PubMed Health⌕ Search

Biomedical subjects

Carlos Nordt

Publications and source records attributed to Carlos Nordt.

14 recordsLinked to original sources
PubMed2006

Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis.

BACKGROUND: Switzerland has been criticised for its liberal drug policy, which could attract new users and lengthen periods of heroin addiction. We sought to estimate incidence trends and prevalence of problem heroin use in Switzerland. METHODS: We obtained information about first year of regular heroin use from the case register of substitution treatments in the canton of Zurich for 7256 patients (76% of those treated between 1991 and March, 2005). We estimated the proportion of heroin users not yet in substitution treatment programmes using the conditional lag-time distribution. Cessation rate was the proportion of individuals leaving substitution treatment programmes and not re-entering within the subsequent 10 years. Overall prevalence of problematic heroin use was modelled as a function of incidence and cessation rate. FINDINGS: Every second person began their first substitution treatment within 2 years of starting to use heroin regularly. Incidence of heroin use rose steeply, starting with about 80 people in 1975, culminating in 1990 with 850 new users, and declining substantially to about 150 users in 2002. Two-thirds of those who had left substitution treatment programmes re-entered within the next 10 years. The population of problematic heroin users declined by 4% a year. The cessation rate in Switzerland was low, and therefore, the prevalence rate declined slowly. Our prevalence model accords with data generated by different approaches. INTERPRETATION: The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Our model could enable the study of incidence trends across different countries and thus urgently needed assessments of the effect of different drug policies.

Adult↗
PubMed2006

Attitudes of mental health professionals toward people with schizophrenia and major depression.

Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.

Adult↗
PubMed2006

Patterns of inpatient care for immigrants in Switzerland: a case control study.

BACKGROUND: Migration has become a major political and social concern in West European societies. METHODS: A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period. RESULTS: Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients. CONCLUSIONS: Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.

Adolescent↗
PubMed2006

Community psychiatry: results of a public opinion survey.

BACKGROUND: Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. AIM: To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. METHOD: Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737). RESULTS: Most respondents have positive attitudes to community psychiatry. In the regression analysis (R2 adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. CONCLUSIONS: In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

Aged↗
PubMed2005

Recommendations of mental health professionals and the general population on how to treat mental disorders.

OBJECTIVE: The objectives of the study are (1) to assess the mental health literacy of mental health professionals, (2) to determine whether there is agreement between different professional groups with respect to different psychopathological conditions and (3) to compare the professionals' knowledge with that of the general population. METHODS: Two representative samples of mental health professionals and laypersons were presented with a vignette depicting either a person with schizophrenia, major depression or without any psychiatric symptoms ('non-case'). Out of 18 treatment proposals, the respondents were asked to indicate the proposals regarded as helpful and those considered as being harmful, respectively, for the person depicted. RESULTS: Mental health professionals view their profession and less often their treatment methods as helpful. Dealing with the situation alone, electroconvulsive therapy, hypnotics and sedatives are consistently regarded as harmful. For the individual with schizophrenia, mental health professionals agree about helpful treatments. Regarding depression, a lack of consensus is found about treatment proposals such as psychiatric hospitalisation, antidepressants and complementary and alternative medicine. An important part of mental health professionals suggests medical help (psychologists and general practitioners) for the non-case vignette. Fewer nurses, social workers, vocational workers and occupational therapists ('other therapists') as compared to psychiatrists and psychologists recommend standard treatment methods. Professionals and the general population significantly differ in their attitudes towards the treatment suggestions, especially regarding medication and alternative medicine. CONCLUSIONS: To improve the treatment of mental disorders, various strategies must be considered. These include permanent education of all mental health professionals, especially nurses and other therapists. A special focus must be given to affective disorders and a potential (over-) treatment of normal behaviour.

Adolescent↗
PubMed2005

Social support modifies perceived stigmatization in the first years of mental illness: a longitudinal approach.

