Seasonally-related inpatient admission of affective patients

Over a period of four years, 316 emotionally disordered patients were inspected for the frequency of seasonally conditioned hospitalisation, considering however solely the most recent prior hospitalisation within the four-year period. A cautious interpretation of the results would suggest significant differences in the seasonal frequency of emotional disorders that have resulted in hospitalisation. Manic depressive disorders, endogenous depression, and involutional depressions treated in hospital occur with the greatest frequency in autumn. These results suggest the possibility of employing thymoleptic treatment, notably to effect an influence on biorhythms, for instance, lithium, deprivation of sleep, and bright-light therapy.     

Normative and legal procedure prerequisites in the commitment of psychiatric patients in relation to Paragraph 6 of the Commitment Law of East Germany

An analysis has revealed the following typical mistakes in the application of article 6 of the Commitment Act: Commitment is often not preceded by an interview with the patient. Many of the patients committed under article 6 would have agreed to hospitalisation anyway. In most cases, the reasons given for commitment under the Act are inadequate and too vague. The patients are not usually given the commitment order in writing. The district medical officers often fail to inform the local councils or the state attorney. The patients are very rarely instructed of their rights. In many cases the demands placed on the hospital responsible for treatment are inadmissible, such as commitment to closed wards or requests for indefinite hospitalisation.     

癫痫诊治中医患同盟建立的实践与策略

癫痫治疗目前仍以长期科学规范的药物治疗为主,为保证医生的治疗计划得到贯彻,在诊治中努力寻求医患同盟的建立尤为重要,让患者清楚地认识到医生对他的关注,认识到医生治疗的计划性、和具有应对各种情况的措施方法和能力,是寻求患方合作的基本条件。本文就医生首诊中的任务、人文关怀的重要性、如何共同进行药物选择、副反应规避、家属不良治疗心态纠正等问题进行探讨。     

Pragmatic Existential Therapy

A pragmatic model of existential therapy is offered to support the thesis that brief, solution focused therapy is a clinical application of existential psychology. Superseding pioneering existential therapies more concerned with insight than with clinical technique, pragmatic existential therapy is a dynamic clinical intervention facilitating in patients, decision, choice, self-commitment, and concrete action, the goal of which is movement toward the future and fulfillment of patients' latent potentials. In addition to clarifying the model's theoretical focus on (a) lived experience, (b) self-creation, and (c) existential anxiety, practical guides to brief existential treatment are offered. Sources from existential philosophy and psychology, as well as brief solution focused treatment, are used to evidence core elements of an existential therapy that is not contemplative and insight-focused, but pragmatic and action-based.     

Coercion and ‘voluntary’ admission: An examination of psychiatric patient views

This article examines coercion in voluntary psychiatric patients. Three main themes are highlighted using qualitative and quantitative data from a sample of 412 psychiatric patients surveyed in 1990 who had experienced at least one period of hospitalisation. The themes are: the extent to which the label of ‘voluntary’ was an indicator of the patients' experience of being in hospital of their own volition; aspects of admission which patients considered to be coercive; and the impact that coercion might have on patients' views about their problem, professionals and treatment. The findings suggest that a substantial number of nominally voluntary patients reported coercive aspects of their hospitalisation. The impact of feeling coerced was found to produce a more rejecting attitude towards psychiatric services. The findings are discussed in relation to British mental health legislation and care. I particularly want to thank David Pilgrim for his collaboration with the research which made this article possible and for his useful and supportive comments. I am also indebted to John Monahan for his helpful comments on an earlier draft of this paper.     

Therapeutic failure in a case of aversion therapy

A problem of paramount importance in the application of behaviour therapy concerns the relationship between personality parameters and the therapeutic outcome of such therapy, particularly in the case of aversion therapy. This report is concerned with a comparison between two patients with similar psychometric scores and similar complaints, one of whom responded well to aversion therapy while the other withdrew from treatment. It is argued that this differential response to treatment was due not to the amount of anxiety present but rather to a specific fear in the case of the latter patient that the treatment itself would precipitate cancer. Precautionary enquiries along these lines should, in future, be carried out prior to embarking on an aversion therapy programme.     

