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Biomedical subjects

H J Haug

Publications and source records attributed to H J Haug.

At least 19 recordsLinked to original sources
PubMed2004

The effect of a training course in aggression management on mental health nurses' perceptions of aggression: a cluster randomised controlled trial.

Nurses' attitudes towards patient aggression may influence their behaviour towards patients. Thus, their enhanced capacity to cope with aggressive patients may nurture more positive attitudes and alleviate adverse feelings emanating from patient aggression. This cluster randomised controlled trial conducted on six psychiatric wards tested the hypotheses that a 5 day training course in aggression management would positively influence the following outcome measures: Nurses' perception and tolerance towards patient aggression and resultant adverse feelings. A repeated measures design was employed to monitor change. No effect was found. The short time frame between the training course and the follow up measurement or non-responsiveness of the measurement instruments may explain this finding.

Adaptation, Psychological↗
PubMed2004

The perception of aggression by nurses: psychometric scale testing and derivation of a short instrument.

Patient aggression is a serious problem in psychiatric nursing. Nurses' attitudes towards aggression have been identified as mediating the choice of nursing interventions. To date, investigations are lacking which elucidate the stability of one of the few scales for measuring the attitude of aggression. This study aimed to investigate the test-retest stability of the Perception of Aggression Scale and to derive a shortened version. In order to test the reliability of the Perception of Aggression Scale items, three groups of psychiatric nurses were requested to fill in the Perception of Aggression Scale twice (30 student nurses after 4 days, 32 qualified nurses after 14 days and 36 qualified nurses after 70 days). We derived the shortened version from an independent data set obtained from 729 psychiatry nurses using principal component analysis, aiming to maximize parsimony and Cronbach's alpha. Amongst competing short versions, we selected those with the highest reliability at 70 or 14 day retest. A scale using 12 of the original 32 items was derived yielding alphas of r = 0.69 and r = 0.67 for the two POAS factors with retest reliabilities of r = 0.76 and r = 0.77. The shortened scale offers a practical and viable alternative to the longer version.

Adult↗
PubMed2004

The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings: report on a pilot study.

Systematic risk assessment and training courses have been suggested as interventions to deal with patient violence in psychiatric institutions. A dual centre prospective feasibility study was conducted on two Swiss psychiatric admission wards to test the hypothesis that such interventions will reduce the frequency and severity of violent events and coercion. A systematic aggression risk assessment, in combination with a standardized training course in aggression management was administered and the frequency and severity of aggressive incidents and the frequency of coercive measures were registered. The incidence rates of aggressive incidents and attacks showed no significant reduction from the baseline through risk prediction and staff training, but the drop in coercive measures was highly significant. A 'ward effect' was detected with one ward showing a decline in attacks with unchanged incidence rates of coercion and the other ward showing the opposite. The severity of the incidents remained unchanged whilst the subjective severity declined after the training course. We conclude that a systematic risk assessment and a training course may assist in reducing the incidence rate of coercive measures on psychiatric acute admission wards. Further testing of the interventions is necessary to measure the effect of the training alone and to counteract 'ward effects'.

Acute Disease↗
PubMed2002

Coercive procedures and facilities in Swiss psychiatry.

BACKGROUND: Coercive measures in psychiatry,although in many cases effective in violence management and injury reduction, have been criticised from a consumerist point of view. METHOD: A questionnaire regarding coercive facilities and procedures was dispatched to the charge nurses of 86 acute psychiatric admission wards in German speaking Switzerland covering a catchment area of 75% of the Swiss population. RESULTS: 95% of all wards responded rendering the survey representative. The majority of wards have seclusion rooms and 55% of charge nurses perceive seclusion facilities as adequate. Two to twenty staff members are involved in overwhelming dangerous patients and some discontent is expressed at the haphazard fashion in which such events occur. Almost 70% of the wards use a form for reporting, 42 % of wards keep statistics on violent incidents and 17% of wards have access to these data. Of all wards 84% register injections against patients' will, 83% seclusion, and 78% mechanical restraint and a minority of wards register the coercive administration of oral medication, forced nutrition, threats of coercive measures in case of pharmacological non-compliance. DISCUSSION: Isolation, the coercive administration of medicine and restraint techniques are sensitive forms of treatment. Deficits reported by the charge nurses point to the need for enhanced facilities and improved forms of coercion management such as training in the use of mechanical restraints and the overwhelming of dangerous patients. CONCLUSION: The data show considerable differences in the facilities, the use, and the recording of coercive measures in the area under scrutiny.

Adult↗
PubMed2001

Disturbed circadian rest-activity cycles in schizophrenia patients: an effect of drugs?

