Chaplains' medical approach to psychiatric patients

Chaplains' understanding of people's psychiatric and medical problems may aid them in dealing with people's spiritual problems. However, exploratory interviews and observations of chaplains and inpatients at a VA psychiatric facility indicate that chaplains take a medical model perspective with patients, often attempting to treat patients' psychiatric problems rather than focusing on their reliigious needs. Chaplains avoid one-on-one religious discussions despite the importance of these conversations to patients. Discussed are implications for the utilization of health services and for the formation of treatment teams.This paper is a revised version of a paper presented at the Society for Applied Anthropology meetings held in Lexington, Kentucky, March 1982.     

Hospitalized psychiatric and medical patients and the clergy

Earlier research suggested that persons in a community with significant psychiatric disorders seek relief from their clergy as often as from trained mental-health professionals. In this research, contacts with clergy about current hospitalization by matched samples of inpatient psychiatric (N=51) and medical/surgical (N=50) patients were compared, as were responses to structured interviews about the importance of religion, religious affiliation, and participation, spiritual needs, and spiritual well-being. The findings suggest that the two groups were similar in demographics, the degree to which religion was a source of strength and comfort in their lives, and percentages reporting as having a clergy person; the group of hospitalized psychiatric patients was significantly less likely, however, than the sample of medical/surgical patients to have discussed their current hospitalization with their clergy persons. Possible causes for this difference as well as areas of further research are discussed.     

Family interaction and acting-out behavior of adolescent psychiatric patients

Although the literature has described how families reinforce and contribute to acting out by adolescents, this phenomena has not previously been studied within the psychiatric hospital. The present study systematically investigated whether family interaction influences the acting-out behavior of hospitalized adolescent psychiatric patients. Data was collected from the clinical charts of 94 adolescents, each hospitalized for over 30 days. The results supported the contention that families do contribute to acting out in the hospital. However, a majority of the acting out was not directly related to family contact. The research highlights how the hospital can serve to offset negative influences by engaging the family in treatment and by considering family contact during treatment planning.     

Naturalistic observations of pathological behavior in hospitalized psychiatric patients

Naturalistic observations were conducted on 19 acutely ill psychiatric patients in the hospital ward milieu. The study was designed to determine relationships between selected social and environment variables and overt atypical behavior. Patients were observed on an individual basis with time-sampling techniques. In total, 16 pathological behaviors were coded and the most frequent (postural deviance, pace, agitation, hyperactivity, withdrawal, foot shake/body sway, leg swing) were selected in order to determine variation in frequency of these behaviors as a function of the following variables: area within hospital, week of hospitalization, distance between the focal subject and his/her nearest neighbor, number of people in an area, and time of day. Results showed differential changes in pathological behavior as a function of week of hospitalization, number of people in a given area, and distance from the focal subject's nearest neighbor. There was no significant change in the frequency of pathological behaviors as a function of area within hospital or time of day. In addition, most pathological behaviors decreased significantly when patients were engaged in the sending or receiving of verbal behavior. Cluster analyses revealed varying degrees of dissociation between pathological behaviors and social-interaction behaviors. These results support (a) a nonunitary concept of the general category pathological and (b) the view that there are inhibitory effects of social interaction on the enactment of atypical behaviors. Clinical implications of these findings are discussed.R.H.P. completed this research during his tenure as a postdoctocal fellow in the Department of Psychiatry, Human Ethology Laboratory, UCLA (NIMH Fellowship 1 F32MHO7627-01). Support for this research also came from the Veterans Administration.     

Catatonic signs in medical and psychiatric catatonias

Patients with psychiatric catatonias vs those with medical catatonias may differ in catatonic phenomenology. To determine if these could be distinguished, the following methods were used: 1) a review of the literature; 2) a chart review; and 3) a prospective series. The literature review of 467 reports of medical catatonias yielded 240 cases that met research criteria. A chart review of 47 episodes of catatonia revealed a higher frequency of negativism in patients with medical catatonias. Prospective data obtained from rating scales revealed an increased frequency of echophenomena in patients with medical catatonias; however, no discriminate pattern of catatonic signs for medical catatonias arose. Overall, catatonic signs appear to share a similar distribution. These findings suggest that psychiatric and medical catatonias are indistinguishable based upon catatonic sign.     

