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PubMed2000

Epilepsy and the family: a review of current literature.

Although the negative effect of epilepsy on patient's psychosocial well-being has been increasingly documented in the last decade, the influence of the condition on the family has attracted much less interest. This paper reviews the present state of family research, examining the influence of both childhood and adulthood epilepsy on the psychological and social well-being of family members. Studies indicate that epilepsy may cause high levels of psychosocial difficulties for all family members, including stigmatization, stress, psychiatric morbidity, marital problems, poor self esteem and restriction of social activities. Studies also suggest that the family environment may be an important intervening factor between the condition and the outcome for the family unit, and a number of family factors are reviewed which have been suggested to mediate this relationship, with recommendations being made for their use in intervention studies. Shortcomings of the family studies to date are discussed and these include: concentration on examination of issues around family life, studies being based on reports from single members of the family and the selection of subjects from clinical populations. Recommendations are made concerning methodological and conceptual issues that need addressing for future research.

Adaptation, Psychological↗
PubMed2000

The information needs and understanding of 5-10-year old children with epilepsy, asthma or diabetes.

This exploratory study compared the information needs and understanding of 25 5-10-year olds with epilepsy with those of 10 children with asthma and 10 with diabetes (of the same age range). The children were interviewed whilst attending specialist clinics by the first author and were unaware of her professional status. All the children had access to specialist nurses and their families had received literature about their condition. The interview covered five main areas: knowledge of their condition, psychological effects, medication, restrictions on lifestyle, where they obtained their information and if they had unanswered questions. The children with epilepsy had far more unanswered questions and felt excluded from discussions with doctors. They also appeared reluctant to tell their friends their diagnosis and, at such a young age, felt stigmatized by their condition. The results highlight a contrast in the understanding of children with epilepsy when compared with those with asthma or diabetes. It is proposed that if a simple biological model were used to explain epilepsy this could aid children's understanding and reduce their reluctance to disclose their diagnosis.

Asthma↗
PubMed2000

Validation of the side effect and life satisfaction (SEALS) inventory.

Diminished quality of life (QOL) is a common feature of epilepsy. It is generally more severe among patients with poor seizure control but prevalent, to a clinically significant degree, even among those whose seizures are well controlled. People with epilepsy frequently report diminished socialization, negative self image, feelings of stigmatization, reduced earnings potential, and diminished hope and ambition. Problems with antiepileptic drug (AED) therapy are common, and AED therapy is recognized as an important determinant of health-related quality of life (HRQOL). A clinically efficient psychometric instrument is needed to measure its impact. The Side Effect and Life Satisfaction (SEALS) inventory is a 38-item, patient-completed questionnaire designed to measure satisfaction with AED therapy. We tested its construct validity in comparison with three widely used psychometric instruments of similar design, the Profile of Mood States (POMS), the Hospital Anxiety and Depression (HAD) scale, and the Medical Outcomes Study-Cognitive Functioning (MOS-COG) scale. All four instruments were completed by 307 epilepsy patients. A matrix of Pearson's correlations was produced for the SEALS inventory and the comparative instruments. A statistically significant correlation was found for each planned comparison. We conclude that the SEALS inventory is a valid psychometric instrument, well suited for use in clinical investigations of AED therapy and in the practical, long-term management of epilepsy.

Adolescent↗
PubMed2001

The quality of life of older people with epilepsy: findings from a UK community study.

The impact of epilepsy on the quality of life of older people with epilepsy has rarely been investigated. As part of a large prevalence study of epilepsy conducted in one UK Health Region, we investigated the burden of their condition in older compared with younger people. A second analysis compared quality of life in those men and women diagnosed after the age of retirement from the workforce compared with those diagnosed before that age. Data were collected from men and women with epilepsy and from their primary and secondary care physicians. There were few differences between older and younger people with regard to their reported quality of life, though younger people were more likely to report feeling stigmatized by their condition. Older people with epilepsy diagnosed in later life were more anxious and depressed than those diagnosed earlier and their overall perception of quality of life was more likely to be negative. Our data emphasize that older people do not necessarily experience poorer quality of life than younger people, but those first diagnosed in later life do appear to have a quality of life which is more impaired. Consideration should be paid to the important psychosocial consequences of epilepsy in the older person.

