The diagnostic value of DIF in the workup of ocular MMP was confirmed. However, biopsies taken from non-conjunctival, cutaneous tissue appear to yield more accurate results.
High utilizers (HU) are patients with an above-average use of psychiatric inpatient treatment. A precise characterization of this patient group is important when tailoring specific treatment approaches for them. While the current literature reports evidence of sociodemographic, and socio-clinical characteristics of HU, knowledge regarding their psychological characteristics is sparse. This study aimed to investigate the association between patients’ psychological characteristics and their utilization of psychiatric inpatient treatment. Patients from the University Psychiatric Clinics (UPK) Basel diagnosed with schizophrenia spectrum or bipolar affective disorders participated in a survey at the end of their inpatient treatment stay. The survey included assessments of psychological characteristics such as quality of life, self-esteem, self-stigma, subjective experience and meaning of psychoses, insight into the disease, and patients’ utilization of psychiatric inpatient treatment in the last 30 months. The outcome variables were two indicators of utilization of psychiatric inpatient treatment, viz. “utilization pattern” (defined as HU vs. Non-HU [NHU]) and “length of stay” (number of inpatient treatment days in the last 30 months). Statistical analyses included multiple regression models, the least absolute shrinkage and selection operator (lasso) method, and the random forest model. We included 112 inpatients, of which 50 were classified as HU and 62 as NHU. The low performance of all statistical models used after cross-validation suggests that none of the estimated psychological variables showed predictive accuracy and hence clinical relevance regarding these two outcomes. Results indicate no link between psychological characteristics and inpatient treatment utilization in patients diagnosed with schizophrenia spectrum or bipolar affective disorders. Thus, in this study, the examined psychological variables do not seem to play an important role in patients’ use of psychiatric inpatient treatment; this highlights the need for additional research to further examine underlying mechanisms of high utilization of psychiatric inpatient treatment.
BACKGROUND COVID-19 has affected everyday life and working conditions for most European people, particularly health care professionals (HCP). The worsening of mental health, work-related stressors, and helpful coping strategies within HCP have been studied by various quantitative surveys for all waves of infection. Longitudinal comparisons of stressors and coping as well as the themes that are particularly stressful for the HCP on different levels of experience at distinct timepoints of the pandemic are missing. OBJECTIVE Analyzing stressors, coping strategies, and underlying psychosocial stress factors and unmet needs expressed by HCP and non-medical staff at the beginning of the COVID-19 pandemic and the third wave of infections in different European countries. METHODS A cross-sectional survey was conducted in two study periods during COVID-19 pandemic in different European countries. The first study period was between April 1st and June 20th 2020 and the second between the November 25th 2021 and February 28th 2022. Quantitative descriptive analysis was conducted for questionnaires on stressors and coping strategies. Thematic analysis was used to complement the quantitative data with the results of the qualitative data to explore further levels of experience of the individual. RESULTS The most severe stressors identified at both timepoints were the uncertainty about when the pandemic will be under control and the fear of infecting the family. Commonly used coping strategies were the use of protective measures and the collection of information on COVID-19. A thematic analysis revealed 8 first level themes (pandemic situation, government/politics, social climate, measures, working conditions, infection effects, daily life, coping) which can be seen as levels of experience. During the beginning of the pandemic, comments focused on needs regarding protective equipment and handling the social-distancing situation, while unmet psychosocial needs came up only in the second study period. CONCLUSIONS Over the course of three years of the pandemic, there is still a need in the psychosocial pandemic preparedness of health care professionals that deserves further research and coverage. Despite many government and work-related measures, a deterioration of mental health in HCP, could be observed. It is important for future crises to cover the gaps in psychosocial support needs revealed by the COVID-19 pandemic. Thus, an improvement in pandemic preparedness and a mentally healthier population must be ensured in the future.
In acute psychiatry, where people with severe mental disorders are frequently treated, there can be contradictions between concepts of illness among, e.g., patients and healthcare professionals, and also between medical and legal aspects. These contradictions do not manifest themselves openly but are immanent in the social practices of the treatment teams as contradictions between the social level and the individual level. They can lead to alienation, which may be reflected in poorer quality of treatment, such as the more frequent use of coercive measures or poorer adherence to therapy in patients. In the normal daily routine of a clinic, these contradictions are mostly hidden by hierarchical structures or by unbalanced concepts of psychiatric illness, or external critique is used to try to solve these contradictions. However, another way of dealing with these contradictions could be to analyze the potential and causes for alienation through systematic analysis and transformation of the whole system of a psychiatric ward to reduce the level of contradiction within it. The aim of this work is to use the concept of meaning elaborated by Luhmann to identify and recognize alienation potentials as concretely as possible and thus make them accessible to immanent critique. Meaning in Luhmann’s use of the term serves to reduce complexity in a social context and always opens up consequential possibilities for action. Consequential limited possibilities at the level of action in a rigid social system (which psychiatric wards can be) can—at an individual level—lead to people subordinating themselves to the rigid system to an excessive degree and thus alienating themselves from the system. Thus, a rigid system with a narrowing of consequential possibilities excludes meaningful consequential possibilities. This leads to alienating contradictions and to possibilities of world appropriation being missed. The aim of the current analysis is not to make a general critique of psychiatry but to improve the theoretical basis to better understand the problem of alienation in acute psychiatry as a symptom of system-immanent contradictions and thus open up the possibility of transforming systems, e.g., psychiatric acute care units, by means of immanent critique.
Dernier recours Les mesures de contrainte se trouvent à la croisée des chemins entre le devoir d'assistance du médecin et le droit à la liberté et à l'autodétermination. Dans ce contexte, les mesures de contrainte dans le traitement psychiatrique sont considérées comme un moyen de dernier recours, qui n'est utilisé que dans des situations d'urgence. Voici un aperçu de l'utilisation des mesures de contrainte en Suisse et de la manière dont la «politique de la porte ouverte» peut contribuer à réduire les mesures de contrainte.
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