Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Open AccessBook Review

by Th. von Salis

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 147; https://doi.org/10.4414/sanp.2003.01366 - 1 Jan 2003

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Abstract

Nr. 2, Juni 2002 [...] Full article

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Open AccessBook Review

Elisabeth Roudinesco: Wozu Psychoanalyse?

by E. Hurwitz

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 146-147; https://doi.org/10.4414/sanp.2003.01365 - 1 Jan 2003

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Abstract

Ein kluges und engagiertes, brillant geschriebenes Plädoyer für die Psychoanalyse – doch weit mehr als nur das: Die in Paris lehrende Historikerin und Psychoanalytikerin begnügt sich nicht damit, den gegenwärtigen Zustand der Psychoanalyse, ihre Funktion und ihre Bewertung in der heutigen Gesellschaft zu [...] Read more.

Ein kluges und engagiertes, brillant geschriebenes Plädoyer für die Psychoanalyse – doch weit mehr als nur das: Die in Paris lehrende Historikerin und Psychoanalytikerin begnügt sich nicht damit, den gegenwärtigen Zustand der Psychoanalyse, ihre Funktion und ihre Bewertung in der heutigen Gesellschaft zu beklagen [...] Full article

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Open AccessBook Review

Gerhardt Nissen: Seelische Störungen bei Kindern und Jugendlichen. Alters- und entwicklungsabhängige Symptomatik und ihre Behandlung

by Th. von Salis

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 145-146; https://doi.org/10.4414/sanp.2003.01364 - 1 Jan 2003

Abstract

Mit Nissens Lehrbuch liegt endlich eine Einführung in die Kinder- und Jugendpsychiatrie auf deutsch vor, die gut lesbar und kompetent den Stand des Wissens und Könnens wiedergibt [...] Full article

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Open AccessBook Review

A. Maercker, Hrsg.: Alterspsychotherapie und klinische Gerontopsychologie

by U. Schreiter Gasser

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 145; https://doi.org/10.4414/sanp.2003.01363 - 1 Jan 2003

Cited by 1

Abstract

Es ist erfreulich, dass ein weiteres Buch zu diesem wichtigen Thema erschienen ist [...] Full article

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Open AccessBook Review

Reinhard Lindner, Michael Klöpper, Hrsg.: Destruktivität. Wurzeln und Gesichter

by Ch. Scharfetter

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 144-145; https://doi.org/10.4414/sanp.2003.01362 - 1 Jan 2003

Abstract

Fünf Aufsätze anlässlich der Arbeitstagung der Arbeitsgemeinschaft für integrative Psychoanalyse zur Destruktivität kreisen um das unerschöpfliche und leider stets aktuelle Thema menschlicher Destruktivität [...] Full article

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Open AccessBook Review

Mario Gmür: Der öffentliche Mensch. Medienstars und Medienopfer

by L. Trüb

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 144; https://doi.org/10.4414/sanp.2003.01361 - 1 Jan 2003

Abstract

Welche Folgen millionenfach verwertbare Medienbilder und -texte auf Individualität und Persönlichkeit heute haben, beschreibt Mario Gmür spannend, provokativ und vielschichtig in seinem neuesten Buch [...] Full article

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Open AccessBook Review

Melitta Breznik: Das Umstellformat

by E. Hurwitz

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 143-144; https://doi.org/10.4414/sanp.2003.01360 - 1 Jan 2003

Abstract

Die Autorin ist Psychiaterin – doch das allein ist nicht der Grund, warum ihre Erzählung hier besprochen wird [...] Full article

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Open AccessBook Review

Heinz Böker, Daniel Hell, Hrsg.: Therapie der affektiven Störung: Psychosoziale und neurobiologische Perspektiven

by J. Küchenhoff

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 143; https://doi.org/10.4414/sanp.2003.01359 - 1 Jan 2003

