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,综合医院开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.     

系统方法对综合医院开放式心理病房的分析

1　开放式精神心理疗法的实施1 1　资料 :来源于 2 0 0 0年 7月～ 2 0 0 2年 4月在广东医学院附属医院心理科住院病人 ,共 6 0 0例。其中男 330例 ,女 2 70例 ,男女比例为 1 2∶1,年龄 11～ 80岁 ,平均 4 5岁 ;住院天数 4～ 5 6天 ,平均 19天。高中文化居多 ;工人、农民、干部居多。1 2　方法 :入院患者需经本科医生筛选 ,有攻击、毁物及高度抗拒行为患者不作为入院对象。病房为开放式 ,在一楼 ,明亮、清洁、安静 ,不设防逃窗及铁门。入院患者留有家人陪护 ,可自由进出病房。对患者不得实施监禁、约束带约束及电休克等强制手段。实行三级查…     

综合医院精神医学问题的认识

综合医院精神医学问题涉及面较广,主要是指除精神病外的各种心理障碍与心理应激相关疾病。患者就诊主诉多样化,就诊医院或专科繁多。提高对综合医院精神医学问题的识别能力对临床各科医务人员非常重要。本文对综合医院常见器质性和功能性精神疾病的临床特点、识别处理作一概述。     

新生儿重症监护病房患儿家属心理状况分析

探讨新生儿重症监护病房（NICU）住院患儿家属的心理状况及影响因素。采用焦虑自评量表（SAS）及自行设计的调查问卷对190名NICU住院患儿家属进行调查。结果显示患儿家属表现出不同程度的焦虑,与全国常模（29．78±0．46）相比,其焦虑情绪标准分49．54±1．07,高于常模组（P〈O．05）。影响因素主要包括文化水平、家庭人均收入及患儿病情严重程度等。患儿父母关注的主要问题包括：病情严重程度、预后、医护人员解释病情满意度及病房探视制度。笔者认为医护人员应加强与患儿家属的有效沟通,满足其心理需求,提高医疗护理质量,促进医患关系和谐。     

从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一。本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性。     

综合医院精神医学问题的认识

综合医院精神医学问题涉及面较广,主要是指除精神病外的各种心理障碍与心理应激相关疾病.患者就诊主诉多样化,就诊医院或专科繁多.提高对综合医院精神医学问题的识别能力对临床各科医务人员非常重要.本文对综合医院常见器质性和功能性精神疾病的临床特点、识别处理作一概述.     

从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一.本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性.     

奇妙的情绪“储存”

芸芸听到奶奶生病的消息虽然心里有些着急,但情绪变化不大;她认为,生病是人之常事,老人生病更不足为怪。当听到奶奶住院的消息,焦急心理得到加强,且添了几分担忧,使焦急演化为焦虑。在医院里,她看到奶奶痛苦的病态,焦虑心理激化,增添了几分悲哀;出于对医院的信任寄托,这种悲哀没有流露。当看到奶奶病入膏肓,再也克制不住自己的感情,冲出病房     

中小学教师心理授权的测量

本研究旨在编制适合我国实际教育情境的中小学教师心理授权问卷。在文献分析的基础上,结合开放式和半开放式问卷调查、教师访谈、专家访谈,采用分问卷开发技术,对1272份有效问卷进行了分析,结果表明中小学教师心理授权由心理授权体验、心理授权技能和心理授权行为三个分问卷构成。其中,心理授权体验包括自我效能、影响力、地位和自主性4个因素;心理授权技能包括决策参与技能和沟通交流技能2个因素;心理授权行为包括影响教学行为和决策参与行为2个因素。本研究编制的心理授权问卷共44个题项,信效度均达到了心理测量学要求,可以用作教师心理授权的测量。     

精神科重症病房的医患沟通

精神科重症病房(PICU)由于患者的风险性高以及封闭的病房管理模式,使得医患沟通在患者的诊疗过程中显得更为重要。文章从精神科重症病房中医患沟通的意义、前提与基础、沟通内容、提升沟通水平的途径对精神科重症病房的医患沟通做了详细的阐述。我们有理由相信,只要医护人员能够放平心态,摆正定位;坦诚相待,充分告知;换位思考,相互理解;依法依规,坚持原则,我们就能尽量将医患沟通做到及时、充分、有效,为临床诊疗工作带来新的动力。     

