability (r = 0.855) and correlations with other constructs were generally as expected. The VPD questionnaire results correlated negatively with the Beliefs About Voices Questionnaire-Revised's (BAVQ-R) items of Benevolence and Engagement-emotion. It correlated positively with Omnipotence and Resistance-emotion, as well as with Negative Content on the Psychotic Symptoms Rating-Scale (PSYRATS). Unexpectedly, no correlations were found with overall severity and command hallucinations. The Voice Power Differential Scale is an important tool for assessing and formulating a voice hearer's experience when they seek treatment or support for their verbal auditory hallucinations. The results of this study enrich the on-going discussion about the importance of voice power for voice hearers.

Gender-gaps and glass ceilings: A survey of gender-specific publication trends in Psychiatry between 1994 and 2014.

BACKGROUND: Within academic psychiatry, women are underrepresented in the higher academic ranks. However, basic determinants of women's lack of academic advancement such as publication activity are poorly understood. The present study examines women's publication activity in high-impact psychiatry journals over two decades and reports developments in the numbers of male and female authorship over time and across cultural areas. METHODS: We conducted a retrospective bibliometric review of all articles published in 2004 and 2014 in three high-ranking general psychiatry journals. Statistical comparisons were made between the two years and with results from a baseline assessment in 1994. RESULTS: The overall percentage of female authors increased from 24.6% in 1994 to 33.2% in 2004 to 38.9% in 2014. Though increases in female authorship were statistically significant for both decades, there was less difference between 2004 and 2014, indicating a possible ceiling effect. Rates of female first authors increased between 1994 and 2014, though to a lesser degree between 2004 and 2014. Numbers of female corresponding authors plateaued between 2004 and 2014. Within Europe, Scandinavia displayed the most balanced gender-wise first author ratios. Western European and Central European countries increased their rates of female first authors substantially between 2004 and 2014. CONCLUSIONS: Despite gains in some areas, our study reveals considerable deficits in the diversity of the current academic psychiatric landscape. Ongoing efforts and interventions to enhance the participation of underrepresented groups on institutional, political and editorial levels are necessary to diversify psychiatric research.

N-substituted tetrahydro-2,4-dioxoquinazolin-1-yl acetic acids as aldose reductase inhibitors.

Novel N-substituted tetrahydro-2,4-dioxoquinazolin-1-yl acetic acids characterized by formal replacement of the substituted benzyl moiety by cyclohexylmethyl and n-heptyl residues, respectively, were synthesized and evaluated as aldose reductase inhibitors.

[The psychiatric health model for meaningful support by family members who must decide on the treatment of life support]. / 'N geestesgesondheidsmodel vir ondersteuning van gesinslede wat moet besluit oor die onttrekking van lewensondersteunende behandeling.

The aim of this research is to develop, describe, operationalize and evaluate a model as framework for meaningful support by the advanced psychiatric nurse, which will serve to support family members who are involved in the decision-making process regarding the withdrawal of life sustaining treatment, in order to promote their mental health. The paradigm of the Department of Nursing of the Rand Afrikaans University, which endorses the Theory for Health Improvement in Nursing (Randse Afrikaanse Universiteit: Departement Verpleegkunde, 200: 1-16) was accepted for the purpose of this research. A theory generating design which is qualitative, descriptive and contextual was used to develop the model as framework of reference for meaningful support. Step one identifies, classifies and defines the central concept "meaningful support", as well as the essential and relative concepts. Step two formulates the inter-relational views of the identified and defined concepts. In step three the guidelines of Chinn & Kramer (1995: 105-124) was utilised for the structural and process description of the model. The structure of the model's process, which comprises three phases, is cyclic. Step four consists of evaluation regarding the process description of the model, done according to the definition of the central concept "meaningful support". The evaluation criteria of Chinn & Kramer (1995: 125-135) were also used.

The experience of HIV reactive patients in rural Malawi--Part I.