Abstract

Welche Anforderungen muss heute ein Lehrbuch erfüllen [...] Full article

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Open AccessCommunication

Mitteilungen der Schweizerischen Vereinigung Psychiatrischer Chefärzte

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 141; https://doi.org/10.4414/sanp.2003.01358 - 1 Jan 2003

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Abstract

Wie aus den Medien zu erfahren war, ist die Lage bezüglich des ärztlichen Nachwuchses im Bereich der institutionellen Psychiatrie prekär [...] Full article

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Open AccessStudy Protocol

Der Umgang mit den chronisch Kranken – Folgen aus der Vergangenheit für die Zukunft

by Klaus Dörner

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 139-140; https://doi.org/10.4414/sanp.2003.01357 - 1 Jan 2003

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Abstract

Meine These für die Lehren aus der Vergangenheit für die Zukunft lautet vorweg: Nur eine Psychiatrie, die ihren Umgang mit sowie ihre Aufmerksamkeit und ihre Verantwortung für die chronisch psychisch Kranken von der letzten an die erste Stelle hebt, die also mit den [...] Read more.

Meine These für die Lehren aus der Vergangenheit für die Zukunft lautet vorweg: Nur eine Psychiatrie, die ihren Umgang mit sowie ihre Aufmerksamkeit und ihre Verantwortung für die chronisch psychisch Kranken von der letzten an die erste Stelle hebt, die also mit den chronisch psychisch Kranken beginnt, verdient zukünftig noch den Namen Psychiatrie. Diese These ist sowohl wahr als auch eine Überforderung, also eine Heraus- Forderung, die in den nächsten Jahrzehnten Priorität für Forschung, Lehre und Versorgung hat [...]
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Open AccessReview

Der Zürcher Fragebogen zur Patientenzufriedenheit in der Psychiatrie: Entwicklung und Charakteristika

by Jirí Modestin, F. Hanselmann, P. Rüesch, H. Grünwald and P. Meyer

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 127-138; https://doi.org/10.4414/sanp.2003.01356 - 1 Jan 2003

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Abstract

Since the beginning of the 1990s, an increasing attention has been paid to patients’ satisfaction with the care they receive. Personal satisfaction is a part of the measurement of the outcome quality in general. We report on the development and characteristics of a [...] Read more.

Since the beginning of the 1990s, an increasing attention has been paid to patients’ satisfaction with the care they receive. Personal satisfaction is a part of the measurement of the outcome quality in general. We report on the development and characteristics of a new self-rating questionnaire designed for psychiatric patients to assess the satisfaction with their care. Mentally ill patients have been shown to be well able to give valid estimates in this regard. Relevant areas were defined in four focus groups with psychiatric inpatients, four focus groups with psychiatric staff of different professional background and one focus group with patients’ relatives. The participants’ views were collected, systematically categorised, and questionnaire items were formulated considering the most important categories and participants’ verbatim statements.To assess the dimension of general satisfaction the short uni-dimensional satisfaction questionnaire ZUF-8 has been incorporated; besides, a broad spectrum of different areas of interest were considered. The first version of the questionnaire was tested in two pretests with regard to the acceptance of the questionnaire and its formal criteria. In the 1st pretest, 157 completed questionnaires were obtained from hospitalised patients, in the 2nd pretest, 51 completed questionnaires from patients just leaving the hospital. The questionnaire was both times well accepted, the patients needed about 10 minutes (median) to fill it out and in the 2nd pretest with the slightly adjusted questionnaire no equivocal or not understandable questions were reported. Afterwards, the questionnaire was tested in five psychiatric hospitals of the Canton of Zurich in two investigations. In the 1st investigation, patients were asked immediately before their discharge to complete the Zurich Questionnaire and the Munsterlinger Questionnaire, another approved Swiss self-rating instrument to assess satisfaction with the psychiatric care. In the 2nd investigation, the same patients were asked 10 days after their discharge to fill out the Zurich Questionnaire once again. Results, based on 288 and 110 completed questionnaires respectively, demonstrate that only exceptionally questions were not answered. The answers were generally well distributed, the highest degree of satisfaction having been indicated in less than 50% on average. Practically all items differentiated well or at least in an acceptable way between satisfied and not satisfied patients. In a factor analysis 6 factors were extracted explaining 59% of the variance. Repeating the procedure with the data from the 2nd investigation, the 6-factor solution could be replicated; sufficiently high inner consistence was confirmed for the first factor on which all ZUF-8 items loaded. The Zurich Questionnaire was found to be reliable: Cronbach’s alpha was 0.89 in the first and 0.91 in the 2nd investigation, and comparing the individual scores of both investigations, the 10–14 days test-retest correlation coefficient was 0.74. ZUF-8 items correlated with the remaining items of the questionnaire with r = 0.75 and 0.76 respectively, the scores of Zurich Questionnaire correlated with scores of Munsterlinger Questionnaire with r = 0.71 pointing to an acceptable convergent validity of the questionnaire. Generally, there was a tendency for older, better-insured and voluntary admitted patients to indicate higher ratings and thus higher satisfaction. Comparing the average satisfaction ratings of the 1st and 2nd investigation by the same patients, practically the same results were obtained. Summing up, the Zurich Questionnaire, largely constructed on the basis of the patients’ statements in the focus groups, proved to be well accepted by the patients. The questionnaire also proved to be reliable and valid and can easily be used. Accordingly, it has been approved by the responsible Swiss authorities as a standard instrument to assess satisfaction of the patients with the psychiatric care they received. Full article