The circadian rest-activity cycle of schizophrenia patients stabilized for more than a year on monotherapy with a "classical" neuroleptic (haloperidol, flupentixol) or with the atypical neuroleptic clozapine was documented by continuous activity monitoring for 3-7 weeks. In this pilot study, the three patients treated with clozapine had remarkably highly ordered restactivity cycles, whereas the four patients on classical neuroleptics had minor to major circadian rhythm abnormalities. This is the first documentation of circadian rest-activity cycle disturbances in schizophrenia related to class of drug.

Antipsychotic Agents↗
PubMed2000

[Antidepressive therapy by modifying sleep].

Depressive symptoms are unspecific and occur in several psychiatric disorders. Sleep disturbances are also frequently present in depressed patients. As a consequence, it has been established that a number of modulations of the sleep-wake cycle can have an antidepressive effect. Total sleep deprivation or deprivation in the second half of the night have proven successful. The main limitation of the otherwise well tolerated treatment is the short duration of the antidepressive effect, which is mostly reversed in nearly all patients after the following night's sleep. New approaches are to shift the timing of sleep to earlier to ensure a possible longer-lasting effect. In clinical praxis the following manipulations should not be used: sleep deprivation in the first half of the night (not successful), REM-sleep deprivation (experimental setting), induced sleep prolongation (negative risk-benefit-ratio). In addition to patients with affective disorders sleep deprivation has proved relevant in patients with schizophrenia (depressed and/or with predominantly negative symptoms) and premenstrual dysphoric disorder. Very few side effects have been reported. Although many hypotheses have been tested, the mechanism of action underlying the antidepressive effect of sleep deprivation is still unknown.

Depressive Disorder↗
PubMed2000

Actigraphy to measure day structure as a therapeutic variable in the treatment of schizophrenic patients.

OBJECTIVE: A component of social skills is the ability to adapt to the social rhythms of the environment. Patients with schizophrenia are often disabled in this adaptation. Thus, structuring activities throughout the day has long been known as part of psychosocial treatments. Actigraphy as a tool to measure acitvity and circadian rhythms may even serve as an indicator for the day-structuring of schizophrenic patients. METHOD: Actigraphy was used in a patient with affective disorder and one with chronic schizophrenia for more than 2 weeks. RESULTS: In comparison to a regular 24-hour rest-activity cycle in a depressed patient, the actigraph of the patient with schizophrenia presents active phases at night, irregular activity levels at day and signs of a delayed-sleep-phase syndrome. CONCLUSION: Actigraphy could serve as a tool to investigate activity levels and circadian rest-activity phases, even in schizophrenia. There may be some further benefit of actigraphy as a tool in psychosocial treatments.

Activities of Daily Living↗
PubMed1999

Deinstitutionalization of psychiatric patients in central Europe.

The central European countries Germany, Switzerland, Austria, and Luxemburg are confronted with a variety of individual problems concerning health care. After an analysis of problems which are shared by all the countries, these individual aspects are analyzed. In Germany there has been a rapid structural change of psychiatric care in the last 30 years. Although there was a broad movement to deinstitutionalize patients with chronic psychiatric disorders who need long-term care, there are still too many psychiatric beds in large psychiatric hospitals and still missing psychiatric departments in general hospitals in some areas. In Austria the process of deinstitutionalization has been delayed but a general survey of the health care system by the government led to an acceleration of this process in recent years. Due to historical reasons, the mental health care system in Switzerland is not easily comparable with the ones in the other two countries. Deinstitutionalization mainly means reduction of beds in the existing psychiatric hospitals rather than a structural change with a conversion to psychiatric departments in general hospitals. Luxemborg is a good example of the fact that economical factors are not the only aspects influencing development in psychiatric care. Psychiatric care is not community based, centralized, separated from medical care, and the supply system concerning complementary outpatients institutions is underrepresented. Thus, in all the countries the process of deinstitutionalization has still not come to a satisfying level. This is not only due to the economically difficult situation in the recent past. A change can only be expected when the opinions about modern principles of psychiatric care receive more weight in general society and with their political representatives.

Chronic Disease↗
PubMed1999

Accelerated post-glucose glycaemia and altered alliesthesia-test in Seasonal Affective Disorder.

BACKGROUND: Little is known about the link between mood, food and metabolic function in Seasonal Affective Disorder (SAD). METHODS: We investigated this link in a combined glucose tolerance-alliesthesia test in eight SAD patients in winter before and after one week light therapy, and in summer. RESULTS: SAD patients exhibited faster post-glucose glycaemic and insulin responses (p <0.05), and increased hedonic ratings of high concentrated sucrose solutions (p <0.035) when depressed in winter than when euthymic (one week after light treatment or in summer). CONCLUSIONS: The rapid glycaemic and insulin responses to an oral glucose load may be a result of accelerated gastric emptying. LIMITATIONS: The number of studied patients was rather small and no control group was studied in parallel. CLINICAL RELEVANCE: the more rapid post-glucose glycaemia may impair glucose homeostasis in depressed SAD patients.

