综合医院心理病房管理模式的探讨研究

为了探讨建立综合医院开放式心理病房新型管理模式的意义及可行性,对郑州市第九人民医院心理科病房采用开放式管理模式,分析480例住院患者的疗效。结果显示,综合医院哥放式心理病房管理模式具有疗效好、住院周期短等优点,提示综合医院开放式心理病房有利于精神病的治疗。     

A community meeting protocol for assault prevention

Assaultive behavior by patients is a serious problem throughout healthcare facilities. Currently, wide variability exists in the approaches used to deal with assaultive behavior. The immediate objective of this study was to perform a consensus validation of the community meeting as a prevention and intervention measure for assault. The community meeting is a regular meeting of all staff and patients for communication, ward management, or psychiatric treatment. A delphi survey, with three iterations, was used to operationalize the collection of judgments and achieve convergence of opinion from expert respondents. A protocol for a Violence Prevention Community Meeting (VPCM) was established.     

A Short-Term,Family-Oriented,Child and Adolescent Psychiatric Inpatient Treatment Program

We describe a short-term inpatient treatment program whose purpose is to integrate the different interventions in the child, his or her family, and the outpatient professional network. The interaction between the family and the ward is the basic structural element of child psychiatric inpatient treatment. The child, the family, the professional outpatient network, and the ward community together form an extended therapeutic system. Inpatient treatment can be understood as a coevolving process between these systems. The essential feature in our working model is the continuous, daily nursing staff supervision and a focus on interactions in the extended therapeutic system.     

Effectiveness of psychiatric departments at general hospitals

A few statistics referring to the psychiatric hospital of the Karl Marx University in Leipzig, which has taken over the function of a local psychiatric unit providing ward and semi-clinical treatment for the inhabitants of an urban district with 110,000 residents, are presented as an index of the work performed and success achieved by this sort of medical facility. The fact that full ward treatment with 64 beds is available is an important aspects. Transfers to specialized psychiatric hospitals are rare exceptions caused almost exclusively by a lack of in-house complementary facilities.     

The team meeting on a rapid turnover psychiatric ward: clinical illustration of a model for stages of group development.

This article illustrates stages of group development in a semi-structured team meeting of staff and patients in an inpatient psychiatric unit. Clinical material drawn from such a group at the Massachusetts Mental Health Center is presented in support of the view that, even in a rapid-turnover ward, group process in a mixed-level, mixed-diagnosis "ward meeting" follows some predictable lines and responds to the articulation of certain predictable concerns. Garland's (1981) model of group development is adapted to show the cyclical nature of group process in a teaching hospital, where doctors as well as patients may make only brief stays. Effective leadership strategies are suggested.     

Clinical pastoral training in an emergency psychiatric service

Summary This paper reports the utilization of an emergency psychiatric service as a new factor in the clinical pastoral training experience. The usual pattern of clinical setting for these students is the hospital ward, where the patient has already been admitted and is making some adjustment to hospital routine and treatment. In such a setting the student misses the opportunity to see the patient at the crisis point of the illness and does not see the large numbers of individuals troubled enough to require psychiatric help but not sick enough to be hospitalized. The latter group constitute the largest portion seen by the parish minister even before psychiatric referral is arranged. During a twelve-week clinical pastoral training program, each student spent a major portion of his time for two of the weeks working on an emergency psychiatric service with a psychiatrist and social worker and seeing a large variety of patients, most of whom were not hospitalized. The experience provided an opportunity to develop evaluative skills and knowledge of appropriate community resources, and offered some experience in brief counseling under supervision. The clinical pastoral training student and the personnel of the emergency service all felt that this was an experience of mutual value and that it should be for a longer period. It is suggested that other clinical pastoral training programs would find it of value to utilize emergency psychiatric clinic settings where available.     