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Open AccessReview

Unfreiwillige psychiatrische Hospitalisierungen im Kanton Zürich 1995 bis 2001: Wieviel? Wer? Wie? Mit welchem Ergebnis?

by Ulrich Frick, P. Rüesch, M. Neuenschwander and W. Rössler

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 116-126; https://doi.org/10.4414/sanp.2003.01355 - 1 Jan 2003

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Abstract

Background: There is a long-term discussion on legitimation and ethical foundation of coercive treatment in psychiatry. Mental health professionals as well as society tolerate coercive measures in a position of double “paternalism”. Medical paternalism favours the hope of fulfilling the assumed real will [...] Read more.

Background: There is a long-term discussion on legitimation and ethical foundation of coercive treatment in psychiatry. Mental health professionals as well as society tolerate coercive measures in a position of double “paternalism”. Medical paternalism favours the hope of fulfilling the assumed real will of a patient by treating the malady that darkens the patient’s will. Social paternalism seeks to protect members of society from perceived though not epidemiologically proven risks stemming from mentally ill persons. Epidemiological data on involuntary hospitalisation has not been available for Switzerland at methodologically sufficient standards. Aims: This paper aims at describing the frequency of involuntary hospitalisation, referral patterns for inpatient treatment, therapeutic measures undertaken and outcome of involuntary patients as compared to voluntary patients. Methods: Involuntary hospitalisation was operationalised as physicians’ ratings of the presumed will of the patient, documented in the database PSYREC of the Swiss canton of Zurich.This database covered all admissions between January 1, 1995 and December 31, 2001 (n = 50 055). It was used to estimate the proportion of involuntary hospitalisations among all psychiatric admissions. A population-based age and sex standardised rate of involuntary hospitalisations per 1000 inhabitants was calculated for the years between 1996 and 2001. Indepth analysis of referral patterns, therapeutic measures and outcome was performed in a subsample of n = 24 607 treatment episodes from January 1, 1998 until December 31, 2000. Results: About 33% of all hospitalisations between 1995 and 1997 were rated as involuntary. For the period between 1998 and 2001 the rate of involuntary hospitalisations had decreased to a lower level of about 28%. The rate of involuntary hospitalisations per 1000 inhabitants rose from 1.57 in 1995 to 1.99 in 2001. The 6-year increase of 27% in the rate of involuntary hospitalisations was considerably smaller than the simultaneous increase of more than 50% for the total hospitalisation rate in the same period. Male and female patients had very similar risks of involuntary hospitalisation. The age profile of voluntary and involuntary patients was similar. Involuntary admissions were more prevalent among patients with diagnoses at admission of mania (F30), delusional disorders (F22) and schizotypal disorders (F21). The great majority of involuntary intakes were initiated by the health care system (general practitioners and psychiatric specialists both >25%, somatic hospitals 17%). Legal authorities were responsible for only 5% of involuntary admissions. The risk of being coercively medicated during the hospital stay was 6-fold for involuntarily admitted patients. Their risk of fixation or isolation was 5.6 times higher.Psychopharmacological medication (either forced or voluntary) is the most prominent therapeutic measure during the hospital stay (for both voluntary and involuntary patients in about 75%). Involuntary patients receive more crisis intervention, but less other therapeutic measures during their stay as compared to voluntary patients. Physicians’ ratings of the outcome of involuntary stays displayed no difference to the outcome of voluntary stays. Discussion:The rate of involuntary treatment is high for the canton of Zurich compared to other European countries.However, hospitalisation rates have increased faster for voluntary patients than involuntary patients, probably due to changing treatment habits in the mental health care system. Outcome of involuntary hospitalisation seems comparable to voluntary hospitalisation despite a lower intensity of measures undertaken, but this result should be validated using more rigorous methodological standards. Full article

