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T Steinert

Publications and source records attributed to T Steinert.

At least 19 recordsLinked to original sources
PubMed1999

Aggressive behavior against self and others among first-admission patients with schizophrenia.

OBJECTIVE: Aggressive behavior directed against self and others was examined in a sample of patients with schizophrenia during their first hospitalization and during any subsequent hospitalizations over the next two years. METHODS: The charts of 138 patients (77 men and 61 women) with a first episode of schizophrenia or schizoaffective disorder admitted to a psychiatric hospital in Weissenau, Germany, were reviewed to obtain information about four types of aggressive behavior (verbal aggression and aggression against objects, self, and others). Similar chart reviews were conducted for 83 patients (47 men and 36 women) who were rehospitalized during the next two years. The severity of the four types of behavior was rated using the Modified Overt Aggression Scale. Stepwise multiple regression was used to identify predictors of the number and duration of rehospitalizations. RESULTS: Seventy-five percent of the men and 53 percent of the women in the sample exhibited some type of aggressive behavior during the first or subsequent admissions. Seventeen percent of men and 26 percent of women attempted suicide. Among the predictors of rehospitalization that were examined, which did not include medication compliance, only aggressive behavior against self and against others were significant predictors during the two years after first admission. Predictors of aggressive behavior against others were male sex, number of hospitalizations, and alcohol abuse (among men only). Self-directed aggressive behavior was correlated with days of hospitalization but not with number of rehospitalizations. CONCLUSIONS: Aggressive behavior against self and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.

Adult↗
PubMed1999

[Standard treatment of schizophrenia and legality of personnel equipment in psychiatric hospitals (German Psych-PV): possibilities and limitations].

BACKGROUND: Comprehensive insight regarding better treatment and social reintegration of patients with schizophrenia has been gained over the past decade. Implementation of this knowledge into everyday's practice should be a major aim prior to the research on new variants of rehabilitative measures. To which extent this takes place has been poorly discussed until now. METHOD: Our comprehensive treatment program includes psychoeducation for patients and relatives, cognitive training, social skills training, additional psychoeducation for patients with dual diagnosis and a variety of a traditional group therapies like work therapy. An intensive cooperation is practised with complementary psycho-social services. In n = 89 consecutive admissions lasting at least 2 weeks we examined which patients were reached by these treatment offers. RESULTS: 84% of the patients participated in group therapies, where they passed 6.9 hours weekly on average. Most patients were reached by occupation therapy (62%), followed by physical therapy (54%), unspecific conversation group (54%), psychoeducation (35%), cognitive training (30%), work therapy (26%) and social skills training (7%). The PANSS Positive Scale at admission was negatively correlated with participation in group therapies. DISCUSSION: The implementation of a variety of psychotherapeutic offers for psychotic patients adequate to the state of the art can be achieved under conditions of standard hospital care in Germany (Psych-PV-law). Required organizational measures therefore are programs offered for patients of several wards in union and participation of employees in education. However, even by such efforts a considerable part of patients is not reached. Strategies to improve treatment results should consider these problems.

Adolescent↗
PubMed1998

[Internal structure of inpatient psychiatric hospital care 22 years after the psychiatry inquest].

Starting with the recommendations of the "Psychiatrie-Enquête", a current empirical stock-taking was undertaken about the structure of care in psychiatric hospital units. 319 treatment units (289 in Germany, 11 in Austria, and 19 in Switzerland) were investigated concerning size of the treatment unit, number of wards, centrality of admission, existence of large observation rooms ("Wachsäle"), specialized wards, single sex wards, regionalization/sectorialization, open-door wards, coercive measures, and intended structural changes. The return rate of questionnaires amounted 59%. The results show that the recommendations of the "Psychiatrie-Enquête" are mostly realized today, but not everywhere. Across countries differences resulted in size of ward, centrality of admission, open-door wards, and coercive measures. Treatment units in the western and eastern parts of germany differed in size of ward and centrality of admission. Differences between psychiatric hospitals, psychiatric departments at general hospitals and psychiatric university hospitals were, though significant, smaller than expected in the light of past controversies. Intended structural changes mainly concerned open-door wards, internal sectorialization, decentralization of admission, and mixing the sexes in single sex wards.

Austria↗
PubMed1998

[Schizophrenia and violence: epidemiological, forensic and clinical aspects].

Recent studies confirm a significantly (several times, in fact) increased risk for schizophrenics to commit severely violent acts compared to the general population. Violent acts of minor degree and threats not followed by forensic detention are even much more common. Data on prevalence depend on study conditions, sample selection, and outcome definitions of violence. In psychiatric hospitals, too, violent and threatening behaviour seems to occur most frequently in schizophrenic patients. However, in this respect findings are inconsistent and display considerable variations across different countries and times (with increasing rates reported within the last decade). Additional risk indicators beside the diagnosis of schizophrenia are male gender, comorbidity with personality disorders, substance abuse, lack of adequate treatment and increasing social disintegration due to an unfavourable course of the illness. The violence risk does not seem to decrease with increasing age in contrast to the general population. Beyond these sociodemographic data and variables related to treatment and course of illness, psychopathological causes of violence are less evident. Even imperative hallucinations are not clearly associated with violence: systematic delusions are associated with severe violent acts, but not with the much more frequent violent acts of minor degree. Most probably, the total of psychopathological symptomatology is associated with the proneness to aggressive behaviour. Neuropsychological and biological findings are also inconsistent.

Forensic Psychiatry↗
PubMed1998

[The disease "picture" of schizophrenia. Change due to operational diagnostic systems and effects on research in epidemiology and disease course].