Psychoanalytic Considerations Regarding the Occupational Therapy Setting for Treatment of the Psychotic Patient

Occupational therapists have always been concerned with the treatment of the psychotic patient. Oddly enough, the traditional setting offered to these patients in occupational therapy has not been the object of too much thought or consideration. In order to attain a therapeutic process, the therapeutic setting must be defined furst. The need for such a measure appears essential in therapy with the psychotic patient since his/her own internal structure is impaired. To understand fully the process of the therapy one must take a look at the impact of all dimensions of the setting. This paper discusses the psychodynamic consequences of the setting in occupational therapy in the treatment of psychotic patients.     

浅谈对慢性前列腺炎的认识与思考

慢性前列腺炎是中青年男性常见疾病,其病因和发病机制尚未明确,诊断标准和治疗方法仍存在不少缺陷。当前须不断提高对慢性前列腺炎的认识,改进和细化分类方法,并重视对慢性前列腺炎患者的心理治疗,从而提高治疗效果。     

关注幽门螺杆菌治疗中的实际问题

我国对Hp感染诊断和治疗有自己的标准,也有很多成熟的经验,但在根除HP治疗过程中,存在诸多问题,如过度医疗、适应证掌握不严格、第一次根除失败后再次治疗不规范等。我们应共同关注这些问题,提高Hp根除率,降低治疗中的副作用,对HP的许多未知问题从不认识到认识。     

Chronic depressive syndrome--characteristics and therapeutic possibilities

The files of 322 patients with depressive syndromes in the period 1978-1987, covering 413 in-patient treatments, revealed therapeutic factors whose tendency is to lengthen the period of hospitalisation. There is no indication of therapeutic factors with a tendency to reduce the length of time spent in hospital. Lithium treatment was again shown to increase the hospital stay (chronicity of the overall disorder), others being (treatment with/Netofenazat), electric shock treatment during the initial disorder, and optimum simultaneous treatment with thymoleptics.     

Response to Comment by Carere-Comes

Carere-Comas is concerned that I have elevated the client as a hero. I point out that what I really am arguing for is a paradigm shift from therapy as treatment to therapy as mutual, intelligent collaboration. I also discuss what it means to say that the client knows what he or she wants and needs. Finally I discuss the idea that it is the client who makes therapy happen.     

Propionibacterium granulosum KP-45 in the treatment of subacute sclerosing panencephalitis

3 groups of patients, who suffered on SSPE (without treatment, with isoprinosine therapy, combined treatment with propionibacterium granulosum and isoprinosine) are compared. The results show a favourable effect of the combined treatment in a part of the patients. They are discussed in detail.     

Manualized Treatment of Panic Disorder in a Medical Setting: Two Illustrative Case Studies

People who experience panic attacks (PAs) typically present to medical settings, concerned that their symptoms signify a life-threatening condition. Despite the efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD), medical practitioners seldom provide this type of treatment. Physicians may lack the time or expertise to impart such behavioral medicine interventions, while patients may find group or individual CBT too costly even when available. Researchers have begun investigating manualized CBT as a cost-effective alternative when traditional forms of this intervention are prohibited. This article describes two case studies in which women presenting to a medical clinic with PD were treated with 6 weeks of manualized CBT after pharmacotherapy was unsuccessful or unpalatable. Both patients exhibited reductions in panic and depressive symptomatology over baseline levels, along with increases in self-efficacy regarding their ability to manage future PAs. Improvements were maintained over 12 months, supporting continued use of manualized CBT as a supplement or alternative to pharmacological methods of treating PD in the medical setting.     