Adolescent↗
PubMed1998

Sleep deprivation response in seasonal affective disorder during a 40-h constant routine.

BACKGROUND: There are no controlled studies investigating the response of patients with seasonal affective disorder (SAD) to a total sleep deprivation (SD). METHODS: The clinical response to SD of patients with SAD in winter was investigated under the stringently controlled conditions of a 40-h constant routine protocol. RESULTS: 52% of the SAD patients (N=11 women) improved, using a mean of a multiple ratings. This is in the range of response found for non-seasonal major depression. In contrast, controls (N=8 women) showed less improvement of mood (29%). CONCLUSION: SAD patients respond to SD as do non-seasonal major depressives. The best discrimination of response was obtained in an observer rating (Clinical Global Impression: global severity improvement), and the morning values of two different self ratings (v. Zerssen depression scale, 100 mm VAS with the criterion of > or =10 mm improvement). LIMITATION: A more reliable estimate of the SD response rate in SAD patients would require a larger group. CLINICAL RELEVANCE: SAD patients do not differ from other subgroups of major depression in their response to SD, and therefore this is an additional treatment option to light therapy.

Adult↗
PubMed1997

[Central to decentralized admission to the psychiatric hospital. Effects of changed admission circumstances on structure and process quality].

The study provides empirical data to compare different systems used for hospital admission procedures in a psychiatric clinic. The Psychiatric University Clinic Basel replaced its traditional central admission ward by direct admission to a number of different treatment settings. This change had consequences for both structural and procedural quality. More admissions occurred after prior notice had been given, and these admissions occurred more often at a time of day when more clinic staff were available. The rate of voluntary admissions increased, and the continuity of care, as measured by the number of transfers within the clinic during the first 5 days post-admission, was improved. These findings, which support an interpretation that the treatment conditions were improved, must be balanced against the drawback of delayed decision-making processes with, for example, longer waiting times for the patient. However, the continuity of therapeutic relationships can be increased through further changes in the procedural quality.

Adult↗
PubMed1996

Sleep electroencephalogram in seasonal affective disorder and in control women: effects of midday light treatment and sleep deprivation.

The role of sleep regulation in Seasonal Affective Disorder (SAD) was studied in 11 female SAD patients and eight controls in winter before and after light treatment (LT, 6000 lux, 10-14h, 5 days). The sleep electroencephalogram (EEG) was recorded at baseline and after the total sleep deprivation (TSD) of a 40-h constant routine. The well-known effects of TSD on sleep parameters and on EEG power spectra were replicated, indicating normal homeostatic sleep regulation in SAD. Sleep improved after LT in both groups. Since the condition following LT was the second session, these improvements may be an order effect and/or an effect of LT itself. After LT, sleep EEG spectra of SAD patients, but not of controls, showed modifications resembling those of recovery sleep. Since only SAD patients curtailed their sleep while remitting during the LT period, these EEG modifications can be explained by normal sleep regulation alone. We conclude that the robust antidepressant effect of LT in SAD is unlikely to be mediated by changes in sleep, and that sleep regulatory mechanisms are not a crucial factor in the pathogenesis of winter depression.

Adult↗
PubMed1996

Suicidality in hospitalized patients with a primary diagnosis of personality disorder.

In this investigation the frequency and clinical importance of suicidal behavior in patients with a primary diagnosis of personality disorder was studied. The sample was drawn from a group of over 8000 psychiatric inpatients admitted to a university psychiatric hospital. Only patients with a primary diagnosis of personality disorder were included. In the subgroup of 226 patients with this diagnosis, it was found that the rate of suicidality was almost as great as that of patients with a primary diagnosis of major affective disorder (39% as opposed to 41%), despite the absence in all but 3% of these patients of an additional diagnosis of affective disorder. Further, this figure was considerably higher than that for all psychiatric inpatients (24%). Suicidal patients had more suicide attempts in their history and had a more serious depressive syndrome, despite the fact that only 3% fulfilled the criteria for major affective disorder. The conclusion which can be drawn is that a high degree of suicidality should not be regarded as exclusively linked to a primary diagnosis of major affective disorder.

Adult↗
PubMed1996

[Non-compliance and lack of indications for depot treatment as reasons for exclusion from adequate prevention of recurrence].

OBJECTIVE: The paper reports on the recruitment of a multicenter study on ambulant prophylactic treatment of schizophrenic disorders. METHODS: For a study of the relapse-preventative effect of different dose patterns of Flupentixol, a screening phase was carried out among of 1129 schizophrenic patients. The aim of the screening phase was to establish the criteria for exclusion or inclusion in the treatment phase of the study. RESULTS: Only 62 patients could be included. The reason for 54 patients not being included was a lack of compliance from either the patient or the clinician. The meaning of patient- and therapist-compliance in carrying out a multicenter study is also discussed.

Double-Blind Method↗