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Biomedical subjects

J Modestin

Publications and source records attributed to J Modestin.

At least 55 records · Page 3Linked to original sources
PubMed1986

Problem patients in a psychiatric inpatient setting. An explorative study.

A total of 26 psychiatric inpatients (5.8% of all admissions) in an intensive treatment unit were identified as problem patients by nursing personnel. Reasons for such identification were behavioral pathology of the patient, difficulties of the staff in the relationship with the patient, and insufficient therapeutic progress, and the use of inappropriate therapeutic methods. Compared with a control group, the problem patients were psychotics or personality disorders. They presented more behavioral pathology, were prescribed more medication, and experienced decisively longer hospitalizations, although they profited less from their hospitalization. Follow-up investigation revealed that the majority did not earn their own living, otherwise they were no more poorly socially adapted than the discharged controls. The suicide proneness of problem patients was high. In the treatment of these patients the necessity of adapting the therapeutic standards and expectations is of the utmost importance.

Adult↗
PubMed1986

Completed suicide and criminality: lack of a direct relationship.

A comparison was made of the crime rate among 181 suicides and 181 controls, representing an unselected sample of the population matched with the suicides for sex, age, marital status, place of residence and occupational level. Sixteen per cent of the suicides and 11% of the controls had a criminal record, a statistically insignificant difference. In addition, no significant differences were found in the proportion of recidivists and of violent offenders, or in the number of their offences and convictions. A significant difference was found regarding the distribution of the offences by particular laws: more than a half of the offences committed by criminal suicides concerned violations of the road traffic laws, this being in agreement with the hypothesis that risky, accident-prone behaviour is a suicidal behaviour equivalent.

Adult↗
PubMed1986

[Relation between criminal and suicidal behavior].

Results of many psychological, clinical, and epidemiological studies indicate a possible relationship between criminal and suicidal behavior. However, most data supply indirect evidence only and they are by no means conclusive regarding such a relationship. The results of a few well controlled studies, devoted specifically to this issue reveal that there is no real inner relatedness between criminality and completed suicide, even though both behaviours can sometimes occur together, e.g. in connection with alcoholism. It is still not clear whether there is a relationship between criminal and parasuicidal behavior.

Aggression↗
PubMed1986

Degree of suffering--a neglected variable.

Treating physicians estimated in 437 acute psychiatric inpatients whether the individual patients subjectively suffered severely from their condition or not. The judgement of the degree of suffering of the patient proved to be not only strongly influenced by the psychopathology of the patient and its relatedness to normal psychological phenomena, but also by the subjective factors of the rater including his interpersonal difficulties and/or prejudices.

Acute Disease↗
PubMed1985

Antidepressive therapy in depressed clinical suicides.

A total of 61 clinical suicides, all of them fulfilling the Research Diagnostic Criteria for a depressive disorder, were examined with regard to the psychopharmacological treatment they received at the time of their suicide. Scarcely half were treated with antidepressants, and only a small minority were optimally treated. One of the reasons for this therapeutic inadequacy lies in a discrepancy between the clinical and RDC diagnoses. An improvement in diagnostic practice, in the sense of paying more attention to the presence of a depressive syndrome, along with an improvement in psychopharmacological treatment, could contribute to a reduction in the clinical suicide rate, which has recently been observed to be increasing.

Adult↗
PubMed1985

Homicide in a psychiatric institution.

A unique case of a homicide committed by a young male psychotic inpatient on a fellow-patient is reported and discussed with regard to the special victim-offender relationship, the relationship between suicide and homicide, the phenomenon of aggression and the question of the management of a highly suicidal psychotic patient, including the issue of continuous observation.

Adult↗
PubMed1984

Clinical diagnostic practice reviewed. A comparison of clinical and RDC diagnoses.

A total of 368 clinical diagnoses were given to 298 patients hospitalized in two Swiss psychiatric institutions during the years 1960-1981. Clinical charts of these patients were scrutinized and all patients were diagnosed anew using the Research Diagnostic Criteria. The clinical diagnoses, strongly influenced by Bleuler and expressed in ICD-9 nomenclature, as well as the diagnoses obtained with the help of RDC, were compared with each other. Considerable differences were found regarding the diagnostic agreement in different diagnostic categories investigated. The most important finding of the study is a tendency to overdiagnose schizophrenic disorders clinically to the disadvantage of affective - mainly depressive - disorders and to overvalue the schizophrenic as compared with the affective - first of all depressive - symptomatology, respectively. This finding may have practical therapeutic consequences.

Adolescent↗
PubMed1983

Diagnosing borderline. A contribution to the question of its conceptual validity.