Family therapy and the notion of accountability: With reference to trends in individual psychotherapy

Family therapy both overseas and within Australia has seen a rapid rise in popularity and general acceptance as an important therapeutic intervention. Along with the growth in interest, however, has come an increased demand for accountability. The foundation stone for the accountability issue surrounds the questions of therapy efficacy. How effective is family therapy, and, indeed, if it is effective, what are the active elements or ingredients which facilitate positive client change? Three groups, in particular, have vested interests in questions relating to the effectiveness of family therapy: researchers, therapists, and consumers. Although both researchers and therapists, for a variety of reasons, have been concerned with the effectiveness of treatment for some time, it has only been relatively recently that there has been a concerted push from various sections of the consumer group, including administrators, legislators, and policy makers. The consumer group is now providing pressure on professionals as to what we have done, and are doing, to demonstrate that family therapy really “works.”     

Annotation: culture and family therapy

This annotation considers the importance of understanding culture for the theory and practice of family therapy. A number of theoretical approaches are described. Some are concerned with ubiquitous and universal family processes like the family life cycle, while others are concerned with the particularity of family life such as the content of myths and rituals. Some practical implications for the participants of the therapy, and the choice of therapeutic approach is discussed.     

Cognitive changes following subthalamic nucleus stimulation in two patients with Parkinson disease

The limits of a drug therapy in severe forms of Parkinson disease have led to refining neurosurgery on the basal ganglia. Deep brain stimulation of the subthalamic nucleus has been recognized as one of the most promising techniques to decrease "off" motor symptoms and motor fluctuations, allowing a reduction of drug therapy and limiting side effects of the drugs. There is still open debate on the possible consequences of chronic subthalamic stimulation in other ways, apart from motor symptoms, of general cognitive performance. We examined and followed two patients with Parkinson disease for 9 mo. after surgery for deep stimulation, studying their cognitive performances. There is a general amelioration of cognitive performances, in particular as far as linguistic capabilities is concerned. We discuss the possible significance of these results, reminding strenuously that only two patients were involved, so the potential for generalization is seriously limited.     

Treatment-resistant panic disorder

A substantial number of patients with panic disorder and agoraphobia may remain symptomatic after standard treatment (including selective serotonin reuptake inhibitors, tricyclic antidepressants, benzodiazepines, or irreversible monamine oxidase inhibitors). In this review, recommendations for the treatment of patients with panic disorder and agoraphobia who do not respond to these drugs are provided. Nonresponse to drug treatment could be defined as a failure to achieve a 50% reduction on a standard rating scale after a minimum of 6 weeks of treatment in adequate dose. When initial treatments have failed, the medication should be changed to other standard treatments. In further attempts at treatment, drugs should be used that have shown promising results in preliminary studies, such as venlafaxine. Combination treatments may be used, such as the combination of an selective serotonin reuptake inhibitor and a benzodiazepine. Psychological treatments such as cognitive-behavioral therapy have to be considered in all patients, regardless whether they are nonresponders or not. According to existing studies, a combination of pharmacologic treatment with cognitive-behavioral therapy can be recommended.     

男性不育症临床工作的问题与思考

在临床工作中,不育越来越受到大家的重视,但仍然有许多问题困扰着我们的医疗工作者,多数医生能对男性不育症做出诊断,并给予治疗。但是由于生殖问题的复杂性和我们认识的局限性,不育症的治疗效果并不满意。在不育症诊断和治疗的思路、方法和方式中仍有许多值得探讨和改进之处。     

Panikattacken – mTGT ohne Pharmakotherapie

Only a limited number of medical studies referring to Animal Assisted Therapy have been published worldwide. The specific concept of medically oriented Animal Assisted Therapy (mAAT) was developed by the Austrian Institute for Animal Assisted Therapy & Research (AIAATR), based north of the city of Krems/Donau in Lower Austria, as a nonpharmacological treatment method for patients with mental or psychological overload. This particular case study describes a 30-year-old female academic who had been brought to the institute by her concerned neighbour because of repeated panic attacks. Despite extensive briefing, the patient vehemently refused any pharmacological intervention. Therefore, two-step management starting with an acute phase therapy of two therapeutic units (ThU), 90 min each over 5 days – during this period the patient stayed at the patient appartement of the institute – followed by a regular treatment cycle of 1 ThU/week over 12 weeks was selected. The HAMA-21 was used to evaluate treatment quality, therapy progress, and success. A total score of 30 at the beginning declined to 3 at the end of treatment.