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L Ciompi

Publications and source records attributed to L Ciompi.

At least 19 recordsLinked to original sources
PubMed1995

Cost-effectiveness over 10 years. A study of community-based social psychiatric care in the 1980s.

More and more, the chronically mentally ill are treated in community-based facilities. A review of international findings indicates that these treatments are on average considerably cheaper than traditional inpatient treatments. The present study adds some further evidence on the cost-effectiveness of a comprehensive programme of community-based treatments provided to a large number of mainly chronically mentally ill patients within a clearly defined catchment area over a 10-year period (1981-1990). The study revealed important needs, as mainly chronically ill, socially handicapped and frequently unoccupied patients, suffering from severe disorders were admitted to the different treatments. These needs were well compensated for by the offer of a differentiated network of crisis-intervention, half-way and community-based treatment facilities. Despite the low staff-patient ratios (0.04-0.5), a coherent pattern of transitions from admission to discharge indicated a good rehabilitative power of this network by diminishing referrals to hospitals and increasing referrals to outpatient and independent services. Performances and costs varied according to the structure of the different services. On average, direct daily costs for community-based social psychiatric care were about half the costs of inpatient treatment over the whole period. Whereas the mean costs for community treatment followed inflation rates, costs for inpatient treatment grew faster. Among the short-term effects, goals set at admission were reached to a great extent, while success rates for autonomy varied according to the different treatment philosophies. In the long-term, success rates for the different treatment facilities studied tended to be confirmed for independent living and work, but professional care was still needed by most of the patients. Despite certain methodological weaknesses of the present study, we suggest that funds for community-based social psychiatric treatment be maintained and we strongly recommend the further allocation of funds for this form of treatment.

Adult↗
PubMed1994

[Social psychiatry today--what is it? Attempt at a clarification].

Related presumably to its heterogenous historical roots, the term "social psychiatry" is understood in divergent ways. The purpose of the present article is a clarification of its definition and contents on the base of current praxis in Switzerland and elsewhere. In the framework of a comprehensive psycho-socio-biological understanding of the psyche, social psychiatry is defined as the domain of psychiatry which tries to understand and treat psychiatric disturbances in close relation with their social environment. Its main focus is in the community, where a whole range of innovative half-way institutions and therapeutic-rehabilitative methods have been developed during the last 10-20 years. They are mainly indicated for patients suffering from disturbances of intermediate severity who no longer need continuous hospitalisation, but generally overtax the possibilities of private psychiatrists and traditional ambulatory services. The relative specificity of social-psychiatric approaches, research questions, therapeutic methods, infrastructures, targeted populations and community-related organisation of care speaks for a further systematic development of social psychiatry on the practical, and especially also on the academical level. This is also indicated from the economical point of view, because community-centered methods of treatment are considerably less expensive than full-time hospitalisations, according to recent cost-benefit -evaluations.

Community Psychiatry↗
PubMed1994

Affect logic: an integrative model of the psyche and its relations to schizophrenia.

The integrative concept of 'affect logic' is based on a hypothesis concerning the laws of interaction between emotion and cognition. 'Affects' are defined as global psychophysiological states which determine the prevailing functional 'logic', i.e. the specific ways in which cognitive elements are selected and linked together. This leads to an integrative psycho-socio-biological evolutionary model of schizophrenia, in which a specific affective-cognitive vulnerability is built up in a first phase, through escalating interactions between unfavourable genetic-biological and psychosocial influences. In a second phase, the mental system is decompensated by psychosocial or biological stressors which induce psychosis. The great variability in long-term course (third phase) is conditioned by the complex interplay of many biological and psychosocial variables. The organising functions of affects are evident in schizophrenic core phenomena such as ambivalence, incoherence, and emotional flattening. This proposed model has numerous practical and theoretical implications.

Affect↗
PubMed1993

[The pilot project "Soteria Bern" in treatment of acute schizophrenic patients. II. Results of a comparative prospective follow-up study over 2 years].