A total of 437 acute psychiatric inpatients were investigated with the help of a questionnaire containing DSM-III diagnostic criteria for schizotypal as well as for borderline personality disorder and criteria of the Flexible System for the diagnosis of schizophrenia. All patients were also independently diagnosed according to the ICD-9. The clinical ICD-9 diagnoses were compared with the diagnoses given on the basis of the three operational criteria sets mentioned. Patients fulfilling the operational criteria for schizotypal personality disorder were clinically diagnosed as mostly schizophrenic, and there was also a considerable overlap between the two groups of patients, those fulfilling the operational criteria for schizotypal personality disorder and those fulfilling the criteria of the Flexible System for the diagnosis of schizophrenia. Schizotypal personality disorder does not seem to be a clinical entity in the sense of a traditional personality disorder. The majority of patients diagnosed as borderline personality disorder received a clinical diagnosis of a personality disorder. The DSM-III criteria of borderline personality disorder discriminated satisfactorily against schizophrenia as diagnosed by the Flexible System and as diagnosed according to ICD-9. On the other hand, there was no relationship between the borderline personality disorder diagnosis and any single of the ICD-9 personality disorder types. The patients fulfilling the criteria of the borderline personality disorder were equally distributed across all ICD-9 personality disorder types. They were also significantly younger than both the non-borderline and the ICD-9 personality disorder patients. The relationship between borderline personality disorder criteria and age might thus be of a greater relevance than the relationship between these criteria and a clinical type.

Adult↗
PubMed1983

Haloperidol in acute schizophrenic inpatients. A double-blind comparison of two dosage regimens.

Using a double-blind experimental design, two dosage regimens of haloperidol were compared in acutely decompensated, newly admitted schizophrenic patients. Patients in group A (n = 21) received 5 mg haloperidol tablets, patients in group B (n = 20) 15 mg haloperidol tablets. The number of tablets did not exceed six a day but could be varied according to the condition of each patient. On the average patients of group A were prescribed 4.0 tablets, corresponding to 20.0 mg haloperidol a day, and patients of group B 3.9 tablets, corresponding to 58.0 mg haloperidol a day. A significant amelioration of the psychopathology as measured by BPRS were observed in both groups. Between both groups investigated, no differences were found neither with regard to therapeutic efficacy nor to the tolerance of the treatment. Administration of higher oral haloperidol doses cannot be recommended as a standard procedure.

Acute Disease↗
PubMed1981

Patterns of overt sexual interaction among acute psychiatric inpatients.

An indepth study was carried out over 1 year on all instances of overt heterosexual interactions among acute psychiatric patients on mixed-sex intensive treatment units. Sixteen of the 1060 patients treated on the units were involved in nine instances of overt heterosexual interactions. Analysis of the interactions showed three distinct patterns, called Types 1, 2 and 3. In Type 1 interactions, overt sexual behavior approaches normality. In Type 2 interactions, overt sexual behavior is of a pronounced demonstrative quality but avoids genital involvement. In Type 3, overt sexual interaction is confined exclusively to sexual intercourse. Multiple determinants of the patients' involvements in overt heterosexual interaction are presented. The type of overt sexual interaction engaged in by inpatients depended more on each patient's history, including past sexual life, than on clinical diagnosis. As a rule, the patient's most relevant and central problems were expressed in a very distinct manner in the overt sexual interaction on the unit. Thus, a thorough investigation of every case of such interaction provides an opportunity to discern these problems rapidly and to elaborate on them therapeutically.

Acute Disease↗
PubMed1981

A fatality during haloperidol treatment: mechanism of sudden death.

The authors report a case of unexpected sudden death in a woman receiving relatively high dose of haloperidol. They postulate that drug-induced laryngeal spasm leading to cardiac arrest via vagal reflexes may represent the mechanism of neuroleptic sudden death in some cases.

Adult↗
PubMed1980

[Concerning the borderline (author's transl)].

A general survey of the borderline literature is presented. The diagnostic label "borderline" has predominantly been used in North America; nevertheless, many roots of this conception originate in the classical European psychiatry and psychoanalysis. The various diagnostic (mainly descriptive) criteria and characteristics of the borderline are discussed, as well as the most important psychoanalytic hypotheses and conceptions (such as splitting, projective identification, identity diffusion). The therapeutic principles are mentioned as well. The analysis of the surveyed literature reveals on the one hand, that a well defined borderline exists neither as a generally acknowledged clinical entity nor as a circumscribed psychopathological syndrome. On the other hand, there are three various borderline concepts clearly discernible: 1) borderline conceptualized as a form of schizophrenia, 2) borderline conceptualized as synonymous with the general category of psychopathy (personality disorder) and 3) borderline conceptualized as a special form of psychopathy.

Antisocial Personality Disorder↗
PubMed1980

Borderline: a concept analysis.

An examination of the literature concerning the borderline reveals that different authors, using different concepts of the borderline state, are describing different patient groups. Related to the background of the generally accepted psychiatric nosological classification, three borderline concepts are clearly discernible: (1) borderline equated with a forme fruste of schizoprenia, (2) borderline equated with a general category of personality disorder (psychopathy) and (3) borderline equated with a special form of personality disorder.

Antisocial Personality Disorder↗