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Biomedical subjects

B Lay

Publications and source records attributed to B Lay.

13 recordsLinked to original sources
PubMed2005

Are immigrants at a disadvantage in psychiatric in-patient care?

OBJECTIVE: To assess the utilization of psychiatric in-patient care among immigrants, and to compare immigrants and natives with respect to sociodemographic and clinical characteristics. METHOD: Analysing a sample of 23 377 consecutive referrals to psychiatric hospitals of a catchment area in 1995-2001. RESULTS: Within this sample, 20% were foreign nationals. Rates of psychotic disorders were similar in immigrants and natives. Regarding other diagnoses, sociodemographic and clinical measures, there were significant differences. Most immigrant groups had higher rates of compulsory admission, were more likely to be admitted with lower illness severity and not to be readmitted, and spent significantly shorter time in hospital, compared with Swiss in-patients. Some of these differences were clearly gender-specific. CONCLUSION: Service utilization and psychiatric treatment decisions are not explained merely by illness-related aspects in immigrants. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.

Adolescent↗
PubMed2001

Effectiveness of home treatment in children and adolescents with externalizing psychiatric disorders.

OBJECTIVE: The study examines effectiveness of home treatment in children and adolescents with severe externalizing behavior disorders. METHODS: Fifty patients with ICD-10 diagnosis F90, F91, or F92 aged 5-16 years were treated in a home treatment setting for 3.5 months. Assessments were made using multiple informants (patients, parents, therapists, supervisors, and clinicians not involved in the treatment) to evaluate psychiatric symptoms, various aspects of psychosocial functioning, and global treatment outcome. RESULTS AND CONCLUSIONS: Findings showed a significant decrease in psychiatric symptoms and improvement in psychosocial adjustment. Positive treatment effects were seen in almost every area of social functioning. The child's compliance and the therapist's professionalism were found to be the most important predictors of treatment outcome. Findings suggest that extent of achieved home treatment effects in externalizing disorders is similar to that in internalizing disorders.

Adolescent↗
PubMed2000

The psychosocial outcome of adolescent-onset schizophrenia: a 12-year followup.

This study examines the educational/occupational outcome and social situation of patients treated for schizophrenia in adolescence (age at admission 11.5-17.9 years; mean 16.0 years). Out of 96 consecutively admitted patients between 1976 and 1987, 85 (89%) could be traced and 65 (68%) were reassessed more than 10 years after the first episode. At followup, 54 of the 65 (83%) had had at least one further inpatient-treated episode and 48 (74%) were receiving psychiatric treatment. Thirty-seven (57%) of the subjects were at least moderately impaired with respect to vocational functions (i.e., did not achieve their premorbid educational/occupational goals). Serious social disability was found in 42 (66%) of the 64 subjects for whom social disability data were available. Regarding means of maintenance, 49 (75%) were financially dependent, supported by parents or public assistance. Impairments were comparable for males and females. History of treatment (longer duration of inpatient stay; more than two inpatient episodes) was found to be predictive of lower vocational functioning at followup. Severity of positive symptoms and more than two inpatient episodes in the early course of illness predicted social disabilities in young adulthood. Findings support the view that, because of early onset, the long-term perspective for many adolescent-onset schizophrenia patients is that of poor social adjustment, severe functional impairment, and high socioeconomic dependence and suggest that consequences are more severe than in adult-onset schizophrenia.

Acute Disease↗
PubMed2000

Clinical and medico-legal aspects of home-based care by nurses as an alternative for inpatient treatment in child and adolescent psychiatry.

Increasing economic restrictions in the supply of inpatient care require the establishment of alternative treatment modalities also in the field of child and adolescent psychiatry. Therefore, home-treatment offers the possibility of effective interventions in the natural environment of the severely disturbed child and its family. In our study practical implementation of therapy was in the hands of nurses specializing in child and adolescent psychiatry. Various aspects of their therapeutic work with disordered children are focussed. Specific characteristics and problems of home-treatment-including interventions in the patient's psychosocial surroundings--are illuminated from the nurse's point of view.

Adolescent↗
PubMed1997

The intellectual functioning of adolescents with anorexia nervosa and bulimia nervosa.

The aim of this study was to investigate the intellectual functioning of a large group of eating disordered adolescents in order to test two hypotheses, viz, that the intellectual functioning of eating disordered adolescents conforms to the normal distribution, and that eating disordered adolescents do not perform better in verbal abilities than in nonverbal abilities. Standard intelligence tests were applied to 190 consecutive out- and inpatients with eating disorder diagnoses. The results were compared with those of a group of patients with other disorders, similar in age, sex, SES, and year of admission. The IQ of the eating disordered patients was significantly higher than that of patients in the comparison group. Patients in the comparison group and bulimic patients, but not anorexic patients, showed better nonverbal than verbal intellectual performance.

Adolescent↗
PubMed1997

Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.

A crossover 'placebo'-controlled, double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder. Effects of diet were compared with those yielded by stimulant medication (methylphenidate). The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim. Change in behavior was measured in standardized situations by trained raters, including behavior assessment when testing with CPT and PAT, during a free play situation, and at school. Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions. Methylphenidate used in 36 children yielded more responders (44%) than diet. The amount of positive changes in behavior in those who received both treatments was about the same. Although only effective in a minority of children, dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Course of adolescent psychotic disorder with schizoaffective episodes.