Following on a previous publication [15], outcomes of 22 acute schizophrenic index patients treated mainly with no- or low-medication strategies and with milieu therapeutic, socio-therapeutic and psychotherapeutic methods in the open therapeutic community "Soteria Berne" are compared, in a 2-year prospective study, with pairwise matched controls from 4 different traditional settings. There were no significant differences concerning psychopathology, living situation, work situation, combined evaluation and relapse rate after 2 years. Total dosage of medication was less than half, but total costs about 1/3 higher in the index group. Differences of costs were directly related to the inclusion of the-often prolonged-phase of rehabilitation in the in-patient treatment in "Soteria", and disappear when this phase is shifted to other settings. These results and additional observations concerning subjective aspects speak in favour of the creation of other treatment facilities of the same type.

Activities of Daily Living↗
PubMed1991

Affects as central organising and integrating factors. A new psychosocial/biological model of the psyche.

A new psychosocial/biological model of the psyche is proposed, in which the affects play a central role in organising and integrating cognition. The psyche is understood here as a complex hierarchical structure of affective/cognitive systems of reference (or 'programmes for feeling, thinking, and behaviour'), generated by repetitive concrete action. These systems store past experience in their structure, and provide the functional basis for further cognition and communication. Affects endow these programmes with a specific qualitative value (such as motivation), connect cognitive elements synchronically and diachronically, and contribute to their storage and mobilisation according to context. They also participate in differentiating cognitive systems at higher levels of abstraction. These assumptions are supported by recent findings on the role of the limbic and hypothalamic system for the regulation of emotion, on neuronal plasticity, and on the phenomenon of state-dependent learning and memory. Refutable hypotheses are formulated for further research on the interaction of emotion and cognition.

Affect↗
PubMed1991

[The dynamics of outcome predictors in the early phase of schizophrenic psychoses--an empirical study].

The interrelationship and predictive validity of certain outcome predictors were studied on 54 young schizophrenic patients. In the first year after outburst the illness shows a great variability and the course seems to be open. Neither the premorbid social adjustment nor the amount of negative symptoms seem to predict the course in the first year. But as in earlier studies the expectations of patient, relatives and staff show to have a certain predictive significance.

Adolescent↗
PubMed1990

[Predictors of the course of schizophrenia--a review of the literature].

As the course of schizophrenia shows a large variability, a prognosis of outcome is extremely difficult. The search for valid predictors shows that there exist numerous predictors with variable predictive significance for distinct outcome criteria and also for different phases of the illness. The indications in the literature are accordingly variable or even inconsistent. The following statements seem us to be proved: A good premorbid social adjustment, a harmonious premorbid personality, and an acute onset of the illness predict a better course, whereas an insidious onset and a development of marked negative symptoms correspond to a poorer outcome. A combination of several factors improves the predictive significance. The importance of the following indicators remains questionable: Genetic loading, neuropathological findings, positive symptoms, and age at onset of the illness. Equally open are these questions: How are the various indicators interrelated and for what span of time have they a predictive power? Psychosocial indicators have more predictive significance than the so far known biological variables. Probably the difficulties in finding valid predictors are not only related to unsolved methodological problems, but above all to intrinsic characteristics of the illness itself.

Female↗
PubMed1987

[Social psychiatry in Switzerland].

Based on a previous questionnaire about psychiatric care in the Swiss cantons (and from other sources), the author tries to give an overview of the evolution of socio-psychiatric concepts, methods of treatment and changes in institutions in Switzerland during the last 10-15 years. According to certain criteria he shows that social psychiatry developed extensively in many places during this period. Most important are the new half-way-institutions (day- and night-hospitals, foster-homes, centers of rehabilitation, sheltered apartments etc.) which have been created; also, the number of coordinated, integrated socio-psychiatric services based on global concepts of care has increased. On the whole, this evolution has contributed nearly everywhere to a reduction of psychiatric beds and length of stay in hospital, and an improvement in the chances of rehabilitation and quality of life for long-term patients. There are, however, still great differences between the cantons. Contrary to initial exaggerated hopes, socio-psychiatric methods of treatment have not been able to solve the problems of chronification of psychoses, drug-addiction or geronto-psychiatric patients in a satisfactory way. - In order to improve the possibilities of future treatment, the development of socio-psychiatrically orientated, global concepts of care should be promoted including decentralized catchment areas, integrated in-patient, half-way and out-patient services and free access to resources of both internal and external services according to the local needs.

