A survey of groups within a psychiatric hospital

Summary

The findings of a survey of the involvement of staff in group activities within a large psychiatric hospital are presented. Over two hundred regular group meetings were being held, excluding ward-rounds and business meetings. There was a wide variation in the type and structure of the groups, the purpose and theoretical underpinning of many of which were unclear to the participants. It is suggested that this lack of clarity reflects the fact that the original therapeutic aims have been subverted in the service of institutionalised defences against anxiety. To be therapeutically effective, groups need clear leadership, good supervision and well-defined aims.     

The status of legally committed psychiatric patients in the psychiatric hospital

101 mental patients hospitalized according to a court decision stayed on average for 9.7 years. General behaviour, social independence and chances for discharge were not related to illness but to the duration of accommodation. The chances for discharge decrease as the stay in hospital increases. The initial medical reasons for hospitalization are the less important factor in the period of in-patient treatment. The foundations for successful medical and social rehabilitation can only be laid in the early stage of accommodation.     

The integration of family therapy in a psychiatric day hospital

The clients, who present themselves at our psychiatric day hospital in Amsterdam, often have long-standing problems. These problems are usually of a complex nature, and the age of the clients plays an imporant role in this. Their age varies from seventeen to forty, with an average of twenty-eight.
Efforts were made over a long period to facilitate solutions to the clients' family conflicts. During this time an extensive range of problems within the family were presented of which the symptoms of the client represent just a part.
Working as a family therapist in a psychiatric day hospital, where clients are admitted individually, places the family therapist in a number of dilemmas, especially when many working in the hospital see the problems only as individual ones.     

Personality profiles of psychiatric groups

The German EPQ was administered to three groups: psychotics, endogenous depressives and normals. Both groups of psychiatric patients were characterized by lowered E and inflated L scores. The endogenous depressives were more neurotic than either psychotics or normals, and lower on L than psychotics.     

Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.     

The use of metaphors in psychotherapy

Metaphors are used in everyday language and play a role in the therapeutic domain. This paper: 1) Examines the linguistic structure of metaphors for its therapeutic relevance. 2) Introduces the concept and use of metaphoric kernel statements. 3) Describes strategic and tactical applications of metaphor in guided metaphoric imagery work, storytelling and metaphoric tasks. 4) Demonstrates the efficacy of metaphor in treatment of cases of traumatic and highly anxiety-provoking issues.     

Reflections on suicide in a psychiatric hospital

Taking into consideration topical bibliography suicidal events of the psychiatric clinic of the special county hospital for neurology and psychiatry Ueckermünde are introduced and discussed from the point of view of therapeutical and organizational-structural conditions. Hereby practical procedures in the handling of suicidal patients are described.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Adult oligophrenia in the large psychiatric hospital

Adult patients with mental retardation are a large group in big psychiatric hospitals. In the last years they were not enough heeded in regard of social psychiatric efforts and rehabilitation. The study shows the problems of misplacement for a big part of that group as in-patients in psychiatric hospitals, points out the necessary integration and continuous social and rehabilitative-pedagogical care. The analysis is based upon some point prevalence studies in the psychiatric hospital BFKH Rodewisch. Finally there are given statements about the future organization of process of caring for adult patients with mental retardation.     

Outpatient groups for chronic psychiatric patients

Long-term support groups have been utilized at the University of Alberta Hospitals since 1977 in order to meet the needs of chronic psychiatric patients who are unwilling or unable to commit to insight-oriented therapy. These groups meet once weekly for one hour and are intended to be drop-in groups, which patients can use regularly or only while in crisis. It is hypothesized that the institution or style of therapy practiced at an institution, rather than the specific therapists, provides a source of stability and support to these patients. Our experience suggests these groups are beneficial and cost-efficient, but research is necesssary to evaluate them to determine components of therapeutic effectiveness.Linda McAuley, M.A., was a staff therapist at the Psychiatric Walk-in Clinic and is currently in private practice.An earlier version of this paper was presented at a meeting of the Canadian Group Psychotherapy Association in Banff, Alberta, October, 1987.     

A suicide epidemic in a psychiatric hospital.

The authors report in detail on an epidemic of six inpatient suicides in a psychiatric hospital in Finland. Suggestion and identification had an effect on the timing as well as on the method of four of the suicides. The epidemic is viewed from individual, network, and organizational perspectives. The authors speculate on how such epidemics could be avoided. An increase in inpatient suicide rates has been reported from many countries, and the Werther effect may thus become a topic of considerable importance in psychiatric hospitals in the future.     

The hidden meanings of metaphors in family therapy

This study investigates how two therapists' beliefs and practices influence the therapeutic process when they organize social interaction according to a metaphor of a royal family. The therapeutic process is described through the case of a boy called Pelle. He comes to therapy together with his family. It is shown how the therapists collaborate in the process of implementing the worldview of the predefined normative standard for family life. In the short term the therapists' use of the metaphor can be seen as an intervention to accomplish immediate change in a non-threatening way. In the long term the cost of using the metaphor was that the mother got a confirmation about herself as a less powerful parent and the child got an image of being a failure. This study points out that metaphors as therapeutic tools have to be analyzed critically before they are used or more specifically the therapists have to examine what kind of values and meanings are hidden in the metaphor and who will gain and loose if it is used as an intervention.     

Parent-child relationships of adopted adolescents in a psychiatric hospital

This study compared the parent-child relationships of 140 adopted and non-adopted adolescents treated in a psychiatric hospital through examination of information contained in the adolescents' medical records. Specifically, comparisons were made of the mention of parental contribution to the problems precipitating hospitalization, psychiatric restriction of parental visits to hospitalized offspring, and referral of parents to an adjunct parents' group. Data were gathered by uninformed research assistants, from the hospital charts of adolescents who had already been discharged from the hospital. Statistical analysis of the data yielded the following results. Adoptive parents were significantly more frequently restricted in their visits to their children. In addition, they were also more likely to have been involved in the precipitants to hospitalization and to have been referred subsequently for adjunctive treatment. It was concluded that parent-child relations may be more problematic among hospitalized adopted, as compared with non-adopted , adolescents. It was also suggested that psychiatric bias concerning "typical" adoptive family dynamics might have contributed to the observed differences.