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Open AccessReview

Die Depression in der Postpartalzeit: eine diagnostische und therapeutische Herausforderung

by Anita Riecher-Rössler and M. Hofecker Fallahpour

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 106-115; https://doi.org/10.4414/sanp.2003.01354 - 1 Jan 2003

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Abstract

Postpartum depression is not a specific entity. There is neither a very specific psychopathology nor evidence for a specific aetiology. The prevalence of severe depression is not significantly enhanced in the postpartum year as compared to women of the same age group without [...] Read more.

Postpartum depression is not a specific entity. There is neither a very specific psychopathology nor evidence for a specific aetiology. The prevalence of severe depression is not significantly enhanced in the postpartum year as compared to women of the same age group without delivery who have quite a high prevalence of depression anyway. Incidence of milder depression might slightly be enhanced in the first postpartum weeks. Giving birth and adapting to the new mother role seem to be stressors contributing to the outbreak of depression in vulnerable, predisposed women or to enhance pre-existing depression. Biological, especially hormonal, as well as psychosocial factors can be relevant stressors in this situation. Although this is not a specific entity, the diagnostic term or specifier “postpartum depression” might still be justified, as depression in early motherhood shows many important specifities. Diagnosis is especially difficult, as women, due to shame, stigma and many fears, do not seek help and doctors, due to misinterpretation of symptoms, often do not recognise the severity of the situation. Untreated, these disorders can have especially severe consequences, not only for the mother, but also for the child and the whole family. These disorders therefore need our special attention and special treatment. This means modifications of our pharmacological, non-pharmacological and psychotherapeutic treatment methods. Therapy – although in principle the same as that of other depressive disorders – has to put a special emphasis on the needs of the postpartum period. Education about the fact that this is a disease and not due to failure as a mother is of utmost importance to relieve the patients from feelings of guilt. Counselling and practical advice for the mother and her family is often needed as well as the help of a midwife, a family nurse, a social worker and/or other health care professionals. A good mother–infant bonding should be a main concern from the start. This means that the mother should not be separated from her infant for longer periods of time. However, she needs a lot of help in order to allow for relaxed contacts with the infant. Pharmacological treatment is often complicated by the patient’s desire to breast-feed, yet there are no controlled trials of antidepressant treatment during lactation as regards the potential side effects and/or long-term consequences for the infant. On the other hand, the risks of ongoing severe depression are generally regarded as higher than the potential risks of medication.Thus, if a mother insists on breast-feeding, she has to be educated about side effects and the baby has to be carefully monitored. Several studies have in the meantime also shown positive effects of oestrogen substitution and non-pharmacological treatments such as brightlight therapy. Psychotherapy should be initiated as soon as possible and be very supportive in the beginning. Specific manualised forms of psychotherapy for women with postpartum depression have also shown very promising results. In the future, more emphasis should be laid on prophylaxis, specific education and the broad implementation of low-threshold services. Under all circumstances, special attention must be given to the mother–child-relationship, on the one hand to reduce feelings of guilt in the mother and thereby to enhance the process of healing, on the other hand to prevent traumatisation of the infant and to avoid deleterious long-term consequences. Full article

