Reluctance to change therapy has clinical and economic implications. Therapists are expected to deliver treatment in a oneto-one setting ending up with patient improvement. Such…
Abstract
Reluctance to change therapy has clinical and economic implications. Therapists are expected to deliver treatment in a oneto-one setting ending up with patient improvement. Such an achievement is difficult to overview. There is great uncertainty as to what works in psychotherapies despite research efforts. Prolonged treatment duration with little positive effect may be caused by factors inherent in therapist and patient and the external environment. Two cases are discussed illustrating the need for better surveillance of what happens in the therapy room. Responsibility for the progress in therapy rests on the shoulders of the therapist. When therapy becomes detrimental to patient and therapist, we do not have a comprehensive system to interfere or help. Delayed recovery emanates as an increase in costs to society and the family. This is the case when return to work after treatment is partly or completely retarded.
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Prediction of increased risk of suicide is difficult. We had the opportunity to follow up 20 patients receiving electroconvulsive therapy (ECT) because of severe depression. They…
Abstract
Prediction of increased risk of suicide is difficult. We had the opportunity to follow up 20 patients receiving electroconvulsive therapy (ECT) because of severe depression. They filled in the Antonovsky sense of coherence test (SOC) and Beck depression inventory (BDI) before and after a series of ECT treatments. Seventeen surviving patients had a mean observation time of 20.6 months, whereas the three deceased patients had 11.3 months. There was a lower mean age at onset of illness and a longer mean duration of disease in the deceased. Other clinical parameters did not differ. The surviving patients had a significant decrease on the BDI from 35 to 18 (P<0.001) and an increase on the SOC test after ECT from 2.45 to 3.19 (P<0.001), indicating both less depression and better functioning in life. The deceased had a larger change on the BDI from 32 to 13, not attaining significance because of the low number of deceased. The SOC test, however, did not increase to a purported normal level; that is, from 2.43 to 2.87. Although the SOC scale has been shown to predict mortality in substance abusers, the SOC test has not been part of earlier reviews of predictive power. Tentatively, a low pathological score on the SOC test may indicate low sense of coherence in life that might increase the propensity for suicide. These preliminary results need replication in larger studies.
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The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a…
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The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium. Whether such tests are in use, and how they are distributed among different patient categories was the aim of the study. All referrals in one calendar year (N=1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants. The difference between ethnic Norwegians and the immigrants was significant (Z=-3.05 and P=0.002). Psychometric tests were thus almost not in use, and even lesser so in immigrants. Mean number of resident days was higher among those tested, 11.7 (SD=11.2) versus those not tested, 7.4 (SD=10.4) days, t=2.97 and P=0.004. Length of stay for ethnic Norwegians did not differ from that for non-Western immigrants 11.4 versus 11.7, respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD=14.4) versus 38.8 (SD=12.1), with a t=2.65 and P=0.03. The difference in resident days between all immigrants and ethnic Norwegians was significant with a Z=−2.232 and P=0.026. Level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more room for testing. Whether this low test-activity influences treatment quality is an unsettled question.
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Depression is a usual comorbidity in patients with Parkinson's disease. It has been known for more than 50 years that electroconvulsive treatment (ECT) has a positive effect on…
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Depression is a usual comorbidity in patients with Parkinson's disease. It has been known for more than 50 years that electroconvulsive treatment (ECT) has a positive effect on the muscular symptoms of Parkinson's disease. Many countries do not allow giving ECT for this indication. We have recently treated a resident patient in an acute psychiatric facility referred to the hospital with moderate depressive symptoms and strong suicidal ideation. Before and after a series of ECT he filled out the Beck Depression Inventory and the Antonovsky Sense of Coherence test. The scores before ECT were 20 and 2.69, respectively, and after 12 treatments 14 and 3.38. Both test results indicate improvement regarding level of depression and coping in life. The physiotherapists treating him observed that his rigidity was reduced and his gait improved. Muscular tonus was reduced and increased his tendency of falling as he had less tonus in muscles close to joints. Self help efficiency in daily tasks improved. He got cognitive impairment during and in the weeks after ECT. Electroconvulsive treatment should be offered to more patients with Parkinson disease and depression in order to lessen the burden of both depression and Parkinson symptoms.
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Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We describe a patient with severe symptoms from the age of…
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Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We describe a patient with severe symptoms from the age of 16 to 44. Her illness is best described as a schizo-affective disorder. Several series of electroconvulsive therapy (ECT) followed by maintenance once a week for more than six years has kept her out of hospital beds for three years. The patient demonstrates the feasibility of long term ECT and the absence of disturbing cognitive reductions.
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Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We present a patient who at the age of 19 developed several…
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Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We present a patient who at the age of 19 developed several schizophrenia - suspect symptoms. Soon inexplicable general seizures where observed. He was treated with antipsychotics, but had two bouts of malignant neuroleptic syndrome. Electroconvulsive therapy (ECT) gave some symptom relief and he continued on maintenance ECT for years with weekly intervals. Interruption of this treatment pattern rapidly increased symptom load. After seven years a lorazepam provocation test was performed as he had a new relapse after 3 weeks without ECT. In the ensuing hours his aggressiveness and nonsense speaking rapidly diminished. Kahlbaums observation of seizures as part of a catatonia was not understood in this case. The publication of the new DSM-V diagnosis of catatonia may hopefully reduce the probability of treating a patient for schizophrenia for years without access to a more targeted medication and ECT plan.
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John E. Berg and Jorid Grimeland
Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a…
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Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations.
Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust.
Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.
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Jim Barry, Elisabeth Berg and John Chandler
Reports on findings from a research project, which has been examining the development of the New Public Management (NPM), a managerial reform movement for change in public sectors…
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Reports on findings from a research project, which has been examining the development of the New Public Management (NPM), a managerial reform movement for change in public sectors worldwide, and reports on a series of semi‐structured interviews with academics in Sweden and England as elements of NPM are introduced into the daily routines of university work. The findings suggest that, despite evidence of common elements of the NPM appearing in Higher Education in the two countries in question, as well as many similarities of experience and response among those subjected to change, there are differences ‐ with academics in England reporting longer hours and increased monitoring of their work than their Swedish counterparts. The article explores the nature of these similarities and differences.
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Jim Barry, John Chandler and Elisabeth Berg
The paper seeks to offer a consideration of the adequacy of the concept of abeyance in accounting for women's movement processes in non‐social movement organisations in periods…
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Purpose
The paper seeks to offer a consideration of the adequacy of the concept of abeyance in accounting for women's movement processes in non‐social movement organisations in periods characterised by quiescence rather than insurgence.
Design/methodology/approach
The article is primarily conceptual.
Findings
By extending the political process school of social movement theory, which relies heavily on visible activism to explain movement success, to include the new social movement approach, it is contended that underlying processes of change, associated with the values and affiliations of those involved in non‐social movement organisations, become clearer. Less visible processes are identified through the variable rhythms and multiple, discontinuous experiences of women's movement supporters characterised as concealed adherents, informal networkers, and fellow travellers who can include male supporters.
Research limitations/implications
Limitations: as the paper is primarily conceptual, there is a need to develop the practical implications beyond those mentioned below. Implications: there is a need to reorient research into organisational change to take fuller account of social movement processes.
Practical implications
It is recognised that the literature on organisational and managerial change in non‐social movement organisations needs to take account of the differing experiences and potential strategies of those likely to be affected.
Originality/value
Originality of the paper lies in the use of insights drawn from the field of political sociology to enrich understanding of gender and organisational change.