Psychic Problems Research Articles

L'étranger et la mise en question des soins en santé mentale aux Pays-Bas

As much of the distress linked to emigration and the loss of social roots is expressed in psychic problems, institutions of mental health become places where the society and the people concerned manifest the effects of social crisis. The psychiatrization-medicalization of social existence is a consequence. The case of African immigrants having fled their country for political reasons calls into question the social and political values determining institutional practices relative to the mental health care given to immigrants. The experience of the Maastricht Regional Center provides new individual and group techniques in this regard.

Life situation of parents of twins and triplets: a qualitative study

Starting in the middle of the 1980s, an increasing incidence of multiple pregnancies in Germany has been reported, with assisted reproduction mainly contributing to this increase. In the management of multiple pregnancies, the main focus is on optimising the obstetric care. The difficult socio-economic and psychosocial situation of parents of multiples, however, is often underestimated. The present study examines the life situation of parents of twins and triplets using focus groups as a qualitative research method. Nineteen mothers and fathers of twins and triplets were interviewed in four focus groups. Main topics were the parental reaction to the diagnosis of multiple pregnancy, the first time at home with the multiples, special situations and wishes and ideas for a better care during multiple pregnancy. The diagnosis of multiple pregnancy was made at early gestational age, with the parental reactions being described between "happiness" and "shock". With this diagnosis, however, the future parents feel alone. Caring for the babies is leading to the limits of parent's ability to take stress. Marital problems and social isolation are discussed controversially. Exceptional situations such as illness of the mother require fast and un-bureaucratic solutions. The interviews suggest that special problems of multiple parenthood such as social isolation, marital and psychic problems are not necessarily related to higher order multiples or handicapped children. It appears to be essential to offer a more individual care for women expecting multiples, whereas the main resource for improving care is in providing contact and information possibilities.

PENUTUPAN FISTULA CELAH LANGITAN MEMAKAI PLAT PROTESA AKRILIK LEPASAN PADA ANAK (Laporan Kasus)

Fistula cleft palate is an abnormal opening from the mouth to the nose (via the palate), where a part of the cleft palate did not heal properly after a surgical treatment. Fistula cleft palate in children is categorized as a psychic problem because of the abnormal appearance and problems to the mouth organ for eating, speech, and hearing. Providing optimal rehabilitation of closing the fistula cleft palate is not easy to achieve and requires a team-work of different experienced specialists. A child of three years with a fistula cleft palate came to the Dental Faculty's clnic with a poor gingival state, a high rate of caries on the deciduous teeth (destroyed and missing). The dental rehabilitation treatment would be to cover the fistula. The closing of the fistula with a removable acrylic protheses as obturator is to establish a normal arch-form, improved and redirected growth of the maxilla, so that the growth and development will be normally active with the feeding and speech development improved. The purpose of this case presentation was to overcome the difficulties in treating the teeth of children with fistula cleft palate.

Congenital melanocytic nevi

Congenital melanocytic nevi are benign skin tumours with a population-based prevalence of 1-6%. They run an increased life-time risk of transformation into malignant melanoma. Additionally, they can be associated with an involvement of the leptomeninges (neurocutaneous melanosis), and may cause considerable cosmetic and psychic problems. In contrast to the past, the risk of congenital melanocytic nevi developing into melanoma is now regarded as well-established. Thus, excision is recommended whenever possible. Large lesions which do not allow complete excision should be treated by dermabrasion within the first weeks of life.

Subjektive Krankheitstheorie und Inanspruchnahme psychosozialer Unterstützung durch Patientinnen mit Brustkrebs

Einführung: Im Rahmen eines psychoonkologischen Modellprojekts an einer gynäkologischen Akutklinik soll ein Beitrag zu einer ganzheitlichen patientenzentrierten Behandlung von Krebspatienten geleistet werden. Mammakarzinonrpatientinnen wurde psychosoziale Unterstützung in Form von Einzel- und Gruppengesprächen sowie Entspannungstraining angeboten. Material und Methode: Die Datenerhebung erfolgte mittels Interview und Fragebogen. Subjektive Krankheitstheorien für die Krebsentstehung wurden in bezug zur Inanspruchnahme der Betreuungsmaßnahmen gesetzt und die psychische Befindlichkeit der Patientinnen untersucht. Ergebnisse: Von den 107 an der Studie beteiligten Brustkrebspatientinnen nahmen 42 die psychosoziale Unterstützung in Anspruch. 67 der Mammakamnompatientinnen antworteten auf eine offene Frage über ihre persönlichen Ursachenerklärungen für die Entstehung des Brustkrebses mit mindestens einer Ursachenvorstellung: Am häufigsten wurde die Attribution eigener seelischer Probleme von 24 Brustkrebspatientinnen genannt. Die Gruppe der 40 Patientinnen ohne ursächliches Krankheitskonzept wiesen in allen Parametern für psychisches Befinden günstigere Werte als die anderen auf. Dagegen schätzten Patientinnen, die an eine psychisch verursachte Krebsentstehung glaubten, ihre Lebenssituation als äußerst belastet ein und litten bei vergleichbaren Krankheitsstadien unter vermehrten körperlichen Beschwerden. Schlußfolgerung: Als einzige Gruppe nahmen Patientinnen mit Psychogenese-Konzept die psychosozialen Angebote häufiger in Anspruch. Bei gleichzeitiger depressiver Krankheitsverarbeitung sollte ihnen ein psychoonkologisches Betreuungsangebot gemacht werden.