Both in classical German psychiatry and in the contemporary operationalized diagnostic systems schizophrenia is conceptualised as a categorical disorder, the presence or absence of which can be verified dichotomously. Empirical results, however, suggest that schizophrenia might be a dimensional disorder. The categorical perspective has advantages for epidemiological research; it produced important results like the finding of a world-wide equal incidence of schizophrenia. Increasing importance is attributed to the definition of criteria, especially those of duration, which is arbitrary in many aspects. Results of research concerning the course of illness and sex distribution vary, depending on the definition of criteria, giving rise to different etiological hypotheses.

Cross-Sectional Studies↗
PubMed1998

[Who is dangerous? Problems of validity and reliability in assessment and documentation of socially aggressive behavior].

Records of violent behaviour and its sequels gain increasing interest as a matter of quality assurance. The paper presents scales and instruments applied in psychiatric institutions until now. While problems of reliability are solved sufficiently, there are major problems of validity in the measurement of violence. To be usable for quality management, a documentation has to provide a clear cut-off for the severity of violent incidents that should be reported. Otherwise uncomparable data and underreporting will result.

Adult↗
PubMed1997

[Comorbidity of schizophrenia and bulimic anorexia. A case with forensic implications].

We are reporting about a 35 year old female forensic patient who has a double diagnosis of anorexia nervosa, bingeeating/purging type, and schizophrenia, paranoid type. She repeatedly attacked her therapists and physicians violently. Her aggressive state is a result of her psychotic interpretation of her constant preoccupation with her body image. We discuss problems concerning antipsychotic medication in her case specifically. Furthermore epidemiological aspects of the comorbidity of eating disorders and schizophrenia are considered; the incidence of schizophrenia in eating disorders seems to be 1-3%, affective and transient psychosis being more common; the comorbidity of schizophrenia and bulimia nervosa is very rare.

Adult↗
PubMed1996

Considerable improvement in a case of obsessive-compulsive disorder in an emotionally unstable personality disorder, borderline type under treatment with clozapine.

We report on a 27-year-old woman with previously therapy-resistant obsessive-compulsive disorder and emotionally unstable personality disorder, borderline type, which improved considerably on treatment with clozapine. Previous treatment attempts with paroxetine, clomipramine and various classic and atypical neuroleptics, as well as extensive psychotherapeutic treatment, had proved ineffective.

Adult↗
PubMed1996

[Does long-term hospitalization modify cardiovascular morbidity in schizophrenic patients?].

Cardiovascular risk factors, electrocardiographic findings and preexisting diseases of the cardiovascular system were recorded in 90 schizophrenic patients (mean age 62.6 yrs., mean duration of hospitalisation 28.6 yrs.). The obtained data were compared with a group of depressive inpatients matched for age and sex and with corresponding data of the german population. Although among the schizophrenic patients heavy cigarette-smoking was significantly more frequent, hints for a myocardial infarction in history were found in only 3 of these patients and, in contrast, in 7 depressive patients. Systolic and diastolic blood pressure did not differ among depressive and schizophrenic subjects with mean levels in both groups being lower than in the corresponding age of the general population. Total cholesterol levels were lowest in the schizophrenics; in the depressive patients, however, lower than in the general population. There was a continual increase of cholesterol with progressive age in depressive subjects and in the general population. An adverse tendency was found in the long-term-hospitalized schizophrenics of both genders. In male schizophrenics a significant negative correlation between the duration of hospitalisation and both serum cholesterol and diastolic blood pressure could be observed. This may explain cardiovascular mortality rates in these patients which are not elevated in spite of heavy smoking and lack of movement.

Adult↗
PubMed1995

Folate deficiency, anticonvulsant drugs, and psychiatric morbidity.

The folic acid (FOA) level was determined in serum and erythrocytes in 100 epileptic patients and 100 control patients using a luminescence assay. A lowered FOA concentration in serum, erythrocytes, or both was observed in 15% of the epileptic patients and in 2% of the control group. In the epileptic patients, the FOA in the serum and in the erythrocytes was significantly lower than that in the control group. Patients receiving carbamazepine monotherapy had a significantly lower FOA level in the erythrocytes than did patients receiving phenytoin monotherapy. The FOA level showed a negative correlation to the duration of epilepsy. None of the patients with lowered FOA had a normal mental status. The course of the supplementation treatment with 5 mg folinic acid (or FOA) of four patients with FOA deficiency could be monitored psychopathometrically. All four patients showed an improvement in their well-being and the majority of measured variables of the cognitive performance.

Adult↗
PubMed1995

[Violent patients. A problem for the therapist in psychiatric clinics?].

At four psychiatric hospitals, 128 doctors, 50 psychologists and 55 social workers were asked to complete a questionnaire about their experience with aggressive patients. Fifty-five percent reported having been assaulted seriously during their career; physical assaults during the last year had occurred for 29%. Forty-nine percent had experienced a situation judged as fairly or very dangerous. Women were concerned less than men, social workers less than psychologists and doctors.

Aggression↗
PubMed1995

[Differential diagnosis of aggressive behavior in epilepsy].

Aggressive behaviour in epileptics may have many causes which are connected more or less closely with epilepsy. Ictal aggression is very rare. In the case of a patient with complex partial seizures and a schizophrenia-like psychosis different forms of generation of aggressive behaviour are discussed.

Adult↗
PubMed1995

[Borderline disorder and schizophrenia. Still a diagnostic problem].

Two case-reports highlight the problems of co-morbidity of schizophrenia and borderline disorder. On the other hand, borderline disorder in schizophrenia can represent a pre-existent, lasting personality disorder, on the other hand it can be temporary syndrome in the course of illness. The assumption that a borderline syndrome can be a recompensation stage in the course of schizophrenia seems evident by clinical and psychodynamic points of view (concerning a coping strategy). The present categories of DSM III-R and ICD-10, however, do not allow an adequate diagnostic classification of this syndrome.

Adult↗