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Biomedical subjects

B Eikelmann

Publications and source records attributed to B Eikelmann.

32 records · Page 2Linked to original sources
PubMed1996

[Rehabilitation of psychiatrically ill and handicapped patients--historical, conceptual and scientific aspects].

Since the early days in the 19th century, psychiatry has been dealing with chronic courses of illness and mental disabilities. The 1975 German "Psychiatry Enquete Report" has played a major role in achieving progress in the care system, allowing mentally ill patients with impending or established handicaps to be rehabilitated or to have long-term care of varying intensity and even at home. In particular, differentiated and graduated systems of sheltered accommodation, a sheltered labour market and leisure-time support have been created. Rehabilitation may induce a response in the disabled patient and improve his skills. It may, however, also be aimed at finding or structuring an adequate living environment to enable the patient to cope. A distinction must also be drawn between early and late rehabilitation: late rehabilitation applies primarily to those patients whose disabilities have become relatively irreversible after protracted illness. The objective in this case is to maintain social integration. Early rehabilitation is desirable today if functional deficits and impairments are found to occur in conjunction with a mental illness. If a substantial disability remains in spite of intensive efforts towards rehabilitation, adequate re-integration of the affected patient may be achieved by adapting the living environment. Although the practical state of development is promising, a large number of theoretical and scientific problems remains unsolved. The topic of psychiatric vocational rehabilitation in particular is raising more and more questions. There is a lack of information on the number of chronically mentally ill patients in the community and their needs, i.e. on the number of potential users. Further studies are needed to investigate the effects, the efficacy and the course of psychiatric rehabilitation.

Chronic Disease↗
PubMed1994

[Ambulatory occupational therapy. Results of a multicenter, prospective evaluation study].

Work is an indispensable component in the treatment of (chronically) mentally ill patients. In critically scientific terms, however, there is no adequate proof of its therapeutic effectiveness. Efforts at evaluation fail because of the complexity of the clinical reality. Moreover, the differential aspects of the indication have been ignored in research. This is exemplary of the problems confronting research on the provision of psychiatric treatment: the status of what has been put to the test and introduced on the basis of routine experience is such that emperical investigations are not carried out because of lack of interest and methodological problems. Against the background of this dilemma, this study seeks a middle course for measuring success. We carried out a prospective study on a representative sample of 126 outpatients in 7 clinical work therapy departments. The results show that outpatient work therapy can be seen as a useful part of differentiated therapy, in particular for chronically mentally ill patients. Previous experience is summed up in a review of the literature.

Activities of Daily Living↗
PubMed1993

[The psychiatric day clinic--a review of experience to date and our results].

Psychiatric day hospitals are a relatively young therapeutic facility insufficiently known to many psychiatrists. This accounts for the application potential of day treatment not being adequately recognised and utilised despite its many advantages (efficacy, flexibility, versatility). Treatment at a day hospital is not a (more or less) acceptable alternative to hospitalisation but has a specific contribution of its own to make in certain situations. Although the scientific standard of the literature published on day hospitals is relatively good, many questions on theoretical and practical aspects remain unanswered. The aim of this paper is to show the opportunities and limitations of the psychiatric day hospital with reference to a survey of the existing literature and to our own experience.

Day Care, Medical↗
PubMed1993

A second labour market? Vocational rehabilitation and work integration of chronically mentally ill people in Germany.

In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work therapy, firms for mentally ill people, workshops for the disabled). The sociodemographic, anamnestic and psychopathological data reveal that these are chronically mentally ill people with significant disabilities, making comprehensive social care and psychiatric treatment essential. Most of the subjects intend to remain in sheltered employment; only 20% hope to change to the open labour market. The level of subjective job satisfaction is surprisingly high despite generally inadequate pay, though it has to be pointed out that many long-term patients are presumably resigned to their circumstances. In conclusion, the relationship of the open labour market to sheltered employment is the subject of critical discussion.

Adolescent↗
PubMed1993

[Results in extramural rehabilitation of chronic mental patients: 5-year follow-up study].

Presented are the findings of a 5-year prospective study concerning residential rehabilitation of 53 subjects with chronic mental illness living in a differentiated system of complementary facilities and services. The focus had been the chronically ill patients' development and disease course, as reflected in their psychological wellbeing, work status, therapeutic requirements, social contacts, as well as periods of rehospitalization. At the end of the 5-year period, 50% of the subjects were living in sheltered communal groups, and some 25% fully on their own. Only 10 percent had returned to psychiatric hospitals as long-term patients. Vocational integration in the general labour market is only rarely achieved, but the work available in sheltered employment is suitable for 40%. All of the patients were in medical care after 5 years. Given a differentiated system of complementary support and services in the residential and vocational spheres, for medical care and leisure activities, persons with chronic mental illness, too, are able to live outside the psychiatric hospital, above all enjoying greater normality in their lifestyles as well as a higher degree of personal autonomy.

