Problems to anticipate in treating difficult patients in a long-term psychiatric hospital.

In a previous report, the authors identified four dimensions of patient pathology associated with treatment difficulty: withdrawn psychoticism, character pathology, violence-agitation and suicidal-depressed behavior. In a subsequent study, they linked these dimensions to patterns of countertransference. The present research extends the two prior reports by examining the relations of the patient pathology dimensions to staff members' dissatisfaction with four areas of treatment: interpersonal approaches, structure and control, quality of teamwork, and medication. The major findings are: withdrawn psychoticism primarily relates to dissatisfaction with interpersonal treatment approaches; character pathology entails dissatisfaction with the level of structure and control; violence-agitation poses particular problems for teamwork; and suicidal-depressed behavior is unrelated to dissatisfaction with any dimension of treatment. The authors propose that these various problems in treatment are, in part, mediated by patterns of countertransference which they described in the prior paper. These findings should help staff members to focus their attention on areas of treatment in which problems are bound to arise in work with different types of difficult patients.

Variation of chicken technological meat quality in relation to genotype and preslaughter stress conditions.

The present study was aimed at estimating the genetic variability between lines of breast and thigh meat quality (pH decline, color, drip loss, and curing-cooking yield) by comparing a slow-growing French label-type line (SGL) and a fast-growing standard line (FGL) of chickens exposed to different preslaughter stress conditions. The birds were slaughtered under optimal conditions or after exposure to 2 h of transport or acute-heat stress (2 h at 35 degrees C). Relationships between meat quality and stress sensitivity were investigated by measuring struggle during shackling and tonic immobility (TI) duration, 1 wk before slaughter, as an indicator of the basal level of fear of the birds. Although most of the meat quality indicators varied between the 2 lines, differences were muscle dependent. In concordance with a lower ultimate pH, curing-cooking yield of thigh meat was decreased for the FGL birds. In contrast, these birds had a higher curing-cooking yield and a lower drip loss of breast meat resulting from a less rapid pH decline in this muscle compared with SGL birds. Thigh meat characteristics were influenced by both preslaughter stresses, but no significant effects were detected for breast meat. The main effect of heat stress in thigh meat was a decrease of the ultimate pH and led to paler color and lower curing-cooking yield; opposite effects were obtained for transport. Breast meat was much more sensitive to physical activity of birds on the shackle line. Longer durations of wing flapping on the shackle line gave more rapid initial pH decline. Whatever the line, no relationship between TI duration and meat quality characteristics or activity was observed. The present study suggested that SGL birds could be at disadvantage due to more struggle during shackling and accelerated postmortem glycolysis, which is detrimental to the quality of breast meat.

Clinical, microbiological and histological findings in lambs affected by 'salivary abomasum disease'.

'Salivary abomasum disease' is a common syndrome in Greece affecting lambs and kids from three to 17 days of age. In this case series, we present clinical and laboratory findings from 37 affected lambs presented alive and subsequently euthanased for welfare reasons and necropsied, and also from 24 other lambs submitted dead that were also necropsied. The clinical signs in the 37 lambs presented alive included lethargy (100 per cent), absence of sucking (83.8 per cent), weakness (37.8 per cent), abdominal distension (40.5 per cent) and increased frequency of urination (24.3 per cent). Diarrhoea was not observed in any affected lambs. At necropsy of these 37 lambs, the abomasum was distended with gas (70.3 per cent), saliva (43.2 per cent) along with mixed milk clots and gastric secretions; while multiple small mucosal and serosal haemorrhages with blood clots ('coffee grains') were recorded (91.9 per cent). Eight of 37 lambs that were examined alive, had elevated blood urea nitrogen concentrations (21.6 per cent). The pH of the abomasal contents ranged from 1.0 to 2.8; Escherichia coli was cultured from six of 37 (16.2 per cent) abomasal fluid samples. A mild to moderate inflammatory cell infiltrate was present in the mucosal lamina propria of 13 of 15 abomasal samples (86.6 per cent). Kidneys were paler than normal in 13 of the total 61 lambs necropsied (21.3 per cent); while acute tubular necrosis was evident on histopathological examination of 11 of 12 examined pale kidneys (91.6 per cent). The low abomasal pH and reported successful treatment with oral sodium bicarbonate suggest that metabolic acidosis may develop during the disease; however, further studies, including blood gas analysis, and determination of D- and L-lactic acid concentrations, are necessary to confirm this hypothesis.

