[Family nursing and occupational therapy in Charles Dickens' "David Copperfield"].
Explore the source record for details and available documents.
Chronic Disease↗
Biomedical subjects
T Reker
Publications and source records attributed to T Reker.
Work therapy for schizophrenic patients: results of a 3-year prospective study in Germany.
Work therapy is a widespread form of sociotherapy. In contrast to pharmacological and somatic forms of treatment, proof of efficacy is difficult to produce in multimodal therapy of schizophrenic patients on account of the many methodological problems involved. Within the framework of an extensive study on the vocational rehabilitation of mentally ill patients, we carried out a naturalistic follow-up study of 83 schizophrenic patients attending outpatient work therapy. The sample, which comprised 44 men and 38 women with a mean age of 35 years (+/- 8.5 years), can be seen as regionally representative. The courses of illness and rehabilitation were documented prospectively at annual follow-ups over a 3-year period. Most of the probands were chronically mentally ill patients with a history of frequent and long-term hospitalisation. At the end of the 3-year period, 22% of the patients were integrated into the open labour market, 26% were working in sheltered employment, 23% were still in work therapy, and 29% were unemployed. Two-thirds had achieved their stated rehabilitation objectives. The 3-year rehabilitation outcome was strongly dependent on the patients' subjective expectations. Other factors proving to be predictors of successful rehabilitation were less pronounced psychopathological symptoms (ADMP), better social functioning (GAS), a higher level of education and an early introduction to work therapy. Work therapy appears to have a favourable impact on hospitalisation rates.
Adult↗
[Prevalence of psychiatric disorders and outcome of social integration of homeless men].
All 52 regular users of a shelter in a medium-sized German city underwent a baseline psychiatric examination in 1990. Mental disorders, especially alcohol addiction and schizophrenic disorders, were recorded among 40 (77%). After four years the residential situation and the number and duration of psychiatric hospitalisations was recorded for 42 of these men. 33 of them mentally ill and 9 with no mental disorders. The four-year follow-up revealed that half the mentally ill men were still living in a homeless environment or had died, whereas most users with no mental disorder had a home of their own again. Longer-term hospitalisation or guardianship was found to have a favourable impact on social integration of the homeless mentally ill. Although psychiatric help without the consent of those concerned cannot solve the social problem of homelessness, it can often improve the living situation of homeless mentally ill patients.
Adult↗
[A program for the rehabilitation of mentally ill students].
The rehabilitation of mentally ill undergraduates is a neglected area. The scope and relevance of this problem are confirmed by the epidemiological figures available. A programme aimed at supporting mentally ill undergraduates at Münster university offers such students psychoeducationally oriented group therapy and intensive individual counselling. The report covers 82 students who have expressed interest in this programme since the 1993 summer semester. 57 took part for at least 1 semester, the majority of them (56%) being schizophrenic patients. The main problem is in structuring and coping with required standards of performance, social isolation, excessively high expectations of their own achievement potential, and insecurity with regard to the prospects of success in their degree courses. Experience to date confirms the need for, and the opportunities offered by on-target support of mentally ill undergraduates.
Achievement↗
[Rehabilitation of psychiatrically ill and handicapped patients--historical, conceptual and scientific aspects].
Since the early days in the 19th century, psychiatry has been dealing with chronic courses of illness and mental disabilities. The 1975 German "Psychiatry Enquete Report" has played a major role in achieving progress in the care system, allowing mentally ill patients with impending or established handicaps to be rehabilitated or to have long-term care of varying intensity and even at home. In particular, differentiated and graduated systems of sheltered accommodation, a sheltered labour market and leisure-time support have been created. Rehabilitation may induce a response in the disabled patient and improve his skills. It may, however, also be aimed at finding or structuring an adequate living environment to enable the patient to cope. A distinction must also be drawn between early and late rehabilitation: late rehabilitation applies primarily to those patients whose disabilities have become relatively irreversible after protracted illness. The objective in this case is to maintain social integration. Early rehabilitation is desirable today if functional deficits and impairments are found to occur in conjunction with a mental illness. If a substantial disability remains in spite of intensive efforts towards rehabilitation, adequate re-integration of the affected patient may be achieved by adapting the living environment. Although the practical state of development is promising, a large number of theoretical and scientific problems remains unsolved. The topic of psychiatric vocational rehabilitation in particular is raising more and more questions. There is a lack of information on the number of chronically mentally ill patients in the community and their needs, i.e. on the number of potential users. Further studies are needed to investigate the effects, the efficacy and the course of psychiatric rehabilitation.
