Biomedical subjects
Publications and source records attributed to S Priebe.
In psychiatry, there are wide-spread efforts to make diagnoses more objective in the sense of psychological test theory. From the point of radical constructivism, psychiatric diagnoses is regarded as a construct and its interactional basis is stressed. So, it always contains an essential subjective dimension, which should be accepted and utilized for treatment.
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Early statements by 41 depressive inpatients about a subjective change in their condition and about their attitude to proposed treatment were examined. These statements, made on the day after admission, were found to correlate with the outcome of the treatment. It was found that early subjective reactions can indicate to some extent, not only the result of hospital treatment for depressive symptoms, but also the outcome measured by objective and subjective criteria, after a 3 to 4 month follow-up.
In a psychiatric emergency situation, the psychiatrist is expected to take immediate decisions and to intervene quickly and competently, what is difficult to realize with neurotic patients in a therapeutically satisfactory way. By openly showing his limitations and helplessness, he can deny a defining element of the emergency situation. By this reframing of the situation, changed and more positive prospects occur for dealing with the problem and the patient.
A case of Parkinson's Disease in a woman of 60 years, who developed a dependence on levodopa is presented. The psychic effects reported by the patient were sedation, sleep inducement, and analgesia.
In the rehabilitation of schizophrenic patients, changes and outcome are usually assessed by members of multiprofessional therapeutic teams and by the patients themselves. In this study, the correlations of different perspectives of change during rehabilitation were investigated. After admission to a partial hospitalization program (printing workshop), 12 schizophrenic patients were examined weekly; the test period lasted 12 weeks. Ratings concerning various aspects of behavior were independently made by the patients themselves, by a work therapist, and by a psychiatrist, and week-by-week changes were analyzed. Factor analysis and correlations among change scores suggest a moderate to high homogeneity of each psychiatrist's and work therapist's ratings. Correlations among the three perspectives of change show little substantial concordance. Consequences for the practical work of multiprofessional teams in the rehabilitation of schizophrenic patients are discussed.
During the first few days after their admission to a day-hospital, 30 patients with schizophrenic or schizoaffective disorders, their clinical case managers, and the therapeutic team in the day-hospital globally assessed the beginning treatment on visual analog scales (VASs). We investigated whether these assessments predicted observer ratings (Brief Psychiatric Rating Scale [BPRS]) and self-ratings of psychopathology during treatment and at discharge. Positive assessments by patients and caregivers were correlated with lower BPRS scores later on in the course of treatment; only the patients' assessments were good predictors of self-rated outcome. Initial global assessments of treatment might indicate qualities of the therapeutic relationship as a relevant nonspecific factor in complex day-hospital treatment.
Over the last 30-40 years the reform of psychiatric care in many countries has led to deinstitutionalization and treatment of many patients in community psychiatric services. There is an ongoing discussion on whether this process may lead to a higher suicide rate. There are only a few studies addressing this issue, and empirical data are scarce. Several methodological problems make it difficult to use suicide rates as an evaluation criterion for community psychiatry. These problems are briefly discussed.
In a sample of 105 community-care patients suffering from schizophrenia, the relationship between reports of involuntary admission in the past, current posttraumatic stress disorder (PTSD) symptoms, and other aspects of psychopathology was examined. PTSD symptoms were obtained on the PTSD interview, and psychopathology was rated on the Brief Psychiatric Rating Scale (BPRS) and on the Present State Examination (PSE). Fifty-seven percent of the patients reported they had experienced involuntary admissions in the past. The degree of PTSD symptoms was high--51% fulfilled the criteria for a PTSD diagnosis. PTSD symptoms were not correlated with reports of involuntary admissions. They were, however, significantly correlated with the BPRS subscale anxiety/depression, and with PSE subscores for specific and nonspecific neurotic syndromes. Because of an overlap of symptom scores, a diagnosis of PTSD according to DSM criteria appears to be very difficult in schizophrenia patients.
This study examines whether schizophrenia patients' global assessment of treatment predicts outcome in community care. Eighty-five patients rated the extent to which their treatment was right for them. The outcome measure was assessed by means of a hospitalization index reflecting the duration of full and partial hospitalization within a follow-up period of 24 months. Patients who dropped out (n = 21) assessed their treatment more negatively than those who remained in the care system during follow-up. Patients with no hospitalization (n = 25) expressed a more negative assessment than patients who were hospitalized in the follow-up period at least once (n = 39). In this latter subgroup, however, patients with a more negative assessment had a longer duration of hospitalization during follow-up, and patients' assessment of treatment was the best single predictor of outcome (r = -0.50, P < 0.01). In a multiple regression analysis, patients' assessment of treatment, the number of previous hospitalizations and the hospitalization index in the two years prior to the interview, together, explained approximately half of the variance of outcome (adjusted R2 = 0.46). The findings underline the relevance of asking patients whether treatment is right for them, although the relationship between patients' assessment of treatment and long-term outcome seems more complex than previous studies suggested.