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Biomedical subjects

E Fähndrich

Publications and source records attributed to E Fähndrich.

At least 19 recordsLinked to original sources
PubMed2005

Prescribing practices in German and Swiss psychiatric university and in non-university hospitals: national differences.

OBJECTIVE: There are great variations between hospitals in the way drugs are prescribed, and these variations may be due to multiple factors such as local prescribing traditions, pharmacoeconomic considerations, drug availability, regional differences of population, disease prevalence etc. Available studies on prescribing habits, apart from studies performed in a unique center, have until now been mainly restricted to single countries or regions and the comparisons across countries or regions have often been limited by the use of diverse methodologies and definitions. The aim of the present study was to compare drug prescriptions between German and Swiss psychiatric services with regard to their preference of newer psychotropics. MATERIAL AND METHODS: Five psychiatric hospitals, associated to the AMSP project, were chosen to represent Swiss and German clinics, university and non-university settings. Data were available from one index day on 572 patients and 1,745 prescriptions. The comparisons were adjusted for age and gender. RESULTS: There was a significant difference (p < 0.001) with regard to the prescription of newer antidepressants (NAD), Swiss clinicians giving proportionally more (65.2%) than the German psychiatrists (48.3%). No significant difference was, on the other hand, found as to the proportion of atypical antipsychotics, the lack of difference being due to the higher proportion of clozapine among the atypical antipsychotics in Germany. CONCLUSION: There seems, therefore, to be a higher propensity for Swiss hospital psychiatrists to prescribe newer antidepressants. This seems to be due to national or regional prescribing traditions. Further studies are needed to investigate the economical influences on antidepressant prescribing in Swiss and German clinics.

Adolescent↗
PubMed2001

[How do geriatric psychiatry patients evaluate their stay in a specialized psychiatric department of a general hospital?].

PURPOSE: Following mainly the patients' view, the study examines whether the treatment of gerontopsychiatric patients in common with younger patients in a general psychiatric ward might entail disadvantages. METHOD: Out of a total of 297 gerontopsychiatric patients treated in 1999, a group of 107 patients was asked via a self-constructed questionnaire about different aspects of common treatment with younger patients. RESULTS: With the exception of an underrepresentation of organic disorders, the 107 interviewed patients did not differ substantially in basic characteristics from the entire group of gerontopsychiatric patients treated in 1999. Life together with younger patients was judged predominantly positively. The older patients themselves rejected the often stated complaint that nurses would neglect the gerontopsychiatric patients on age-mixed wards. CONCLUSIONS: Neither objective facts nor the subjective judgement by the users point to assume that common treatment of gerontopsychiatric patients together with younger patients could be disadvantageous. The contrary seems to be the case.

Aged↗
PubMed2001

[Family consultation as a part of routine management in a psychiatric and psychotherapy department of the general hospital].

BACKGROUND: Covers two years experience of family visits (FV) as a routine fixture at a psychiatric ward in a General Hospital. PATIENTS AND METHODS: In the course of one year 98 visits took place involving a total of 481 contacts between therapists, patients, and relatives. 269 patients participated up to 10 times in FV. A total of 666 family members participated, the bulk of them partners, mothers and children. Each FV contact is restricted to 20 minutes, but can be repeated as often as desired. An ever recurrent theme is the question family members ask as to the causes of the patients condition and how they can expedite the healing process and ensure compliance. The 269 FV patients do not differ markedly from the other patients concerning age, sex, diagnosis and treatment time. CONCLUSION: FV are experienced by patients and relatives as positiv and enriching. For psychiatric workers an ideal way to learn the psychotherapeutic rudiments.

Caregivers↗
PubMed2001

[Mother-child treatments within the scope of public community psychiatric care. Clinical treatment concept and experiences over 5 years].

BACKGROUND: Described are mother-child treatments performed within the framework of regional maximum care at general psychiatric units not having such a treatments focus. PATIENTS AND METHODS: The new clinical concept with its social and psychodynamic aspects is described. It provides realistic perspectives for all involved. Last but not least it puts the child in a position as a helpful companion for the mother. Over a space of 5 years, 20 mother-child treatments were performed at four different wards. 12 mothers suffered from schizophrenia (F20), 7 had depressive complaints (F32, F43), and one patient had a borderline personality disorder (F60). Treatments lasted an average of 10 weeks, all mothers retained their children. 16 patients were sent home; 2 were referred to a mother-child facility; 1 patient was placed in a half-way home and another in a house for women, in both cases with offspring. CONCLUSION: Mother-child treatment under specific spatial conditions is not only possible, but is an enrichment for all at general psychiatric units attending heterogeneous patients. The main requirement is a certain level of treatment care, such as an established primary care track, a clinic team that is flexible and open to novel approaches and, as a result, willing to accept a certain level of stress as normal.