Age Factors↗
PubMedDate not supplied

[Psychosocial support of patients with homozygous beta-thalassaemia].

The prognosis and therewith the quality of life of patients with beta-thalassaemia major is decisively influenced by the compliance with the therapy of the patients and their families, who are massively burdened with this lifelong and much time requiring treatment. To improve the compliance with therapy a group of 10 afflicted adolescents and young adults aged between 15 and 27 years was founded in 1992. The aims are to get to know the reasons for the unsatisfactory compliance with therapy, to promote the exchange of experience how to deal with the disease and its treatment, to give comprehensive medical informations and to improve in this way the own responsibility and the compliance with therapy. At the monthly meetings aspects of interaction between parents and the child with a hereditary disease are discussed. Also the themes of self-image and body image of these adolescents are set who are stigmatized by thalassaemia and grow up in uncertainty about the development of their disease and often suffer from mortal fear. Possibilities and limits of integration of these chronically ill patients within school and profession, and not at last within the clinique are debated. Although two members of this group have died, our patients show more interest in their disease, their therapy and their prospects since the beginning of this psychosocial care. The compliance with therapy has become better in the majority of patients.

Adolescent↗
PubMed2002

Psychopharmacological treatment of aggression in schizophrenic patients.

Aggressive behavior is frequently observed in schizophrenic patients. More than 50 % of all psychiatric patients and 10 % of schizophrenic patients show aggressive symptoms varying from threatening behavior and agitation to assault. The pharmacological treatment of acute, persisting and repetitive aggression is a serious problem for other patients and staff members. Not only is violent behavior from mentally ill patients the most detrimental factor in their stigmatization, aggression is also a considerable direct source of danger for the patients themselves. Based on rather limited evidence, a wide variety of medications for the pharmacological treatment of aggression has been recommended: typical and atypical antipsychotics, benzodiazepines, mood stabilizers, beta-blockers and selective serotonin reuptake inhibitors (SSRIs). Most clinical information on treating aggression has been collected for atypical neuroleptics, particularly for clozapine. Several retrospective and open studies indicate its efficacy. Treatment duration of 6 months is recommended to induce a stable reduction of physical and verbal aggression. Severe side effects have very rarely been seen. At the moment, clozapine seems to be the first choice in aggression treatment. Within the last few years, about 10 articles were published showing that this is the most effective antiaggressive agent in the treatment of aggression and agitation in psychiatric patients, independent of psychiatric diagnosis. However, clozapine, like all the other substances used, does not have an established indication for the treatment of aggressive symptoms. Noncompliance with medication makes it difficult to choose the right preparation for the medication: tablets, liquids, intramuscular injections and readily soluble "FDDFs" are available. Ethical, juridical and methodological problems prevent controlled studies from establishing a reference in the treatment of aggression in mentally ill patients. This review summarizes the current discussion and publications on the pharmacological treatment of aggression in schizophrenic patients of the last 20 years. In addition, we will briefly present studies and case reports concerning the treatment of aggression in other psychiatric patients.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Psychosomatic aspects of endometriosis].

Endometriosis is a varied and unspecific disorder, which can be detected by way of subtle diagnostics in almost every woman. In one case it is a minor accidental finding, in another case it is a cancer-like, mostly incurable, chronic painful a disease, which often has sterility and aggressive therapies as subsequence. For the origin of endometriosis many causes are discussed. The theory of retrograde menstruation through an hyperperistaltic-dystocic uterus presents on one hand an organic explanation-concept. From the psychosomatic point of view this unphysiological menstruation could also be seen as the result of an unsolved conflict, which might be connected with the gender-role or personal, familiar and social attitudes about menstruation. The exo- and endogenic supply with hormones in a time with less pregnancies and therefore more menstruation is also a contributing factor to the origin and development of this disturbance. Beside the theory of endometriosis as an autoimmune disease also implicates psychosomatic thoughts. Though there is always a repeatedly talk the "cancer of the career-woman", there are however very few psychosomatic research projects regarding endometriosis. Therefore it is a characteristic of this disease, that finding and feeling are very often controversial. This emphasizes the importance of psychosomatic, psychosexual, social and biographical aspects in connection with endometriosis. This point of view makes a relative plausible and comfortable explanation for the CPPS and sterility uncertain. Without question diagnosis and therapy of endometriosis followed on one hand by stigmatization and on the other hand by often restriction of quality of life leads to a lot of subsequent psychosocial problems.

