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Biomedical subjects

T Hubschmid

Publications and source records attributed to T Hubschmid.

At least 19 recordsLinked to original sources
PubMed1998

Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries.

This study examines attitudes toward work, work incentives, and the impact of work on quality of life for people with schizophrenia, and investigates whether these findings differ among Western countries. We interviewed 24 randomly selected subjects with schizophrenia and schizoaffective disorder (12 employed and 12 unemployed) at each of three sites: Boulder, Colorado, United States; Berlin, Germany; and Berne, Switzerland. No significant differences were found in the subjects' attitudes toward work or subjective well-being, although Swiss patients had a higher cost-of-living-adjusted income. Unemployed subjects reported a lower subjective reservation (minimum financially worthwhile) wage than employed subjects in Berlin and Berne, whereas the reverse was true in Boulder. When subjects from all sites were combined, employed patients displayed less psychopathology and significant advantages in terms of objective and subjective measures of income and well-being: They were also more likely to stress the importance of work. The results suggest that work is associated with a markedly better quality of life for people with schizophrenia, but that disability pension programs in the United States might introduce work disincentives.

Adult↗
PubMed1996

[Experiences with handling violence in the psychiatric clinic].

Open or hidden violence tends to be ubiquitous in the psychiatric hospital. It causes tensions, anxiousness, burnout, and much human suffering. Especially exposed are psychiatric nurses. In the present paper observations and experiences with violence are presented: dealing with disruptive patients needs intensive and periodical training although violence should not be accepted as a common daily phenomenon. Over-stimulation by crowded wards and noise, but also lack of occupation are important triggers. Victims should be given solidarity by peers and superiours, whereas analyses of the events tend to cause further trauma. Finally it should be kept in mind that victims often suffer from posttraumatic stress disorders.

Adult↗
PubMed1995

[The "WunderBar"--a project for reducing drug abuse in the psychiatric hospital].

A major reason for the patients' increasing drug abuse is inactivity and tediousness. The psychiatric hospital reacts primarily with repression but then tries more constructive measures: a special room, a sort of bar and disco for young people is created allowing all sorts of leisure activities and informal meetings. The target population of young patients is successfully engaged, they help rising the "WonderBar" which seems to gain some importance to them, and in the hospital, the paralysing feelings of helplessness in front of the drug problems disappear.

Adolescent↗
PubMed1995

[Folie à deux. Review of the literature and an unusual case].

We present a review of the concept's history and discuss different possible varieties of "folie à deux". Following this we report the case of a couple whose "folie à deux" has lasted for ten years. They have four of their own children and three further children from the husband's first marriage. Of special interest is the personality of the protagonists, their psychological assessment, and the so far ineffective therapeutic interventions that have been undertaken in efforts to save the children.

Adolescent↗
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↗
PubMed1993

[Psychotherapy in the psychiatric institution--on therapy at the other pole of the diagnostic spectrum].

In psychiatric facilities we treat patients with severe disturbances under conditions which do not fulfill what are generally thought to be the necessary ingredients of psychotherapy. Additionally our staff tend to devalorate themselves by thinking that in fact they should work differently that, what they do, was actually not real psychotherapy. The present paper shows with concrete examples what is psychiatric psychotherapy, it asks what are the needs of severely ill patients, and concludes that this difficult work is real psychotherapy in the best sense of the word.

Adult↗
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↗
PubMed1991

[Long-term treatment of chronic psychiatric patients--a rewarding responsibility].

Psychotherapy is generally believed to be insight-oriented, and functional psychoses to be incurable and inaccessible for a psychotherapeutic approach. The present paper demonstrates through a concrete example that even a severe and chronic schizophrenia can be cured with special psychotherapeutic means. Such an attempt may seem unending, troublesome, and laborious, but by setting adequate goals, such an attempt is often very successful and therefore rewarding. A modern theoretical framework of psychiatric illness and a corresponding treatment approach are described.

Activities of Daily Living↗
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↗
PubMed1989

Interactions in high- and low-EE families.

In order to find out whether the level of Expressed Emotion represents only the emotional engagement of the closest relative, or whether it corresponds to a special sort of relationship between relative and patient, 17 parents of schizophrenic patients were examined with the Camberwell Family Interview and rated as high or low EE. They were also questioned in a semi-structured interview about interactions between themselves and the patient. Transcripts of these reported interactions were analysed and described with an interpersonal instrument (SASB). The comparison of the data from CFI and SASB shows that EE-measures of the parents correlate strongly with certain features of the relationship. High EE relationships have a more negative emotional climate, a conflict-prone structure and especially rigid patterns of interaction. In addition, there were significant correlations between SASB-variables and two subscores of the CFI (criticism and emotional overinvolvement). These results add to the validity of the EE-concept and suggest that EE-measures of relatives correspond with certain qualities of the patient-relative relationship.

