Biomedical subjects

Michael Grube

Publications and source records attributed to Michael Grube.

8 recordsLinked to original sources

PubMed2006

[Parenthood and mental illness].

UNLABELLED: OBJECTIVE, METHODS: To estimate the impact of various independent variables on "parenthood", "number of off-springs", "living together with off-springs" information from 438 patients was gathered. RESULTS: 193 patients were parents of 375 off-springs. "Living alone", "schizophrenia", "organic psychiatric syndrome" decreased, "being an immigrant", "older age", and "female gender" (as a trend) increased the chance of "parenthood". "Being an immigrant" and "cohabitating relationship" increased whereas "schizophrenia" decreased the number of off-springs. 184 children lived together with 103 patients. "Cohabitating relationship", "being an immigrant", "child-care support" and "affective disorder" increased, "addiction" decreased the chance of "living together with children". "Being an immigrant" and "affective disorder" increased the number of children living together with their mentally ill parents. In families with schizophrenic fathers who live together with their children, the age of the first and second child was rather low. In contrast the child-care services were used only by 10.7 %. CONCLUSIONS: Our data show the relevance of parenthood and associated therapeutic issues.

Adolescent↗

PubMed2006

Towards an empirically based validation of intuitive diagnostic: Rümke's 'praecox feeling' across the schizophrenia spectrum: preliminary results.

BACKGROUND: The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named 'praecox feeling' by the Dutch psychiatrist Rümke in 1941. SAMPLING AND METHODS: To evaluate the diagnostic quality of this kind of intuitive clinical approach we investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the 'praecox feeling' was rated in four degrees: not present--mild--moderate--high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. RESULTS: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of 'praecox feeling'. The single variable 'affective disturbances' had the highest impact on the intensity of 'praecox feeling' in an ordinal regression analysis. Furthermore a high intensity of 'praecox feeling' strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of 'praecox feeling'. CONCLUSION: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent.

Adolescent↗

PubMed2006

Compliance and coping potential of cancer patients treated in liaison-consultation psychiatry.

OBJECTIVE: To investigate the impact of psychiatric illness, aggression, and other covarying variables on the compliance and coping potential of cancer patients treated in liaison-consultation psychiatry. METHODS: The study involves 270 cancer patients who were admitted to the oncology ward for diagnosis and treatment. Each patient took part in a psychiatric consultation. We used the Transplant Evaluation Rating Scale (TERS), which provides a system for differentially recording the patient's compliance and coping potential (total score for the TERS items 3-10). Following standardization using the basic psychooncological documentation (PO-BADO), the demographic variables were recorded. We also identified the internal processes which each patient used to deal with the disease using criteria established by Kübler-Ross as well as the phases of cancer experience according to Fawzy. RESULTS: Twenty-three variables were checked for their relationship to the coping and compliance potential. For 13 of these, the Mann-Whitney U-test or Spearmann-Rank correlation calculated exceeded the required Bonferroni-adjusted significance level. The calculation of an ordinal regression model containing these significant single variables showed that the following variables are associated with a lower compliance and coping potential according to their estimate (Beta-value): aggression as the dominant form of dealing internally with cancer (Kübler-Ross), pre-existing DSM IV Axis 1 psychiatric disorders, carcinoma-induced psychiatric disorders, necessity of treatment with neuroleptics and male gender. Acceptance as the dominant form of dealing internally with cancer (Kübler-Ross) is strongly associated with a higher compliance and coping potential. CONCLUSION: The results show that the compliance and coping potential of oncological in-patients can be comprehensively described by the Transplant Evaluation Rating Scale. The instruments of measurement used in the study are also useful for describing risk factors associated with low levels of compliance and coping potential.

Adaptation, Psychological↗

PubMed2004

Which types of aggressive behaviour are associated with suicidal and self-injurious behaviour at the time of admission?

BACKGROUND: In psychiatry and psychotherapy, dealing with aggressiveness and autoaggressiveness is of great importance. Our aim was to find a link between overt aggressive and autoaggressive behaviour, which could be readily observed. SAMPLING AND METHODS: We investigated the frequency, type and intensity of aggressive, suicidal and self-injurious behaviour exhibited by 521 successively admitted psychiatric patients at the time of admission with the help of a standardised instrument (Social Dysfunction and Aggression Scale). The Social Dysfunction and Aggression Scale enables the investigation of 9 different types of overt aggressive behaviour and 2 different types of autoaggressive behaviour (suicidal vs. self-injurious behaviour). After calculating correlations between single variables, we attempted to estimate the predictive value of the different types of aggressive behaviour for suicidal and self-injurious behaviour by using ordinal regression models. In addition, the categorical information of our data was evaluated by loglinear analyses. RESULTS: Our study showed that all degrees of aggressiveness (low, moderate, high), which are exhibited in different types of aggressive behaviour, were linked to an increased risk of self-injurious behaviour. No correlation was found, however, between overt aggressive behaviour and suicidal behaviour. Only in the subgroup of depressive disorders did we establish that the risk of aggressive behaviour was decreased and the risk of suicidal behaviour was increased at the time of admission. CONCLUSIONS: The strong relationship between aggressive behaviour and self-injurious behaviour has previously been described in specific diagnostic subgroups, but not yet in a heterogeneous population of psychiatric in-patients from a defined catchment area. We, therefore, conclude that the link between aggressive and self-injurious behaviour could be a general one. Exhibiting aggressive behaviour and self-injurious behaviour within a short time span may be the result of an increased or disinhibited aggressive potential, which is independent of a specific diagnosis. As such, it possibly represents the general consequence of a highly altered state of mind and does not seem to be linked to a specific diagnostic subgroup. In psychiatric emergency situations, the previously described close relationship between aggressive and self-injurious behaviour should be taken into account.