Malawi has a population of 9 million people with AIDS the leading cause of death in the 20-40 age group. The HIV positive prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994:1). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but patients who do not see the benefit of knowing their HIV status increasingly refuse testing. The counselling practise as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of the research study was to describe a model of counselling that would meet the needs of an AIDS patient in rural community in Malawi. A qualitative research design that was explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is explored as the other major factor in the phenomenon examined. One phase of the research is described in this article namely exploring and describing the experience of the HIV reactive patient in rural Malawi. Results show that patients are in an advanced stage of AIDS when they are diagnosed and complain of weakness and an inability to do work, including an inability to do their daily chores. This causes a feeling of desperateness that is worsened by the perception that support systems are inadequate. Support systems are mostly identified as parents, partners and siblings to assist mainly with the physical care and financial support. Despite the fact that the family is very important to patients there is a reluctance to acknowledge their HIV status. Patients fear being rejected once it is known that they have AIDS--not only because AIDS is a sexually transmitted disease, but also because it is perceived that financial and other support will be withheld if it is known that patients have AIDS and will therefore die and not be able to return the support provided. Patients feel they have no future once a diagnosis of AIDS has been made which results in refusal of testing, as they do not see the benefit of knowing their HIV status. Assessing the coping ability of the patient within the household as part of an overall assessment is one proposed strategy that could be taken. Secondly the patient is encouraged to take a more active role in the counselling process, which could be achieved by narration. The family should be incorporated into the counselling process as early as possible.

A care counselling model for HIV reactive patients in rural Malawi--Part II.

The purpose of the research conducted was to explore and describe HIV patients experience of their illness within the context of rural Malawi and, based on the results of the study, to describe a model for counselling HIV reactive patients in rural Malawi which would meet both the internal and external needs of the patient. Nursing for the Whole Person Theory, as well as symbolic interactionism and the research model of Botes, were used as paradigm, as the researcher believes a person is fundamentally a historical social being who can only be understood in a specific cultural context of space and time. The research was also conducted within a counselling context and different disciplines were integrated in the study. The research method followed two phases each addressing a different objective. Firstly, exploration and description of the HIV reactive individual's experience of illness, compilation of a demographic profile of the patients in the study and a description of their identified needs as well as possible resources, exploration and description of the primary care givers' experience of HIV reactive patients and the exploration and description of the viewpoint of counsellors in terms of counselling HIV reactive patients. In the first phase of the study in-depth phenomenological interviews were conducted with identified groups. Focus interviews were conducted with a hundred AIDS patients to identify the needs and resources of the patients and to compile a demographic profile. Focus groups discussions were conducted with counsellors for more complete comprehension. Data-analysis and literature control was undertaken. In the second phase of the study theory generation was used in order to develop a counselling model for AIDS patients and guidelines for implementing the model were generated. Based on the results of the analysis the major concept enable was identified as the essence of a model for counselling AIDS patients in rural Malawi. The visual model developed described a process of enablement with the counsellor as negotiator and the patient as a narrator in which the patient, family and community are encouraged to participate actively. By utilising the deductive reasoning strategy, relationship statements were inferred from the model. Guidelines were described for all three phases of the model, namely pretest counselling, post-test counselling and community care, in terms of objectives, strategies and activities. The value of this research was embodied in addressing a very real and urgent need in Malawi and proposing a solution with practical guidelines.

A model of facilitative communication for support of general hospital nurses nursing mentally ill people. Part 2: model description and evaluation.

Part 1 of this article dealt with a full description of the research design and methods. This article aims at describing a model of facilitative communication to support general hospital nurses nursing the mentally-ill. In this article a model of facilitative communication applicable to any general hospital setting is proposed. Fundamental assumptions and relationship statements are highlighted and the structure and process of facilitative communication is described according to the three steps employed: 1) assisting the general hospital nurse learn the skill; 2) assisting the general hospital nurse practise the skill in order to develop confidence; and 3) using the skill in a work setting. The guidelines for operationalizing this model are dealt with in the next article. The evaluation of the model is also briefly described.

A model of facilitative communication for the support of general hospital nurses nursing mentally ill people. Part I: background, problem statement and research methodology.

