1,721,712 research outputs found
Understanding psychiatric institutionalization: a conceptual review
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Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis - a cluster randomised controlled trial
No full textBackgroundLarge numbers of patients with psychosis have regular meetings with key clinicians in the community. There is little evidence on how these meetings should be conducted to be therapeutically effective. DIALOG, a computer mediated procedure, was shown to improve outcomes in a European multi-centre trial. DIALOG structures the patient-clinician communication and makes it patient-centred, but does not guide clinicians as to how to respond to patients’ concerns. DIALOG has been further developed into DIALOG+, which uses advanced software and, additionally, provides a four step approach - based on a solution focused model - for addressing patients’ concerns. We designed a cluster randomised controlled trial to test the effectiveness of DIALOG+ in improving treatment outcomes of patients with psychosis in the community.Methods/designKey workers are recruited from community mental health teams in East London and randomly allocated to either the intervention or control group. Out of their case loads, we identify patients with schizophrenia (F 20–29) and a moderate or lower level of subjective quality of life (MANSA score <5), who are treated according to the allocation of their key workers. Key workers in the intervention group are trained in using DIALOG+ and use it with each patient over a six-month period. Control patients rate their satisfaction with life and treatment on a tablet to control for the effect of regular ratings and the use of modern technology. We are recruiting up to 42 key workers to reach a total sample size of 180 patients. Clinical and social outcomes including costs are assessed after 3, 6 and 12 months. Primary outcome is subjective quality-of-life at 6 months.DiscussionThe trial aims to evaluate the effectiveness of a novel intervention (DIALOG+) which uses modern technology to support routine patient-clinician meetings in community care, makes the communication patient centred and guides patients and clinicians to address concerns. DIALOG+ is a generic and widely applicable intervention. If shown as effective, it can be used to improve outcomes of community care on a large scale, ensuring that routine encounters are therapeutically effective. DIALOG+ can also be implemented across services at relatively low additional costs
Friends and Symptom Dimensions in Patients with Psychosis: A Pooled Analysis
Full text linkPMCID: PMC3503760This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
A pilot trial of treatment changes according to schizophrenic patients' wishes
No full textThis is not the final published version. The published version is available from: http://journals.lww.com/pages/default.asp
Prognosis of schizophrenia from the viewpoint of patients and relatives An explorative study
No full textObjective: This study is aimed at exploring what schizophrenic patients and their closest relatives expect the further course of the illness will be like and how it can be influenced. Method: Problem-centered interviews were conducted with 31 schizophrenic patients and their closest relatives at discharge from hospital treatment. The verbatim transcripts of the interviews were analyzed by means of structuring qualitative content analysis. Results: Most frequently, the respondents expected an improvement of the illness or they were unsure whether the actual recovery from psychosis will persist or whether a further relapse will occur. Less frequently, the respondents were sure that this will be the case or that the illness will take a chronic, eventually deteriorating course. The majority was convinced that the course of the illness can be influenced, by psychiatric treatment as well as by the patients themselves. As concerns the social situation in the near future, particularly changes of the occupational status were hoped for. Conclusion: The assessment of the prognosis of the schizophrenic illness by most patients and relatives appears quite realistic. Rather than considering themselves as helpless victims they see opportunities for influencing the further course of the illness. This should have a positive influence on the readiness to use mental health service and to Comply With treatment recommendations
Reinstitutionalisation in mental health care - This largely unnoticed process requires debate and evaluation
No full textPublisher version available at: http://www.bmj.com/content/326/7382/175.ful
Causes of schizophrenia - Patients' viewpoint
No full textObjective: According to a quantitative study on causal beliefs patients with functional psychoses favour psychosocial over biological explanations. They also tend to endorse a multicausal concept. The aim of this study is to try to replicate these findings using semi-qualitative methods. Methods: Problem-centered interviews were conducted with 78 schizophrenic patients consecutively discharged from inpatient or dayhospital treatment. Results: As in the previous study, patients provided more frequently psychosocial explanations. Biological causes were relatively rarely mentioned - mostly in response to suggestions of the interviewer. In addition, they were rather brief and not very elaborated. By contrast to the previous study, hardly any indications for a multicausal concept could be observed. Discussion: Patients' beliefs are contrasted with the results of psychiatric research on the causes of schizophrenia
Causes of schizophrenia - Beliefs of patients' relatives
No full textObjective: In a former quantitative study on relatives' beliefs about the causes of functional psychoses a preference for psychosocial explanations was found. There were also indications of an inclination towards a multicausal concept. The aim of this study is to try to replicate these findings using semi-qualitative methods. In addition, we are interested in knowing to what extent the causal beliefs of relatives are similar to those of the patients, Method: Problem-centered interviews were conducted with 31 relatives of schizophrenic patients. A computer-assisted qualitative content analysis was carried out with the transcripts of the interviews. Results: As in the previous study, relatives showed a strong propendency to endorse psychosocial explanations. However, among only one third a multicausal concept could be observed. The causal beliefs of relatives and patients were quite similar. Discussion: The findings are discussed with reference to the concept of subjective illness theory and the concepts social representations
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