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PubMed2006

Quality of life among unemployed and employed people in northern Sweden. Are there any differences?

This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (Hörnquist's QLcs) covering the life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", in 487 unemployed subjects and 2917 employed subjects aged 25-64, in a population-based cross-sectional study in northern Sweden. In line with previous findings, results showed that unemployed people exhibited poorer QoL. Unemployed women scored higher in existential life domains than unemployed men did. Unemployed men were worst off in terms of general life situation. Employed respondents benefited in QoL by a university/college education, while unemployed respondents with a university/college education did not. Close social relations and money reserve were associated with higher QoL generally. It was concluded that further research is needed to differentiate various aspects of QoL and unemployment, and to compare with other samples.

Adult↗
PubMed2005

Some ethical dilemmas faced by Jewish doctors during the Holocaust.

The discourse on physicians and ethics in the Nazi regime usually refers to the violation of medical ethics by Nazi doctors who as a guild and as individuals applied their professional knowledge, training and status in order to facilitate murder and medical "experimentation". In the introduction to this article I will give a brief outline of this vast subject. In the main article I wish to bear witness to the Jewish physicians in the ghettos and the camps who tried to the best of their ability to apply their professional training according to ethical principles in order to prolong life as best as they could, despite being forced to exist and work under the most appalling conditions. These prisoner doctors were faced with impossible existential, ethical and moral dilemmas that they had not encountered beforehand. This paper addresses some of these ethical quandaries that these prisoner doctors had to deal with in trying to help their patients despite the extreme situations they found themselves in. This is an overview of some of these ethical predicaments and does not delve into each one separately for lack of space, but rather gives the reader food for thought. Each dilemma discussed deserves an analysis of its own in the context of professionalism and medical ethics today.

History, 20th Century↗
PubMedDate not supplied

[Expert decisions concerning disability pensions in the area of psychiatry--in view of a court-appointed expert].

Inability of social services to provide a non-working person with the necessary minimal financial support as well as a high unemployment rate make acquiring of a disability pension appear the only means of coming to terms with existential problems. After the fairly tolerant decision policy of the Social Insurance Institution (ZUS) in the first half of the 1990s, the criteria of granting disability pensions hassince been made stricter--through replacing of the former disability pensions by the concept of inability to work. The author evaluates the theory and practice of experts' decision-making in the prospect of his over ten year experience as an expert appointed by the Regional Court of Law in Cracow. Mental disorders are rated third among disturbances most frequently indicated as the reason for deciding about long-term inability to work. Psychiatric disorders, unlike most illnesses from other domains of medicine--do not require the use of modern methods of instrumental diagnostics. The only instrument supporting the clinical diagnosis is a psychological examination--especially in regards to the assessment of the depth of intellectual deficit. In psychiatry, clinical diagnosis is of a descriptive character: "As the district psychiatrist perceives or wants to perceive the patient during the examination--so does he describe this patient in the medical documentation". It is verification of actual intensity of mental disorders during a short examination--here the examination by a Social Insurance Institution's expert physician or an expert appointed by court--that becomes a problem. Of special importance in decision making must be prescribed to medical documentation, including regularity of treatment, applied pharmacotherapy, hospital treatment and its duration, etc.

Community Psychiatry↗
PubMed2004

[Respecting rights of hospitalized children].

Children's rights are nowadays an important social, pedagogic, legal and moral problem. Practical respecting of resolutions included in the Convention on the Rights of the Child is far from perfect and requires changing social way of thinking. To attain this, the contents and essence of children's rights have to be disseminated and consequently enforced. The aim of my research was to answer the question: "What are the conditions for upholding children's right to respect at children wards?". The subject of my analysis was nurses' value hierarchy and individual conditions influencing respecting children rights. Research procedures were directed towards finding the answer to the following question: "What is the range of upholding children's right to respect?". I defined children's right to respect on the basis of analysis of Janusz Korczak's scientific output and the provisions of the Convention on the Rights of the Child. The rights being the subject of my research are classified either as "soft" or "hard" rights. "Soft" rights are defined in articles no. 12-16 and 31. Rights defined in articles no. 6, 7, 9 and 24 are referred to as "hard" rights. The synthesis of research results leads to the following solution of the research problem: The assumption of a strong influence of the most important values on mental life-thinking, perception, emotional-motivation processes, attitude and behavior of questioned nurses did not have proper empirical confirmation. Nurses' value hierarchy does not ensure upholding of children's right to respect in hospitals. Nurses' awareness of children rights reaches average level, while their knowledge and activity are at low level, and understanding of essence of children's rights and valuation of the rights--at average level. Average level of awareness of respecting children's rights makes children's existence in hospital imperiled by intuitive, often routine activities of nurses. The level of nurses' awareness is differentiated by age, place of employment and seniority. The dependence of awareness level upon questioned nurses' education has not been proved. The scale of upholding of children's right to respect has been defined on the basis of assumed indices conditioning the respect at an average level. It does not prove that children rights are respected in hospitals, as some of the rights are respected only to a small extent, causing menace to children existence. To change the existing situation, regular assessment of respecting children rights by all medical personnel shall be conducted regularly. Legal issues shall be included in the list of obligatory subjects of nursing studies and of all external forms of additional nurse training. These and other activities shall ensure existential safety for children in the hospital and increase the prestige of a nurse as a job.

