The development of a case group concept for patients with mental diseases

In the year 2000 the German legislative decided to implement a case-dependent reimbursement system in an acute inpatient setting beginning in 2003. The German-Diagnoses Related Group System (G-DRGs) will adopt the refined version of the Australian-Diagnoses Related Group System (AR-DRG, version 4.1). Based on empirical data and expert? panels the acute psychiatric hospitals have been exempted from the adoption of the case-based payment system. With regard to national and international experiences in the development of patient classification systems in psychiatry and medical rehabilitation this article illustrates the development of a case group concept for patients with mental disorders.     

Selection of outcome assessment instruments for inpatients with severe and persistent mental illness

The purpose of this article is to describe a procedure to assist in selecting outcome measures for inpatients treated at a state psychiatric hospital. The procedure combines evidence-based criteria from the literature, instruments shown to be sensitive to change in clinical trials, and the perspectives of a multidisciplinary team of researchers, administrators, providers, and patient advocates. Recent efficacy and effectiveness studies were used to identify recurrently used outcome instruments. A computerized search of more than 30 bibliographic databases, such as PsycINFO, MEDLINE, Social SciSearch, and ERIC, was conducted for articles published between 1990 and 2002. Comparisons of the most frequently used instruments were made on seven criteria proposed as best-practice indicators, including sensitivity to change and robust psychometrics. The sample produced 110 measures. Rater-completed instruments were represented more often than patient-completed ones. However, considerable variability across both methods was found on the criteria. The limited resources associated with publicly funded inpatient facilities led to a recommendation to select at least one rater-completed and one patient-completed instrument.     

Psychometric evaluation of a self-report measure of depression for individuals with mental retardation

The psychometric properties of the Self-Report Depression Questionnaire (SRDQ) were evaluated, extending a previous assessment of this instrument. Data from two independent studies (Esbensen, 2004; Seltzer & Krauss, 1989) were pooled to generate a sample of 192 individuals with primarily mild or moderate mental retardation. Reliability estimates of this questionnaire were good to excellent and corroborated prior findings. In addition, the measure was found to have sound validity as evidenced by convergent validity, discriminant validity, and predictive validity and by comparing individuals with and without clinical diagnoses of depression. Thus, the SRDQ appears to be a reliable and valid measure of depressive symptomatology for individuals with mild or moderate mental retardation. Screening procedures are suggested.     

住院精神障碍患者抗精神病药物一日处方调查

目的 了解我院住院精神障碍患者抗精神病药物的使用情况及其用药规律.方法 采用一日法对本院住院精神疾病患者的抗精神药物应用状况进行调查.结果 (1)住院精神疾病种类构成发生了一些变化;(2)两药联用与单药治疗并重;(3)药物以利培酮处方量第一;(4)St精神病药物的使用剂量基本都在推荐的安全剂量之内.结论 目前本院药物使用以非典型抗精神药物为主,抗精神病药物使用合理.     

住院精神疾病患者药物治疗临床分析

目的:分析目前住院精神疾病患者所接受的药物治疗是否规范.方法:采用自行设计的问卷,调查湖南省7所精神病院住院病人658例用药情况.结果:62.6%的病人为单一用药.精神分裂症治疗最常用药物是氯氮平(41.9%),最常用的联合用药为氯氮平 舒必利;情感障碍治疗最常用药物是碳酸锂(41.8%),最常用的联合用药是碳酸锂 氯氮平.结论:多数精神病院的住院病人的用药是规范的,但也存在不合理用药的现象.     

Increasing self-esteem: Efficacy of a group intervention for individuals with severe mental disorders

BackgroundIndividuals with psychosis are known to have a lower self-esteem compared to the general population, in part because of social stigma, paternalistic care, long periods of institutionalization and negative family interactions. This study aimed at assessing the efficacy of a self-esteem enhancement program for individuals with severe mental illness and at analyzing the results in their European context.MethodA randomized cross-over study including 54 outpatients with a diagnosis of schizophrenia from Geneva, Switzerland, was conducted. Twenty-four were recruited from an outpatient facility receiving traditional psychiatric care whereas 30 came from an outpatient facility with case-management care. Psychosocial, diagnostic and symptom measures were taken for all the subjects before treatment, after treatment, and at 3-months' follow-up.ResultsResults indicated significant positive self-esteem module effects on self-esteem, self-assertion, active coping strategies and symptom for the participants receiving case-management care. Results were not significant for those receiving traditional care. However, 71% of all participants expressed satisfaction with the module.ConclusionIndividuals with schizophrenia appear to be benefit from the effects of the self-esteem module, particularly when they are involved in a rehabilitation program and followed by a case manager who liaises with the other partners of the multidisciplinary team. This encourages reconsidering the interventions' format and setting in order to ensure lasting effects on the environment and in turn on coping, self-esteem and overall empowerment.     

