Search PubMed⌕ Search

Biomedical subjects

Stefan Priebe

Publications and source records attributed to Stefan Priebe.

At least 55 records · Page 3Linked to original sources
PubMed2003

[The future of psychiatric care--dreams and nightmares].

AIM: The paper aims to identify perspectives for future mental health care. METHOD: Personal reflection based on the history of mental health care, own experience and current developments. RESULTS AND DISCUSSION: Mental health care and the relationship between patients and professionals within it have changed significantly in the last five decades. Current developments may be seen as characterised by a) a widening remit of mental health care with an increasing clientele with non-severe mental disorders; b) re-institutionalisation for the severely mentally ill, e.g. with a rising number of forensic beds; and c) a tension between consumer orientation in a post-modern society and dominance of evidence-based medicine. Mental health care has always lived in a balance between social control and therapeutic aspiration. Yet, we now seem to witness a stronger split between the two with re-institutionalisation for patients with severe mental illnesses who might upset the public on one hand, and a growing private market of various treatment options for patients who actively seek treatment and can--directly or indirectly--pay for it on the other. This leads to the anticipation of positive as well as negatives scenarios for the future which are briefly described and contrasted.

Deinstitutionalization↗
PubMed2003

[German-speaking mental health services research - what and how is reported? An analysis of publishing in Psychiatrische Praxis 1999-2002].

OBJECTIVE: In mental health service research, the investigated services and care systems as well as the research methodology should be described in a precise and transparent fashion so that findings can be clearly interpreted and used. Therefore, this study investigates what is reported in German language publications on mental health service research. METHOD: All original papers on mental health service research, that were published in the Psychiatrische Praxis between 1999 and 2002, were systematically reviewed and, using a structured classification system, subjected to content analysis. In particular, it was assessed what forms of care had been studied and what characteristics of care were reported. RESULTS: 54 % (199) of all original publications reported mental health service research in a wide sense. Of these, 8 % were qualitative studies. 58 % of studies investigated in-patient treatment, 20 % comprehensive care systems, and 4 % services provided by psychiatrists or psychotherapists in private office practice. There were hardly any studies on innovative service models. In 51 % of studies, authors had conducted investigations within their own service or care system. In most articles characteristics of the patient sample were exactly described, whilst precise information on the researched service, such as funding, staffing and organisation, was usually missing. DISCUSSION: There still is relatively little research on outpatient services, and mental health service research is not yet appropriately based in the community. Requirements for exact and comprehensive descriptions of the researched services' and care systems are rarely met. In general, the findings suggest that mental health service research in German speaking countries might benefit from studies with researchers who are independent from the investigated service, the evaluation of innovative service models, and above all a standardised description of the services and context in research studies.

Germany↗
PubMed2003

Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review.

BACKGROUND: Inequalities of service use across ethnic groups are important to policy makers, service providers and service users. AIMS: To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings. METHOD: A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate. RESULTS: Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33-5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments. CONCLUSIONS: There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.

BACKGROUND: Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result. AIMS: To characterise London assertive outreach teams and determine whether there are distinct groups within them. METHOD: Semi-structured interviews with team managers plus one month's prospective process of care data collection were used to test for 'model fidelity' to ACT and, by cluster analysis, to identify groupings. RESULTS: Fidelity varied widely, with four teams (out of 24 studied) rated 'high fidelity' and three teams rated 'low fidelity' by US standards and 17 rated 'ACT-like'. Three clusters were identified, with voluntary sector teams being the most distinct group. CONCLUSIONS: There is wide variation in the practice of assertive outreach in London. The role of the voluntary sector requires increased attention. Heterogeneity in practice is a clinical challenge but a research opportunity in distinguishing effective from redundant components of the approach.

Adult↗
PubMed2003

Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2.

BACKGROUND: The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability. AIMS: To describe self-reported views and work experiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team. METHOD: Confidential staff questionnaires in London's assertive outreach teams (n=187, response rate=89%) and nine randomly selected CMHTs (n=114, response rate=75%). RESULTS: Staff in assertive outreach teams and CMHTs were moderately satisfied with their jobs, with similar sources of satisfaction and stress. Mean scores were low or average for all sub-scales of the Maslach Burnout Inventory for the assertive outreach team and the CMHT staff, with some differences suggesting less burn-out in the assertive outreach teams. Nine of the 24 assertive outreach teams had team means in the high range for emotional exhaustion and there were significant differences between types of assertive outreach team in some components of burn-out and satisfaction. CONCLUSIONS: These findings are encouraging, but repeated investigation is needed when assertive outreach teams have been established for longer.