Perceived stigmatization of mentally ill people impairs their social relations and well-being. While perceived stigmatization theoretically and empirically has been accounted for as an independent and unalterable factor, this longitudinal study focuses on reciprocal effects between stigmatization and social ties. The duration of mental illness is included as a grouping variable to extend the longitudinal perspective. A sample of severely mentally ill persons (n=165) in two psychiatric hospitals in Zurich took part in a structured interview during their admission and 1 year later. Cross-lagged path models were designed to test the interrelations of (1) perceived stigmatization, (2) a defensive stigma coping orientation, (3) concrete stigmatizing experiences, and either (4) social network, or (5) perceived social support as dependent variables. Contrary to previous findings, neither of the three components of stigmatization tested has any influence on social network or support. Social support, though, strongly predicts perceived stigmatization 1 year later, but only in the group with a more recent onset of illness. This finding suggests that the perception of stigma is subject to modification in the course of new life circumstances and underlines the importance of activating social resources in the first years of mental illness. Duration of illness should be included as a central variable in future research, as it influences the nature of the relation between stigmatization and social ties.

Adult↗
PubMed2005

Can a seizure help? The public's attitude toward electroconvulsive therapy.

Despite controversial discussions in the general population, little is known about the public's attitude toward electroconvulsive therapy (ECT). We examined in a representative opinion survey (N=1737) (1) whether the lay public views ECT as an appropriate treatment for schizophrenia and depression, and (2) how demographic, psychological, sociological, and cultural variables influence attitudes. Most respondents (57%) considered ECT as a harmful treatment, and only a small number (1.2%) were in favor of ECT. A large number of respondents did not consider ECT as a treatment. We identified three predictors of negative attitude toward ECT (younger age, cultural area, greater degree of contact with the mentally ill; R2=0.042). The finding was not affected by the type of illness. Thus, having a prejudice toward ECT is a 'uniform attitude' that does not significantly vary between individual, demographic, or cultural contexts.

Adolescent↗
PubMed2004

Factors influencing social distance toward people with mental illness.

BACKGROUND: When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance-the willingness to engage in relationships of varying intimacy with a person--is an indicator of public attitudes toward persons with mental illness. METHODS: Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). RESULTS: The level of social distance increases if situations imply 'social closeness.' The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance (R2) is 44.8%. CONCLUSIONS: Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondent's general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches.

Adolescent↗
PubMed2004

Perceived stigmatization of mentally ill people and its consequences for the quality of life in a Swiss population.

The awareness of social conceptions of mental illness is essential in understanding the social realities of people with mental illness. Labeling due to psychiatric hospitalization can have a powerful influence on people's life chances. Little is known about subjective perceptions of stigmatization and discrimination and the influence of these beliefs on the quality of life of mentally ill people. We used a psychiatric inpatient sample and a community sample to analyze and compare perception of stigmatization and discrimination. Both patients and community members believed that most people rejected former mental patients. Thus, attitudes toward mental illness have their source in the socialization of the individual and his or her cultural context rather than in the currently pathological state of those affected. In a multiple regression analysis, we showed that even if controlled for demographic and clinical factors, perceived devaluation and discrimination had a significant negative effect on the quality of life of the mentally ill people. For planning and implementing psychiatric treatment programs, it is important to be aware of social conceptions of mental disorder.

Adult↗
PubMed2004

[Is methadone maintenance provided by private practitioners effective?].

OBJECTIVES: Involvement of private practitioners in methadone maintenance treatment (MMT) enhances its availability. However, effectiveness of such treatments is still debated. METHODS: A retrospective case register analysis comparing the retention of private practices with that of specialised institutions. All methadone maintenance treatment starting between January 1, 1997 and December 31, 1999. Kaplan-Meier survival estimates to test for different retention times; Cox-regression procedure to control for baseline differences between the two populations. RESULTS: Even after controlling for distinct patient characteristics, MMT by private practitioners resulted in a longer retention time. CONCLUSION: Our findings favour the involvement of private practitioners. Providing better professional and financial support may enhance their participation.