Psychological indications for prenatal diagnosis.

Women undergoing prenatal diagnosis (PND) for psychological reasons constitute a considerable proportion (10-20 per cent) of tests carried out on pregnant women. In these cases, the couple is below the lower limit for parental age, and there is no increased genetic risk. The aim of the present study was to describe the psychosocial background of women asking for PND on psychological grounds and to evaluate their wish for PND. A consecutive series of 51 women were interviewed in the 12th-15th week of gestation before attending for the test. Forty-five per cent were close to the limit for advanced maternal age (35-37 years). Most of them were educated and had stable partners; more than half of the women worked in nursing. Almost half (23/51) of them had previous psychic problems and 29/51 showed depressive mood. During childhood, 21 women had experienced severe disease or handicap. One-third (17/51) of them had been a consolidating member in their family. More than half (33/51) described considerable problems in relation to their mother or to motherhood and 10/51 in their relation to their father. Half of the women described at least three and only three women none of the following six identified predisposing factors: previous or present psychic insufficiency, experience of disability in childhood, role as a significant supporter in childhood, problems in relation to own mother, problems in relation to own father. These women's anxiety was understandable when their psychological history and current mental status were recognized. More than half of the women (29/51) were considered to have strong and 22 moderately strong psychological reasons for their desire to have prenatal diagnosis.

PSYCHOLOGICAL INDICATIONS FOR PRENATAL DIAGNOSIS

Women undergoing prenatal diagnosis (PND) for psychological reasons constitute a considerable proportion (10–20 per cent) of tests carried out on pregnant women. In these cases, the couple is below the lower limit for parental age, and there is no increased genetic risk. The aim of the present study was to describe the psychosocial background of women asking for PND on psychological grounds and to evaluate their wish for PND. A consecutive series of 51 women were interviewed in the 12th–15th week of gestation before attending for the test. Forty-five per cent were close to the limit for advanced maternal age (35–37 years). Most of them were educated and had stable partners; more than half of the women worked in nursing. Almost half (23/51) of them had previous psychic problems and 29/51 showed depressive mood. During childhood, 21 women had experienced severe disease or handicap. One-third (17/51) of them had been a consolidating member in their family. More than half (33/51) described considerable problems in relation to their mother or to motherhood and 10/51 in their relation to their father. Half of the women described at least three and only three women none of the following six identified predisposing factors: previous or present psychic insufficiency, experience of disability in childhood, role as a significant supporter in childhood, problems in relation to own mother, problems in relation to own father. These women's anxiety was understandable when their psychological history and current mental status were recognized. More than half of the women (29/51) were considered to have strong and 22 moderately strong psychological reasons for their desire to have prenatal diagnosis.

Somatization in frequent attenders of general practice.

The DSM-III-(R) definition of somatization disorder is too restrictive for use in general practice. A more comprehensive definition, the "somatic symptom index" (SSI) has shown good validity in open populations. However, a definition has to differentiate validly within a population of frequent attenders to be a useful diagnostic instrument in general practice. We studied a threshold of five complaints (nearly identical to the SSI) in 80 Dutch general practice patients. Patients were selected on age (20-44 years), history of back, neck or abdominal complaints, and on frequency of consultation- at least 12 consultations in the previous 3 years, corrected for consultations with compelling somatic reason for encounter. Prevalence of somatization in this group was 45%. Women had a 2 times higher risk of somatization. A relation with age was not found. Somatization was related to depressive complaints (relative risk 2.5) and probably also to anxiety. Somatizing patients consulted their general practitioner more often and had more health problems (especially psychic problems) than non-somatizers. These results support the validity of this definition. The distinction between our definition of somatization and somatization defined as a symptom of psychiatric (e.g. depressive or anxiety) disorder is emphasized.