Child↗
PubMed2005

[The endless bonds and the challenges to medicine].

This paper summons to contest some of the bonds that will be severed, probably, by the new eugenics, and may be repaired by narrative-based medicine, two of the most extreme and contradictory challenges to today's--and tomorrow's--medical practice. Accordingly, I intend to frame its development into the unbounded mathesis of biomedicine with the hindsight intention of questioning the foundations both of the ethical basis of the beginning of life medical decisions and of the end of life medical decisions. I will defend that, since clinical experience always embodies existential and anthropological density, and always has moral value, medical decision making seems not to be totally reducible to any algorithm or to the genetization of the live world.

Bioethical Issues↗
PubMed2006

[Relief for surviving relatives following a suicide].

After the suicide of a 43-year-old woman with known depression, a 41-year-old paraplegic man who recently developed diarrhoea and a 41-year-old woman with probable depression with symptoms of psychosis, the general practitioners of the surviving relatives offered a sympathetic ear, answered questions and prescribed sedatives and/or follow-up counselling. Completed suicide occurs 1500 times each year in the Netherlands and is strongly associated with psychiatric morbidity as well as psychological features like hopelessness and inability to solve problems. Generally, this irreversible act ofdespair can lead to existential difficulties in surviving relatives. Following a loss, acceptance of reality is essential to initiating effective emotional processing. The general practitioner is often first and foremost involved in providing support and comfort to bereaved families, during which many questions about the cause of death are brought up. The general practitioner helps the family to reconstruct the rationale behind the suicide in order to initiate effective emotional processing. In addition, the general practitioner can assess the risk of psychiatric morbidity, including suicidal behaviour, in surviving relatives.

Adult↗
PubMed2003

Rethinking mental health: a European WHO perspective.

In spite of recent clinical and research advances, an increased burden of mortality and morbidity related to stress and mental ill health can be noted, especially in European societies and populations undergoing stressful transitions and dramatic changes. A societal syndrome, consisting of depression, suicide, abuse, risk-taking and violent behaviour as well as vascular morbidity and mortality, can be observed, reflecting individual psychopathology related to disturbances of the serotonin metabolism as one of the oldest, most basic cerebral instruments of mankind to survive, to socialize, to cope with stress and danger. In a time where mental health professionals look for new and challenging identities, they have a tendency to abdicate from social psychiatric and public health activities in favour of more prestigious positions in brain research, genetics or advanced psychotherapy. A redefinition, reconceptualization and renaissance of social psychiatry seems timely and necessary, responding to the burden, advances and possibilities related to mental health we find today. It should proceed from the reductionism which often has characterized earlier psychosocial and social psychiatric approaches, utilize modern knowledge about neuroplasticity, psychoimmunology, neuropsychology and neurophilosophy, reflect the interaction between environment and structure, nature and nurture, and integrate different areas of knowledge in a holistic public mental health approach. Political decisions and societal solutions can be more or less in line with basic human preconditions. Consequences of failure to respect this already can be seen. A new awareness and responsibility-taking with regard to basic human ethological, physiological, psychological and existential conditions is needed and has to be concretized in innovative public mental health approaches.

Journal Article↗
PubMed2006

[Hopelessness in patients with schizophrenia. Suffering from and with schizophrenia].

BACKGROUND: Clinical experience shows that feelings of hopelessness quite often arise in patients with schizophrenia. AIM: To describe these feelings of hopelessness, obtain insight into interrelated factors, distinguish hopelessness from depression, study the influence of hopelessness on suicidal behaviour andfind out how feelings of hopelessness can influence the treatment that is provided. METHOD: We searched the literature via MEDLINE and PsyCINFO using the key words 'schizophrenia', 'hopelessness', 'demoralization', and 'disappointment'. RESULTS: Demoralization is a broader term than hopelessness and is used quite often. Positive correlations arefound between hopelessness and: (1) awareness of illness; (2) engulfment; and (3) depressive symptoms. Negative correlations are found between hopelessness and: (1) cognitive disorders; and (2) an avoidant coping style. Hopelessness and demoralisation cannot be equalled with depression. Hopelessness clearly heightens suicidal tendencies. Feelings of hopelessness in a patient suffering from schizophrenia signal that closer attention should be given to that patient. CONCLUSION: Feelings of hopelessness in patients with schizophrenia are not necessarily a sign of pathology but may point to existential suffering. This needs to be recognised by those dealing with persons sufferingfrom schizophrenia,

Major Depressive Disorder↗
PubMed2006

Palliative care for specific populations.

