"Difficult to place" psychiatric patients.
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Attitude to Health↗
Biomedical subjects
M Eisemann
Publications and source records attributed to M Eisemann.
Variability in physicians' decisions on caring for chronically ill elderly patients: an international study.
OBJECTIVES: To determine what treatment decisions physicians will make when faced with an incompetent elderly patient with life-threatening gastrointestinal bleeding and to identify the factors that affect their decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. OUTCOME MEASURE: A self-administered questionnaire containing three case vignettes. Each provided the same details on an incompetent elderly patient; however, one gave no information about the wishes of the patient and his family (no directive), the second provided a do-not-resuscitate (DNR) request, and the third included a detailed therapeutic and resuscitative effort chart (DTREC) requesting maximum therapeutic care without admission to the intensive care unit (ICU). The four treatment options were supportive care only, limited therapeutic care, maximum therapeutic care without admission to the ICU and maximum care with admission to the ICU. MAIN RESULTS: Treatment decisions varied and were systematically related to age, level of training and country (p less than 0.001). The older physicians and those in family medicine were less likely than the others to choose aggressive treatment options. Brazilian and US physicians were the most aggressive; Australian physicians were the most conservative. The DNR request resulted in a significant decrease in the number of physicians choosing aggressive options (p less than 0.001). The DTREC resulted in a move toward more aggressive treatment, as outlined in the directive (p less than 0.001). Overall, however, about 40% of the physicians chose a level of care different from what had been requested. Furthermore, over 10% would have tried cardiopulmonary resuscitation despite the DNR request. CONCLUSION: Treatment of incompetent elderly patients with life-threatening illness varies widely within and between countries. Uniform standards should be developed on the basis of societal values and be communicated to physicians.
Advance Directives↗
Perceived parental rearing, depression and coping behaviour. A pilot study in psychiatric patients.
Within the framework of Perris' vulnerability model of psychopathology the relationships between perceived parental rearing and coping behaviour in adulthood have been investigated. Rejecting and punitive rearing practices of both parents seem to contribute to the formation of intrapsychic, emotion-oriented coping strategies. The results indicate that childhood social experiences, in particular, parent-child relations, both directly affect vulnerability to psychopathological manifestations in later life and indirectly influence the conditions through the aquisition of coping strategies.
Adaptation, Psychological↗
Perceived parental rearing and state versus trait aspects of adult depression.
In a pilot study of 72 psychiatric inpatients, relationships between state versus trait aspects of depression and perceived parental rearing have been investigated. It appeared that trait aspects (assessed by the mood scale of the Giessen test) yielded the most frequent and highest correlations with the factors rejection, emotional warmth and overprotection of the EMBU (Egna Minnen av Barndoms Uppfostran--My Memories of Upbringing) questionnaire of parental rearing. Particularly rejecting maternal rearing behaviour during childhood seems to constitute a risk factor for the development of trait depression during adulthood.
Depressive Disorder↗
Parental rearing behaviour, family atmosphere and adult depression: a pilot study with psychiatric inpatients.
In a sample of 72 depressed inpatients the relationships between severity of depression, emotional family atmosphere and perceived parental rearing were studied at admission, discharge and follow-up. The results indicate that paternal rejection and overprotection might be of particular importance for developing social skills used to form close relationships, whereas maternal emotional warmth seems to have a preventive effect by promoting emotional stability.
Child↗
[The EMBU project--a multinational study of the importance of parental child rearing behavior for the development of psychopathologic phenomena].
The influence of childhood experience on psychological development is discussed from various scientific viewpoints. Against this background, the origin of the cross-cultural, multinational EMBU Project on the relationship between upbringing in the family and psychopathology is described. It becomes obvious that a systematic, cross-cultural, and theory-orientated approach can bring significant material for the development of psychiatric theory.
Child↗
Cross-national generalizability of dimensions of perceived parental rearing practices: Hungary and The Netherlands; a correction and repetition with healthy adolescents.
In a previous study, an attempt was undertaken to examine whether dimensions of parental rearing style as measured with the Egna Minnen Beträffande Uppfostran (EMBU) on dimensions of Rejection, Emotional Warmth, Overprotection, and Favoring Subject can be generalized from Dutch adult samples, for whom they were originally interpreted from factor analyses, to an Hungarian adult sample. The findings suggested either differences in the meaning of the constructs between Hungarians and the Dutch or the presence of errors of translation in the Hungarian version. To rule out the possibility of inadequate translation, the Hungarian item-content was cross-checked by our Hungarian coworkers and, after reformulating several items, used for obtaining new data with a sample of adolescents. On the whole, negative findings with the old version disappeared with the new; clear evidence was found here for qualitative similarity/identity of the Rejection, Emotional Warmth, and Overprotection dimensions across the Dutch and Hungarian samples. Further studies with Hungarian persons are needed to examine whether these dimensions generalize from (nonpatient) adolescent to adult samples.
Adolescent↗
[Public opinion poll: Public attitude and knowledge are important for the reintegration of psychiatric patients to society].
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Attitude to Health↗
The early family situation of Hungarian depressed patients.
In a series of fifty depressed patients and 258 controls possible differences in the early family situation as concerns parental rearing practices have been investigated by means of the Swedish EMBU inventory. The results show that the depressive experienced their parents as more "rejecting", more "overprotecting" and less "emotionally warm" as compared to their normal counterparts.