Adult↗
PubMed2000

[Antidepressive therapy by modifying sleep].

Depressive symptoms are unspecific and occur in several psychiatric disorders. Sleep disturbances are also frequently present in depressed patients. As a consequence, it has been established that a number of modulations of the sleep-wake cycle can have an antidepressive effect. Total sleep deprivation or deprivation in the second half of the night have proven successful. The main limitation of the otherwise well tolerated treatment is the short duration of the antidepressive effect, which is mostly reversed in nearly all patients after the following night's sleep. New approaches are to shift the timing of sleep to earlier to ensure a possible longer-lasting effect. In clinical praxis the following manipulations should not be used: sleep deprivation in the first half of the night (not successful), REM-sleep deprivation (experimental setting), induced sleep prolongation (negative risk-benefit-ratio). In addition to patients with affective disorders sleep deprivation has proved relevant in patients with schizophrenia (depressed and/or with predominantly negative symptoms) and premenstrual dysphoric disorder. Very few side effects have been reported. Although many hypotheses have been tested, the mechanism of action underlying the antidepressive effect of sleep deprivation is still unknown.

Depressive Disorder↗
PubMed1999

[Hallervorden-Spatz syndrome. Differential diagnosis of early onset dementia].

We report the history of a 38 year old patient who began to develop mental deterioration at the age of 26. After a time of 7 years neurological signs like writing dystonia occurred. Hallervorden-Spatz-Disease (HSD) was diagnosed at the age of 36 in vivo with the clinical presentation of severe dystonia, rigidity, dementia, and typical signal loss in the globus-pallidus the reticular part of the substantia nigra, and the nucleus ruber in the T-2 weighted MRI. The "eye-of-the-tiger"-sign, a bilateral hyperintensity in the rostral globus pallidus, was not observed in follow-up examinations. HSD is a rare autosomal-recessive or sporadic disease of unknown etiology. In one third of the patients a dementing process is the first clinical sign of the disorder, and is a rare differential diagnosis of early onset dementia.

Adult↗
PubMed1999

[The police in psychiatric daily routine].

PURPOSE: The following is a description of those patients brought by the police to the emergency room of a general hospital of Berlin for a psychiatric exploration. METHOD: The medical records of those patients brought in to the emergency room during one year were analyzed retrospectively. RESULTS: Within one year, 317 (10.8%) out of 2903 patients were brought by the police to have an emergency psychiatric exploration. The ratio of men to women was 2:1, and the median age was 41. Most illnesses diagnosed were schizophrenia, disorders caused by psychotropic substances, alcoholism, alcohol intoxication, and adjustment disorders/stress disorders. One third of the 317 patients were under influence of alcohol. 21.8% of the 317 patients were suicidal. Over two thirds of the patients were admitted to the psychiatric ward. Only 31 patients were not admitted to the ward for lack of indication. The most frequent reason for intervention of police was suicidal behaviour (35%), "strange behaviour" (28.7%) or aggressive behaviour (23%). CONCLUSION: The results show that those patients brought in by the police are in acute crisis situations often involving suicidal tendencies and suffer from more severe psychiatric illnesses. The psychiatric emergency exploration initiated by the police was generally justifiable.

Adult↗
PubMed1998

[The psychiatric department evaluated by patients. A user survey as part of quality assurance in psychiatry].

UNLABELLED: Prior to discharge 351 patients in a psychiatric ward of a general hospital were requested to complete a 31-question survey pertaining to their hospital stay. The highest marks were given to the nursing staff and the individual psychiatric therapy. The survey also reflected dissatisfaction with the doctors' rounds led by the medical director, the information given about the medications and the early morning exercise programme. RESULTS: The patients were very cooperative and took the questions seriously. The questionnaire should not contain more than 10 clear and simple questions. The very act of posing the questions to the patients brought about changes in the ward.

Adult↗
PubMed1998

[Are restraints used too frequently? Indications, incidence and conditions for restraint in a general psychiatric department. A prospective study].

A 10-month prospective study of 148 restraints on the acute psychiatric wards of a general hospital aimed to describe the institutional context of restraints. Nursing and medical staff were inquired according to a standardised procedure about ward atmosphere, staffing, medication and other factors. 81% of restraints lasted up to 2 hours, danger of harm to others was found the principal indication criterion (70%). 41% restraints occurred during the first 3 days after admission, mainly within the late shift of nursing staff and outside the regular office hours of the doctors. Ward atmosphere was rated rather relaxed, whereas nursing staff twice as often as doctors rated medication as insufficient. Implications for indication on the use of restraints and for future research are discussed.