Community meeting: review, update, and synthesis

The community meeting is a frequent regular meeting in a psychiatric ward or institution that is attended by all staff and patients. It meets for the purpose of communication, ward management, or psychiatric treatment. The conditions of the current hospital psychiatric treatment environment are very different from the treatment environment where the therapeutic community concept was first established, particularly in terms of the shortened length of hospital stay and the emphasis on pharmacologic rather than psychotherapeutic methods of treatment. However, even with these changes, an admixture of psychopharmacologic treatment and therapeutic community principles has been advocated as an effective, realistic, and desirable treatment modality in today's hospital environment. A synthesis of an extensive literature review from both a theoretical and research perspective on the community meeting is presented. A schema has been developed listing elements for practice in today's hospital climate.     

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.     

Behavioural analysis of ward rounds within a general hospital psychiatric unit.

A naturalistic observational procedure was used to examine the content of staff verbal interaction during the ward rounds of two inpatient teams in a general hospital psychiatric unit. Observers reliably rated staff discussion of 10 neurotic and 10 psychotic inpatients, using a nine category behavioural scale. The major focus of this scale was the extent to which three broad orientations, viz the medical, psychotherapeutic and sociotherapeutic models, were utilized by the staff. It was found that an eclectic approach was used by staff in their discussion of patients' aetiology, treatment and prognosis. However, the medical model was primarily utilized to formulate patient care, with the sociotherapeutic approach being employed for approximately one-third of the time. The psychotherapeutic orientation was only used 2.9% of the total time that patients were discussed. This pattern of use of the three orientations was consistent across the psychotic and neurotic patient groups. The behavioural data were found to be at variance with the degree to which staff believed the models should be applied. Analysis of the amount of time during which each professional group spoke in the ward rounds, and the rate at which they were found to make denned ‘authority statements’, indicated that a hierarchical model of management operated in the unit. These findings are related to the concept of shared power and responsibility within the therapeutic team.     

Setting up the Willesden Centre for Psychological Treatment

SUMMARY

The Willesden Centre for Psychological Treatment is a new facility built and funded by the Mental Health Unit in the London District of Brent. The unit was opened for clinical work in June 1985 and is a joint enterprise providing facilities for out-patient psychology services for Brent and a base for psychotherapy resources that were previously located at Shenley Hospital. Shenley is a large Victorian mental hospital situated about 20 miles from London in Hertfordshire and is the designated hospital for acute in-patient psychiatric services for Brent. In the first part of this paper I give an overview of the history of the negotiations that took place to bring about the opening of the Centre and then go on to make some general comments about the nature of the negotiating process itself.     

Mixing qualitative methods versus methodologies: A critical reflection on communication and power in inpatient care

This paper offers an illustrative example to demonstrate one way of combining qualitative methods. The context for the study was a UK inpatient psychiatric hospital. Data set one was collected from weekly ward rounds where inpatient staff met with autistic patients to review medication, listen to patient concerns and make plans or adjustments in light of this. Data set two was reflective discursive interviews with patients and staff. The research objective was to critically consider the potential reasons for discrepancies in dissatisfaction reports from patients in the interviews, compared to relative compliance exhibited by patients in the ward rounds. Utilising a video‐reflexive design and critical discursive psychology approach, both data sets were analysed together. It is possible to simultaneously analyse two different data sets, one naturally occurring and one researcher generated because of the epistemological congruence in the overall design. We have presented an argument for the benefits of mixing two qualitative methods, thereby extending the mixed‐methods evidence base beyond the traditional discussions of quantitative and qualitative paradigms.     

Young suicide attempters compared with a control group: psychological, affective, and attitudinal variables

Suicide attempters admitted to a general hospital psychiatric ward completed questionnaires to elicit information following their suicide attempt. Compared to normal controls who had never attempted suicide, suicide attempters were significantly more hopeless, depressed, and hostile. The suicide attempts seemed to occur in response to stress. A crisis intervention model was suggested as the most appropriate way of managing these patients.     

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.     

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.     

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.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.