Adult↗
PubMed2003

Do people recognise mental illness? Factors influencing mental health literacy.

BACKGROUND: Mental health literacy has been defined as the public's knowledge and the beliefs about mental disorders enhancing the ability to recognise specific disorders. AIMS: Firstly, to determine whether the public recognises a person depicted in a vignette as mentally ill or as experiencing a crisis. Secondly, to reveal the factors influencing the correct recognition. METHODS: Multiple logistic regression analysis of an opinion survey conducted in a representative population sample in Switzerland (n=844). RESULTS: The depression vignette was correctly recognised by 39.8% whereas 60.2% of the respondents considered the person depicted as having a 'crisis.' The schizophrenia vignette was correctly identified by 73.6% of the interviewees. A positive attitude to psychopharmacology positively influenced the recognition of the two vignettes whereas a positive attitude to community psychiatry had the inverse effect. Moreover, for the depression vignette previous contact to mentally ill people had a positive influence on the recognition. For the schizophrenia vignette instead, rigidity and interest in mass media had a negative influence, respectively. CONCLUSIONS: The low knowledge about mental disorders, particularly depression, confirms the importance and the need to increase mental health literacy. Furthermore, professionals must openly discuss illness models with their patients, especially emphasising the differences between illness and crisis.

Adolescent↗
PubMed2003

[Increased stigma through a former stay in a mental hospital? Results of a public survey in Switzerland].

OBJECTIVE: The perception of how most people stigmatize mentally ill persons has consequences for the affected. Is a former stay in a mental hospital connected with an additional stigma? METHOD: In three linguistic areas of Switzerland we conducted a representative opinion survey (N = 1737) on public attitude towards mental illness, psychiatric treatment, and the institutions involved. Using Link's "devaluation-discrimination-scale" a randomly selected sample was asked on the telephone about the perceived stigma concerning (1) a currently mentally ill person or (2) a former mentally ill person or (3) a former mental inpatient. RESULTS: In all three linguistic areas of Switzerland we found in the case of current illness a lower social acceptance or a higher discrimination, respectively. Also in all linguistic areas those who were asked about "former mental illness" or "former stay in a mental hospital" did not differ regarding perceived acceptance or discrimination. DISCUSSION: Our data does not confirm the assumption of increased stigma because of a former stay in a mental hospital. An inquiry of subjective experience of a hospital stay, however, would probably lead to other results than that of a public survey.

Adolescent↗
PubMed2002

Determinants of attitude to volunteering in psychiatry: results of a public opinion survey in Switzerland.

BACKGROUND: The United Nations proclaimed 2001 the "International Year of Volunteers". Little is known about factors influencing the attitude to volunteering in psychiatry. However, knowledge about these factors is important as target groups to be addressed by an awareness and promotion campaign could be identified. AIMS: To determine the influence of demographic, psychological and sociological factors on the attitude to volunteering in psychiatry. METHODS: Multiple logistic regression analysis of the results of an opinion survey conducted on a representative population sample in Switzerland (n = 1737). RESULTS: Public attitude is mostly positive. It depends, however, on the form of volunteering. Two explanatory models for volunteering in psychiatry were found: first, the "antipathetic person" having social distance to and negative stereotypes towards the mentally ill. Second, the "people with social responsibility and commitment" who have former experience in volunteering, a positive attitude to community psychiatry, interest in mass media, a social profession and perceive discrimination of mentally ill persons. Age and gender are significant predictors. CONCLUSIONS: An awareness and promotion campaign to use the vast potential of people willing to volunteer in psychiatry can be primarily focused on those with a basic interest in social issues. Volunteering must be limited in time and responsibility. Contacting people with a positive attitude by mass media is a promising way.

Adult↗