[Policy concerning chronic psychiatric patients].
Explore the source record for details and available documents.
Chronic Disease↗
Biomedical subjects
R Giel
Publications and source records attributed to R Giel.
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↗
Patterns of mental health care for the elderly. A cohort study in a Dutch register area.
Four cohorts of patients of 65 years or more who had contact with a mental health service in the first 3 months of 1975, 1977, 1979 and 1981 were followed for 1 year to study their pattern of care. Data were collected in a psychiatric case register covering a town of approximately 45,000 inhabitants in the north of the Netherlands. Patterns of care were analysed for various diagnostic groups. Findings suggest that the socially determined age of retirement of 65 years, makes less sense from a psychiatric point of view. Typical disorders of the aged, such as dementia manifest themselves in significant numbers at a much older age.
Age Factors↗
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↗
The feasibility of cost-benefit studies of mental health care. An attempt with a Dutch Case Register.
A cohort of 928 people, aged 20 to 60 years, were entered in a Dutch Case Register for the first time as outpatients during the period from 1974 to 1977. They were each followed up for 1 year in order to identify patterns of care and calculate their cost. The latter was calculated for groups of patients, according to diagnosis and type of service at entry. This approach required registering face-to-face contacts for each patient, and close collaboration with the services involved, to calculate costs.
Adult↗
On vagrancy and psychosis.
Paradoxically, due to recent mental health legislation, the mentally handicapped of the developed world find themselves in the same situation as the majority of those in the developing world who never had contact with a mental health service. A survey of the literature and of the situation in Egypt and Lesotho suggests marked coincidence of vagrancy and chronic mental illness. In both the developed and developing world, adequate services to support these people are lacking.
Community Mental Health Services↗
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↗
The burden of mental illness on the family. Results of observations in four developing countries. A report from the WHO Collaborative Study on Strategies for Extending Mental Health Care.
As part of the WHO Collaborative Study on Strategies for Extending Mental Health Care 259 families in four developing countries (Colombia, India, Sudan and the Philippines) were screened with regard to the social burden caused by mental illness of one of its members. Levels of subsistence, previous illness, financial burden, personal relations and social acceptance were studied. The social burden was greatest in the urban areas.
Adult↗
The WHO collaborative study on strategies for extending mental health care, II: The development of new research methods.
Teams in seven developing countries under sponsorship of the World Health Organization have been carrying out collaborative operational research on providing mental health care through primary health care services. New techniques of identifying mental disorders in children and adults have been developed and tested. Methods of assessing the skills and attitudes of health workers toward mental health work and of gauging community attitudes toward mental illness have also been developed. Results have been directly applied in planning better mental health care. The authors conclude that cross-cultural collaborative research is effective in improving mental health care for those in greatest need.
Attitude of Health Personnel↗
The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results.
Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.
Attitude of Health Personnel↗
Mental health problems in the community: a discussion of their assessment.
Explore the source record for details and available documents.
Community Mental Health Services↗
An epidemiological approach to the improvement of mental health services in developing countries.
Explore the source record for details and available documents.
Developing Countries↗
The classification of psychiatric disorder. A reliability study in the WHO collaborative study on strategies for extending mental health care.
Altogether 26 psychiatrists and other mental health workers, from Colombia, Brazil, Sudan, Egypt, India and the Philippines tried to reach agreement on the classification of 10 case histories, using the International Classification of Diseases (8th revision). The exercise was part of the WHO Collaborative Study on Strategies for Extending Mental Health Care. Conventions, mistakes, differences of opinion and a lack of rules are discussed as causes for disagreement.
Adult↗
The medical certificate: a double dilemma.
Explore the source record for details and available documents.
Affective Symptoms↗
Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.
To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.
Adolescent↗
Coping with outpatients who cannot cope : management of persistent complainers in an African country.
Some 15 to 20% of patients visiting general outpatient services in developing countries suffer from some emotional disorder although they present mainly with somatic complaints. Their contact with the services is generally a frustrating experience for themselves and for the health worker, resulting in undue medical attention to their problem. A series of five consecutive steps, of increasing psychiatric sophistication, to assist in the management of these cases is described, permitting the health worker to stop at a level not exceeding his competence.
Developing Countries↗
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↗
Mortality in the long-stay population of all Dutch mental hospitals.
A study of 1,506 deaths reported over a period of 2 years to the National Psychiatric Case Register of the Netherlands, on the total cohort of 17,211 long-stay patients counted on prevalence day (31 December 1969), showed very much higher death-rates than in the general population. Malignancy and cardiac disease were not so common, while respiratory disease was still common in inpatients.
Adult↗