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Biomedical subjects

D Wiersma

Publications and source records attributed to D Wiersma.

49 records · Page 3Linked to original sources
PubMed1991

Costs and benefits of day treatment with community care for schizophrenic patients.

The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new approach did not improve prognosis with respect to psychiatric symptomatology, social role disabilities, or number of readmissions during the first year of followup. Total cost of treatment was less for day-treatment patients than for ordinary clinical patients.

Activities of Daily Living↗
PubMed1988

The Groningen Social Disabilities Schedule: development, relationship with I.C.I.D.H., and psychometric properties.

Most of the existing instruments for the assessment of social dysfunctioning of psychiatric patients are merely lists of precoded items, leaving little or no room for posing supplementary questions. In this article a new, semi-structured questionnaire--the Groningen Social Disabilities Schedule (GSDS)--is described, in which this shortcoming is met. The development of the GSDS is based on social role theory and on the existence of a hierarchy in social disabilities, demonstrated in an earlier World Health Organization study. Compatibility was sought with the International Classification of Impairments, Disabilities and Handicaps (ICIDH), a trial-classification of the World Health Organization, to be used in research on the consequences of illness. It is concluded that the inter-rater reliability of the GSDS is good. To a large extent the hierarchy proved to hold true for this instrument. Some implications for future research and for the ICIDH are discussed.

Disability Evaluation↗
PubMed1986

Psychological impairments and social disabilities: on the applicability of the ICIDH to psychiatry.

The applicability of the theoretical framework of the ICIDH to the practice of psychiatry is discussed. A critical analysis reveals some major conceptual difficulties with respect to the distinction between mental disorder and psychological impairment, and also between social disability and handicap. The principle of the triaxial classification, impairment----disability----handicap, has eventually been challenged. It is proposed to direct clinical research on psychological impairments as objective signs of psychological dysfunctions, and social disabilities as restrictions of social role performance.

Persons with Disabilities↗
PubMed1985

Social disability and outcome in schizophrenic patients.

To gain more insight into the social (as opposed to clinical) outcome of schizophrenia, a unidimensional, heirarchical scale was constructed. Items were selected from the Disability Assessment Schedule (DAS)--a new instrument, used in the WHO Collaborative Study on the Assessment and Reduction of Psychiatric Disability. Data were derived from the Dutch cohort participating in this study, which consisted of patients with a first life-time episode of a non-affective, functional psychosis. Patients were followed-up during the first three years of their illness, and analyses of the stability and reliability of the scale proved to be satisfactory. It was subsequently used to characterise the course of social disability.

Activities of Daily Living↗
PubMed1984

Prognosis and outcome in a cohort of patients with non-affective functional psychosis.

Over a period of 3 years since the first in a lifetime onset of an episode of non-affective functional psychosis a cohort of 82 Dutch patients was studied at set intervals with regard to prognosis and outcome. Prognostic statements on remission, relapse, duration of episode, length of stay in hospital, and occupational, family and overall social adjustment were checked against actual outcome after 1 year. In general, the research team of three psychiatrists, a psychologist and a sociologist began quite optimistically, but became slightly more pessimistic with time. However, their predictions proved hardly better than chance statements. The team appeared to be more pessimistic about the diagnosis of schizophrenia than about that of reactive psychosis, although they were not correct with one diagnostic category more often than with the other.

Adolescent↗
PubMed1984

Foulds' hierarchical model of psychiatric illness in a Dutch cohort: a re-evaluation.

In order to evaluate Foulds' hierarchical model of psychiatric illness, a study was carried out using data from a 3-year follow-up of patients suffering from functional non-affective psychoses. Of the 177 Present State Examinations carried out 86% yielded symptom patterns compatible with the model. It was shown that failures to fit the hierarchy can be explained either by measurement error or by the masking of major symptoms by the simultaneous presence of minor ones. A one-dimensional scale to measure the severity of psychiatric illness was constructed. Patients' scores were compared with ratings on the Index of Definition and the diagnosis of current mental state. The results of these comparisons were considered to be supportive validatory evidence. Some of the implications of the model and the data are discussed.

Delusions↗
PubMed1983

Social class and schizophrenia in a Dutch cohort.

Recent data from a 2-year follow-up of functional non-affective psychosis, and particularly schizophrenia, favoured social selection rather than social causation theory. Data concerning the cohort were compared with inter- and intra-generational mobility in a random Dutch sample. The results indicate that the educational and occupational mobility of patients, relative to their fathers, was greater than expected. Although patients were better educated than the random sample, they fared less well occupationally. An analysis of patterns of occupational mobility before and after the onset of psychosis also showed that social selection played a major role in achieving social status. The outcome of patients' occupational career at follow-up was poor, and only a minority succeeded in obtaining or keeping a regular job.

Adolescent↗
PubMed1978

Mental illness, neuroticism and life events in a Dutch village sample: a follow-up.

In a 5-year follow-up of 32 patients identified during a survey of a Dutch village in 1969, approximately two-thirds were found to have recovered. This result was reflected in the scores on a self-reporting questionnaire. A control group showed little change over those years. The persistence of psychiatric problems was related to life experience, as measured by a life-event interview.

Adaptation, Psychological↗
PubMedDate not supplied

Clinical predictors of discrepancy between self-ratings and examiner ratings for negative symptoms.

Little is known about the awareness of negative symptoms or its correlates. The aim of this study was to examine whether a number of clinical variables can predict the discrepancy between ratings of negative symptoms made by schizophrenic patients and by an examiner. This discrepancy could provide a measure for the awareness of negative symptoms. Eighty-six schizophrenic patients used a self-rating scale for negative symptoms with items derived from the Scale for the Assessment of Negative Symptoms (SANS). A psychiatrist assessed all patients using the SANS and other instruments, including the Present State Examination (PSE) item "insight into psychotic condition." Nurses assessed all patients using the Rehabilitation Evaluation Hall and Baker (REHAB), a scale for the measurement of psychiatric disability. All measurements were repeated after 2 months. A sensitive index for the underestimation of the severity of negative symptoms was developed, the discrepancy score. Multiple regression analysis was used to examine the predictability of discrepancy scores. Since scores for SANS items were used to calculate discrepancy scores, all regression analyses were performed with the SANS summary score as a covariate. The first step was to assess the independent contribution of each variable to the prediction of discrepancy scores. The second step was to examine the predictive quality of the 19 variables together. The variables themselves failed to make an independent contribution to the prediction of discrepancy scores at both assessments. REHAB scores, for instance, contributed to the prediction of discrepancy scores at the first assessment, but not at the second. The results of the second step showed that the best model for the prediction of discrepancy scores included the variables of depression (negative association) and anxiety (positive association). The absence of an association with the PSE item suggests that the awareness of negative symptoms is not related to insight into positive symptoms. An important limitation of our study is the arbitrary method of discrepancy quantification.

Adult↗
PubMedDate not supplied

A Dutch patient classification system for community care.

In the Netherlands, a prototype patient classification system for community nursing has been developed to enhance planning, budgeting, and quality of care. This patient classification system encompasses three parameters: type of care needed, expected number of home visits, and the total length of service. The authors describe the classification system and present the results of an evaluation study. Nurses stated that the instrument was useful for determining the demand for care, staffing needs, and work load. Although not all results were positive, the system currently is recommended for use as a long-term planning instrument.

Community Health Nursing↗