Feed restriction strategy in the growing rabbit. 2. Impact on digestive health, growth and carcass characteristics.

A field enquiry mentioned the potential positive impact of a feed restriction on the health of young rabbits, but no objective information relates the intake to digestive health. The effects of a post-weaning feed restriction strategy were thus studied on digestive health and growth and carcass parameters of the growing rabbit, using a monofactorial design that produces a quantitative linear reduction of the intake, from ad libitum (AL group) to 80%, 70% and 60% of AL. The study was performed simultaneously in six experimental sites, on 1984 growing rabbits (496 per treatment) collectively caged from weaning (34 to 38 days of age, depending on the site) to slaughter (68 to 72 days). The feeding programme was applied as followed: restriction during 21 days after weaning, and then ad libitum till slaughter. During the feed restriction period the growth rate was linearly reduced with the restriction level, by 0.5 g/day for each percent of intake reduction. When returning to ad libitum intake (after 54 days old) a compensatory growth and a higher feed efficiency occurred. Therefore, the impact of the feeding programme on the slaughter weight (SW) was significant (-4.5 g/% of restriction), but relatively moderate: the weight loss of the more-restricted rabbits (60%) reached 7.7% (-200 g) compared to the AL group. Over the whole fattening period, the feed restriction reduced linearly and significantly the feed conversion (FC) (-0.0077 unit/% of restriction). Carcass traits were little affected by the feeding programme, except for a slightly lower decrease of the dressing percentage (mean: 1.2 units between AL and the three restricted groups). On the six experimental sites, mortality and morbidity were always caused by acute digestive disorders, namely diarrhoea and/or caecal impaction. Independent of the treatment, the mortality rate strongly varied according to the site (between 7% and 18% from weaning to 54 days and for the AL group). During feed restriction, the mortality was significantly lower from a restriction threshold of 80% (meanly: -9% compared to AL). The morbidity was also significantly reduced (-6%) for the two most restricted groups (70% and 60%). The favourable effect of a lower intake on health did not persist after returning to ad libitum intake (54 days to slaughter), since mortality and morbidity were not significantly different among the treatments. Such a feeding strategy thus represents a double benefit in terms of feed costs and lower losses of young rabbits.

Behavioural and physiological responses of three chicken breeds to pre-slaughter shackling and acute heat stress.

1. The aim of this study was to compare the behavioural and physiological responses to hanging and acute heat stress in three different chicken breeds. Chicks were obtained from a slow-growing French 'Label Rouge' line (SGL), a fast-growing standard line (FGL) and a heavy line (HL). The SGL, FGL and HL birds were slaughtered at their respective market ages of 12, 6 and 6 weeks, in an attempt to achieve similar body weights. Before stunning, birds were either shackled by their legs on the moving line for 2 min (shackling stress: SH) or placed in a room at 35 degrees C and 60% of humidity for 3.5 h and then shackled for 2 min (acute heat stress plus shackling: H + SH) or subjected to minimal stress by shackling for 10 s before stunning (control group: C). 2. Bird physiological responses to the three pre-slaughter treatments were estimated by measuring blood corticosterone, glycaemia, creatine kinase activity, acid-base status and electrolyte concentration as well as lactate content and glycolytic potential in the breast (Pectoralis major) and thigh (Ilio tibialis) muscles. Behavioural responses to shackling stress were evaluated by measuring wing flapping duration, straightening up attempts and vocalisations. 3. Blood corticosterone was higher in SH and H+SH groups than in the C group, regardless of genotype. The struggling activity on the shackle line differed among chicken breeds. It was more intense and occurred more rapidly after hanging in the SGL birds than in both other breeds. Furthermore, SGL struggling activity was not affected by hanging duration while it increased with hanging duration in FGL and HL birds. 4. Wing flapping duration was negatively correlated with blood pH, bicarbonate concentration and positively correlated with breast muscle lactate content, indicating that struggling stimulated antemortem glycolysis activity in breast muscle. Acute heat stress affected blood Ca2+ and Na+ concentration and increased glycaemia and glycolytic potential of thigh muscle. 5. Both acute heat stress and shackling before slaughter were experienced as stressful events by all types of birds.