Chronic Disease↗
[Ambulatory occupational therapy. Results of a multicenter, prospective evaluation study].
Work is an indispensable component in the treatment of (chronically) mentally ill patients. In critically scientific terms, however, there is no adequate proof of its therapeutic effectiveness. Efforts at evaluation fail because of the complexity of the clinical reality. Moreover, the differential aspects of the indication have been ignored in research. This is exemplary of the problems confronting research on the provision of psychiatric treatment: the status of what has been put to the test and introduced on the basis of routine experience is such that emperical investigations are not carried out because of lack of interest and methodological problems. Against the background of this dilemma, this study seeks a middle course for measuring success. We carried out a prospective study on a representative sample of 126 outpatients in 7 clinical work therapy departments. The results show that outpatient work therapy can be seen as a useful part of differentiated therapy, in particular for chronically mentally ill patients. Previous experience is summed up in a review of the literature.
Activities of Daily Living↗
[The psychiatric day clinic--a review of experience to date and our results].
Psychiatric day hospitals are a relatively young therapeutic facility insufficiently known to many psychiatrists. This accounts for the application potential of day treatment not being adequately recognised and utilised despite its many advantages (efficacy, flexibility, versatility). Treatment at a day hospital is not a (more or less) acceptable alternative to hospitalisation but has a specific contribution of its own to make in certain situations. Although the scientific standard of the literature published on day hospitals is relatively good, many questions on theoretical and practical aspects remain unanswered. The aim of this paper is to show the opportunities and limitations of the psychiatric day hospital with reference to a survey of the existing literature and to our own experience.
Day Care, Medical↗
A second labour market? Vocational rehabilitation and work integration of chronically mentally ill people in Germany.
In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work therapy, firms for mentally ill people, workshops for the disabled). The sociodemographic, anamnestic and psychopathological data reveal that these are chronically mentally ill people with significant disabilities, making comprehensive social care and psychiatric treatment essential. Most of the subjects intend to remain in sheltered employment; only 20% hope to change to the open labour market. The level of subjective job satisfaction is surprisingly high despite generally inadequate pay, though it has to be pointed out that many long-term patients are presumably resigned to their circumstances. In conclusion, the relationship of the open labour market to sheltered employment is the subject of critical discussion.
Adolescent↗
[Results in extramural rehabilitation of chronic mental patients: 5-year follow-up study].
Presented are the findings of a 5-year prospective study concerning residential rehabilitation of 53 subjects with chronic mental illness living in a differentiated system of complementary facilities and services. The focus had been the chronically ill patients' development and disease course, as reflected in their psychological wellbeing, work status, therapeutic requirements, social contacts, as well as periods of rehospitalization. At the end of the 5-year period, 50% of the subjects were living in sheltered communal groups, and some 25% fully on their own. Only 10 percent had returned to psychiatric hospitals as long-term patients. Vocational integration in the general labour market is only rarely achieved, but the work available in sheltered employment is suitable for 40%. All of the patients were in medical care after 5 years. Given a differentiated system of complementary support and services in the residential and vocational spheres, for medical care and leisure activities, persons with chronic mental illness, too, are able to live outside the psychiatric hospital, above all enjoying greater normality in their lifestyles as well as a higher degree of personal autonomy.
Adult↗
[Current practice of psychiatric occupational rehabilitation. Results of a representative study in sheltered environments in the Westfalen area].
The number of patients suffering from chronic mental disorders but living outside the psychiatric hospital is undergoing a steady increase, which is reflected in an increasing demand for appropriate vocational and occupational facilities. This demand is met primarily by outpatient work therapy, self-help enterprises and enterprises providing jobs to supplement pensions, and by special departments for the mentally retarded in workshops for the handicapped. Within the framework of a prospective study on vocational rehabilitation of the mentally ill, 502 rehabilitants forming a representative sample for the Westphalia-Lippe region of Germany were examined. This sample comprised 313 male and 189 female probands with an average age of 36, almost two-thirds of them suffering from schizophrenic disorders. Only 12.8% of those questioned are able to cover their living expenses primarily from their earnings. Half of them are living in sheltered accommodation, one quarter with their parents, and only one quarter on their own. Most are resigned to remaining in sheltered employment. Only 16.7% expect to change to the open labour market. The level of subjective job satisfaction is high in general. Together with other complementary facilities, sheltered employment permits chronically ill patients to live outside the psychiatric hospital and offers them positive social and psychological aspects of work. With few exceptions, it does not offer an opportunity to cover living expenses. Our follow-up investigations will provide information on the further course of vocational rehabilitation.
Adult↗
Pathways into sheltered employment.