The psychiatric infant—family ward at Tampere University Hospital

This article describes a new integrated evaluation and intervention program for infants, small children and their families, a child psychiatric infant–family ward treatment model at Tampere University Hospital. A centerpiece of the model is a 3-week treatment period for the whole family at the infant–family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are used as tools, including a reflective working model and sharing concrete interaction with the family. Theoretically, the treatment is based on an integrative model where psychoanalytical and systems theories as well as a behavioral approach are applied in defining the strengths and problems of the family and of the infant and in choosing the best intervention techniques. The fact that the whole family is present at the ward creates a strong therapeutic holding relationship context and an open therapeutic reflection, which are the cornerstones of this new and encouraging treatment model. © 1998 Michigan Association for Infant Mental Health     

Schools of Psychoanalytic Thought by Ruth L. Munroe

This paper assesses the impact of large-group processes and dynamics upon the patient-staff community meeting in hospital treatment. It focuses upon the therapeutic values and limitations of the large-group format by examining, from an integrated general systems and object relations perspective, how size, structure, patient population, staff training, and leadership variables reciprocally affect the process and content of the community meeting. The special problems associated with selecting an appropriate format for the meeting and the intense pull of regressive group forces upon the large-group leader are discussed.     

A virtual psychiatric ward for orientating patients admitted for the first time

Misconceptions about psychiatric wards frequently cause newly admitted mental patients to stay away from these wards despite their need for treatment. Although ward orientation is typically conducted by nurses in an attempt to help patients to adapt to the new environment, it is considered time-consuming, and the method of orientation and the explanations given may vary among different nurses. This situation calls for a more effective and standardized approach to orientating mental patients on their first admission. To this end, a computer-based interactive virtual environment was developed based on a real psychiatric ward by using virtual reality (VR) technologies. It enables the patient to navigate around to gain understanding about the ward through a virtual guided tour. The effectiveness of this VR orientation approach was investigated by a randomized controlled trial with consecutive sampling. Fifty-four Chinese participants were randomly assigned to undergo ward orientation by either using the VR-based approach or reading text-based electronic information sheets about the ward with a computer. Subjective and objective measures were obtained respectively using the Chinese version of the State-Trait Anxiety Inventory questionnaire and the heart-rate variability measurement before and after the intervention. In addition, a test on the level of understanding about the ward was administered at the end of the session. The results showed that the VR orientation approach is helpful in reducing patients' anxiety while also improving their level of understanding about the ward.     

Troubles du comportement et adolescence. Problématiques d'accès aux soins et modalités de réponses nouvelles

The psychopathology of adolescence requires particular adaptation of treatments. This article presents the specific organization of psychiatric treatment for adolescents developed in a mental ward. It works in collaboration with paediatric services, school medicine, community homes for adolescents, parents and attending physicians. Going towards adolescents signalled by those partners, we make easier the access to treatment, the “out of walls reception”. Reciprocal therapeutic commitment, worked with the adolescent, allows him to access to a variety of special cares: consultations, therapeutic groups, hospitalisation, “indirect treatments”. Results from three years allows us to stress the relevance of such a specific organization namely for tricky clinical situations.     

Observations on the behaviour of patients in a state mental hospital and a general hospital psychiatric unit: A comparative study

The study sought to compare the naturally occurring behaviour of psychiatric patients within a traditional mental hospital ward and a general hospital psychiatric unit. Direct behavioural observations were undertaken to determine the pattern of behaviour exhibited by patients, the amount of time spent in interaction, with whom interaction took place and the content of that interaction. Data were reliably collected by trained observers, using a 10 category behaviour scale. Within each setting 10 psychotic patients, matched for age, sex and diagnosis, were the subjects and 30 min of behaviour was recorded for each subject. Observations revealed that patients in the mental hospital exhibited more disturbed behaviour, and spent less time in interaction, than did those in the general hospital unit. However, the amount of time patients spent interacting with staff was comparable in the two settings, despite marked differences in staffing levels. Analysis of the content of interaction that did occur indicated that the manner in which staff responded to patients' behaviour was not consistent with the application of a behavioural engineering approach to the modification of abnormal behaviour. While staff in both settings were indiscriminate in the way in which they responded to appropriate and inappropriate patient behaviour, a rather more punitive style of interaction was observed in the mental hospital environment. It is concluded that, from a behavioural perspective, neither setting achieved an optimum therapeutic environment.     

