Search PubMed⌕ Search

Biomedical subjects

Stefan Priebe

Publications and source records attributed to Stefan Priebe.

64 records · Page 4Linked to original sources
PubMed2002

[Patient characteristics, length of treatment and costs in a model institution of community mental health care].

AIM: Since the 1970s, a model institution for community mental health care with three partial hospitalisation programmes and various out-patient services was run in the Berlin district Charlottenburg. The study evaluates, to what extent the institution fulfilled its aim to provide long-term care for severely and chronically ill patients at relatively low costs. It also identified predictors of outcome. METHOD: Case register data of 1194 patients who were treated within a period of 23 years were analysed. Patient characteristics, length of care and treatment costs are presented. Costs were calculated on the basis of daily rates as paid to care providers in 1996. Regression analyses were computed for predicting length of care and costs after the first year. RESULTS: On average, length of care was 2.4 years and costs per year were 57 000,- German Marks ( 29 000,-). Patients with shorter and longer duration of care differed in only a few of the recorded sociodemographic and clinical characteristics. Significant predictors for long-term costs were the legal status of being under a care order and costs in the first year. However, only 18 % of the variance of costs after the first year were explained. CONCLUSIONS: The findings suggest that a) community mental health care in the studied form may not reach all patients with severe mental illness, b) in most cases, the notion of a lifelong treatment in such care systems does not reflect reality, c) the paid costs are lower than for long-term in-patient care, but still rather high, and d) the usually recorded patient characteristics are of little value for predicting long-term outcome.

Adult↗
PubMed2002

[Housing and work as criteria of the "Social Integration" of the mentally ill - development in Germany between 1900 and 2000].

AIM: This paper analyses, in what way psychiatrists considered housing and work as criteria of social integration of mentally ill people and what models of care were suggested in Germany throughout the 20th century. METHOD: Publications in 29 German professional and scientific psychiatric journals through the complete period from 1900 to 2000 and monographs were searched for papers on the above issues. RESULTS: Until the second half of the century, integrative initiatives related to housing and work generated in asylums without the aim of a full social integration of the patients. In the activistic concept of NS-psychiatry, work became an obligation for patients and a criterion for selection that decided on life and death. Not until the late 1950s, there again was an orientation towards integration in psychiatric care in both German states. Whilst already in 1963 the "Rodewisch Theses" outlined recommendations for the rehabilitation of the mentally ill already in the GDR (East Germany), a similar mark of reform ideas was published in the "enquete" in the FRG (West Germany) in 1975. In the GDR initiatives were limited to a small number of locations. In the FRG and the re-unified Germany various forms of sheltered housing and work were established - also with significant regional variation. However, a clear discussion of underlying aims and implications for the structure of mental health care was not found in the psychiatric literature. CONCLUSIONS: In the 20th century a tradition of psychiatric ideas related to housing and work did not develop in Germany. Particularly, there were only sporadic contributions from university psychiatry. Work was more frequently explicit subject of discussions than housing. Both areas were - slowly and in discontinuity - established as criteria of integration of people with mental illnesses, which was increasingly accepted as an aim of mental health care.

Deinstitutionalization↗
PubMed2002

[Institutionalisation-index--a simple method to estimate direct treatment costs for institutionalised forms of community mental health care].

AIM: Investigations of treatment costs are of increasing importance in community mental health care. Yet, they are often difficult and expensive to conduct. This study explores whether and, if so, to what extent direct treatment costs as paid by insurance companies and social welfare in the German health care system can be estimated through a simple Institutionalisation-Index. METHOD: Based on the literature and clinical judgment, a simple Institutionalisation-Index was formed reflecting the degree of institutional protection in supported housing, long-term day care, partial hospitalisation and full hospitalisation programmes. As part of a comprehensive evaluation of a model institution for community mental health care in Berlin, actually paid treatment costs and Institutionalisation-Index (II) were identified for 1194 patients over a total period of 23 years and compared with each other. RESULTS: The Pearson correlation coefficient between II and paid costs was 0.97 (p < 0,001). In calculations for subgroups and different periods of time, II and costs were almost identical, too. CONCLUSIONS: The Institutionalisation-Index provides a sufficiently precise estimate of direct costs as paid by insurance companies and social welfare for different forms of care in community based institutions and hospitals. The II can be adjusted to incorporate further forms of community based care. In systems with similar funding arrangements, the simple method to establish a Institutionalisation-Index should facilitate cost analyses in community mental health care.

Berlin↗
PubMed2002

Subjective evaluation: is there more than one criterion?

Previous cross-sectional investigations have shown that subjective evaluation criteria (criteria that are used in psychiatric research for evaluating care based on patients' statements) do overlap and that there exists a single general factor underlying all these criteria. In this study, we tested longitudinally and in two different samples of schizophrenia patients the distinctness and covariation at baseline and at followup of three common subjective evaluation criteria (subjective quality of life, self-rated needs, and self-reported symptoms). Scores were intercorrelated at both baseline and followup and showed some intercorrelations over time, suggesting temporal covariation. One stable subjective appraisal factor was identified at both baseline and followup, summarizing a negative subjective quality of life and more symptoms and needs. This factor explained 50 percent to 69 percent of the variance. It was found to be strongly associated with observer-rated mood and was mainly predicted by reporting dark thoughts and being dissatisfied with life as a whole. In subjective evaluation, there appears to be a need to distinguish between a general appraisal factor and specific aspects of different criteria. Therefore, future research needs to focus on how the general factor can be assessed more directly and to identify how the specific variance of different criteria independent of that factor can be maximized.