Adult↗
Psychiatric morbidity among relatives of different subgroups of neurotic depression.
The morbidity risk for affective disorders was calculated among the relatives of subgroups of reactive-neurotic depressive patients. The patients were divided into reactive and neurotic depressives. The parents of the neurotic subgroup had a significantly lower morbidity risk of affective disorders in comparison with the parents of the reactive subgroup. The role of genetic and environmental factors in the etiology of reactive-neurotic depression was discussed.
Adjustment Disorders↗
Depressive symptomatology at admission in Hungarian and Swedish depressed patients.
Within the framework of an ongoing cross-national study of hospitalized depressed patients the symptomatology of age, sex and diagnosis matched depressives consecutively admitted to a University Department of Psychiatry in Budapest, Hungary and in Umeå, Sweden has been compared. Only minor differences in symptomatology were detected between the two groups.
Adolescent↗
Social class and social mobility in depressed patients.
In the present study current social class, parental social class and social mobility have been compared in a series of 111 depressed patients of different diagnostic subgroups and of 97 non-psychiatric controls. Social class III was shown to be overrepresented in the unipolar, bipolar and unspecified groups. However, no differences concerning parental social class emerged. Unipolar and bipolar patients were more downwardly mobile than the neurotic depressives, the unspecified depressives and the controls.
Adjustment Disorders↗
Perceived depriving parental rearing and depression.
Four groups of depressed patients 47 unipolars, 21 bipolars, 34 with neurotic-reactive depression, and 39 with unspecified depressive disorder completed, after recovery, the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing practices. The results for three factors: "rejection", "emotional warmth" and "over-protection" and the global judgement scores of "severity" and "consistency" in rearing attitudes were compared with those obtained from 205 healthy individuals. Depressed patients, particularly in the unipolar unspecified groups rated both parents lower than the controls on emotional warmth. Patients tended also to rate their parents as less consistent in their rearing attitudes. The variables emotional warmth and overprotection allowed 64% of the patients and 72 of the unipolar depressives to be classified correctly. These results, like those of previous studies, support the hypothesis that deprivation of love during childhood represents an important psychological risk factor in the background of depressive disorders.
Adult↗
Cross-national invariance of dimensions of parental rearing behaviour: comparison of psychometric data of Swedish depressives and healthy subjects with Dutch target ratings on the EMBU.
A psychometric study on Swedish and Dutch samples used the EMBU, a self-report instrument designed to assess memories of parents' rearing behaviour. Of the four primary factors identified previously with Dutch individuals (Rejection, Emotional Warmth, Over-protection, and Favouring Subject), the first three were retrieved in a similar form in the two Swedish groups (depressives and healthy, non-patients). Examination of the metric equivalence of the scales and the strength of the factors for each group indicated that comparisons of patterns and levels between groups from the respective countries on the three factors showing cross-national constancy would be warranted. Scale-level factor analyses of these dimensions produced identical two-factor compositions (CARE and PROTECTION) across national groups which further supported this conclusion.
Adult↗
[Cycloid psychoses and their status within the scope of the classification of endogenous psychoses].
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Bipolar Disorder↗
Morbidity risk for psychiatric disorders in families of probands with affective disorders divided according to levels of platelet MAO activity.
In a series comprising 166 subjects with affective disorders, the lowest and highest quartiles in the male and female platelet monoamine oxidase (MAO) distribution, respectively, were included. The morbidity risk in the first-degree relatives (parents and siblings) of these low and high platelet MAO subjects was determined. First-degree relatives of low platelet MAO probands were found to have an increased morbidity risk for neurotic-reactive depressions and for alcoholism. The results seem to be in line with the biological high-risk paradigm, indicating that platelet MAO could be a biological marker for increased vulnerability. First-degree relatives of high platelet MAO probands were found to have an increased morbidity risk for bipolar affective disorders.
Adjustment Disorders↗
Perceived parental rearing behaviour in unipolar and bipolar depressed patients. A verification study in an Italian sample.
Two groups of former depressed Italian patients comprising 54 bipolars and 52 unipolars completed the Italian version of the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing behaviour. As in a previous study of Swedish depressives, three factors, "rejection", "emotional warmth", and "over-protection", have been taken into account. The results obtained in the patient group have been compared with those obtained in Italian healthy controls. Depressed patients rated both parents significantly lower than the controls on the factor "emotional warmth". The present results cross-validate those obtained previously in the Swedish depressives and strengthen, together with other findings in the literature, the assumption that the lack of emotional warmth in the parents' rearing practices might be a crucial variable in the pathogenesis of depressive illnesses.
Attitude↗
Cross-national study of perceived parental rearing behaviour in healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden: pattern and level comparisons.
Samples of healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden completed the EMBU, a Swedish questionnaire aimed at assessing the experience of parental rearing practices. For the purpose of comparison three factors - "emotional warmth", "rejection" and "overprotection" - obtained in a previous factor analytic study, have been used. The most pronounced differences occurred between the Dutch and the Swedish sample on the one hand, and the Italian and Australian sample on the other, with the Danish sample in between. Differences in perceived parental rearing should be considered when comparing personality characteristics and/or psychopathological conditions in subjects from different countries.
Adult↗