Variations in chicken breast meat quality: implications of struggle and muscle glycogen content at death.

1. Pectoralis major (P. major) muscle pH and meat quality traits were studied in relation to bird response to ante-mortem stress in three chicken lines: a fast-growing standard line (FGL), a slow-growing French 'Label Rouge' line (SGL) and a heavy line (HL). Ninety-nine birds of the three genetic types were slaughtered at their usual marketing age (6, 12 and 6 weeks for FGL, SGL and HL birds, respectively) on the same day. The birds of each line were divided into three different ante-mortem treatment groups: minimum stress (shackling for 10 s) (C), shackling for 2 min (SH) and acute heat plus shackling stress (exposure to 35 degrees C for 3.5 h and shackling for 2 min before stunning) (H + SH). 2. Regardless of chicken line, wing flapping duration (WFD) between hanging and stunning was strongly negatively related to P. major muscle pH at 15 min post-mortem. It was also moderately negatively related to P. major muscle glycolytic potential (GP), which represents glycogen level at death. Increasing WFD induced an increased ultimate pH (pHu) only in HL. The consequences of increased WFD for breast meat traits were dependent on the chicken line: it induced lower L* and b* and higher a* and drip loss in SGL while it only increased breast a* in HL birds. By contrast, WFD variations did not alter breast meat quality traits of FGL birds. Regardless of the chicken line, increased GP was associated with lower pHu and higher L* and drip loss. In SGL, it also increased b* and decreased curing-cooking yield of breast meat. 3. Struggling activity on the shackle line and muscle glycogen content at death could partly explain line and pre-slaughter variations in breast meat pH and quality traits. The water holding capacity of the raw and cooked meat was impaired by long shackling in the case of SGL birds while it was barely affected by ante-mortem conditions in the two standard lines. In conditions which minimised bird struggling (C), SGL and FGL birds had meat with a better water holding ability than that of broilers from the heavy line. However, when broilers were subjected to SH or H + SH conditions, the breast meat water holding capacity of SGL birds was lowered to the same level as that of the heavy line birds.

Patterns of staff perception of difficult patients in a long-term psychiatric hospital.

In a study to determine which psychiatric patients are perceived by staff as most difficult to treat, clinical staff from several disciplines rated problem behaviors of 127 long-term inpatients in a private psychiatric hospital; staff also rated overall treatment difficulty, progress, and prognosis. No single patient characteristic determined staff's perception of patients as difficult to treat. Instead, four clusters of patient characteristics contributed to this perception; in decreasing order of influence, they are withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The study also showed that the patients who are considered particularly difficult are perceived as improving less and as having a poor prognosis.

An anatomy of countertransference: staff reactions to difficult psychiatric hospital patients.

Countertransference among hospital staff was investigated as part of ongoing research on difficult-to-treat psychiatric hospital patients. Staff's ratings of their emotional reactions to 127 patients on long-term units were analyzed by factor analysis, and the resulting factors were correlated by discipline with patient problem behaviors. Among the conclusions were that different forms of psychopathology elicit characteristic patterns of emotional reaction from staff; that some dimensions of psychopathology, particularly suicidal-depressed behavior and violence-agitation, elicit different emotional reactions among different disciplines, thus laying the groundwork for division among staff; and that the more difficult the process of hospital treatment, the more likely staff will experience a variety of emotions.

Profiles of difficult psychiatric hospital patients.

In a study of 127 long-term psychiatric hospital patients perceived as difficult to treat, investigators used hierarchical grouping analysis to differentiate ten profile groups of patients. The groups are based on four dimensions or clusters of characteristics previously derived by factor analysis: withdrawn psychoticism, severe character pathology, suicidal-depressed behavior, and violence-agitation. The ten profile groups are described and are related to staff ratings of overall treatment difficulty, prognosis, sex, diagnosis, and other variables. The main conclusion is that treatment difficulty stems in large part from the compounding of different dimensions of severe psychopathology. Thus a pan-symptomatic group, with high scores on all four dimensions, ranks highest in overall treatment difficulty.