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Kostko, Aaron. "Epistemic and Nonepistemic Values in Psychiatric Explanation and Classification". University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396522414.
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Slade, Tim Psychiatry Faculty of Medicine UNSW. "Using epidemiology to inform classification in psychiatry". Awarded by:University of New South Wales. Psychiatry, 2002. http://handle.unsw.edu.au/1959.4/19059.
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Classification systems in psychiatry are a work in progress. Therefore, continued efforts to improve their validity are necessary. Epidemiology provides a scientific method to assess the extent of psychiatric morbidity in community populations. However, data from epidemiological surveys have also contributed, either directly or indirectly, to many changes in the classification systems. Recent reviews of the current state of psychiatric classification indicate four unresolved issues: 1) the presence of two differing classification systems, 2) the role of the clinical significance criterion in differentiating psychopathology from normality, 3) the relationship of the exclusion criteria to the co-occurrence of psychiatric disorder pairs, and 4) the relative validity of categorical versus dimensional conceptualizations of psychiatric disorders. The current thesis examines these four unresolved issues, using data from a large-scale epidemiological survey of psychiatric disorders. With regard to GAD, differences in diagnostic criteria between DSM-IV and ICD-10 resulted in different types of cases identified, despite similarities in prevalence. The DSM-IV diagnostic criterion for clinical significance impacted, albeit to different degrees, on the prevalence, health service use and impairment of five disorders. The exclusion criteria in both DSM-IV and ICD-10 were significantly related to the patterns of co-occurrence found in the data. Using the example of depression, symptoms were more consistent with a dimensional rather than a categorical structure. A specific research agenda is proposed, the aim of which is to provide possible avenues of research that may benefit revisions to classification systems and the conduct of epidemiological surveys. This research agenda contains a number of suggestions. Future revisions will benefit from an explicit understanding of the differences between the classification systems. Better definitions of the concepts of clinical significance and psychiatric disorder are required. The co-occurrence of disorder pairs in epidemiological data informs understanding of the exclusion criteria, but the validity of these criteria relies on different data. Dimensional models of classification may yield more information than categorical models, and methods for incorporating them in large-scale surveys are proposed. It is concluded that epidemiological data should continue to play a significant part in the refinement of psychiatric classification.
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Hargreaves, Isabel R. "Dimension and hierarchy in the description of psychological disorder". Thesis, Bangor University, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282727.
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Abu, Ghazal Yazan. "The classification of psychoses and the detours of psychiatric research at the end of the nineteenth century". Thesis, Paris, Ecole normale supérieure, 2015. http://www.theses.fr/2015ENSU0050.
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Le présent thèse cherche à explorer le statut épistémologique de la Psychiatrie. En prenant la question de la méthode (“Methodenfrage”) comme fil directeur, nous discuterons la question de savoir dans quelle mesure la Psychiatrie, entendue comme une discipline clinique, est autorisée à emprunter les principes méthodologiques en usage dans les sciences humaines. Dans ce contexte une importance capitale sera accordée à l’analyse des développements conceptuels de la Psychopathologie de langue allemande dans la période suivant la Deuxième Guerre Mondiale. Le point de départ de ce travail sera l’analyse de la dichotomie introduite par Karl Jaspers entre “Erklären” (expliquer) et “Verstehen” (comprendre) ainsi que celle des limites épistémologiques de ces deux modes d’accès à l’anormalité psychique qu’est la schizophrénie. La deuxième partie de ce travail sera consacrée à l’analyse de l’élargissement sur le plan méthodologique des limites du “Verstehen” dans la psychopathologie de la schizophrénie. Dans ce cadre nous analyserons les conséquences de l’introduction de la “Situation analyse” et du concept d’“ordre” (comme principe organisateur de la vie psychique et sociale) pour la psychopathologie de la schizophrénie. A la lumière des résultats acquis nous analyserons les apports de ce développement conceptuel de la psychopathologie allemande pour les tentatives de conceptualisation des normes dans les théories psychiatriques sur la schizophrénieThis thesis explores the ways in which psychiatrists and researchers have developed new tools to deal with the unknown in psychiatric classifications. In the following four chaptersI seek to understand why the modes of thinking that dominated late nineteenth century psychiatry have proved to be durable and stable, and why the history of what is now called schizophrenia is the history of psychiatry itself.In this context, I situate my argument within the debates regarding the historiography of psychiatry, and more specifically the historiography of schizophrenia.My approach can be understood as an attempt to move away from common approaches to the history of psychiatric classifications.In my view, the influence of German psychiatry, from Griesinger’s unitary psychosis to Bleuler’s schizophrenia tells us more about psychiatry and its modes of conceptualization, than thus far recognized.Against the narratives that presuppose a direct line of development, I argue that the path starting with primäre Verrücktheit—one of the most commonly diagnosed psychic diseases in 1870s – leading to ”paranoia”—a term used as synonym for insanity by most authors in the1880s and 1890s – and ending in “dementia praecox” and schizophrenia was not a linear one.By tracing the detours followed by psychiatric research in the last three decades of the nineteenth century, I show how, paradoxically, the progress in the special nosology delayedconsiderably the future development in psychiatric theories
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Skene, Allyson. "Psychiatric classification, medicine and madness an examination of Ontology and Epistemology in DSM-IV /". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0005/NQ43452.pdf.