This study examines educational/occupational outcome and social functioning of adolescents treated for psychosis (mean onset age 16.1 yrs +/- 1.3). In a sample of 157 subjects, 26 patients with schizoaffective episodes (defined as any episode meeting ICD-9 criteria for schizoaffective psychosis, occurring at any time during the course of illness) were compared to 101 patients with schizophrenia, and to 30 affective disordered patients, all without schizoaffective episodes. Follow-up information (mean interval 7.3 yrs +/- 4.3) was obtained on 130 subjects. The three groups did not differ concerning sex, duration of first inpatient treatment, symptoms and social competence at discharge, nor at follow-up. At the time of outcome subjects with schizoaffective episodes showed greater similarities to schizophrenic than to severe affective disorder. Educational and occupational impairment was found in 72% of the schizoaffective group (schizophrenic group 79%, affective group 40%), obvious or more severe social disability in 86% of the schizoaffective group (schizophrenic 79%, affective 40%). Disabilities regarding performance of specific social roles and specific downward educational and occupational drifts were found to be more marked in schizoaffective than in affective disorder. Implications for further research and clinical practice are discussed.

Adolescent↗
PubMed1997

[Does cognitive performance of adolescents with anorexia nervosa change with treatment?].

In the present pilot study 52 inpatients with anorexia nervosa were examined with regard to cognitive impairments. A psychological assessment was made on admission (T1) and shortly before discharge (T2), the focus being on fluency aspects of cognitive functioning. The results showed high test scores at T1 on all cognitive measures and improvement in cognitive functioning in the course of inpatient treatment. However, the level of cognitive functioning was not correlated with weight loss or duration of illness. Patients who were discharged with a BMI below 17.5 kg/m2 scored even higher at T1 (reaction time, concentration task) than those with a BMI above 17.5 kg/m2, pointing to a negative association between cognitive performance and outcome (target weight). Psychopathological variables that may play a role and that should therefore be considered in future research are discussed.

Adolescent↗
PubMed1996

[Evaluation of disruptive behavioral disorders: how situation specific and temporally accurate are behavior observations?].

The stability of expert behavior ratings was analyzed in an unselected inpatient sample of 49 children admitted for disruptive behavior disorders. Expert behavior ratings were obtained for two highly standardized situations (play behavior on ward, on-task behavior during tests) at two time points (T1: 1 week and T2: 4 weeks after admission). These scores were compared with initial diagnostic assessments (clinical judgement) and objective behavior data (actometer) in the test situation. A comparison of the standardized behavior ratings over time showed that in both settings problem behavior was more pronounced at T2 than at T1. Actometer data indicating a higher activity level at T2 were significantly correlated with behavior ratings. There was only a weak association between expert behavior ratings and an initial diagnosis of conduct disorder; the correlation between an initial diagnosis of attention-deficit hyperactivity disorder and the behavior ratings was statistically significant. In general, T2 behavior ratings corresponded better to the initial clinical judgement. Implications for the use of multiple sources of information and of repeated measurements are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1995

Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years.

Of 118 child and adolescent schizophrenic patients (ICD-9: 295.x; mean onset age 16.0 years), 97 (82.2%) could be completely investigated at follow-up (mean interval 7.4 years; mean age 23.1 years). At follow-up 30% of the patients were semi-dependent or dependent, 72% still required psychiatric treatment, 44% were at least moderately impaired with regard to educational/occupational functions and 58% with regard to social functions; 73% had experienced at least one further schizophrenic episode. Comparison with schizophrenia beginning in adulthood showed that the impairment in social function was much greater in the younger group of patients. These results support the belief that schizophrenic psychoses starting in adolescence have a worse outcome than those beginning in adulthood. The most efficient indicators for a worse outcome were long duration of inpatient treatment at first admission, a high number of symptoms and low social competence at discharge.

Adolescent↗
PubMed1994

[Follow-up of schizoaffective psychoses in adolescence].

Of 156 adolescent inpatients with psychotic disorders (ICD-9: 295.0 to 296.9), 25 had a schizoaffective psychosis with onset before age 18. Of these, 21 were followed up an average of 6.5 years later. Six of the subjects had had only one schizoaffective episode and 15 had had a second episode an average of 14 months later. Half of the subjects had had schizoaffective episodes only. More of the patients with an initial affective episode developed schizoaffective psychosis than of those with an initial schizophrenic episode. On average there had been 0.91 episodes per year during the follow-up period. Seventy-one percent of the subjects had been unable to continue their education or work at the previous level and most had marked deficits in social adaptation. The level of social competence at the end of the first episode was of predictive value for the later social handicap. A comparison with other groups of patients of the same age showed that those with affective disorders had faired better and those with schizophrenia appeared to have the poorest outcome. The schizoaffective group tended to resemble the schizophrenic group more closely than the affective group. Patients whose schizoaffective disorder began in adulthood had fewer problems on the educational and occupational level, better social adaptation and fewer episodes per year and had spent less time in inpatient treatment than those whose disorder had begun before age 18.

Adolescent↗
PubMed1994

[Diagnosis of expansive behavior in children: how do different observers assess in various situations?].

The present study addressed the question of the extent to which parental assessment of expansive behavior disorders can be validated by clinical assessment and how both types of assessment are correlated with behavior ratings by trained outside observers. The agreement between these different sources of information was analyzed in an unselected sample of 49 children aged 5 to 11 admitted to our inpatient unit for expansive behavior disorder. Most of the children met the clinical criteria for both attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). With regard to diagnoses, there was good agreement between the parents' assessment and the clinical assessment made one week after admission. However, the parents rated ADHD as more severe than the clinicians did. Ratings of the children's overt behavior in two standardized situations (play situation, test situation) by trained outside observers had only weak correlations with the parental and clinical assessments. The only significant correlation was between the clinical assessment of hyperactivity and the behavior ratings. The contribution of the situational variability of the children's behavior to the low agreement between the different sources of information is discussed. Where feasible, multiple perspectives should be taken into consideration.

Attention↗