Objective: To investigate the relationship between patients' perception of the real and ideal ward atmosphere and their satisfaction.
Method: Patients filled in the Ward Atmosphere Scale (WAS, Real ...and Ideal Form) and a satisfaction questionnaire. Patient characteristics were derived from clinical assessments.
Results: WAS ratings were almost independent of patient characteristics. Patients in locked wards perceived more anger and aggression and patients subjected to coercive measures perceived less autonomy and practical orientation. Patient satisfaction was predicted by higher scores on the WAS Relationship‐ and System Maintenance dimensions, explaining 41% of the variance. In particular support, order and organization predicted satisfaction. Except from the areas of anger/aggression and staff control, patients gave the ‘ideal’ ward higher ratings on all subscales. The perceived gap between the ‘ideal’ and ‘real’ ward explained 45% of variance in satisfaction.
Conclusion: Patients' perception of ward atmosphere is a clinically meaningful measure appearing to be a strong predictor of satisfaction.
Background: There is an increasing focus on the impact of psychosocial factors and stressors on the course of bipolar affective disorder. The life event research has revealed many biases and the ...results are conflicting. In a prospective study we examined the relationship between life events and affective phases in a group of bipolar patients with a long duration of the disease.
Methods: A group of patients with at least three admissions to hospital for bipolar disorder was followed every 3 months for up to 3 years. At each examination an evaluation of affective phase was made according to the Hamilton Depression Scale, the Newcastle Depression Rating Scale and the Bech‐Rafaelsen Mania Rating Scale. Moreover, the patients were rated according to the Paykel Life Events Scale. Their current medical treatment was noted.
Results: Fifty‐six patients (19 men and 37 women) were included in the study. Women experienced a significantly higher number of life events than men. In 21% of the 353 examinations of women, a new phase was preceded by life events whereas this was the case only in 8% of the 152 examinations of men. In 13% of the male examinations the patients were in a manic phase and in 5% in a depressive phase. In 5% of the female examinations the patients were in a manic phase and in 15% in a depressive phase. Half of the women's depressive phases were preceded by life events, but none of the depressive phases of men. The categories of life events preceding the depressive phases presented a significant overweight of somatic ill health and conflicts in the family.
Conclusion: We found a gender difference in the course of bipolar affective disorder, as women had a significantly higher number of depressive episodes than men and men had a higher number of manic episodes than women. In bipolar patients with long duration of disease a significant number of depressive episodes in women were preceded by negative life events. Somatic health problems and conflicts in the family were significant factors preceding new depressive phases.
Background: In 1984, Rosenthal et al. described a group of patients characterised by repeated winter depression with atypical symptoms eventually followed by summer mania or hypomania (seasonal ...affective disorder, SAD). The relationship between SAD and the classical manic-depressive disorder is uncertain. The aim of this study was to validate the Seasonal Pattern Assessment Questionnaire (SPAQ) classification in relation to the DSM-III-R criteria of seasonal patterns in a group of patients with bipolar affective disorder and to evaluate the stability of the SPAQ score index over time.
Methods: A group of bipolar patients were followed for 3 years with examinations every third month and at hospitalisation. At inclusion and at each following examination the patients were rated with the Hamilton Depression Rating Scale, the Newcastle Depression Rating Scale, and the Bech-Rafaelsen Mania Rating Scale. At inclusion and once a year the patients completed the SPAQ.
Results: Fifty-six patients agreed to participate and 46 patients completed 1 year or more. Eight patients, all women, had at least one SPAQ score index (SSI) of 11 or more. Women scored significantly higher than men on SPAQ. The test/re-test reliability of SSI between two consecutive years was good, but decreased as the time difference between tests increased. Moreover, we found no relation between seasonal variations of affective episodes according to SSI and DSM-III-R.
Limitations: The group of patients with seasonality according to DSM-III-R or SSI was small.
Conclusion: The validity of SSI between two consecutive years is good, but decreases as the time difference between tests increases. There is no relationship between seasonality defined by DSM-III-R and SSI. Female bipolar patients show, as the general population, seasonal variations in mood, energy, sociality, appetite, and sleep independently of their affective episodes. SSI cannot be used for the prediction of seasonal variation in a group of bipolar patients.