精神疾病住院患者幻觉属性分析

目的：了解幻觉属性的相互关系。方法：应用幻觉量表对83例精神疾病患者进行评定，并进行18项属性的相互的相关分析。结果；18个属性中的大多数属性之间都存在着统计学意义的相关性。结论：幻觉大多数属性相关性好，效应属性项目可能是幻觉的主要特征。     

Factors associated with self-report of sexual violence against men and women with mental disorders in Brazil

Objectives

Patients with mental illness (PMI) are more vulnerable to sexual violence (SV). This study aimed at assessing factors associated with SV against PMI, stratified by gender in Brazil.

Methods

Cross-sectional multicenter study with a national sample of 2,475 PMI randomly selected from 26 psychiatric services. Odds ratios were estimated with 95% confidence interval using logistic regression.

Results

A high prevalence of lifetime SV against PMI was observed (19.8%) and it was higher among women (26.6%) than men (12.5%). Among women, episodes of SV were more often caused by intimate partners and in the domestic environment, and among men, by strangers and in the streets. Among women, the following variables were independently associated (p?Conclusions The prevalence of SV in the studied population was high, especially among women. Women have more behavior factors associated with SV and they need protection, especially those in isolation and socially deprived. However, men also suffer SV, usually more often during childhood than adulthood and special attention should be given to lifetime illegal drug use and earlier psychiatric hospitalization. Preventive actions beyond mental health are important, such as social and economic actions to improve the living conditions of PMI.     

Cognitive-behavioral group therapy for insomnia in individuals with serious mental illnesses: a preliminary evaluation

Chronic insomnia is a problem among individuals with serious mental illnesses. In an effort to expand treatment options, we examined whether well-established cognitive-behavioral treatments for insomnia developed for individuals in the general population generalize to those for people with serious mental illnesses. Individuals participated in comprehensive sleep evaluations and cognitive-behavioral therapy. Results suggest that sleep problems often began during periods of distress and/or exacerbation of illness but were maintained by environmental, behavioral, and cognitive factors. With the treatment, participants reported improvement in many sleep parameters. Initial indication is that cognitive-behavioral therapy does generalize. More rigorous research seems warranted.     

Substance abuse and mental disorders: the dual diagnoses concept

The concept of "dual diagnoses" is reviewed along with its clinical implications. Prevalence studies report substance abuse in psychiatric populations as ranging between 20% and 75%, depending on reporting, demographic variables and the community availability of substances. On the other hand, 20% to 65% of alcoholics entering rehabilitation suffer from another major psychiatric disorder. The clinical impact of dual diagnoses involves the development and expression of psychiatric disorders depending on the choice of drugs, the severity of psychopathology and risk of assaultive behaviour, possible misdiagnosis such as the confusion between alcoholism and affective disorders, the increased use of psychiatric resources including emergency, an earlier onset of symptomatology and poorer prognosis. The evolutionary impact of the concept, reflected in successive psychiatric diagnostic classifications, is discussed along with its bridging influence between the fields of mental health and addictionology. Appropriate assessment tools along with treatment strategies are suggested. Effective features of a group process include a nonconfrontational approach with emphasis on education, an expectation of abstinence as a goal, a discussion of diagnoses and medication and lastly particular attention to vocational rehabilitation and constructive use of leisure time.     

精神障碍非自愿住院患者胁迫体验及其影响因素

目的 初步调查精神障碍非自愿住院患者在入院过程以及住院期间的胁迫体验感知,并 探讨其影响因素。方法 选择2017 年3— 8 月于上海交通大学医学院附属精神卫生中心徐汇院区 的6 个封闭病房内根据《精神卫生法》第三十条要求入住的254 例精神障碍非自愿住院患者,在入院 后的第3 周采用自编的基本情况调查表、简明精神病量表（BPRS）、MacArthur 入院体验主观胁迫分量表 （MPCS）、胁迫体验问卷（CES） 进行问卷调查。根据本次入院前是否征求过本人意见将所有患者分为征求 意见组（115 例）与未征求意见组（139 例）。应用SPSS 22.0 软件进行统计学分析,组间比较采用独立样本 Mann-Whitney 检验或Kruskal-Wallis 检验、χ2 检验, 采用Bonferroni 法校正显著性水平的事后两两比较。 采用相关分析了解MPCS、CES 与BPRS 症状得分的相关性,采用回归分析探索胁迫体验得分的影响因 素。结果 （1）相对精神科的封闭环境,患者的胁迫体验更多源于自我选择和决定权的受限。（2）入院 时未征求意见组患者较征求意见组患者在MPCS 总分［4.00（2.00,5.00）分比1.00（0,2.00）分,Z=8.592, P＜ 0.01］、CES 量表总分［52.00（39.00,81.00）分比44.00（34.00,56.00）分,Z=3.236,P＜ 0.01］及维度分 ［权利限制13.00（9.00,27.00）分比9.00（9.00,15.00）分,Z=3.746,P＜ 0.01;被动14.00（10.00,24.00）分比 12.00（9.00,18.00）分,Z=2.861,P＜ 0.01;负性环境9.00（6.00,13.00）分比8.00（6.00,10.00）分,Z=2.000, P＜ 0.05;负性反应4.00（2.00,6.00）分比3.00（2.00,5.00）分,Z=2.706,P＜ 0.01）］上得分更高。（3）入院 前未征求意见、公安机关送诊、教育程度高是MPCS总分的影响因素（F=25.076,P＜0.01）,经历约束措施、 BPRS 思维障碍严重和入院时胁迫体验高是CES 总分的影响因素（F=5.135,P＜ 0.01）。结论 精神障碍 患者在入院和住院过程中存在一定胁迫体验,这种主观负性体验与多种因素有关,临床上应多加关注, 并采取针对性措施降低患者对胁迫的感知。     