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Open AccessArticle

Le trouble de l’adaptation, un diagnostic anodin? Une étude comparative avec le trouble dépressif majeur

by Anne Lott, F. Borgeat and R. Carron

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 96-105; https://doi.org/10.4414/sanp.2003.01353 - 1 Jan 2003

Cited by 4 | Viewed by 38

Abstract

Adjustment disorder is a very frequent disorder but surprisingly it has not been studied much and it remains a controversial diagnosis. In different studies, it has been considered either as a minor form of a specific disorder, a psychological vulnerability revealed by a [...] Read more.

Adjustment disorder is a very frequent disorder but surprisingly it has not been studied much and it remains a controversial diagnosis. In different studies, it has been considered either as a minor form of a specific disorder, a psychological vulnerability revealed by a stress factor or a precursor of a major psychiatric disorder. Those three different points of view raise the basic question of the aetiology of this disorder.The objective of this study is to show if adjustment disorder is a clearly differentiated diagnosis whose existence is justifiable. In order to answer this question, we attempted to compare this diagnosis with another frequent and important psychiatric diagnosis, major depressive disorder. In this retrospective study we selected all the patients with a diagnosis of adjustment disorder (77) or major depressive disorder (125) among the patients hospitalised in the psychiatric hospital of Malévoz in Valais during the year 1993 (580). It is based on clinical diagnosis.Their social and demographic characteristics (age, sex, nationality, marital status, professional activity), their past psychiatric history (earlier psychiatric hospitalisations, ambulatory treatment and attempted suicide), their hospitalisations during the next 5 years, their index hospitalisation (length, attempted suicide, comorbidity) and their drug treatment (number and class of prescribed drugs) were compared. This survey confirms certain differences between adjustment disorder and major depression disorder: patients suffering from adjustment disorder were more often men, not married, younger than those suffering from major depression; their hospitalisations were shorter with a better evolution between hospitalisations and they received less medication.However, the study does not allow to clearly distinguish between the two diagnoses or to conclude that adjustment disorder is not only a minor form of a specific psychiatric disorder.Yet it confirms that adjustment disorder is not a light diagnosis (importance of the psychiatric past, high number of past attempted suicides, rehospitalisations, number of comorbid disorders and weight of the prescribed psychotropic treatments among which neuroleptics were frequent). The three aetiological hypotheses that have been proposed (minor form of a specific disorder, specific psychological vulnerability revealed by a stress factor or precursor manifestation of a major psychiatric disorder) can still be considered as plausible. The diagnosis of adjustment disorder points to methodological limitations of the atheoretical approach of the DSM-III-R. The fact that, in its DSM-III-R definition, it is stated that the diagnosis of adjustment disorder has often to be based only on clinical judgment shows very well that such a diagnosis inevitably refers to a psychopathological theory. Indeed, the authors consider an approach without such a reference as difficult, a reference which remains the only way to appreciate accurately the symbolic weight of a given event for an individual person. Full article

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Open AccessEditorial

Editorial

by Thomas von Salis

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(3), 95; https://doi.org/10.4414/sanp.2003.01352 - 1 Jan 2003

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Abstract

Emanuel Hurwitz hat in einem früheren Editorial einen ethischen Gesichtspunkt aufgegriffen, als er den Ausstellungsbetrieb der Pharmafirmen an einem Jahreskongress der Schweizerischen Gesellschaft für Psychiatrie kritisierte [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 154, Issue 3 (01 2003) – 15 articles

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