The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa creates stress among nurses employed in these settings who are not psychiatric trained. This manifests itself in negative attitudes displayed towards mentally ill people. The aim of this paper is to discuss the process followed in the development of the model of facilitative communication. A theory generative design was used. The research methods were dealt with in four steps of theory generation as set out below. Step 1 entailed concept analysis. This step was dealt with in two phases, namely concept identification and concept definition. During concept identification, a qualitative research strategy that is explorative, descriptive and contextual was used. This was achieved through field research conducted in an urban general hospital. A sample of twelve professional nurses was selected from a population of 800 professional nurses employed in a general hospital using the purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. Giorgi's method of descriptive data analysis (1985) was used. Four themes emerged from the results of the study. The main concepts of the model were identified and classified using a survey list of Dickoff et al. (1968). Step 2 dealt with the creation of interrelationship statements between concepts identified in Step 1, while Step 3 dealt with the description of the model using strategies proposed by Chinn and Kramer (1991). In Step 4, the description of guidelines for operationalizing in practice was ensured. To ensure valid results, a model for trustworthiness proposed by Guba (Lincoln & Guba, 1985) was used. The following criteria for trustworthiness were applied in all the steps of theory generation: truth value, applicability, consistency and neutrality.

The Experience of Biological Fathers of their Partners' Termination of Pregnancy

The purpose of this article was to explore and describe how single adult biological fathers experience the termination of pregnancy their partners had. The research design entailed qualitative; descriptive; explorative and contextual design. Cuba's model of ensuring trusnvorthiness in qualitative research was applied The phenomenological strategy was used to collect data from a purposive sample of respondents; consisting of nine adult biological fathers who met the sampling criteria. Three themes emerged from the analysis of respondents which were : poverlessness related to the inability to have a choice in the decision of the termination of pregnancy; emotional turnoil related to the impact of the decision on inter-personal and intra-personal relationships; ancl lastly psychological defence mechanisms as a way of dealing with the stressfull effect of the termination of pregnancy. A literature control was done to verify the results and recontextualise it within the field of psychiatric nursing. Conclusions and recommendations were made

The promotion of mental health of adolescents in a township in Swaziland.

A number of adolescents have been observed drinking alcohol, pushing and abusing drugs and also stealing cars. A lot of adolescents idle in the township streets, girls are falling pregnant and dropping out of school. No research has been done to elicit the opinions of families on the everyday life of the adolescents in this township. The objectives of this research were twofold, namely. To explore and describe the families' opinions on the everyday life of adolescents in a specific township in Swaziland, and to describe guidelines for advanced psychiatric nurse practitioners to assist these families to mobilize resources in order to promote, maintain and restore mental health as integral part of health of adolescents in this township. A qualitative, exploratory, descriptive and contextual design was used where the research was conducted in two phases. Trustworthiness measures as well as ethical measures were applied throughout the research. Five categories were identified from the result of the focus group interviews with families: Adolescents presenting ineffective communication patterns due to lack of support from their families; adolescents engaging into risky lifestyles related to lack of support and healthy relationship with their parents; families unable to create a supportive and conducive environment for their adolescents due to their focus on own family stumbling blocks and non-availability of recreational centres related to lack of a supportive and conducive environment in the community and inadequate accommodation leading to overcrowding. Guidelines for advanced psychiatric nurse practitioners were deducted from identified themes and the literature control.

Support for nurses directly involved with women who chose to terminate a pregnancy.

Research conducted by Poggenpoel, Myburgh and Gmeiner (1998:2-8) on "One voice regarding the legalization of abortion: Nurses who experience discomfort" indicated that the nurses were in favour of the fact that nurses should volunteer to participate in terminating a pregnancy of a woman. From our observations in clinics where nurses voluntarily participate in providing reproductive health services, including termination of pregnancy, it became clear that supporting these nurses may be essential. To be able to provide support, it is necessary to identify, explore and describe nurses' experience of being directly involved with women who terminate their pregnancy. To enable us to address the identified problems, a qualitative research strategy was implemented in which respondents were included in the sample through purposive sampling. Phenomenological interviews were conducted individually. Data was analyzed by means of Tesch's descriptive approach. Thereafter, guidelines for operationalization were inferred from the results and a literature control completed to verify and enrich guidelines. Measures to ensure trustworthiness have been applied in the research and ethical measures have been strictly adhered to regarding this sensitive issue.