BACKGROUND: Ensuring access for all Australians to high quality palliative care requires an understanding of special considerations for specific populations, including children, older persons, and Indigenous Australians. OBJECTIVE: This article reviews some specific considerations for selected populations requiring palliative care. DISCUSSION: The complex clinical and support needs of children needing palliative care requires a well coordinated multidisciplinary team, inclusion of parents and siblings as part of the unit of care, and the use of developmentally appropriate communication strategies. Older people too may have different palliative needs. These include the need for careful assessment to ensure that reversible conditions, and emotional and existential concerns are not overlooked. Where the preferences and wishes of the person cannot be obtained, various clinical, ethical and legal principles will guide decisions. To ensure culturally appropriate care is provided to Indigenous Australians requiring palliative care, both Indigenous organisations and people should be included in the planning and provision of care.

Aged↗
PubMedDate not supplied

[The eclectic individual psychotherapy of a dysthymic patient--case study].

The article describes the case of eclectic individual psychotherapy of a dysthymic patient. The therapeutic process integrated elements of the following psychotherapeutic approaches: psychodynamic, behavioural-cognitive, systemic, interpersonal, existential and Gestalt. The paper discusses history of treatment, diagnosis of dysthymia, indications for psychotherapy, course of the sessions. Anamnesis, factors contributing to the disorder, triggers and factors sustaining the symptoms, personality factors were also analysed. Therapeutic goals and applied techniques are presented.

Adult↗
PubMed1978

[Gestalt therapy.].

The authors describe Gestalt Therapy. They retrace its fundamental theoretical axes. These are psychoanalysis, character analysis, the german Gestalt theory of perception, existentialism, and the Orient. Some principal concepts are then elaborated more fully such as the cycle of awareness, desensitization, excitation anxiety and the five defense mechanisms: retroflection, introjection, projection, deflection, and confluence. The nature and goals of the therapeutic process are also described before the presentation of some techniques specific to this approach such as enactment and role playing. Finally, certain basic Gestalt rules, which aim at facilitating and intensifying the communication process among group members, are enunciated.

English Abstract↗
PubMed2006

[Psychological and psychopathological assessment of the patient with amyotrophic lateral sclerosis].

Management of patients with amyotrophic lateral sclerosis (ALS) implies the participation of many health care professionals. The needs and goals of the patients cannot be limited to functional factors and should be considered in their full psychological, social and familial settings. Thus, much of the care for patients with ALS must focus on symptom relief, comfort and psychological support in order to improve their quality of life (QOL). Studies have demonstrated the significant role of psychological, existential and supportive factors in determining QOL in these patients. This work deals with psychological assessment in patients with ALS and reported studies within this population. Psychological assessment may vary and its methodology depends on the goals. Most frequently, psychological assessment implies depression and anxiety, coping strategies or quality of life.

Amyotrophic Lateral Sclerosis↗
PubMed2006

[Handicap and quality of life assessment in amyotrophic lateral sclerosis].

Measures of handicap progression alone are insufficient for assessing what a patient experiences. Handicap results from the interaction between a person's disabilities and the social, familial and environmental factors which determine his or her living conditions. Other factors condition quality of life: of these, psychological and existential factors and an individual's ability to adapt play a fundamental role. Measuring handicap and quality of life must provide medical care providers with comprehensive knowledge of the way in which an individual experiences the disease, his or her handicap and the side effects and constraints of treatments within his or her own life context.

Amyotrophic Lateral Sclerosis↗
PubMed2006

[Psychological management of patient with amyotrophic lateral sclerosis and their caregivers].

Psychological management of patients with amyotrophic lateral sclerosis (ALS) and their caregivers is a relatively recent concern, probably because there was previously a tendency to consider only physical functioning. Recent work have focused more on psychological well-being concerning patient and their close relative and have highlighted the great need for considering psychological reactions after such a diagnosis. The needs and goals of the patients cannot be limited to functional factors and should be considered in their psychological, social and familial settings. Currently, we consider that close relatives should benefit from psychological support just like patients with ALS. This review suggests different ways to improve management of patients with ALS, while considering personal for strategies coping with the disease, the familial and social context, and individual factors that could improve quality of life (QOL). Studies have demonstrated the significant role of psychological, existential and support factors in determining QOL in these patients.