Geophysical variables and behavior: LXIX. Solar activity and admission of psychiatric patients.

Numbers of first admissions per month for a single psychiatric unit, from 1977 to 1987, were examined for 1829 psychiatric inpatients to assess whether this measure was correlated with 10 parameters of geophysical activity. Four statistically significant values were 0.197 with level of solar radioflux at 2800 MHZ in the corresponding month, -0.274 with sudden magnetic disturbances of the ionosphere, -0.216 with the index of geomagnetic activity, and -0.262 with the number of hours of positive ionization of the ionosphere in the corresponding month. Percentages of variance accounted for were very small.     

Stomatologic studies in schizophrenic patients--contributions to the problem of medical and social integration of psychiatric patients

Stomatological examination was carried out on 173 patients with schizophrenia (IKK-Nr. 295). It was observed that this group of patients showed a diminished dental and oral care in comparison to the average population of the same region. The close cooperation of dentists with the institutions for chronic patients will be as prophylactic measure in favour of the patients encouraged.     

Group therapy reduces medical and psychiatric hospitalization.

This article studies the impact of outpatient group therapy on medical care at a large city-county hospital. Of the 65 group therapy outpatients, 33 persons met the criterion of having attended at least 12 group sessions over the course of a year. We compared a control period (the year prior to initiating group therapy) with a study period (months 6-18 after starting group) and found a sharp decrease in the number of hospitalizations and in-hospital days. There was significantly increased use of neuroleptics and nonpsychotropics and increased attendance at nonpsychiatric clinics.     

Violent behavior patterns on psychiatric wards

A study of 379 violent incidents between pairs of psychiatric inpatients during an eight-month period indicates a substantial number of patterned associations between assaulting patients and those struck. In addition, regularities are observed in these incidents between frequency of occurrence and spatiotemporal and other contextual factors. Taken in the aggregate, these relationships support enlargement of most current conceptualizations of the violent act in psychiatric settings, which focus almost exclusively upon physiologic and psychologic state changes within the identified initiator of violent acts.     

Aggressive behavior in the psychiatric clinic

Self and other directed violence of male psychiatric patients have been registered. The diagnostic analysis revealed an unequivocal correlation to delusional diseases and cerebroorganic hamper. Few patients caused a high percentage of all registered aggressions. Due to limited possibilities of drug treatment, changes of organization of communication and of the socio-organisational framework are aspired for the future.     

Comparison of non-suicidal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit

The aim of the current study was to examine differences in personality, coping skills, and select psychopathology symptoms in psychiatric patients with and without non-suicidal self-injury and/or suicide attempts. We collected data in a sample of 128 psychiatric patients by means of self-report questionnaires measuring self-harm, psychological symptoms, personality and coping skills. Results support a continuum of self-harm such that patients with both non-suicidal self-injury and suicide attempts exhibit significantly greater levels of psychopathology and lower levels of adaptive personality traits and coping skills. The findings point to the clinical importance of making a distinction between non-suicidal self-injury and suicide attempts, and offers additional variables to consider outside of intent when appraising suicide risk.     

EPQ and the psychiatric patients of Bangladesh

The Eysenck Personality Questionnaire, standardized in Bangladesh, was administered to a group of 358 psychiatric patients—109 male and 108 female neurotics and 78 male and 63 female psychotics. The neurotic Ss were analysed separately according to sex, and were also divided into groups according to psychiatric nosology. The major findings that clearly emerged from the study of neurotic individuals were that they returned very elevated N scores and depressed E scores as against the norms, while the depressive patients of both sexes gave the lowest E scores. Most of the psychotic Ss of both sexes were diagnosed schizophrenic. The major finding of the investigation of psychotic individuals was that they returned much elevated scores on the psychoticism scale as compared with norms, and they also gave low E and high N scores. It is suggested that the EPQ be used to promote a better understanding and more efficacious therapeutic intervention of the psychiatrically ill person in this culture.     

Self-concepts of hospitalized and day-care psychiatric patients

The authors administered questionnaires to 44 hospitalized and 55 day-care psychiatric patients in Hong Kong. The groups were similar in sex, age, and education. The hospitalized participants, compared with the day-care participants, showed significantly higher self-concepts in general as well as in the particular aspects of social and personal aspirations. The findings indicate that support at the community level is important to help the psychiatric patients' transition from hospital care to day care.     

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.