Use of and satisfaction with support received among survivors from three Scandinavian countries after the 2004 Southeast Asian tsunami.

INTRODUCTION: There is limited guidance regarding effective preventions for post-disaster mental health problems and what kind of support is preferred by disaster survivors. AIM: To describe the use of and satisfaction with support in three Scandinavian countries after the tsunami and analyzing the association between support and posttraumatic stress reactions. METHOD: The sample comprises 6772 responders who returned to Scandinavia from the tsunami-struck countries of Southeast Asia in 2004. RESULTS: Most were satisfied with informal support on site. Support from embassies/consulates was not received well, leaving about 64% of the Danes/Norwegians and 73% of the Swedes dissatisfied. After returning home, support from close relatives rendered highest degree of satisfaction. Consultation with general practitioner (GP) was reported by 63% of Norwegians, 40% of Danes, and 16% of Swedes. Most responders (60-77%) were satisfied with their GP, although Norwegians were least satisfied. Using support was associated with higher levels of posttraumatic stress symptoms. CONCLUSIONS: Informal support was used to a high degree and rendered considerable satisfaction in all three countries, while the use of and satisfaction with formal support varied more. Lack of satisfaction with embassies and consulates may indicate deficiencies in the authorities' preparedness in assisting disaster stricken citizens abroad.

[An acute psychiatric ward moves into the community. An empirical test of the satellite model]. / Eine psychiatrische Akut-Station zieht in die Gemeinde Das Satellitenmodell auf dem empirischen Prüfstand.

A satellite ward is a psychiatric ward at a general hospital settled within a catchment area that is administered by a distant psychiatric hospital. The objective of the satellite model is to close the gap between patients and their community on the one hand and between psychiatry and general medicine on the other. The essential size of the satellite ward that enables it to take care for the patients in its catchment area is discussed controversially. This study investigated admission rates and number of beds needed in two catchment areas distant to the psychiatric hospital from 6 months before opening until 12 months after the opening of a satellite ward with 21 beds in one of the two catchment areas. We registered an 81% increase of admission rates in this catchment area (from 130 admissions in the half-year before the opening of the satellite ward to 235 admissions in the 2nd half-year after it) and a 41% increase in beds needed (from 28.8 beds in the half-year before opening to 40.7 beds in the 2nd half-year following). This increase was significant in comparison to the increase in the controlled catchment area. Thus, only 168 (71%) patients of the catchment area (but 82% of the patients with schizophrenia) were treated in the satellite ward. The remaining patients were treated in the parent house. A selective admission of severely ill patients into the parent house was not observed.

[Reasons for Hospital Treatment of Psychiatric Patients before and after the Opening of a Satellite Ward]. / Anlässe zur Krankenhausbehandlung psychisch Kranker vor und nach der Eröffnung einer Satellitenstation.

A satellite ward is a psychiatric ward at a general hospital settled within the catchment area that is administered by a psychiatric hospital. The objective of the satellite model is to approach community treatment on the one hand and somatic medicine on the other hand, consequently diminishing the threshold for hospital treatment. This study investigated whether the diagnostic, psychopathologic and social reasons for admissions changed from this catchment area due to the lower threshold of a satellite ward. The results were controlled with another catchment area's admissions to the 30 km distant psychiatric hospital. The opening of the satellite ward was followed by an 81 % increase of admissions. In particular, admissions of patients with neuroses and personality disorders were more frequent. There was no change of the severity code of psychopathology at admission. From the catchment area of the satellite ward less patients were admitted involuntarily whereas more admissions happened due to social reasons and after patients' own decision.

Considerable improvement in a case of obsessive-compulsive disorder in an emotionally unstable personality disorder, borderline type under treatment with clozapine.

We report on a 27-year-old woman with previously therapy-resistant obsessive-compulsive disorder and emotionally unstable personality disorder, borderline type, which improved considerably on treatment with clozapine. Previous treatment attempts with paroxetine, clomipramine and various classic and atypical neuroleptics, as well as extensive psychotherapeutic treatment, had proved ineffective.

[Borderline disorder and schizophrenia. Still a diagnostic problem]. / Borderlinestörung und Schizophrenie. Immer noch ein diagnostisches Problem.