The use of a resident daily scheduling procedure to increase appropriate social,ward, and scheduling behavior in adult psychiatric residents (patients)

The purpose of the present experiment was to investigate the efficacy of a goal orientation procedure in their treatment of apathy, isolation, and insufficient goal setting skills in chronic psychiatric residents. The experiment was conducted in a behaviorally-oriented deinstitutionalization program in a state psychiatric hospital. Three male and four female chronic psychiatric residents served as research participants. A group repeated measures design with four within-participant phases (ABA‘B’) was utilized. The goal orientation procedure included a written schedule that was completed by each research participant daily. This Daily Living Schedule required that a behavior be specified by the participant for every half-hour period during the day (8:30 a.m. to 9:00 p.m.). During all four phases of the experiment, research participants were observed on the ward from 8:30 a.m. to 12:00 noon and 1:00 p.m. to 5:00 p.m. for engagement in scheduled target behaviors. The daily scheduling procedure produced substantial increases in appropriate behavior such as social activities, ward jobs, and participation in treatment programs, whereas decrease were produced in inappropriate behavior such as isolation and day time sleeping.     

Group climate and group development in a community meeting on a short-term inpatient psychiatric unit

Group climate and group development of the community meeting on a short-term inpatient psychiatric unit are examined. The Group Climate Questionnaire (GCQ) was administered to all staff and patients present at the weekly community meeting on an acute treatment unit in a teaching hospital over a 12-week period. Results show that staff and patients perceive the community meetings in relatively similar ways, that the group climate of a community meeting can attain a positive working state, and that, at times, the meeting can progress through developmental stages of group process. Behavioral observations support the GCQ as a measure of group interaction.The authors gratefully acknowledge the assistance of Mary Pat Donnelly with the statistical analyses and the cooperation of all staff and patients who participated in this study.     

The future of psychotherapeutic environments: Learning from experience at a Swedish therapeutic community

Ten years' experience in a Swedish therapeutic community outside the organisation and culture of the psychiatric services is summarised with reference to a longitudinal prospective study. This therapeutic environment proved to be better suited to patients' needs, and the organisation and setting were more in accord with the treatment philosophy than at other units with which it was compared. It was possible to identify different phases in the history of the therapeutic community and the development of patients. The patient group as a whole have shown improvement in psychiatric terms, as well as with regard to psychosocial interpersonal and emotional functioning. The more lasting personality traits have not, however, altered. Difficulties in the work, and obstacles to change, appeared to derive from: the therapists' tendency to disregard problems in the relationship; not enough work focused on separation and negative, hostile feelings. Termination of treatment was a strain which the patients found difficult to manage. The period subsequent to the stay at the therapeutic community was decisive for the long-term outcome. Today, it is necessary to amend our concepts of a decisive and complete cure.     

Adolescent sexuality in a therapeutic community: staff countertransference issues

Issues connected with sexuality such as heterosexual relationships, homosexuality, sexual identity, and seductiveness, create conflict and countertransference dilemmas for staff who work with psychiatric patients in a therapeutic community. When the therapeutic community is composed of adolescents, these issues are exacerbated since sexual identity and sexual development are major concerns. The staff reacts strongly to the issue of self-determination and violation/infringement on a basic human need. These philosophical differences have their roots in countertransference feelings. Staff sometimes find it difficult to confront adolescents on emotionally charged issues that have a sexual coloring. A system is proposed for articulating and working through these feelings. A unique solution is posited for solving this conflictual attitude (based on object relations theory), whereby the residential treatment center serves as the analog of the home in order to allow adolescents to develop a sense of self before they can move on to the halfway house where heterosexual behavior is allowed (as part of the therapeutic process). This facilitates the meeting of the "self" with the "other." This procedure is explored in light of Sullivan's concept of intimacy.     

