Psychiatrische Praxis
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Psychiatrische Praxis · Sep 2009
Review[At home in a home? Did de-hospitalisation mean de-institutionalisation?].
In the last decades, long-time patients were systematically discharged from psychiatric hospitals in order to integrate this disadvantaged population into the community. This procedures where adequately evaluated and are regarded to be completed in the western world today. However, few evidence has been presented regarding the further course of integration following discharge from mental hospitals: was integration into community really successful or were patients permanently placed in sheltered housing staffed 24 hours 7 days a week. This review focuses on the question whether papers describing large de-institutionalisation projects mention the level of institutional support in the years following discharge from hospital. Furthermore we tried to find out which parameters are dealt with when describing successful community integration. ⋯ Reviewing the available data about the level of support regarding accommodation of former long time patients, the danger of "trans-institutionalisation" has to be pointed out. Evidence is lacking concerning support models tailored to the individual needs of the patients. Similarly, possible side effects of long-term stays in sheltered housing staffed 24 hours a day have not yet been established. Therefore, we see a need for further evaluation of different models of supported housing for former long-term hospitalised patients, as well as for new chronic mentally ill patients.
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Psychiatrische Praxis · Nov 2007
Review[Treatment guidelines for non-schizophrenic psychotic disorders?].
To provide an overview of diagnostics, outcome and treatment of "non-schizophrenic psychotic disorders" (ICD-10: delusional disorders, acute and transient psychotic disorders and schizoaffective disorders). ⋯ There is a substantial need for controlled studies on the treatment of "non-psychotic schizophrenic disorders". Alternatively, clinical guidelines could be based on a dichotomy of affective and schizophrenic disorders or on a dimensional approach.
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Catatonia is a neuropsychiatric syndrome characterized by mental, motor and behavioral symptoms. It occurs in up to 18 % of acute admissions and is most frequently associated with affective and psychotic disorders. ⋯ Despite this, they are often not recognized in clinical practice, are not part of the therapeutic strategy and thus remain untreated. The following article is intended to give a review of the most pertinent questions related to the diagnosis and treatment of catatonia in order to improve clinicians' ability to recognize and treat catatonic symptoms and syndromes adequately.
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Psychiatrische Praxis · Jul 1994
Review[Confusional states in advanced age--a current review of the literature].
Delirium--a state of acute or subacute confusion--is a common organic mental syndrome occurring predominantly in old age. The disorder is highly prevalent in psychiatric institutions, in general hospitals and nursing homes. Patients affected by delirium carry an increased mortality-risk and will become dependent on nursing care in a high percentage. ⋯ A review of recent publications indicates that substantial advances in knowledge on epidemiology, operationalized diagnosis, risk factors, and course of delirium have been attained. There are, however, important aspects--e.g. the evaluation of prophylactic and therapeutic measures--which have been neglected. With regard to the high prevalence of delirium and the inderdisciplinary relevance of this syndrome scientific activities on this field should be increased as well as refreshment of knowledge of medical and nursing staff should be aimed at.