Endometriosis↗
PubMed2003

[Increased stigma through a former stay in a mental hospital? Results of a public survey in Switzerland].

OBJECTIVE: The perception of how most people stigmatize mentally ill persons has consequences for the affected. Is a former stay in a mental hospital connected with an additional stigma? METHOD: In three linguistic areas of Switzerland we conducted a representative opinion survey (N = 1737) on public attitude towards mental illness, psychiatric treatment, and the institutions involved. Using Link's "devaluation-discrimination-scale" a randomly selected sample was asked on the telephone about the perceived stigma concerning (1) a currently mentally ill person or (2) a former mentally ill person or (3) a former mental inpatient. RESULTS: In all three linguistic areas of Switzerland we found in the case of current illness a lower social acceptance or a higher discrimination, respectively. Also in all linguistic areas those who were asked about "former mental illness" or "former stay in a mental hospital" did not differ regarding perceived acceptance or discrimination. DISCUSSION: Our data does not confirm the assumption of increased stigma because of a former stay in a mental hospital. An inquiry of subjective experience of a hospital stay, however, would probably lead to other results than that of a public survey.

Adolescent↗
PubMed2004

Reduction of clozapine-induced hypersalivation by pirenzepine is safe.

INTRODUCTION: Hypersalivation is known as a frequent, disturbing, and socially stigmatizing side effect of therapy with the atypical antipsychotic clozapine. It has been shown that the addition of the anticholinergic pirenzepine is able to reduce clozapine-induced hypersalivation, probably by blocking M4-receptors. Nevertheless, a pharmacokinetic interaction between both compounds cannot be excluded. METHODS: In this pilot study, 29 schizophrenic patients (ICD-10; 51.7 % female; age: 36.7 +/- 8.7 years [mean +/- SD]) were included. Serum concentrations of clozapine and its pharmacologically active metabolite N-desmethylclozapine were determined under steady-state conditions by automated HPLC with UV detection before and after addition of pirenzepine for 3 days. RESULTS: Significantly fewer patients reported hypersalivation after addition of pirenzepine (69 % vs. 34.5 %, P = 0.002). No significant differences of clozapine and N-desmethylclozapine serum levels before (329 +/- 181 ng/ml and 218.0 +/- 123.4 ng/ml, respectively) and 3 days after (336 +/- 215 ng/ml and 235.9 +/- 164.4 ng/ml, respectively) addition of pirenzepine were found. In three patients, however, clozapine serum levels increased; this was probably unrelated to pirenzepine. CONCLUSION: In conclusion, treatment of clozapine-induced hypersalivation with pirenzepine is a recommendable combination with low risk of additional side effects.

Adult↗
PubMed2005

[Between responsibility and delimitation: emotional distress of caregivers].

OBJECTIVE: The purpose of this article is to provide an overview regarding the emotional burden of relatives of the mentally ill. METHODS: The relevant literature were identified by means of a computerized MEDLINE research on the years 1993 - 2004 and scanning of review articles. A content analysis of interviews with 32 caregivers about their emotional burdens was carried out to complete and elucidate the review. RESULTS: The emotional burden of caregivers are manifold. Following categories can be distinguished: anxiety and sorrows due to the lack of information about the illness and treatment, unsureness and overcharge with the symptoms of the illness, sorrows about the treatment of the patient, helplessness and palsy, loneliness and responsibility on his own, feelings of being excluded from the treatment of the patient, anxiety about the future, feelings of restrictions of the own autonomy and problems in demarcation, hope and disillusionment, grief and feelings of loss, fear of relapse and suicide, sense of shame and stigmatization, discouragement, feelings of guilt, anger and disappointment, changes in family roles and role-conflictions, problems in the sexuality of the partnership and anxiety about an illness of one's own or heredity to the children of one's own. CONCLUSIONS: The distinct knowledge of caregivers' emotional burdens can help to avoid overcharging the capacity of the carers, to decline high expressed-emotion-levels in the families and to reduce relapse rates of the patients.