Adolescent↗
PubMed2003

Assertive outreach teams in London: patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3.

BACKGROUND: Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions. AIMS: To assess patient characteristics and outcome in routine assertive outreach services in the UK. METHOD: Patients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes--days spent in hospital and compulsory hospitalisation--were assessed over a 9-month follow-up. RESULTS: The 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for. CONCLUSIONS: Routine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.

Adult↗
PubMed2003

Personality factors and posttraumatic stress: associations in civilians one year after air attacks.

There is an ongoing debate on which risk factors for developing posttraumatic stress symptoms are more important--personality traits reflecting vulnerability, previous stressful experiences or characteristics of the traumatic event. In this study, posttraumatic stress symptoms and their relationship with personality traits, previous stressful experiences and exposure to stressful events during air attacks in Yugoslavia were investigated. The Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), Impact of Events Scale (IES; Horowitz, Wilner, & Alvarez, 1979), Life Stressor Checklist Revised (LSCL-R; Wolfe & Kimerling, 1997), and List of Stressors were administered to a homogeneous group of medical students 1 year after the attacks. In multiple regression analyses, compulsive and passive-aggressive personality traits and a higher level of exposure to stressors during air attacks independently predicted the degree of intrusion symptoms. Avoidance symptoms were predicted by avoidant personality traits and a higher exposure to stressors both previously in life and during the attacks. In the next step, we tested in analyses of variance whether personality traits, previous stressful experiences, and stressful events during attacks as independent variables interact in predicting intrusion and avoidance symptoms. For this, students were clustered into three groups depending on their predominant personality traits. In addition to direct predictive effects, there were significant interaction effects in predicting both intrusion and avoidance. The findings suggest that each of the tested factors, i.e., personality traits, previous stressful experiences, and exposure to traumatic events may have an independent and direct influence on developing posttraumatic stress. However, the effect of these factors cannot just be added up. Rather, the factors interact in their impact on posttraumatic stress symptoms. Bigger samples and longitudinal designs will be required to understand precisely how different personality traits influence response to stressful events.

Adaptation, Psychological↗
PubMed2003

Community mental health care in Europe--an overview.

Europe shares some historical roots of modern psychiatry. Even before the 19th century, there had been institutions for the mentally ill, such as the Bethlem in London which was founded more than 750 years ago, and organised forms of care in the community for people with mental illness, such as the tradition of family care in Geel in Belgium. Modern psychiatry, however, was initiated through the spirit of enlightenment and began around 1800. This beginning was marked by the symbolic cutting of the chains of mentally ill patients in Paris, the first publication of the term 'psychiatry' ("Psychiatric") in Germany in 1803, and the establishment of the retreat in York, England. The rise of modern psychiatry as a speciality of medicine was closely linked to the development of new institutions in both health care and academia. In the 19th century, various universities established chairs and academic departments of psychiatry, and large asylums for the mentally ill were built across Europe. The asylums were meant to replace the family as carriers for the material needs of patients--since many families could not fulfill that function in an industrialising society anymore--remove the mentally ill from the public scenes of urban life and provide a therapeutic environment.

Community Mental Health Centers↗
PubMed2002

Engagement of patients with psychosis in the consultation: conversation analytic study.

OBJECTIVE: To investigate how doctors engage with patients with psychotic illness in routine consultations. DESIGN: Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder. SETTING: Two psychiatric outpatient clinics in east London and south west London. PARTICIPANTS: 7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder. MAIN OUTCOME MEASURE: Mutual engagement in communication during the consultation. RESULTS: Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms. CONCLUSIONS: Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.

Adult↗
PubMed2002

Subjective quality of life and depressive symptoms in women with alcoholism during detoxification treatment.

The study investigated whether subjective quality of life (SQOL) differs in alcoholic women with and without depressive symptoms being in detoxification treatment. Moreover, we tested whether depressive symptoms were correlated with other subjective evaluation criteria. SQOL and psychopathology were obtained in 70 alcoholic women during treatment. Alcoholic women with depressive symptoms showed a lower SQOL regarding several life domains, in particular their family situation, and life as a whole. Additionally, they reported more needs for support and more negative consequences of alcoholism. The findings underline the relevance of quality of life ratings in detoxification treatment and their association with depressive symptoms.