Adult↗
PubMed2002

Predictors of posttraumatic stress in civilians 1 year after air attacks: a study of Yugoslavian students.

The level of posttraumatic stress, other psychological symptoms, and potential predictors were assessed in 139 medical students 1 year after experiencing air attacks in Belgrade, Yugoslavia. Eleven percent of the students showed high levels of posttraumatic stress (scores > 34) on the Impact of Event Scale; lower degrees of intrusion symptoms were reported by 32% of the students and avoidance symptoms were reported by 45%. Although gender, distress during previous stressful events, and exposure to trauma during the attacks were all of some predictive value, distress during the attacks was the best predictor for symptoms. This association remained significant when the influence of other psychological symptoms was controlled. The type of previous stressful events interacted with the degree of exposure to trauma during the attacks in predicting avoidance symptoms, but not intrusion symptoms. The findings suggest that predictors for high and low thresholds of symptoms may be similar. The quality of previous stressful events can modify the response to subsequent trauma.

Adult↗
PubMed2002

Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia.

This study investigates subjective illness theories of patients with schizophrenia, how they define their health problem, what they assume causes their illness and which course of illness they expect. The predictive value of those theories for patients' compliance with antipsychotic medication is tested. A problem-centered interview was conducted with 77 schizophrenic patients at discharge from inpatient or day hospital treatment. All patients were on clozapine treatment. Interviews were analyzed by means of computer-assisted content analysis. In addition, potential determinants of compliance were assessed using the 9th version of the Present State Examination, the UKU side effect rating scale, a checklist for patients' evaluations of the effect of psychotropic drugs, and a helping alliance scale. Compliance with medication was assessed by interviewing patients at discharge and three months later. Only slightly more than one half of the patients considered themselves mentally ill. They tended to endorse psychosocial causes more frequently as compared with biological causes. Slightly more than 25% of the patients each expected an improvement of the illness, a reoccurrence of the acute psychosis, or a chronic course. Whereas the quality of the helping alliance, delusion of grandiosity, and attitude toward psychotropic drugs proved to have an influence on patients' compliance with antipsychotic treatment, the three components of subjective illness theory (definition as mental illness, assumed etiology, and prognosis) did not have a statistically significant influence. Subjective illness theories vary in patients with schizophrenia. Although they might reflect different styles of coping with the illness, there is no evidence that they directly determine compliance with medication. Patients' views of the helping alliance and attitudes toward drugs should be considered in predicting compliance with antipsychotic medication.

Adolescent↗
PubMed2002

A phenomenological account of users' experiences of assertive community treatment.

Assertive community treatment (ACT) is a widely propagated team approach to community mental health care that 'assertively' engages a subgroup of individuals with severe mental illness who continuously disengage from mental health services. It involves a number of interested parties--including clients, carers, clinicians and managers. Each operates according to perceived ethical principles related to their values, mores and principles. ACT condenses a dilemma that is common in psychiatry. ACT proffers social control whilst simultaneously holding therapeutic aspiration. The clients' perspective of this dilemma was studied in interviews with 12 clients using the 'grounded theory' approach. Results suggest that clients' disengagement is as much a historical and cultural phenomenon as a result of lack of insight. Many clients had experienced rejection of early help-seeking behaviour and all had been subject to coercive interventions. These coercive interventions were experienced as an attack on identity. All felt that their voice had not been listened to in previous interactions with psychiatric services. Consequentially the clients had an increased level of arousal around issues of power, which needs to be incorporated when examining the ethics of community psychiatry. Traditional notions of the difference between persuasion and coercion--for example--may need to be adapted for this client group. Results are compared with the provider perspective. We conclude that the perspectives differ on two key dimensions. Such an empirical approach to examining psychiatric ethics may ensure that we incorporate the subjectivities of various interested parties in the clinical decision-making process.

Adult↗
PubMedDate not supplied

Morale of mental health professionals in Community Mental Health Services of a Northern Italian Province.

AIMS: To explore morale of psychiatrists and psychiatric nurses working in Community Mental Health Centres (CMHC) in an Italian Province, and identify influential factors. METHODS: Thirty psychiatrists and 30 nurses working in CMHCs in Modena completed questionnaires on burnout, team identity and job satisfaction. They also answered open questions about different aspects of their work. Answers were subjected to content analysis. Regression analyses were used to identify factors that predicted morale across groups. RESULTS: Psychiatrists had higher scores on emotional exhaustion and depersonalisation. There were no significant differences between the two groups in job satisfaction and job or role perception. Professionals reported positive relationships with patients as the most enjoyable aspects of their job, whilst team conflicts and high workloads were seen as most difficult to cope with. Multivariate analyses showed that being a psychiatrist and perceiving team conflicts as a main cause of pressure in the job predicted higher burnout. CONCLUSIONS: Simple open questions coupled with quantitative measures appear a promising tool to investigate morale of mental health professionals and identify factors determining morale. Research, training and service development should focus on relationship aspects both with patients and within teams to reduce burnout in CMHCs.

Adult↗
PubMedDate not supplied

The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study.

Three issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention--as compared to current best standard practice--will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimised.

Community Mental Health Services↗