Affective Symptoms↗
PubMed2005

[Is there currently a boom of stigma research in psychiatry?].

OBJECTIVE: Recently, there has been a growing awareness among psychiatrists of the stigma of mental illness. In numerous countries programs aimed at reducing stigmatization and discrimination because of mental illness have been launched. The question arises as to what extent the increasing interest in stigma has stimulated research in this area. METHOD: A search for papers on stigma of mental illness that have been published in scientific journals since 1990 has been carried out, using different search strategies. RESULTS: During the 1990 s, there is a marked increase of articles dealing with the stigma of mental illness. There is no indication of an end of this trend. DISCUSSION: Despite more research we are still far from understanding the stigma process in detail. This, however, is the prerequisite for developing successful anti-stigma interventions.

Cross-Sectional Studies↗
PubMed2005

[Consequences of nosographic and trans-nosological concepts of schizophrenia].

This essay starts with a brief remark about the -- necessary -- de-tours of the historical pathway to the concept of schizophrenia. The first part on nosographic approaches then describes the results of cross-sectional and longitudinal psychopathological symptom-assembling, subgrouping by factorial analyses, and the cross-cultural stability of the emerging disease concept: The human idiopathic syndrome of structural mental decline in its clinical variegation. The second part about de-nosological approaches provides an account of the clinical concepts of basic symptoms, spectrum disorders, neuropsychological deficits and their genetic family loading. Genetics of neuropsychological deficits demonstrate in detail that risk and protective factors to schizophrenia are genetically closely enmeshed. Higher familial loading of some neuropsychological deficits compared to the actual disease itself points at the dilemma that functional psychopathology deepens causal understanding and yet looses specificity for the disease syndrome. The concluding part of this essay emphasizes some sequelae of de-nosological approaches: Better tools for earlier recognition treatment and prevention; ego-distal concepts of basic dysfunctions rather than the previous ego-proximal concepts, hence better self-esteem, insight, and de-stigmatization for patients.

History, 20th Century↗
PubMed2006

Complications in septoplasty.

The most frequent complications of septoplasty are deformities, infections, and perforations. The effects of each of these complications, however, can be very different. Dislocations and deformities of the septum may result not only in an impaired airway but also in visible deformities of the entire nasal base and dorsum. A patient who underwent septoplasty can be "stigmatized." Infections may lead not only to septal abscess but also to endocranial complications such as meningitis or septicemia with endocarditis. Permanent perforations of the nasal septum can result in significant symptoms if they are located in the anterior part of the nose. Surgical closure is the treatment of choice, with a high success rate if the patients are selected properly. Besides these three major types of complications there are many others, from smell disturbances to blindness. Causes, prevention, and correction of selected complications are presented and data of the recent literature reported.

Abscess↗
PubMed1991

[The Stasi persecution syndrome].

For many years western psychiatrists only out of their clinical experience have known about a syndrome for which the name Stasi-persecution-syndrome will be used here. Stasi was the all powerful secret police of what was the East German Democratic Republic. The syndrome concerns an hitherto unknown number of the aprox. 50,000 survivors. It is a sequel of a form of persecution now more generally named torture. The characteristics of the persecution include arrestion, interrogations, degradation, humiliation, maltreatment, assault, mass detention in tiny rooms, hunger, cold, discrimination, defamation, disgrace, outlaw, social degradation, absence of rights, uncertainty of future, life threatening, and stigmatizing. The sequels resemble in many aspects of what is known by the psychiatry of the persecuted, but own a special flavor. Among the sequels are persisting and paranoid anxieties, re-arousable by specific situations. There are also realistic anxiety and persecution dreams, mood disturbances, lack of confidence, attempted suicide and complaints about lack of understanding by others, which the victims suffer from. Questions of indemnification for psychiatric sequelae have entered into a new stage after the East-German parliament had passed a rehabilitation bill and because of corresponding declarations in the unification treaty. Psychiatrists should fight for treatment costs and appropriate compensation for physical and psychiatric sequels of Stasi persecution to be set into reality as soon as possible. There is urgent need for a not yet existing scientific literature and publications of clinical experiences.