Psychiatric disorders and the need for mental health services among a sample of orthopedic inpatients.

This report concerns psychiatric disorders and the need for mental health services among patients admitted to a general orthopedic surgery service. The planning of mental health services for medical and surgical inpatients in terms of current community mental health concepts is discussed.It has been observed that patients being treated for medical or surgical conditions have a higher than expected incidence of psychiatric disorders.^1–6 Previous studies of inpatients with orthopedic or other surgical conditions report a wide range (19%–86%) of psychiatric disorders depending upon the diagnostic criteria employed. In spite of the documented need for mental health services among such patients, primary physicians are often reluctant to request psychiatric consultation, and the psychiatrist is usually consulted only when a patient presents a difficult management or diagnostic problem.^3,7,8 Thus, many other medical or surgical patients could benefit from mental health consultation if their needs could be identified.In recent years, psychiatrists have become more involved in the functioning of general medical services, with consideration being given to the application of the principles of community mental health to the consultation services.^2,4,9–12 Psychiatrists have participated in indirect consultation through the medical and nursing staff in addition to providing direct consultation within medical and surgical settings. In planning this type of consultation service, more information is needed about the kinds of mental health problems experienced by medical and surgical patients.     

上海市民政系统精神病院住院的精神疾病患者共病躯体疾病分析

目的:了解上海市民政系统精神病医院住院慢性精神疾病患者共病躯体疾病状况。方法:采用自制《病例收集表》调查上海市民政系统精神病医院住院的所有精神疾病患者合并躯体疾病情况及影响因素。结果:1 707例患者中900例(52.7%)共病躯体疾病;前6位依次为高血压病(349例,20.5%)、糖尿病(204例,12.0%)、贫血(145例,8.5%)、心律失常(141例,8.3%)、白细胞减少症(131例,7.7%)及冠心病(120例,7.0%);共病躯体疾病1种600例(35.2%),2种228例(17.0%),≥3种72例(4.2%);共病率随患者年龄及住院时间增加显著增高(P0.01或P0.05)。服用抗精神病药患者糖尿病和心律失常的共病率明显高于未服药患者(P0.05或P0.01);服用第二代抗精神病药患者心律失常和冠心病共病率明显高于服用第一代药患者,白细胞减少发生率明显低于服用一代药患者(P均0.05);联合用药患者心律失常及冠心病发生率明显高于单一用药者(P0.01或P0.05);躯体疾病共病为因变量的回归分析显示患者年龄及服用抗精神病药数量进入模型(P均0.01)。结论:民政系统长期住院的慢性精神疾病患者躯体疾病共病率高,以高血压病、糖尿病、贫血、心律失常和白细胞减少症常见;年龄及服用抗精神病药数量是其影响因素;对共病躯体疾病的患者更应单一用药。     

A creative reminiscence program for older adults with severe mental disorders: Results of a pilot evaluation

Objective: Older adults with severe mental disorders experience major dissatisfaction with conditions of life that are connected with aging. To assist them in developing a coherent, meaningful life-story and to improve their life satisfaction, we conducted a pilot evaluation of a creative reminiscence program called Searching for meaning in life.

Methods: One week before and one week after the intervention 36 participants from three psychiatric hospitals and one sheltered housing program were interviewed. Life satisfaction was measured with the Manchester Short Assessment of Quality of Life (MANSA) and the Philadelphia Geriatric Center Moral Scale (PGCMS). At follow-up questions were also asked about the intervention.

Results: About 78% of the participants completed the course. Most of them were satisfied with the course (74%). The overall sample showed significantly more life satisfaction after the intervention. Participants with a psychotic disorder also improved significantly in life satisfaction but at the same time their depressive symptoms increased significantly. Participants with a moderate to high level of depressive symptoms at baseline had relatively favorable outcomes. Their life satisfaction had improved significantly and they especially had a better attitude toward their aging.

Conclusion: The program is feasible and acceptable for adults with severe mental illness and it has potential benefits for them. More research is needed to find out what explains the increase of depressive symptoms for participants with psychotic disorders.