Adult↗
PubMed1997

[Compulsory treatment in psychiatry from the viewpoint of the patient. A prospective study].

During a 6-month period all patients who had been treated involuntarily in a state-funded mental mental health unit were studied prospectively. They were interviewed after the first compulsory measure and at the end of treatment. A control group of patients (not experiencing involuntary treatment) were interviewed as well. The aim of the study was to establish whether the groups differed with respect to judgement of subjective well-being and satisfaction with treatment. The stability of these judgements over time and especially changes in perception and acceptance of involuntary treatment during the course of treatment were also monitored. the 36 patients in the study group perceived themselves as being far less ill at both time points and were less satisfied with treatment than the 29 control patients. At the end of treatment, all patients judged themselves to be significantly more ill retrospectively and patients of the study group were more satisfied with treatment than at the beginning. When questioned in the days after an involuntary measure, 25% of the patients concerned denied that any measure had taken place against their will; at the end of the hospital stay this figure had increased to 42%. In contrast, four control patients complained that they had been involuntarily subjected to treatment. In discordance with the previously published literature, the acceptance of involuntary treatment declined over time.

Adult↗
PubMed1995

[Commitment of mentally ill and community psychiatry].

The question was investigated whether during the time of building up a psychiatric department in a General Hospital the situation changes in the Mental Hospital already in evident points e.g. the rate of compulsory admissions. Two years were compared: 1984 the year before the psychiatric department was established and 1988 the year with half of the number of planned beds built up in the psychiatric department. The number of admissions to the Mental Hospital was cut in half. The total sum of compulsory admissions to the Mental Hospital as well as to the psychiatric department was reduced from 255 (1984) to 148 (1988). Already in this time of building up the psychiatric department the compulsory admitted, the gerontopsychiatric patients and the foreigners were over proportional represented among the patients in the department compared to the Mental Hospital. The often presumed selection did not take place.

Adult↗
PubMed1994

Acute vs. chronic EEG effects in maprotiline- and in clomipramine-treated depressive inpatients and the prediction of therapeutic outcome.

Patients treated with the norepinephrine uptake inhibitor maprotiline showed an opposite tendency between acute and chronic effect of EEG. Whereas the acute effect indicated a decrease upon EEG vigilance, the chronic effect indicated an increase. Under clomipramine which acts upon different transmitter systems in a complex, up to now not fully understood way, acute and chronic EEG effects could not be differentiated.

Adult↗
PubMed1994

[Acute psychosis and pregnancy].

A patient with a paranoid psychosis becomes pregnant. The course of the symptomatology as well as considerations about the psychopharmacological, psychotherapeutical and social treatment were described.

Adult↗
PubMed1992

[Poverty on the psychiatric unit--a central problem in mental health treatment].

72 patients of the psychiatric department of the general hospital in Berlin Neukölln were interviewed unselectedly to the subjects of lodging and income with the help of a semistructured interview. Only 16 (22%) patients still had a job, 17 (24%) were without job and 31 (43%) were on pension. 10 patients (14%) were homeless, 12 patients (17%) lived in insufficient conditions of housing. Only 11 patients (15%) earned their own wage/salary. All together 25 patients (36%) were in some way dependent on support by social security. Half of the patients had a regular income of less than DM 1000.--a month. The everyday dealing with the problem of poverty on the ward is pointed out and discussed. Obviously this theme is not integrated enough in the therapeutic process. This subject can not only be delegated to the responsibility of the social worker.

Adult↗
PubMed1990

Diurnal variations of mood in depressed patients in relation to severity of depression.

This study investigates the relationship between the severity of the depressive syndrome and the occurrence of diurnal mood variation. Several authors have proposed that diurnal variations of mood cease in the severest states of depression. By contrast, others suggest a rhythm-inducing effect of depression. We could not find any correlation between the severity of depression and various measures of diurnal mood variation in a group of 70 patients. These findings are discussed against the background of chronobiological hypotheses.

Adult↗
PubMed1989

Diurnal variations of mood in psychiatric patients of different nosological groups.

In order to investigate whether diurnal variations of mood (DV) are pathognomonic for the diagnosis of endogenous depression, 130 patients and 21 healthy control subjects were examined. The patients differed in the type of primary disease (neurotic, endogenous depression, depression in schizophrenia). All subjects recorded their subjective mood on the Visual Analogue Scale every morning and evening over a period of 3 weeks. In addition, they were classified by expert rating according to clinical criteria as belonging to one of the three different groups of rhythmic type: morning type, evening type, indifference type. The results reveal that DV occur frequently but that they are nonspecific. No correlation between nosological diagnosis and rhythmic type was found. It follows that DV, therefore, cannot improve sample homogeneity in studies on psychoactive drugs.

Affect↗