The open dialogue approach to acute psychosis: its poetics and micropolitics

In Finland, a network-based, language approach to psychiatric care has emerged, called "Open Dialogue." It draws on Bakhtin's dialogical principles ( Bakhtin, 1984 ) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: "tolerance of uncertainly,""dialogism," and "polyphony in social networks." A treatment meeting shows how these poetics operate to generate a therapeutic a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment, Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild psychotic symptoms remaining; and only 23% were on disability allowance.     

Group-as-a-whole concepts and the therapeutic milieu on the inpatient psychiatric unit

This paper focuses on large group process on the inpatient psychiatric unit. General systems theory and group-as-a-whole concepts are used to understand the dynamics of the therapeutic milieu. Using this information as a tool, the therapist can make various interventions on an individual and group level that will help patients understand and deal with their own psychopathology. Another benefit of this process is that it will develop a community on the psychiatric unit where patients help each other to get well. Three clinical examples are used to illustrate the relevance of this concept. With the advent of short-term psychiatric hospitalization, the therapeutic milieu has shown a drastic decline. Emphasis has been placed on the individual as opposed to the group and a valuable therapeutic tool has been lost. Using a group-as-a-whole concept can help reverse this trend and make the milieu on the inpatient psychiatric unit instrumental in the recovery of the patient.     

Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies

Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients’ coping strategies, relational and communication skills, and overall quality of life.     

Die psychiatrische Vorgeschichte schizophrener Maßregelpatienten -Rahmenbedingungen der Deliktprävention durch die Allgemeinpsychiatrie

Background

People suffering from schizophrenic disorders are at increased risk of committing violent crimes. In the present study, we investigated the conditions of preventing offences by general inpatient psychiatric services.

Method

The sample enclosed 75 patients treated at forensic hospitals in Baden-Württemberg, Germany. Data on frequency and date of previous delinquency and general psychiatric treatments were collected from the clinical records and from the psychiatric expertise provided for the sentencing.

Results

Prior to the severe offence leading to forensic detainment, eighty-three per cent of the cases had been treated at least once at a general psychiatric hospital while indications of a risk of delinquency were already present. Even if more specific risk indicators were used and patients with only one general psychiatric treatment episode were excluded, nearly two thirds of cases remain as target group for prospective general psychiatric prevention programs. On average, six inpatient treatments during the course of six years would have provided opportunities to prevent delinquency. However, in twenty-five per cent of the cases, the crime leading to admission to a forensic unit took place within an institutional environment (wards, penal institution). Of the offences that were committed outside of an institution, fifty per cent occurred during the first year after a general psychiatric treatment. Two thirds of the sample had committed an offence before first admission to general psychiatric treatment. On average, the first offence preceded the first admission by 4,6 years.

Conclusions

General psychiatric services provide promising opportunities to prevent delinquency among schizophrenics at risk for criminal offending. Specific programs that are effective beyond discharge from a general psychiatric ward should be developed and evaluated.     

Electrical Injury and Lightning Injury: A Review of Their Mechanisms and Neuropsychological,Psychiatric, and Neurological Sequelae

Exposure to electrical current via industrial or residential accidents or lightning strikes is a serious and growing concern in today's medical community. The sequelae that result are referred to as electrical injury (EI) or lightning injury (LI). The relevant principles in electricity are reviewed with particular attention given to their damaging capabilities on the body. Specific neuropsychological, psychiatric, and neurological signs and symptoms as well as objective measures of psychological and neuropsychological functioning and brain imaging in victims of EI and LI, are reviewed from past research. Important issues relevant to researchers in the field are discussed. Finally, the role that neuropsychology might play in this area is outlined.