Community-based curriculum in psychiatric nursing science.

As community-based health care delivery is now a prominent feature of the health care system in South Africa, nursing curricula are being challenged to prepare student nurses for community-based nursing roles and responsibilities. The purpose of this study was to describe guidelines for a community-based curriculum in psychiatric nursing science for a nursing college in KwaZulu-Natal. A qualitative, quantitative, exploratory, descriptive and contextual design was employed. To reach the purpose of the study, a situational analysis was done in three phases to identify the principles for a community-based curriculum for psychiatric nursing science. PHASE I: A document analysis of relevant government policies and legislation. PHASE II: Statistics from psychiatric hospitals and community psychiatric clinics. PHASE III: Focus group interviews with nurse educators and literature control and conceptual framework. The principles obtained from the three phases were used to formulate the guidelines for a community-based curriculum in psychiatric nursing science. (PHASE IV): Eight guidelines with practical implications are described for the implementation of a Community-based curriculum in Psychiatric Nursing Science.

The experience of mothers caring for their teenage daughters' young children.

The purpose of this study was firstly to explore and describe the experiences of mothers who are looking after their teenage daughters' young children. Secondly, to formulate guidelines (based on the results obtained) for psychiatric nurses in assisting these mothers to mobilise resources in order to promote, maintain and restore their mental health as an integral part of health. An exploratory, descriptive, contextual and qualitative design was used and Guba's model for ensuring trustworthiness in qualitative research was applied. The phenomenological approach was used to collect and analyse data from a sample of seven respondents who were purposively selected. Three independent themes emerged from the analysis of results: Meaning of the parenting role, life-style changes and support systems. The results further show that for these mothers the problem of teenage pregnancy and parenthood ends up being their problem. Their experiences in looking after these babies, although sometimes fulfilling and meaningful, are most of the time stressful. This has implications on their mental health. Guidelines are recommended in order to facilitate these mothers to mobilise their resources for mental health.

[Effective communication with the mentally challenged person during treatment of minor ailments]. / Fasiliterende kommunikasie met die verstandelik vertraagde persoon tydens die behandeling van geringe ongesteldhede.

The research objectives were to explore and describe the nature of communication with the mentally retarded adult during treatment of minor ailments; and to describe guidelines for the community nurse in order to facilitate more effective communication during the treatment of minor ailments in the mentally retarded adult for the promotion, maintenance and restoration of the mentally retarded individual's health. The community nurse pays attention to the protection of the mentally retarded individual's health, and identifies and treats minor ailments encountered by the mentally retarded individual. Because of the disability of the adults, lacking communication and obstacles in the exchange and interpretation of communication, could take place between the community nurse and the mentally retarded adult. The responsibility lies with the community nurse to facilitate effective communication, since the mentally retarded individual is not always capable of speaking on his/her own behalf. Guidelines are needed for the facilitation of effective communication between the community nurse and the mentally retarded adult during the treatment of minor ailments. In this research, use were made of a qulitative, exploratory, descriptive and contextual design. The research method consisted of participative observation during which video recording and the taking of field notes were applied. Two themes were identified during data analysis, namely: Verbal communication is aimed at the treatment of wounds. The more functional and task-orientated the community nurse's interaction with the mentally retarded individual, the more the mentally retarded individual would generate symptoms to establish emotional contact and interaction; The non-verbal behaviour of the community nurse focuses on the treatment of wounds and organisation of the environment. The more structure is created, the more play-out-behaviour is shown by the mentally retarded individual in need of contact. The researcher came to the conclusion that the community nurse refrains form near/close contact with the mentally retarded individual, to bridge her own discomfort. The community nurse is "busy" with the act of treating wounds, in order to refrain from effective interaction.