Community Mental Health Services↗
PubMed1986

["Soteria Bern." Initial experiences with a new milieu therapy for acutely schizophrenic patients].

The authors report first clinical experiences with 28 schizophrenic patients who were treated and socially rehabilitated by a specially selected team in a small, stimulus-protected, continuous, open and community-near environment (therapeutic community "Soteria Bern"). The therapeutic concept is based on the vulnerability- and information-processing hypothesis and on further psycho-, socio- and milieutherapeutic experiences with schizophrenics. Neuroleptic drugs were used in comparatively very small doses. With about 2/3 positive outcomes, the first results are encouraging. In a research project over several years they will be systematically compared with more traditional treatment strategies.

Acute Disease↗
PubMed1985

Aging and schizophrenic psychosis.

The author discusses the question of the interference of schizophrenia and aging, and specially of the impact of biologic and organic versus social and situational factors. The presentation is based on long-term follow-up studies by the author himself and others, showing favorable outcomes in about half of the cases. Contrary to general beliefs, old age has quite often a favorable influence, eg. by dampening acute productive symptoms and drives, and by improving interpersonal relations. Psycho-organic deterioration is hardly more frequent, in schizophrenics, than in the general population. In conclusion, in old age, too, schizophrenia does no longer appear as a fatally progressive organic disease, but as a multiconditional open life process in vulnerable individuals with persisting potential for improvement even in old age.

Adolescent↗
PubMed1984

[Model concepts of the interaction of biological and psychosocial factors in schizophrenia].

On the basis of the current research, his own contributions and complementary theoretical considerations, the author develops four possible models on the causal relations between biological and psychosocial factors in schizophrenia, namely 1. a biological-psychosocial model, 2. a psychosocial-biological model, 3. a parallelist- or multilevel-model and 4. a circular model. According to the latter as currently most probable model, variable interactions between biological and psychosocial factors lead to a premorbid vulnerability with lowered information processing capacities and increased tendencies to psychotic functioning under stress. Equally, variable interactions between different biological and psychosocial factors furnish the best explanation for the enormous multiformity and nearly unforeseeable variability of the long-term evolutions. The circular model is also particularly fruitful for therapeutic purposes.

Brain Damage, Chronic↗
PubMed1984

Is there really a schizophrenia? The long-term course of psychotic phenomena.

The author fundamentally questions the traditional concept of the disease-entity (or several disease entities) of 'schizophrenia' and discusses an alternative concept, based on vulnerability and information-processing. According to this, schizophrenia-like psychotic phenomena develop in three phases. In the first, premorbid phase, combined biological (genetic and possibly other organic) and psycho-social influences lead to a premorbid 'vulnerability', characterised by a low tolerance of cognitive and emotional stress, corresponding to an insufficient capacity for the adequate processing of complex information. In the second phase, stressful life-events can lead to unique or repeated acute productive psychotic episodes. The third phase, that of long-term evolution, depends more on psycho-social influences than on biological factors. Under unfavourable conditions, it may lead to predominantly unproductive residual states of various degrees, which can largely be understood as regulatory mechanisms to restrict stressful over-stimulation. There is no clearly delimitable disease entity of schizophrenia with constant causes, psychopathological picture, or course, but rather a multi-conditioned life-process, occurring in people with a particular vulnerability, interacting with complex life-events and circumstances. This new concept has important consequences for therapy and prevention.

Adult↗
PubMed1984

[Effect of social factors on the long-term course of schizophrenia].

On the basis of the literature and of his own research concerning the long-term-evolution and the vocational rehabilitation of schizophrenics, the author shows that social factors play an important role in the long-term-evolution of schizophrenia. Of particular importance is the influence of the therapeutic setting, of overtaxing "life-events", of the family atmosphere, of the institutional infrastructure, of the expectations of the social environment, and of several socio-economic and cultural factors. Biological and psychosocial influences can be combined into a multiconditional model of schizophrenia in three phases, in which the vulnerability- und information-processing-hypothesis are central. This model leads to interesting consequences for the prevention and the therapy of schizophrenia.

Antipsychotic Agents↗