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Kalckreuth, Sophie, Friederike Trefflich i Christine Rummel-Kluge. "Mental health related Internet use among psychiatric patients: a cross-sectional analysis". BioMed Central, 2014. https://ul.qucosa.de/id/qucosa%3A13091.
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Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.
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SUARATO, JEAN-PIERRE. "Essai sur une nosographie sexologique : a propos de la classification proposee en 1980 par l'american psychiatric association (d.s.m. iii) ; la sexologie medicale aux confins de la psychiatrie et de la medecine organique". Aix-Marseille 2, 1989. http://www.theses.fr/1989AIX20124.
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Merikangas, Kathleen R., Rajni L. Mehta, Beth E. Molnar, Ellen E. Walters, Joel D. Swendsen, Sergio Aguilar-Gaziola, Rob Bijl i in. "Comorbidity of substance use disorders with mood and anxiety disorders: Results of the international consortium in psychiatric epidemiology". Technische Universität Dresden, 1998. https://tud.qucosa.de/id/qucosa%3A26799.
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This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.
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Vega, William A., Sergio Aguilar-Gaxiola, Laura Andrade, Rob Bijl, Guilherme Borges, Jorge J. Caraveo-Anduaga, David J. DeWit i in. "Prevalence and age of onset for drug use in seven international sites: Results from the international consortium of psychiatric epidemiology". Technische Universität Dresden, 2002. https://tud.qucosa.de/id/qucosa%3A26810.
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This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization’s composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.
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Cochez, Florent. "Psychiatrie et classifications des homicides". Bordeaux 2, 1999. http://www.theses.fr/1999BOR23012.
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Wittchen, Hans-Ulrich, i Gavin Andrews. "Clinical practice, measurement and information technology: Editorial". Cambridge University Press, 1995. https://tud.qucosa.de/id/qucosa%3A26398.
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LENDER, PIERRE-ETIENNE. "Classifications diagnostiques et informatique en psychiatrie : elaboration de la base de connaissance d'un systeme informatique de recherche en psychiatrie a partir d'une classification diagnostique". Lille 2, 1989. http://www.theses.fr/1989LIL2M192.
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Kessler, Ronald C., James C. Anthony, Daniel G. Blazer, Evelyn Bromet, William W. Eaton, Kenneth S. Kendler, Marvin Swartz, Hans-Ulrich Wittchen i Shanyang Zhao. "The US National Comorbidity Survey: Overview and future directions". Technische Universität Dresden, 1997. https://tud.qucosa.de/id/qucosa%3A27015.
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This report presents an overview of the results of the US National Comorbidity Survey (NCS) (Kessler et al., 1994) and future directions based on these results. The NCS is a survey that was mandated by the US Congress to study the comorbidity of substance use disorders and nonsubstance psychiatric disorders in the general population of the US. (...)
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Gopchandani, Sandhya. "Using Word Embeddings to Explore the Language of Depression on Twitter". ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/1072.
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How do people discuss mental health on social media? Can we train a computer program to recognize differences between discussions of depression and other topics? Can an algorithm predict that someone is depressed from their tweets alone? In this project, we collect tweets referencing “depression” and “depressed” over a seven year period, and train word embeddings to characterize linguistic structures within the corpus. We find that neural word embeddings capture the contextual differences between “depressed” and “healthy” language. We also looked at how context around words may have changed over time to get deeper understanding of contextual shifts in the word usage. Finally, we trained a deep learning network on a much smaller collection of tweets authored by individuals formally diagnosed with depression. The best performing model for the prediction task is Convolutional LSTM (CNN-LSTM) model with a F-score of 69% on test data. The results suggest social media could serve as a valuable screening tool for mental health.