Adolescents previously involved in Satanism experiencing mental health problems.

No research has previously been done regarding the phenomenon of adolescents who have previously been involved in Satanism and who experience obstacles in their strive for mental health. Adolescents previously involved in Satanism present behavioral problems like aggressive outbursts, depression, "psychosis" or suicide attempts, that could lead to suicide. In the phenomenon-analysis semi-structured, phenomenological interviews were performed with the respondents and their parents. The respondents were requested to write a naïve sketch about their life. After completion of the data-control, guidelines for nursing staff were set. The guidelines are set for the management of adolescents who have previously been involved in Satanism and who experience obstacles in their strive for mental health. Interviews with experts in Satanism were conducted, literature in the form of books, magazines and newspaper-clippings were used to verify the research findings. The most important guidelines are that the caregivers have to be reborn Christians; they are not allowed to show any fear or sympathy; they must have sufficient knowledge about Satanism; the adolescents have to be unconditionally accepted; the caregivers have to work in a team and the adolescents have to be taught to deal with their emotions.

A model for culture-congruent psychiatric nursing.

The purpose of the research conducted was to explore and describe the influence of culture on approaches to mental illness and the patients' compliance with psychiatric treatment, and to generate a practice model for culture-congruent psychiatric nursing from which guidelines were described. The Nursing for the Whole Person Theory was used as the paradigm. The research method followed three phases--each addressing a different objective. Firstly, explanatory, descriptive research was conducted to compile explanatory case studies reflecting cultural approaches to mental illness and the patients' compliance with psychiatric treatment. The sample consisted of four psychiatric patients purposively selected from four long-term wards of a psychiatric hospital, a group of psychiatric nurses, and the psychiatrists treating each of these patients based on information obtained from the semi-structured interviews, field notes and the patients' clinical documents. From the results of the case studies a practice model for culture-congruent psychiatric nursing was generated using Chinn and Kramer's approach as framework and the major concept "negotiation". Guidelines for a culture-congruent approach in psychiatric nursing were compiled from the model using deductive reasoning and analysis.

[Adolescents previously involved in Satanism: mental health problems experience]. / Adolessente betrokke by Satanisme: wat geestesgesondheidsprobleme ondervind.

As far as the phenomena of adolescents previously involved with satanism that experience obstacles in the strive for mental health, no research has previously been done. Adolescents previously involved in satanism, presents behaviour problems like aggressive outbursts depression, "psychosis", or suicide attempts that can even lead to suicide. In the phenomena-analysis semi-structured, phenomenological interviews with the respondents and their parents, were performed. The respondents were requested to write a naive sketch about there life. After the data-control was done, guidelines for nursing staff had been set. The guidelines are set for the management of adolescents that has previously been involved in satanism, and experiences obstacles in their strive for mental health. Interviews with experts in satanism was done, literature in the form of books, magazines and newsclippings were used to verify the findings in the research. The most important guidelines are that: the caregivers have to be reborn Christians; they are not allowed to show, any fear or sympathy; they have to have sufficient knowledge about satanism; the adolescent has to be unconditionally accepted; the caregivers have to work in a team; the adolescents have to be taught to deal with their emotions.

One voice regarding the legalisation of abortion. Nurses who experience discomfort.

The legalisation of abortion has been implemented since February, 1997. No research has been conducted on the effects of abortion on nurses. The objectives of this project were: 1. to explore and describe nurses' experience of abortion, and 2. to describe guidelines to support nurses. A qualitative, explorative, descriptive and contextual research design was used. The research was conducted in two phases, i.e., the exploration of nurses' experience, and description of guidelines. Trustworthiness measures as well as ethical measures were applied. Five themes were identified from the result of the interviews with nurses: freedom of choice of nurses to provide support; negative perceptions regarding the women who requested the abortion and staff providing the abortion; need for information; turmoil regarding life versus death, and recommendations from nurses regarding the management of abortion. Guidelines to support nurses were deducted from the identified themes.