Adult↗
PubMed2002

Research in supported housing.

BACKGROUND: De-institutionalization has led to the provision of various forms of housing with or without support for people with mental illness in the community. In this paper, we review the conceptual issues related to the provision of supported housing schemes, the characteristics of residents, research methods and outcomes, and the factors influencing the quality of care provided. METHODS: A Medline and hand search of published literature was complemented by information derived from contacting expert researchers in the field. FINDINGS: There is considerable diversity of models of supported housing and inconsistent use of terminology to describe them. This makes it difficult to compare schemes, processes, and outcomes. Patients in supported housing are characterized by deficits in self-care and general functioning, whilst behavioral problems such as violence, drug abuse and extreme antisocial habits predict exclusion from supported housing. Most evaluative studies are merely descriptive. In terms of outcomes, it seems that functioning can improve, social integration can be facilitated, and residents are generally more satisfied in supported housing compared with conventional hospital care. Further evidence suggests that most patients prefer regimes with low restrictiveness and more independent living arrangements, although loneliness and isolation have occasionally been reported to be a problem. Little information is available on the factors that mediate outcomes and on skills required by staff. CONCLUSION: Research in supported housing for psychiatric patients has so far been neglected. Large scale surveys on structure, process, and outcomes across a variety of housing schemes may be useful in the future to identify some of the key variables influencing outcomes. The use of direct observation methods in conjunction with other more conventional, standardized instruments may also highlight areas for improvement. In conducting research, structure and process, as well as outcomes, need to be considered. Thus, we need to know not just what to provide, but how to provide it in such a way that it will maximize beneficial outcomes. This represents a considerable research agenda.

Community Mental Health Services↗
PubMed2002

Do long-term hospitalised patients benefit from discharge into the community?

OBJECTIVE: The study investigated whether long-stay patients would benefit from discharge into the community in Berlin, Germany. METHOD: In a prospective controlled study, all long-term hospitalised psychiatric patients from a defined catchment area were assessed using established standardised instruments. Quality of life, treatment satisfaction, needs and psychopathology were re-assessed in 63 non-discharged patients 1.5 years later, and in 65 resettled patients 1 year after discharge. RESULTS: Discharged patients were younger and had spent less time in psychiatric hospitalisation. Whilst patients who remained in hospital care did not show significant changes over time, discharged patients did. Changes in subjective quality of life and total number of needs - but not in psychopathology, unmet needs, and treatment satisfaction - were significantly more favourable in resettled patients as compared to the control group. CONCLUSION: The findings are in line with other studies and suggest that long-stay patients can benefit from discharge into the community, particularly with respect to their quality of life. Positive changes in the process of deinstitutionalisation seem not dependent on the specific national context, and also apply to younger patients who have not yet spent 10 or more years in psychiatric hospitals.

Adult↗
PubMed2002

Detention of the mentally ill in Europe--a review.

OBJECTIVE: The frequency of compulsory admission varies widely across Europe. Although there has been some research on a nation-wide level, no work has been done to compare mental health legislation in different countries in relation to detention rates and to patients' perception of hospital detention. METHOD: Databases and government statistics were searched for regional, national and European data. Legal frameworks were compared and reviewed in relation to patients' and professionals' views. RESULTS: Nearly 20-fold variations in detention rates were found in different parts of Europe. Criteria for detention of the mentally ill are broadly similar when it comes to patients at risk to themselves or others. However different rules apply for involuntary treatment in the interest of the patient's health. CONCLUSION: Variations in detention rates across Europe appear to be influenced by professionals' ethics and attitudes, sociodemographic variables, the public's preoccupation about risk arising from mental illness and the respective legal framework.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Do cenesthesias and body image aberration characterize a subgroup in schizophrenia?

OBJECTIVE: To identify and characterize a subgroup of schizophrenia patients with marked and dominating bodily sensations (cenesthesias and body image aberration). METHOD: We assessed cenesthesias and different aspects of body image aberration systematically along with common (general, positive and negative symptoms) and ego-psychopathology in 60 patients with acute paranoid schizophrenia. Cluster analysis was applied to identify subgroups. Psychopathology scores of the clusters were compared at admission and after 2 weeks of hospital treatment. RESULTS: One of the three clusters comprised of 14 patients (23.3%) with marked disturbances of body experience (underestimation of lower extremities, desomatization, boundary loss and diminution). The subgroup was further characterized by significantly higher ego-psychopathology scores at admission. Some of the differences held true over a 2-week period. CONCLUSION: The findings from the present study suggest that cenesthesias and body image aberration might represent an additional dimension of psychopathology that might be used for defining a nosological subtype of schizophrenia.