Work ranks high in the rehabilitation of the mentally ill. Currently sheltered employment is often the only alternative to unemployment. We present a sample of 121 patients working at various facilities for vocational rehabilitation. All of these patients are chronically mentally ill, 77% of them suffering from schizophrenic disorders. With respect to their vocational backgrounds, they represent four groups that had come to the sheltered workplace by various means. One group of young patients had never had gainful employment, a second group had found jobs on the open labour market after onset of their illness, and a third group had been employed both before and after the onset of mental illness. The largest group, however, comprised those patients who had dropped out of normal working life immediately on onset of their illness to work in sheltered employment. The rate of isolation from working life was found to be influenced neither by professional qualification nor by the extent of vocational integration prior to the onset of mental illness. We discuss the consequences of the subjective experience of patients and the opportunities and problems presented in practice by vocational rehabilitation of the chronically mentally ill. A 5-year prospective study on the course of vocational rehabilitation is being designed by our group to provide further information on this subject.
Activities of Daily Living↗
A modern therapeutic approach for chronically mentally ill patients--results of a four-year prospective study.
A 4-year prospective study was carried out on 53 chronically mentally ill patients living in a differentiated complementary residential complex. Our main question was how the lives of these patients develop, as reflected in their psychological wellbeing, working capacity, therapeutic requirements and any necessary periods of rehospitalization. At the end of a 4-year rehabilitation period, 50% of the patients were living in sheltered communities and about 25% on their own. Only 10% had returned to the psychiatric hospital as long-term patients. The psychological findings were characterized by apathetic, depressive and psycho-organic syndromes (AMDP system) and were subject overall to minimum variation. Very few patients succeeded in obtaining work on the general labour market, but the work available on the sheltered labour market was suitable for a large proportion (40%) of them. All patients were undergoing medical care after 4 years. Patients suffering from chronic mental disorders can be cared for in the community even after long-term hospitalization. Special success has been achieved with rehabilitation in the residential sphere. Adequate care implies numerous services to ensure that patients are integrated into the labour market, to help establish contacts and to enable chronically ill patients to take part in social and cultural life. Most patients retain a considerable degree of psychological disturbance and are permanently dependent on psychiatric therapy or psychosocial care. On the other hand, they benefit from the fact that their living circumstances are largely normal and that they have higher degree of personal autonomy.
Activities of Daily Living↗
[Music therapy evaluated by schizophrenic patients].
Music therapy is presented as an integral part of the therapeutic program of an open reception ward at a state-funded psychiatric hospital. The target group for music therapy comprises schizophrenic patients whose primary psychopathological symptoms are characterized by basic disorders, autistic withdrawal, anergia and limited means of verbal communication. A sample of 30 schizophrenic patients selected for music therapy is described. The subjective evaluation and rating of the music therapy was registered using a specially developed questionnaire. The primary results are: 1. Music therapy has a high level of subjective acceptance among patients. 2. No negative effects are recorded despite the therapy being introduced in the post-acute phase. 3. The positive therapeutic effects quoted are relaxation, activation, reduced anxiety, easier contact-making, and improved opportunities for emotional expression. The duration of the effects is limited. 4. The training-related concept and the clearly structuring behavior of the group leader are given a positive rating by the patients.
Adult↗
[Perspectives in the vocational rehabilitation of the mentally ill and disabled--an overview of the current status and problems in the region of Westphalia].
The number of persons suffering from chronic mental disease but living outside the psychiatric hospital in the community, is rising, resulting in an increasing demand for facilities for occupation, occupational therapy and rehabilitation and for paid employment. The past few years have seen a distinct increase in the number of sheltered workplaces for the mentally ill. This development has also led to qualitative differentiation in the offers. In the region of Westphalia there are currently some 940 work places in special departments for the mentally handicapped at workshops for the disabled. Self-help enterprises and those offering opportunities for persons living on social benefits or pensions to supplement their income currently offer some 470 workplaces for the mentally ill, ten psychiatric hospitals are giving their former patients an opportunity to take part in occupational therapy as outpatients. Considerable differences are to be registered with regard to the offers of work, the forms of organization, the tasks involved and the types of supervision. Finally, a specialized psychosocial service has been established within the past four years by the head welfare office of the Landschaftsverband Westfalen-Lippe; this service is designed for the care of the mentally ill at their work place. Like many developments in social psychiatry, the differentiation of occupational rehabilitation has resulted from practical experience. Empirical findings on the indication for and efficiency of individual measures are virtually non-existent. A prospective five-year study is planned to investigate further results.
Community Mental Health Services↗