Adult↗
PubMed1993

[Current practice of psychiatric occupational rehabilitation. Results of a representative study in sheltered environments in the Westfalen area].

The number of patients suffering from chronic mental disorders but living outside the psychiatric hospital is undergoing a steady increase, which is reflected in an increasing demand for appropriate vocational and occupational facilities. This demand is met primarily by outpatient work therapy, self-help enterprises and enterprises providing jobs to supplement pensions, and by special departments for the mentally retarded in workshops for the handicapped. Within the framework of a prospective study on vocational rehabilitation of the mentally ill, 502 rehabilitants forming a representative sample for the Westphalia-Lippe region of Germany were examined. This sample comprised 313 male and 189 female probands with an average age of 36, almost two-thirds of them suffering from schizophrenic disorders. Only 12.8% of those questioned are able to cover their living expenses primarily from their earnings. Half of them are living in sheltered accommodation, one quarter with their parents, and only one quarter on their own. Most are resigned to remaining in sheltered employment. Only 16.7% expect to change to the open labour market. The level of subjective job satisfaction is high in general. Together with other complementary facilities, sheltered employment permits chronically ill patients to live outside the psychiatric hospital and offers them positive social and psychological aspects of work. With few exceptions, it does not offer an opportunity to cover living expenses. Our follow-up investigations will provide information on the further course of vocational rehabilitation.

Adult↗
PubMed1992

Pathways into sheltered employment.

Work ranks high in the rehabilitation of the mentally ill. Currently sheltered employment is often the only alternative to unemployment. We present a sample of 121 patients working at various facilities for vocational rehabilitation. All of these patients are chronically mentally ill, 77% of them suffering from schizophrenic disorders. With respect to their vocational backgrounds, they represent four groups that had come to the sheltered workplace by various means. One group of young patients had never had gainful employment, a second group had found jobs on the open labour market after onset of their illness, and a third group had been employed both before and after the onset of mental illness. The largest group, however, comprised those patients who had dropped out of normal working life immediately on onset of their illness to work in sheltered employment. The rate of isolation from working life was found to be influenced neither by professional qualification nor by the extent of vocational integration prior to the onset of mental illness. We discuss the consequences of the subjective experience of patients and the opportunities and problems presented in practice by vocational rehabilitation of the chronically mentally ill. A 5-year prospective study on the course of vocational rehabilitation is being designed by our group to provide further information on this subject.

Activities of Daily Living↗
PubMed1991

A modern therapeutic approach for chronically mentally ill patients--results of a four-year prospective study.

A 4-year prospective study was carried out on 53 chronically mentally ill patients living in a differentiated complementary residential complex. Our main question was how the lives of these patients develop, as reflected in their psychological wellbeing, working capacity, therapeutic requirements and any necessary periods of rehospitalization. At the end of a 4-year rehabilitation period, 50% of the patients were living in sheltered communities and about 25% on their own. Only 10% had returned to the psychiatric hospital as long-term patients. The psychological findings were characterized by apathetic, depressive and psycho-organic syndromes (AMDP system) and were subject overall to minimum variation. Very few patients succeeded in obtaining work on the general labour market, but the work available on the sheltered labour market was suitable for a large proportion (40%) of them. All patients were undergoing medical care after 4 years. Patients suffering from chronic mental disorders can be cared for in the community even after long-term hospitalization. Special success has been achieved with rehabilitation in the residential sphere. Adequate care implies numerous services to ensure that patients are integrated into the labour market, to help establish contacts and to enable chronically ill patients to take part in social and cultural life. Most patients retain a considerable degree of psychological disturbance and are permanently dependent on psychiatric therapy or psychosocial care. On the other hand, they benefit from the fact that their living circumstances are largely normal and that they have higher degree of personal autonomy.

Activities of Daily Living↗
PubMed1990

[Perspectives in the vocational rehabilitation of the mentally ill and disabled--an overview of the current status and problems in the region of Westphalia].