Psychologische Interventionsstrategien und Therapieziele bei Patienten mit Spondylitis ankylosans (Sp.a.)

A variety of psychic problems of conditions and necessaries of life according to stage and course of disease an defined. Psychological interventions aim at mean to alleviate the process of adaption to disease and to cope the problems with impaired functionality, modified body-image and with chronic pain. Psychotherapeutic measures of single-/grouptherapy and training-programs which include the methods of clinical psychology and psychological paintherapy are effective for ankylosing spondylitis patients. A psychological treatment program should besides the mentioned interventional strategies, include a multimodal therapy concept, which integrates complementary principles of patient education, elements of interdisciplinary back school and techniques of short-time-therapy to adapt treatment individually to the ankylosing spondylitis patients in their stage-dependent specific mental strain and coping tasks.

From input to outcome: Changes in OHS-education and training

Work organization, technology and working population characteristics change rapidly in many countries, although not always in the same direction. In many industrialized countries new trends are a growing services sector, an aging working population, and an increased work pressure. The participation rate of women is growing in the Netherlands, in contrast with the rate of handicapped workers. In the working population, work-related musculoskeletal diseases and psychic problems like mental break-down and burn-out prevail. Sickness absence and disability are important issues. Risk assessment and health and safety information are new duties of the employer. Nowadays Occupational Health and Safety Services are more multidisciplinary organized and have to prove their quality and utility. Therefore, occupational health and safety professionals have to learn skills like risk assessment, health and safety promotion, consultation, rehabilitation, and interdisciplinary cooperation. Experiential learning connects the practical experience of the participants with reflection and new insights during the course.

Psychic Experience and Problems of Technique.

Psychic Experience and Problems of Technique.

Vad får man från ’socialen’? Sociala insatser vid socialbyråer i Stockholm

What do you get from the social welfare office? Measures taken at social welfare offices in StockholmFor two years 400 clients were studied with respect to the type of measure taken. There were four main types of measure. The majority of clients received social allowance at some occassion and some of them for a long period of time. Many clients also received “advice and support”, and measures which may be called “administrative”; for example help to seek support from other authorities, or advice how to seek such support. A small number of clients were placed at various institutions, some with coercion, others voluntarily. To a very large extent, clients turned to the social welfare office because of economic problems. That clients, above all, needed economic support was also the opinion of social workers, even though some of them had the ambition to do something about the clients social and psychic problems. Nothing in the study indicates that the social welfare offices and the social workers did perform, or were expected to perform, the task of changing the lives of clients. That is to say; social welfare offices and social workers seem to have worked as a factor inhibiting and interrupting long periods of dependence on social allowance. Social welfare offices seem to have fulfilled a complementary function: to give support when other sources of income and other social networks fail.

Psychic Experience and Problems of Technique

Psychic Experience and Problems of Technique

Prodromal Signs and Precipitating Factors in Attempted Suicide

What characterizes the presuicidal phase of suicide attempters in a military population? And what precipitates their suicidal action? These questions were investigated in a sample of 112 male suicide-attempting conscripts serving in the Norwegian Armed Forces. One-half of the subjects had shown behavioral signs such as isolation or aggression, over 80% displayed psychiatric symptoms. A majority verbally expressed their psychic problems, but few had explicitly stated suicidal ideas. Two major clusters of suicide precipitants were identified. Loss traumas were recorded in one-third of cases, some sort of conflict situation in 40% of cases. Implications for suicide preventive measures are discussed.

Active Living with Cancer – A Support Program for Cancer Patients and Their Families

Diagnosis of cancer causes acute traumatic stress which becomes chronic as the disease progresses. Both patient and his/her family experience cancer as a threat to their very existence. The most frequent psychic problems caused by the diagnosis of cancer are feelings of anxiety and depression on the part of the cancer patient. Relatives and close friends frequently experience feelings of helplessness, loneliness and the inability to communicate. Despite well-documented positive results from psychosocial support measures to help the patient cope with his/her disease, comprehensive psychooncologic services are still rare in Germany. This study presents the program ‘Aktiv leben trotz Krebs’ (‘Active living with cancer’) as one way of offering psychosocial support to cancer patients and their relatives. This structured group support program is the German version of the American program ‘I can cope’. The ‘I can cope’ program is part of the standard rehabilitation measures for cancer patients and their relatives, supported and sponsored by the American Cancer Society. Initial results obtained from a German adaptation of the ‘I can cope’ program at the Cancer Center of Wurzburg University will be presented in subsequent articles.

Illness behavior and personality changes in patients with chronic prostatitis during a two-year follow-up period.