Two case-reports highlight the problems of co-morbidity of schizophrenia and borderline disorder. On the other hand, borderline disorder in schizophrenia can represent a pre-existent, lasting personality disorder, on the other hand it can be temporary syndrome in the course of illness. The assumption that a borderline syndrome can be a recompensation stage in the course of schizophrenia seems evident by clinical and psychodynamic points of view (concerning a coping strategy). The present categories of DSM III-R and ICD-10, however, do not allow an adequate diagnostic classification of this syndrome.

[Psychiatric family care in the Tapiau/East Prussia Asylum (1907-1940)]. / Die psychiatrische Familienpflege der Anstalt Tapiau/Ostpreussen (1907-1940).

At the end of the so-called "Weimar Republic" in German between the two world wars, and during the time of the Nazi regime, the psychiatric hospital and asylum in Tapiau near Königsberg/Kaliningrad had the highest incidence of psychiatric patients being looked after on an out-patient basis by host families. Data on this type of psychiatric care by external families were repeatedly published in detail between 1930 and 1937 by Karl Knapp, a psychiatrist who was actively engaged there for many years. After sterilisation of mentally diseased patients had been legally enforced and finances were restricted, family care stagnated, promoting instead a type of family care that was independent of psychiatric hospitals and was carried out on a "district" basis. After 1940, when in the course of enforcement of euthanasia almost all the inmates of psychiatric hospitals and asylums in East Prussia were murdered, the traces of patients entrusted to host family care faded out.

[Origin of problematic constellations in psychiatric family care. Theoretical considerations and presentation of the course of a discontinued family care episode]. / Die Genese problematischer Konstellationen in der psychiatrischen Familienpflege. Theoretische Uberlegungen und Darstellung des Verlaufs einer abgebrochenen Familienpflege-Episode.

Psychiatric family care is a therapeutic environment for mentally ill long-term patients that pays particular attention to the individuality of the patient, contrary to the hospitalising psychiatric clinic. The influence exercised by the host family on the positive development of the integration process is undisputed in literature, but has been hardly investigated so far in respect of its actual contents. Those who are practically engaged in family care have been discussing for some time whether successful integration is effected by "good host families" or by the special constellation that develops between the host family and the guest. The present article tries to emphasise (following a review of the literature) on the basis of a discontinued family care episode that integration into a host family is not a static affair but a highly sensitive process determined by the biography of the guest and the integration between host family and guest (or guests). The possible consequences for the care process are discussed.

[Methods for selecting foster families for psychiatric family care]. / Selektionsmechanismen bei der Auswahl von Gastfamilien für die psychiatrische Familienpflege.

Psychiatric foster family care of no more than two patients living in the foster family can be seen as a therapeutic setting, where longterm chronic patients can improve in their social functioning. Recent studies found the family characteristics as decisive for potential therapeutic effects. So the question arises how to select adequate foster family applicants. In an empirical study with 105 applicant-families we have tried to uncover the selection-procedures and mechanism of the foster care team that finally lead to adequate/non-adequate distinction. The results of the study show that the differences between the two applicant groups (selected vs non selected) are not identical with the intended selection criteria of the team members. Some major differences were found in areas that were totally independent from the team-criteria: the selected-as-adequate-families had a more intensive exchange with the outside world, educated more children and were therefore assumed to be socially more competent than the not selected applicant group. So selecting foster families comes up as a complicated decision making process that goes beyond checking up some criteria.

[Psychiatric family care in Ravensburg-Weissenau--development and initial experiences]. / Die psychiatrische Familienpflege in Ravensburg-Weissenau--Aufbau und erste Erfahrungen.

It is unfortunate that mental patients with long-term hospitalisation patterns are still necessarily scheduled for long-term stay in mental hospitals and institutions designed for the care and treatment of psychiatric cases, since such institutions are characterized by a rather sterile, low-stimulation atmosphere underlining rather than relieving the severity of the disease. This article presents a possible alternative, namely, care of mental patients within the framework of a foster family; these patients has been hospitalised for a long time and are now living in families who are remunerated for their efforts and are given medical assistance in performing their task as hosts. An attempt is made to describe the initial work in setting up such host patterns, particularly during the first year after initiation of the scheme, and to point out the mistakes that were committed and the resulting re-orientation efforts. Case reports on host families and "guests" illustrate the principles of psychiatric family care.