The number of persons suffering from chronic mental disease but living outside the psychiatric hospital in the community, is rising, resulting in an increasing demand for facilities for occupation, occupational therapy and rehabilitation and for paid employment. The past few years have seen a distinct increase in the number of sheltered workplaces for the mentally ill. This development has also led to qualitative differentiation in the offers. In the region of Westphalia there are currently some 940 work places in special departments for the mentally handicapped at workshops for the disabled. Self-help enterprises and those offering opportunities for persons living on social benefits or pensions to supplement their income currently offer some 470 workplaces for the mentally ill, ten psychiatric hospitals are giving their former patients an opportunity to take part in occupational therapy as outpatients. Considerable differences are to be registered with regard to the offers of work, the forms of organization, the tasks involved and the types of supervision. Finally, a specialized psychosocial service has been established within the past four years by the head welfare office of the Landschaftsverband Westfalen-Lippe; this service is designed for the care of the mentally ill at their work place. Like many developments in social psychiatry, the differentiation of occupational rehabilitation has resulted from practical experience. Empirical findings on the indication for and efficiency of individual measures are virtually non-existent. A prospective five-year study is planned to investigate further results.

Community Mental Health Services↗
PubMed1989

[Complementing and replacing the clinic sensibly--on the management, effectiveness and indications for a complementary psychiatric residence. Results of a 1-year prospective evaluation study].

The complementary psychiatric (home) area is a relatively new branch of institutional psychiatry, the therapeutic evaluation and integration of which into everyday psychiatric thinking and acting has not yet become a reality. The evaluative study presented here covered 53 inmates and concerned their everyday life, the success of the treatment, predictors and perspectives. A gradual change in the means and aims of psychiatric rehabilitation seems to be materializing: the (re-)integration of the subject into his family of origin or into the psychosocial network will probably become more important than just reinstating the patient into his original place and kind of work. For the future it appears desirable that the inmates and the equipment are financially secured, that the entire setup is integrated into the system of psychiatric institutions, and that the method can be applied to further groups of patients.

Adult↗
PubMed1988

Suspension of neuroleptic therapy in acute schizophrenia.

What are the effects of the abrupt discontinuation of neuroleptics (suspension therapy) in acutely schizophrenic patients with unsatisfactory remission under standard neuroleptic therapy? This question was investigated in a prospective study of 159 patients. In addition to the psychopathologic results of the AMDP system, the self rating (VAMS) and nurses' rating (NGI) of psychopathologic parameters were assessed. Indication for suspension of the neuroleptic treatment was established in 21 patients (13%) following definite criteria. Suspension therapy brings about a rapid improvement in psychopathologic results. The paranoid-hallucinatory syndrome also undergoes remission; this is to be understood as an immediate effect of suspension of therapy. In one-third of the cases complete suspension effects, in another third partial suspension effects, and in the remaining third failure occur. Further advantages of suspension therapy are the reduction in neuroleptic drug requirements and a favorable influence on the entire treatment course. The investigation does not permit any statement as regards prediction of the suspension effect or concerning the mechanism underlying the suspension therapy.

Acute Disease↗
PubMed1987

[Work--its significance in the therapy and rehabilitation of chronic psychiatric patients].

More and more chronic mental patients live in the communities and are jobless. Most of them cannot be expected to become gainfully employed in the near future, but the aim of all efforts should always be a permanent working place or at least meaningful activity. Due to the multitude of institutions participating in rehabilitation work the only chance of maximum utilisation of available chances can be achieved only by a local rehabilitation team. The article discusses the available scientific data on evaluation, success prediction, environmental structuralization and organisation of psychiatric working area.

Chronic Disease↗
PubMedDate not supplied

[What are the contributions of social psychiatry services to psychiatric patient management? Results from a mid-size, psychiatrically well supplied city 1988 and 1989].

Every year 10-12.5% of the population are in need of psychiatric treatment. Statistical investigations lead us to believe that indeed only one-third of the mentally ill receive treatment. Above all, alcohol- or drug-induced dependence and geriatric illnesses are becoming increasingly prevalent. Patients of the Social Psychiatric Services of the city of Muenster (FRG) for the years 1988 and 1989 were examined for sociodemographic and diagnostic data, and the case histories documented. In 1988 1,019 in 1989 915 citizens were looked after. The treatment was concentrated on the severely mentally ill (22%), psychic geriatric patients (16%) and above all, chronic alcoholics (33%). The studies show that the patients are frequently lonely, have poor accommodation (app. one-third receive only welfare aid, one-third are pensioners) and exist on state hand-outs. App. one-tenth are either under care or guardianship. The peripatetic home visits (1988: 1,923, 1989: 1,512 home visits) are particularly helpful for persons who are immobile or reluctant to establish contacts, and for their relatives. Crisis intervention was necessary for 10% and commitment to institutional care for 6-8%. The Social Psychiatric Services are assuming an increasingly important function in the care of the chronic mentally ill, who--because of "dehospitalisation"--have no access to regular professional care.

Adolescent↗