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Köllner, Volker, i Christina Archonti. "Psychotherapeutische Interventionen vor und nach Organtransplantation". Karger, 2003. https://tud.qucosa.de/id/qucosa%3A27474.
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Die Organtransplantation hat sich in den letzten 20 Jahren zu einem Standardverfahren in der Therapie schwerer, anders nicht mehr behandelbarer Organerkrankungen entwickelt. In Deutschland werden jährlich etwa 3000 Transplantationen durchgeführt. Über 13 000 Menschen stehen auf der Warteliste für einen solchen Eingriff. Sowohl die Wartezeit als auch die verschiedenen Phasen nach dem Eingriff fordern erhebliche psychische Anpassungsleistungen von Patienten und Angehörigen, was häufig zu psychischen Störungen führt. Das Transplantationsgesetz von 1997 fordert daher ausdrücklich eine psychosomatische Mitbetreuung in den Transplantationszentren. Trotz dieses Therapiebedarfs fehlt es bisher an empirisch gesicherten therapeutischen Strategien. In der Transplantationsmedizin ist ein methodenübergreifender Betreuungsansatz sinnvoll. Kognitiv-verhaltenstherapeutische Therapieelemente scheinen aufgrund ihres pragmatischen und lösungsorientierten Ansatzes für diese Patientengruppe besonders geeignet. Ziel dieses Artikels ist es, auf Basis klinischer Erfahrungen und der wissenschaftlichen Literatur eine Übersicht über die unterschiedlichen Phasen der Transplantation solider Organe, ihre spezifischen Belastungen und therapeutische Strategien für Patienten und ihre Angehörigen zu geben. Der Bedarf an empirischer Forschung auf diesem Gebiet, gerade was die Wirksamkeit verhaltensmedizinischer Interventionen angeht, wird deutlich.About 3,000 patients per year receive a transplant in Germany and some 13,000 patients are on waiting lists. Waiting period and the different stages of recovery demand special coping strategies from patients and their families. Psychological disorders are frequent before and after the transplantation and psychological risk factors are relevant for the outcome of the transplantation. Therefore special psychosomatic care for patients and their families is necessary. However, evidence based knowledge on appropriate therapeutic interventions is still scarce. In transplantation medicine, an overall approach is reasonable. Cognitive-behavioral aspects seem to be especially promising. The article describes strategies and techniques for the psychosomatic assessment of patients before transplantation and psychotherapeutic interventions for patients and their families before and after solid organ transplantation. More research on the effects of psychotherapeutic interventions in this field is necessary.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Weygandt, Martin. "Computer-based diagnostic and prognostic approaches in medical research using brain MRI". Doctoral thesis, Humboldt-Universität zu Berlin, Lebenswissenschaftliche Fakultät, 2016. http://dx.doi.org/10.18452/13984.
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Die vorliegende Habilitationsschrift zu „Computer-based diagnostic and prognostic approaches in medical research using brain MRI“ ist in zwei Abschnitte gegliedert. Konkret wird im ersten Abschnitt eine Übersicht über verschiedene Aspekte des Computer- und MRT-basierten Vorhersageansatzes gegeben. Im zweiten Abschnitt werden die Artikel aus diesem Feld beschrieben, die ich für die Habilitation eingereicht habe. Konkret beginnt der erste Abschnitt der Habilitationsschrift damit, das grundlegende methodische Konzept des Vorhersageansatzes zu beschreiben. Danach werden die drei prozeduralen Stadien beschrieben, die seine Anwendung charakterisieren, d.h. die Phase der Feature-Bestimmung, des Trainings von Regressionsalgorithmen und schließlich des Tests dieser Algorithmen mit Daten unbekannter Genese. Daran schließt sich eine Beschreibung der Entwicklung des Ansatzes in Form von drei Epochen an, die charakterisiert sind durch die Entdeckung diagnostischer Information in Signalen der Magnetresonanz, die erste Nutzung statistischer Regressionsverfahren zu deren Analyse, und die massenhaften Anwendung des Ansatzes. Schließlich werden zum Ende des ersten Abschnittes die Forschungsfragen skizziert, die mit dem Ansatz adressiert werden, d.h. die automatisierte Diagnostik, die Verfeinerung bestehender diagnostischer Richtlinien und die Identifikation neuer Biomarker. Im zweiten Abschnitt beschreibe ich im Detail die Forschungsartikel, die ich im Rahmen der Habilitation eingereicht habe. Über diese Artikel oder Studien hinweg wurden alle oben genannten Forschungsfragen adressiert, die mit dem Verfahren in der Literatur untersucht werden. Darüber hinaus wurden vielfältige technische Herausforderungen des Ansatzes in unterschiedlicher Weise bearbeitet. Zusammenfassend lässt sich daher sagen, dass die vorliegende Habilitationsschrift und die darin beschriebenen Fachartikel einen umfassenden Überblick über die konzeptionelle und methodische Vielfalt des Ansatzes geben.This habilitation thesis on ‘Computer-based diagnostic and prognostic approaches in medical research using brain MRI’ is divided in two parts – an introductory first part that gives an overview on various aspects of the computer- and MRI-based disease prediction approach and a second part describing the research articles from this field that I submitted for habilitation. In particular, in the first part the habilitation synopsis starts by outlining the basic