Adult↗
PubMed1989

[The social dependence of the long-term patient--a study in social psychiatric ambulatory care].

56 mostly schizophrenic longterm patients of a community based outpatient facility were questioned about their autonomy referring to living, working and finances, to their dependence on parents, partners, relatives and professional helpers in accomplishing every-day tasks to their social contacts and to their contentment. Only 11% of the patients live with parents and 4% are financially dependent from them. Parents are only helping by accomplishing every-day tasks, when the patients are living with them. Even then patients accomplish more than half of their affairs by themselves. However there is a strong emotional tie on parents. Professional helpers, mostly working in halfway facilities, relieve relatives in a high degree. 36% of the patients live single and are very independent, they accomplish 82% of their affairs by themselves. 23% live with a partner, who helps probably not more than he would do with a healthy partner. 3/4 of the patients are content with their living conditions. Possible explanations are discussed. The investigated patients, mostly quite impaired, are altogether far more autonomous than expected. We think that this is due to a comprehensive social network of outpatient treatment and halfway facilities combined with a sufficient invalidity insurance. This network seems to lighten the burden of the relatives, mainly the parents, as demanded by the family-burden-literature.

Activities of Daily Living↗
PubMed1988

[Long-term psychiatric patients in the workplace--a survey of employers].

23 employers, who had hired 26 psychiatric patients coming from the vocational rehabilitation workshop of the social-psychiatric university clinic in Bern (Switzerland), were questioned about the performance and behaviour of these patients. Secondly, they were asked about their experience in cooperating with the psychiatric caretaking service provided. The employers seemed to be very motivated in helping to reintegrate mentally ill patients. They have acquired an astonishing amount of knowledge in dealing with patients and with problems emerging at work. They expressed interest in more contact with psychiatrists and other caretakers, and in more information about mental illness. The authors conclude that employers should be contacted more often and that in particular the treating psychiatrist could support and further motivate employers, which would certainly be helpful for the employed patient.

Administrative Personnel↗
PubMed1988

[Reintegration in residential facilities--a catamnestic study].

A rehabilitation programme at the University Clinic of Social Psychiatry, Berne, is described. The facility includes a half-way house and sheltered home in a suburb, where 20 psychiatric long-stay patients are trained for an independent life in the community. In a follow-up study 80 patients, mostly chronic schizophrenics, were examined in order to evaluate the outcome. After an average time-interval of 6 years only 14% were in a mental hospital, 31% lived in sheltered accommodations, and 55% lived independently in the community. 57% of the patients were working full- or part time and a further 20% worked in sheltered workshops. Apart from these very good results a careful assessment of the social circumstances reveals an ongoing impairment: 80% have only poor social relations and depend on psychiatric treatment and medication, 77% need invalidity rents and more than one third live or work in sheltered institutions. The study shows that psychiatric long-stay patients can reach a stable reintegration in the community. The ongoing impairment mainly affects the social relations and the financial resources, areas which are important for the quality of life.

Adolescent↗
PubMed1987

[Current knowledge about the rehabilitation of chronic psychiatric patients].

Our considerations are based upon a new concept of schizophrenia and upon our clinical experience which has been controlled in two catamnestic studies. The new concept contains the notion of vulnerability, saying that there is no specific process underlying mental illness but there is a variety of interacting organic and psychosocial factors causing a special vulnerability leading towards psychotic break down in situations of stress. An optimal treatment should therefore consist of preventing relapse and at the same time of a soft promoting of social learning; thus an optimal treatment is a rehabilitation. Clinical experience and catamnestic studies show that mentally ill patients can be reintegrated into occupation and independent living even after a long history of illness and hospitalization. But we also find a severe ongoing handicap concerning social relations and quality of life, a strong indicator for the fact that rehabilitation has to continue even after a successful reintegration.

Antipsychotic Agents↗
PubMed1987

[Experiences with family therapy and work with relatives in social psychiatry].

Psychiatric thinking takes the social context of our patients more and more into account. The practitioner is confronted with a great variety of different approaches and concepts such as multiple forms of family therapy, family education, supportive family intervention, relatives' groups, and relatives' self-help. The author, a structural family therapist, describes his own experiences with several of these approaches and discusses questions of practicability, indication and effectiveness.

Community Health Services↗
PubMed1985

[From family therapy to work with relatives or from the therapeutic to the preventive-rehabilitative paradigm in schizophrenia treatment].

Although family therapy (or family psychotherapy) originated from schizophrenia research and therapy, it seems to be labouring particularly under the difficulties presented by schizophrenia; in the author's opinion this is due to an epistemological error. A promising new approach has emerged in recent years, once again originating from schizophrenia research, namely, "family education" or co-operation with closest relatives of the patient. The present article compares family therapy and family education, describes an updated and valid model of schizophrenia, and derives from this a preventive-rehabilitative approach.

Adult↗