Adolescent↗
PubMed2002

[Trauma and Psyche in German Psychiatry since 1889].

AIM: This paper summarises the psychiatric concepts on trauma in Germany since 1889. METHOD: Literature review and historical analysis. RESULTS: Based on the notion that traumatic experience may lead to mental disorders Oppenheim described the traumatic neurosis in 1889. Subsequently, there was an intensive discussion on different concepts until 1918. Since then, the history of psychiatric concepts of trauma in Germany has been characterised by change, repitition and discontinuity. After 1945, mental disorders following traumatic experience hardly featured in textbooks with the exception of the vaguely defined survivor syndrome. In the last 10 years, the concept of posttraumatic stress disorder as originated in the USA became dominant. CONCLUSIONS: Psychiatry in Germany has a long and inconsistent tradition of theories and concepts on trauma. The historical view may enrich the current debate in which the concept of posttraumatic stress disorder has been increasingly criticized.

Germany↗
PubMed2002

[Prognosis of schizophrenia from the viewpoint of patients and relatives. An explorative study].

OBJECTIVE: This study is aimed at exploring what schizophrenic patients and their closest relatives expect the further course of the illness will be like and how it can be influenced. METHOD: Problem-centered interviews were conducted with 31 schizophrenic patients and their closest relatives at discharge from hospital treatment. The verbatim transcripts of the interviews were analyzed by means of structuring qualitative content analysis. RESULTS: Most frequently, the respondents expected an improvement of the illness or they were unsure whether the actual recovery from psychosis will persist or whether a further relapse will occur. Less frequently, the respondents were sure that this will be the case or that the illness will take a chronic, eventually deteriorating course. The majority was convinced that the course of the illness can be influenced, by psychiatric treatment as well as by the patients themselves. As concerns the social situation in the near future, particularly changes of the occupational status were hoped for. CONCLUSION: The assessment of the prognosis of the schizophrenic illness by most patients and relatives appears quite realistic. Rather than considering themselves as helpless victims they see opportunities for influencing the further course of the illness. This should have a positive influence on the readiness to use mental health service and to comply with treatment recommendations.

Adult↗
PubMed2002

[Disturbances of body-experience in acute anxiety and depressive disorders - neuroticism or somatization?].

In view of the uncertain relationship between body related "Boundary loss" and anxiety as well as depression symptoms we carried out the following study. Our aim was to explore these symptoms in their diagnostic and clinical significance and to define body distortions and organic disturbances. We examined the body perception (via Image Marking Procedure), aspects of body image via Body Distortion Questionnaire and via Visual Analogue Scales on self-perception of body weight and size) and body cathexis/satisfaction (via Visual Analogue-Scale) and their changes during hospital treatment in 28 patients with anxiety disorders (ICD-10, F40 - F41) and 40 patients with depressive disorders (ICD-10, F32 - F34). The phenomena were assessed by following instruments: Hamilton Anxiety Scale, Hamilton Depression Scale, Clinical Anxiety Scale, State-Trait Anxiety-Scale, Brief Psychiatric Rating Scale. Functional somatic complaints were assessed by Zerssen Complaint list three days after admission and again two and four weeks after inpatient treatment. Body size estimation was also assessed longitudinally in a control group of 44 healthy individuals (ward staff). On average, both patient groups displayed body dissatisfaction and high scores in the somatic complaint list as well as somatic depersonalisation and boundary loss, but in comparison with the control group there were no relevant disturbances of body size estimation. The body related phenomena were all closely correlated among each other as well as with psychopathology scores of anxiety and depressive disorder. The symptoms decreased significantly together with reduction of the psychopathological phenomena. The results could be regarded as body related equivalent of these psychopathological disturbances or they could be interpreted as symbolic (somatized) bodily represented negative cognitions and emotions. The hypothesis that these body-related phenomena outlasting the acute phase of illness could be used as neuroticism markers was not confirmed.

Acute Disease↗