methodological concept of the disease prediction approach and by describing the three fundamental procedural stages characterizing it, i.e. the feature determination, training and test stages. Then, it continues by delineating the development of the approach in terms of three epochs that are characterized by the discovery of diagnostic information in MR signals, the first use of statistical regression techniques to analyze this information, and the mass use of the approach. Finally, it outlines the research aims pursued with the approach, i.e. automated diagnosis, refinement of diagnostic guidelines, and identification of novel diagnostic biomarkers. In the second part, I describe the peer-reviewed research articles that I submitted for habilitation. Across these articles or studies respectively, all of the three research aims pursued with the approach were addressed. Furthermore, technical challenges connected to the approach were addressed in various different fashions. Thus together, these studies and this habilitation thesis provide a substantial overview on the methodological and conceptual diversity of the field.
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Wichmann, Susann, Stefan R. Bornstein, Thomas Lorenz i Katja Petrowski. "Stress hormone response to the DEX-CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-233439.
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This study tested whether the hormonal stress response to the DEX-CRH test may be predictive of the psychotherapy success for panic disorder (PD). Thirty-four patients diagnosed either with agoraphobia with PD or PD without agoraphobia were subjected to cognitive behavioural therapy (CBT). Patients (pre-therapy) and healthy volunteers were exposed to the DEX-CRH test. Blood samples were taken for cortisol and adrenocorticotropic hormone (ACTH) assessment. Established panic-specific questionnaires were handed out for the pre-therapy and post-therapy evaluation of disease severity (with reference to panic beliefs and agoraphobic cognitions, fear of bodily sensations, agoraphobic avoidance behaviour). Repeated measures ANCOVA were conducted for the analysis of the pre-therapy hormonal response, and Pearson\'s correlation analysis to test for associations with the psychotherapy outcome. Data analyses revealed large effect sizes for CBT in the clinical measures (η2 ≥ 0.321), main effects of time for cortisol and ACTH with no differences between both groups, and significant associations between cortisol release and agoraphobic cognitions for the patients. PD diagnosis had no impact on the hormonal response. However, those patients with higher cortisol release showed less improvement after CBT (significantly for agoraphobic cognitions). Clinical implications of these findings are the prediction of the therapy success from a potential endocrine correlate whose persistency (if assessed repeatedly) during the treatment may predict (non-)response to the current treatment, possibly representing a decision support for a change in treatment to avoid the continuation of an inefficient treatment.
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Richard, Marion. "Apport de la modélisation ontologique pour le partage des connaissances en psychiatrie". Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066202/document.
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La psychiatrie est une spécialité médicale qui vise à fournir un diagnostic et à traiter des troubles mentaux. Malgré des classifications internationalement reconnues, la catégorisation des patients selon des critères diagnostiques reste problématique. Les catégories actuelles peinent à prendre en compte l'hétérogénéité interindividuelle, les difficultés de délimitations des syndromes et l'influence sur les symptômes de nombreux facteurs dans l'histoire individuelle ou dans l'environnement. La recherche en psychiatrie nécessite une amélioration de la description des comportements, des syndromes ou des dysfonctionnements associés aux troubles psychiatriques. À cette fin, nous proposons OntoPsychia, une ontologie pour la psychiatrie, divisée en deux modules : les facteurs sociaux et environnementaux des troubles mentaux, et les troubles mentaux. L'utilisation d'OntoPsychia associée à des outils dédiés permettra la prise en compte des facteurs sociaux et environnementaux, la représentation de la comorbidité et une proposition de consensus autour des catégories descriptives des troubles psychiatriques. Dans un premier temps, nous avons développé les deux modules ontologiques selon deux méthodes différentes. La première propose une analyse de comptes rendus d'hospitalisation, tandis que la deuxième propose un alignement de différentes classifications psychiatriques, pour répondre au besoin de consensus. Dans un deuxième temps, nous avons développé un cadre méthodologique pour valider la structure et la sémantique des ontologiesPsychiatry is a medical speciality that aims at providing diagnosis and treating mental disorders. Despite internationally acknowledged criteria leading to diagnostic categories, most psychiatric disorders are syndromes with common symptoms or dimensions between these diagnostic categories. In addition, the analysis of the prevalence and incidence of social and environmental risk factors of diseases is crucial to understand and treat them and might have significant impacts on policy decisions (therapeutic as well as the length or the cost of