Illness behavior and personality changes during a 2-year follow-up period were studied in 40 patients with chronic prostatitis. In the first study, the existence of psychic problems among the subjects was high. Sexual problems were striking. During the follow-up period the personality of the patients did not change, but subjective well-being, both psychosocial and somatic, was impaired. Sexual problems and homosexual behavior also increased. In addition, the cooperation of the patients markedly decreased and their illness behavior became problematic. The results indicate a strong need for psychic support of these patients.

Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems, and assault.

Except for infectious diseases all the main occupational hazards affecting health workers are reviewed: accidents (explosions, fires, electrical accidents, and other sources of injury); radiation (stochastic and non-stochastic effects, protective measures, and personnel most at risk); exposure to noxious chemicals, whose effects may be either local (allergic eczema) or generalised (cancer, mutations), particular attention being paid to the hazards presented by formol, ethylene oxide, cytostatics, and anaesthetic gases; drug addiction (which is more common among health workers than the general population) and psychic problems associated with promotion, shift work, and emotional stress; and assault (various types of assault suffered by health workers, its causes, and the characterisation of the most aggressive patients).

Regional prospective study of psychiatric sequelae of legal abortion

117 (45%) of the 263 women of German nationality who underwent socially indicated abortions in the postal-code area 2300 (Kiel) in the first quarter of 1982 were investigated before the abortion as well as one year later. As far as age, marital status and number of children were concerned, these women did not differ significantly from the other 55%. One year later information was collected on the women's emotional adjustment by means of a questionnaire concerning feelings of guilt and loss, personal reports of adjustment process and the investigator's judgement. According to the findings, 79% of the women had adjusted without any problems, 14% were still in a state of emotional imbalance, 7% were clearly impaired emotionally and in their everydays functioning. 21% of the women, who had adjustment problems, had already been more depressive before the abortion. One year later, they were also more depressive than the other women, more dissatisfied with their lives in general and with their sex lives. They were in greater doubt as to whether they had made the right decision, showed less inclination to consider a further abortion and reported stronger post-abortive feelings of guilt. Significantly connected with later emotional difficulties were low social class, a difficult financial situation, lack of intrapsychic differentiation between sex and reproduction, no partner or negative relation with partner and partner disagreements, particularly in the case where the male partner was more in favour of abortion than the woman. Statistically insignificant, although tendencially noticeable were social isolation, non-employment and pre-pregnancy psychical problems. Age, marital status, number of children, simultaneous abortion/sterilisation, previous abortions, a broken home in the patient's youth had no effect on the emotional adjustment after the abortion. The common factor of all variables predicting post-abortive emotional problems seems to be an external motivation for abortion together with a greater ambivalence towards the pregnancy.

Atherosclerosis precursors in Finnish children and adolescents. XI. Psychological aspects.

The role of psychic risk factors in the early history of atherosclerosis was studied in 3,596 Finnish children and adolescents, aged 3, 6, 9, 12, 15, and 18 years. The family atmosphere, behavioural pattern and self-esteem were tested. The results showed that the abuse of alcohol by the parents and daily smoking by the child were the factors most clearly indicating the existence of psychic problems. The results showed that boys manifested in every age group behaviour most disposed to coronary heart disease (CHD). Furthermore, low serum HDL-cholesterol, high serum triglycerides, thick triceps skinfold and self-esteem problems coexisted and they can be supposed to independently contribute to the aetiology of CHD.

Views of parents of children with leukemia and tumors concerning disclosure of the diagnosis (author's transl)

33 close relatives of 25 children with acute lymphoblastic leukemia, non-Hodgkin-tymphoma or a solid malignant tumor spoke about their reactions to the doctors ways of telling the diagnosis and their reactions to the diagnosis as such. All parents wanted to know the truth about the disease of their child. Some had already anticipated a life threatening disease. 2 parents thought that the suspicion of a malignant disease should also be verbalized. Some parents had been confronted with the ,,hopelessness" of their child's disease by uninformed doctors and stressed the necessity of giving hope when telling the diagnosis. Difficulties arising from contradictory remarks made by doctors, contrary reactions of different parents to the same doctor, aggressions against the oncologic team and vexating causal need became evident. The verbalisation of the diagnosis ,,leukemia" or ,,malignant tumor" puts parents into an exceptional state which incapacitates some of them to grasp details. Thus parents often are less informed than their doctors think they are. The most important mistakes made by the doctors: too much information at the same time, not enough time for emotional help, too many medical terms. Only over and over repeated information could enable parents to understand the situation which might prevent additional suffering caused by lack of knowledge. For this reason and for the fact that the better prognosis of children with malignant disease causes more psychic problems and social difficulties than in earlier times additional also non medical personnel should be included in pediatric oncological teams.