Developments in psychiatry have been steered by a number of factors influencing decisions taken by the politicians. Some of the more typical factors that could be mentioned are: political attitudes; ...trend phenomena in the population; economic aspects; and evidence-based knowledge. Bearing in mind the results of developments in psychiatry during the last decades, psychiatrists are encouraged to live up to their responsibility by focusing on scientific results, when giving their advice to politicians. Hopefully political initiatives will, in the future, primarily be based on evidence about psychiatric treatment.
In bipolar disorder, the factors provoking a new episode are unknown. As a seasonal variation has been noticed, it has been suggested that weather conditions may play a role. The aim of the study was ...to elucidate whether meteorological parameters influence the development of new bipolar phases. A group of patients with at least three previous hospitalizations for bipolar disorder was examined every 3 months for up to 3 years. At each examination an evaluation of the affective phase was made according to the Hamilton Depression Scale (HAM-D17), and the Bech-Rafaelsen Mania Rating Scale (MAS). In the same period, daily recordings from the Danish Meteorological Institute were received. We found no correlations between onset of bipolar episodes defined as MAS score of 11 or more (mania) and as HAM-D17 score of 12 or more (depression) and any meteorological parameters. We found a statistical significant correlation between mean HAM-D17 scores and change in mean and maximum temperature, and non-statistical significant correlations between mean MAS scores and rainfall plus atmospheric pressure, and non-statistical significant correlations between mean HAM-D17 scores and hours of sunshine and cloudiness. Though meteorological factors may have an impact on triggering new episodes in bipolar patients, they do not constitute a dominant cause.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
8.
Climatic factors and bipolar affective disorder Christensen, Ellen Margrethe; Larsen, Jens Knud; Gjerris, Annette ...
Nordic journal of psychiatry,
2008, Letnik:
62, Številka:
1
Journal Article
Recenzirano
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
CSF 5-HT and 5-HIAA were measured in endogenously depressed patients (ICD-9) (n = 23) and controls (n = 11). Distribution of sex, age and body height was similar in the two groups. Non-parametric ...statistics were used. In depressed patients CSF 5-HT concentrations were found to be higher (P less than or equal to 0.01) than in controls. A further classification of the depressed patients by the Newcastle Scale showed that the highest values were found in the endogenous group compared to the non-endogenous group (P less than or equal to 0.02). CSF 5-HIAA was found to be equal in the two groups, even when pairs matched for height were compared. No relation between clinical recovery due to drug treatment and changes in CSF 5-HT was seen. Our data support a possible involvement of 5-HT in the biology of depression, but the anatomical and functional levels of a serotonin derangement are still unknown.
The purpose of the study was to compare patient and staff perceptions of the social climate in a
psychiatric department, in order to investigate to what extent the two groups agree in their view
of ...the ward milieu. Ninety-six patients and 66 staff members answered the Ward Atmosphere
Scale (WAS) questionnaire, comprising a 100-item "real-form" concerning the ward atmosphere
as it is actually perceived and a 100-item "ideal-form" concerning the atmosphere in an
imagined "best of all" ward. Staff scores were significantly higher than patient scores on the
WAS-R subscales Involvement, Spontaneity, Practical orientation, Personal problems orientation
and Program clarity, and on the WAS-I subscales Spontaneity, Practical orientation, and
Anger and aggression. Patient scores were significantly higher than staff scores on the WAS-R
subscale Staff control and on the WAS-I subscales Support, Autonomy and Staff control. At the
same time, the findings showed that the WAS-profiles of the two groups were highly concordant
regarding both "realities" and "ideals". In conclusion, patients and staff do to some extent differ
in their perception of the social climate in the ward. However, the differences seem to reflect
nuances in views rather than fundamental differences in opinion. From an overall point of view,
the findings suggest a basic agreement between patients and staff regarding the valuation of the
treatment environment as well as the general preferences concerning the ward milieu.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
