Bibliotheca psychiatrica最新文献

Administration of prophylactic 36 h total sleep deprivation to 9 manic-depressive patients (5 bipolar and 4 unipolar depressives) reduced the frequency of relapses and increased the duration of normothymia in 5 patients, left the course of illness unchanged in 3 patients whilst in 1 patient the effect could not be evaluated. Sleep deprivation appeared to be more effective in women, 'rapid cyclers', patients with a positive family history of mental illness and patients with recurrent depression. These observations confirm previous impressions and suggest a possible prophylactic effect of sleep deprivation.

Many patients suffering from injury or chronic illness appear to experience greater disability than one would expect from the nature of their physical lesion. Although one suspects that emotional problems are complicating their somatic illness, the defence of counterdependence masks an overt show of emotional disturbance. Furthermore, their personality structure places them at risk for developing chronic psychological invalidism, the prevention of which requires (1) an early diagnostic recognition of patients characterologically at risk for psychological complications, and (2) behavior of caretakers designed to foster the drive of each patient toward independence and to minimize the regression towards psychological invalidism.

Factors related to occupational rehabilitation of 40 psychiatric patients (and a subgroup of 30 schizophrenic patients) hospitalized at the Day Hospital of Athens' University Department of Psychiatry were studied. Rehabilitation was negatively associated to a statistically significant degree with: chronicity of illness, time spent in unemployment, and male sex. Time spent in unemployment was also negatively related to rehabilitation at the previous employment setting. More women than men were rehabilitated. Duration of illness and duration of present hospitalization were longer for men, commitment to the hospital's daily schedule was stronger for women, and male patients had more absences from treatment sessions in comparison to female patients.

Patients who have suffered a depressive illness frequently relapse when treatment is stopped. A controlled study of continued medication after clinical recovery was carried out. Of 92 patients studied, 22% of those who received amitriptyline or imipramine relapsed during 6 months of observation, compared with 50% of those who received placebo. Patients who experienced persistent residual symptoms derived more benefit from the active drug during continuation treatment than those who made a complete recovery from their illness.

The emotional complications following gynaecologic operations are investigated in an effort to search for their causes and find ways of prevention. A study of the authors in women after hysterectomy compared to a control group showed a great percentage of reactive depression, 6-12 months following the operation. Based on the findings concerning family attitudes, sexual misconceptions and body image changes, certain preventive measures are proposed: pre-operatively, proper psychological approach of the woman, investigation of the special individual and family attitudes and problems, provision of accurate information about the nature of the operation, and post-operatively adequate psychotherapeutic support.

Even when schizophrenic patients are maintained on long-acting neuroleptics in the community, about one-third relapse over a period of 1-2 years. Relapse on medication is associated with acute stress in the form of life events and chronic stress in the form of the emotional atmosphere in the patient's home. The noxious elements in the emotional atmosphere have been identified as criticism, hostility, and overinvolvement by the relatives. Strategies are discussed for reducing the level of these emotions and their effect on the patients. A preliminary report is given on the progress of a controlled trial of social intervention with patients at high risk of relapse.