Adolescent↗

PubMed2004

[Ethnic minorities and aggressive behaviour in psychiatric in-patients: an investigation using a "Matched-Pair" design].

In a group of 105 mentally ill immigrants we investigated the intensity and the frequency of aggressive behaviour at the time of admission with the help of two standardized instruments: the "Social Dysfunction and Aggression Scale" (SDAS) and the "Modified Overt Aggression Scale" (MOAS). As many as possible collateral informants were contacted to gather all information available for the aggressiveness rating. The immigrant group was compared to a matched group of German patients. 416 German patients had to be investigated until 105 of them fulfilled the matching criteria. The matching variables were: age, gender, diagnosis (ICD-10), severity of mental illness (CGI) and social status. The physicians who carried out the matching process and who carried out the aggression-rating were "blind" to the aim of the investigation. We found out that there was no significant difference between immigrants and German patients when the sum-scores of the SDAS and the MOAS are compared (N = 210). When SDAS single variables were compared German patients had a higher severity and frequency of "physical violence towards other persons". We interpreted this finding as an increased level of disinhibition which may be correlated to a higher acceptance of aggressive behaviour in German culture compared to normative beliefs of Mediterranean immigrants.

Adolescent↗

PubMed2003

[Emotional reactions of staff-members managing highly aggressive mentally ill patients].

Highly aggressive behaviour of psychiatric in-patients often provokes intense emotional reactions and countertransference-feelings in staff especially when it is necessary to control aggression in psychiatric emergency units. We investigated the emotional reactions immediately after the manifestation of a patient's aggressive behaviour in a group of 53 staff members. The amount of aggression was measured with the help of the "Modified Overt Aggression Scale" (MOAS). The type and intensity of the staff-emotions can be adequately described by using a special self-rating questionnaire: "Eigenschaftswörterliste" (EWL 60 S). Using principal component analysis, three factors were differentiated: experience of stress, experience of sovereignty and experience of calmness. Several independent variables were identified as selectively increasing the probability of priority of each emotional factor mentioned above. In addition, a subgroup of staff members who have a raised risk of stress experience compared to the other staff members was compiled by cluster analysis. Based on an aggressiveness sequence model, useful strategies were discussed which directly aim to improve the coping abilities of staff members dealing with their emotional over involvement.

Adaptation, Psychological↗

PubMed2002

[Sexual dysfunctions in a group of psychiatric in-patients].

41 mentally ill patients with sexual dysfunctions were examined by means of a semistructured interview. In this interview we tried to assess quality, intensity and duration of the sexual dysfunctions. In addition to this we developed a self-rating-scale in order to assess the patients' possibilities to talk about their sexual problems with a therapist. These attitudes were related to the attitudes of the staff towards the same issue. We found out that the dysfunctions had lasted for 11.0 years on average and that 58.8 % of the patients hadn't made any attempts for specific therapeutic steps so far. Patients with sexual dysfunctions such as erectile impotence were more interested in having additional talks about their sexual problems than patients with sexual disturbances such as libido loss. They were also more inclined to see psychiatric medication as a cause for their sexual problems. In addition to this, the complete group of the examined patients considered as to be less important that the therapist was of the same sex than the staff, particularly if the interviewer was not of the same sex. Our results confirm the thesis, that it is worth paying more attention to sexual dysfunctions of mentally ill patients, necessary therapeutic steps should be taken if possible. A positive effect of this probably seems to be a better compliance.

Adult↗

PubMed2002

[Tolerance of ambiguity, art therapy and psychiatric illness].

Tolerance of ambiguity means the ability to tolerate contradictory and incalculable informations. There is the hypothesis that a high degree of tolerance of ambiguity correlates with creativity. It is unclear how various psychiatric illnesses and psychopathological conditions affect tolerance of ambiguity. Therefore we carried out a study concerning the tolerance of ambiguity: 154 persons were systematically investigated with a standardized questionnaire (31 schizophrenic in-patients, 41 neurotic in-patients, 49 members of the staff as control group, 33 artists as control group). In addition we examined the degree of depression in the neurotic group, the anancasm score and the well-being in general. In the schizophrenic group we assessed psychotic symptoms, the positive and negative symptoms, medication, anancasm and depression. Tolerance of ambiguity decreased in the following sequence: artists - members of the staff - neurotic in-patients - schizophrenic in-patients. It became evident that in the schizophrenic group negative symptoms negatively correlates with tolerance of ambiguity. The results seem to confirm the hypothesis that there is a positive correlation between tolerance of ambiguity and creativity. In addition, the higher degree of intolerance of ambiguity in schizophrenic patients may represent a protective mechanism. Intolerance of ambiguity possibly protects from too many contradictory informations. Furthermore the necessity is confirmed that creative therapy methods should be carefully chosen to avoid irritation on the one hand and not to neglect the required training of creative basic functions on the other hand. Although our results weaken the thesis that psychiatric illness is generally associated with an increase of creativity they don't exclude that highly creative performances in some individuals are possible who are especially talented in spite of or even because of their emotional suffering.

Adult↗