Anxiety Disorders↗
PubMed1991

[High-caloric nutrition in radiochemotherapy, nasogastric tube and parenteral nutrition versus PEG (percutaneous endoscopic controlled gastrostomy)].

The advantages and problems of different types of artificial feeding are discussed. For patients needing long-term nutritional support, we see the following special advantages of PEG: physiological enteral nutrition with an only small risk of tube dislocation, no additional handicap of the natural swallowing procedure and without stigmatizing the patient by an external visible tube (Tab. 3). To help to spread this method of artificial feeding for the benefit of the patient, this article gives some informations on how to cope with the problems that might occur when using PEG (for example: a diet plan for building up the tube food nutrition (Tab. 4).

Antineoplastic Agents↗
PubMed2004

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

BACKGROUND: The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. METHODS: We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. RESULTS: Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. CONCLUSIONS: This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

Adolescent↗
PubMed2002

Airborne pollen: a brief life.

The transfer of pollen, whether it is transported by insects or carried by the wind, from floral anther to recipient stigma is the critical reproductive event among higher plants. In this scenario, the pollen grain functions as a fully constituted life-cycle stage, capable of growth (albeit limited) and delivery of gametes. Pollen is prepared for this role by an intricate developmental process with dual sources of structural elements and chemical constituents, including allergens. The resulting complexity relates, at least in part, to the requirements of an unforgiving recognition process at stigmatic surfaces and of active growth before the achievement of gametic union. Recently, the basic participants in pollen-stigma interactions have been defined, and they provide a striking counterpoint to human histocompatibility concerns. Pollen development offers a useful tableau in terms of which to reexamine forces affecting pollen prevalence and their interactions. Development also provides clues to the sources and significance of more minute bioaerosols now known to carry pollen allergens.

Air Pollutants↗
PubMed2001

The pouch acting as a mediator between "being a person with an ostomy" and "being a professional": analysis of a pedagogical strategy.

OBJECTIVE: This study analyzes the process of constructing and reconstructing the meanings of the concepts ostomy, ostomy patient, and the nurse's role in managing an ostomy after the experience of wearing a pouch. SUBJECTS AND SETTING: Thirty nurses who were students in the Enterostomal Therapy Nursing Education Program in 1992 and 1993 participated in this study. All of the participants were female, ages 20 to 55 years, had graduated from nursing at least 6 years previously, and had been working at acute care hospital units or at outpatient care centers. The research was completed at the Enterostomal Therapy Nursing Education Program in the Nursing College of the University of São Paulo. METHODS: All participants wore a pouch and lived as an ostomy patient for a 24-hour period and then were interviewed about their experience. Two major themes were identified after analysis: "being a person with an ostomy" and "being a professional." RESULTS: The experience of wearing a pouch promoted changes in perceived role, self-esteem, body image, sexuality, and social relations. These changes were sometimes perceived as stigmatization and sometimes as enhancing social support. The perceptions caused a crisis that provoked the use of coping and social defense mechanisms that ultimately altered the participants' perceptions of the meaning of "being a nurse." Prior to this learning experience, the participants' management of patients with ostomies was fragmented and marked by a dissociation among activity, thinking, and feeling. Before the experiences, participants defined their management of patients with ostomies as mostly technical, focusing on the ostomy and the pouch. Following the experience, participants proposed changes in practice designed to care for the whole human being, revealing an incorporation of the affective, symbolic, and relational dimensions critical to managing the care of patients with an ostomy. CONCLUSION: The results showed that having subjects wear a pouch as a pedagogic strategy was successful in directing the participants' thinking about new meanings concerning "being a professional," resulting in some potential profound changes in the future nursing care of their patients.

Activities of Daily Living↗