Amyotrophic Lateral Sclerosis↗
PubMed2006

[Religiosity and mood in the last week of life: an explorative approach based on after-death proxy-interviews].

The current contribution focuses on the role of religiousness on aspects of mood in the last week of life. After-death interviews with proxy respondents of deceased participants of the Longitudinal Aging Study Amsterdam provided information on depressive mood and anxiety in the last week of life, as well as on a sense of peace with the approaching end of life. Furthermore, the proxy respondents were asked about serious physical symptoms in the last week of life, cognitive decline, salience of religion, and whether the deceased respondent had talked about religion. Other characteristics were derived from the last interviews with the respondents when still alive: depressive symptoms, religious affiliation, church-attendance, orthodoxy, salience of religion, and cosmic transcendence. None of the characteristics of religiousness were significantly associated with depressive mood or anxiety as estimated by the proxy-respondent. A sense of peace, however, was predicted by higher church-attendance, Protestant affiliation (as compared to no affiliation), and the proxy's estimate of the salience of religion. It is concluded that religiousness does not affect depressive mood or anxiety in the last week of life in the current sample. Possibly, religiousness supports a sense of peace, which may be a more existential facet of mood, and which is discussed as relevant in the last phase of life and in palliative care.

Adaptation, Psychological↗
PubMed1991

[The experience of being a family caregiver to a person after a stroke: a review of the literature].

This paper presents a review of literature on the subject of being a family caregiver to a stroke patient. This review allows the nurse to better understand the factors which influence the role of the family caregiver and identifies directions for action to improve the quality of care to this population. The article examines the multidimensional aspects of being a family caregiver to a stroke patient. The Given et al. (1988) model of care explains the interaction of the factors which have an effect on the role of the caregiver. These factors include the quality of the marital relationship, the personal characteristics of the family caregiver, the needs and reactions of the ill person and the environment of the family caregiver. The aim of the model of care is to ensure maximum functioning of the ill person and minimize the negative effects of being a caregiver. The paper also explains how the Strauss and Corbin (1988) health problem trajectory model helps nurses to better understand the reactions and perceptions of a stroke patient. As well, it specifies the existential phenomelogical perspective advocated in caring theory. This care model teaches nurses to understand the individual reactions of the family caregiver and helps her realize the hard realities of life. Such insight assist the family caregiver to develop inner strengths and a sense of control over life which will help the caregiver to transcend her situation.

Cerebrovascular Disorders↗
PubMedDate not supplied

[Macro-social stress in adolescence--results of a repeat-interview about war anxiety and anxiety of environmental destruction].

The article reports first results from a follow-up survey (N = 837) on existential anxieties with a sample of 8- to 20-year-olds from the Federal Republic of Germany who had been questioned first in 1985. The report focuses only on data gathered with the 'worry scale' by Goldenring und Doctor. Analyses based on a time-sequential-design show that (cross-sectionally as well as longitudinally) personal worries (concerned with everyday hassles, critical life-events, and micro-social stressors) decline with age. For politically based worries (concerned with so-called macro-social stressors), however, there is a strong gender difference: While in the cross-sectional analyses there is no mean difference between older and younger adolescents of both sexes, the longitudinal analyses show a possibly historical effect: Not only do girls express more personal als well as political worries (in whatever way this may be interpreted psychologically), their worries in the political field even increased at the end of the eighties whereas fears of boys in that domain remained constant. Consequences of the gulf war are briefly discussed.

Adaptation, Psychological↗
PubMed1991

Religious involvement and subjective well-being.

This study examines the multifaceted relationships between religious involvement and subjective well-being. Findings suggest that the beneficent effects of religious attendance and private devotion reported in previous studies are primarily indirect, resulting from their respective roles in strengthening religious belief systems. The positive influence of religious certainty on well-being, however, is direct and substantial: individuals with strong religious faith report higher levels of life satisfaction, greater personal happiness, and fewer negative psychosocial consequences of traumatic life events. Further, in models of life satisfaction only, the positive influence of existential certainty is especially pronounced for older persons and persons with low levels of formal education. Finally, there are persistent denominational variations in life satisfaction, but not in happiness: nondenominational Protestants, liberal Protestants, and members of nontraditional groups such as Mormons and Jehovah's Witnesses report greater life satisfaction than do their unaffiliated counterparts, even with the effects of other dimensions of religiosity held constant. Several directions for additional research on religion and psychological well-being are discussed.

Female↗