hospitalisation). This overlap between diagnoses and the heterogeneity within the defined diagnoses stresses the need to improve our capability to detect, to quantify the behaviour and to model the symptoms and the social and environmental risk factors associated to psychiatric disorders. To that end, we propose OntoPsychia, an ontology for psychiatry, divided in two modules: social and environmental factors of mental disorders and mental disorders. OntoPsychia associated with dedicated tools will help to perform semantic research in Patient Discharges Summaries (PDS), to represent comorbidity, to reach a consensus on descriptive categories of mental disorders. In a first step, we developed two ontological modules using two different methods. The first proposes an analysis of PDS, while the second proposes an alignment of psychiatric classifications to meet the need for consensus. In a second step, we have developed a methodological framework to validate the structure and semantics of ontologies
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Fernandez, Anthony Vincent. "Phenomenology and the Crisis of Contemporary Psychiatry: Contingency, Naturalism, and Classification". Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6235.
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This dissertation is a contribution to the contemporary field of phenomenological psychopathology, or the phenomenological study of psychiatric disorders. The work proceeds with two major aims. The first is to show how a phenomenological approach can clarify and illuminate the nature of psychopathology—specifically those conditions typically labeled as major depressive disorder and bipolar disorder. The second is to show how engaging with psychopathological conditions can challenge and undermine many phenomenological presuppositions, especially phenomenology’s status as a transcendental philosophy and its corresponding anti-naturalistic outlook.
In the opening chapter, I articulate the three layers of the subject matter of phenomenological research—what I refer to as “existentials,” “modes,” and “prejudices.” As I argue, while each layer contributes to what we might call the “structure” of human existence, they do not do so in the same way, or to the same degree. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change and alter, it is paramount that these layers be adequately delineated and defined before investigating these changes.
In chapters two through five, I conduct hermeneutic and phenomenological investigations of psychopathological phenomena typically labeled as major depressive disorder or bipolar disorder. These investigations address the affective aspects of depression and mania, and the embodied aspects of depression. In addition to clearly articulating the nature of these phenomena, I show how certain psychopathological conditions involve changes in the deepest or most fundamental layer of human existence—what I refer to as existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, this presupposition is challenged through the examination of psychopathological and neuropathological conditions, undermining the status of phenomenology as a transcendental philosophy.
While this challenge to classical phenomenology is only sketched in the early chapters, in chapters six and seven I develop it in more detail in order to achieve two distinct ends. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but nonetheless maintains the capacity to investigate how the natural world stands independent of human subjectivity (and how events in the natural world can bring about changes in the most fundamental structures of human existence). In the seventh chapter I argue that a phenomenology in which existentials are contingent and variable rather than necessary and unchanging allows phenomenologists to contribute to new dimensional approaches to psychiatric classification. Rather than begin from distinct categories of disorder, these approaches begin from distinct core features of human existence. These features, referred to as either dimensions or constructs, can vary in degree and are studied in both normal and pathological forms.
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Martins, Paula Andrea Shinzato Ferreira. "Sistema de classificação de pacientes na especialidade enfermagem psiquiátrica: validação clínica". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7136/tde-20042007-105158/.
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A escassez de publicações a respeito de dimensionamento de pessoal na enfermagem psiquiátrica motivou o desenvolvimento de um Instrumento para Classificar o Nível de Dependência na Enfermagem Psiquiátrica, etapa inicial para o estabelecimento do número ideal de profissionais na Equipe de Enfermagem da especialidade. Para tornar público um Sistema de Classificação de Pacientes, o pesquisador deve garantir a validade de conteúdo e do constructo, além da confiabilidade da ferramenta, permitindo à comunidade científica sua adoção como método, ou mesmo, como material de referência no desenvolvimento de novos modelos. Desta forma, o instrumento foi construído e teve seu conteúdo validado em estudo anterior. Assim, seus objetivos buscaram a validação clínica, por meio de testes de confiabilidade e validade do constructo, além da verificação de sua aplicabilidade na prática gerencial do enfermeiro. Duas amostras foram utilizadas, sendo n=40 pares de instrumentos preenchidos na Fase 1 da coleta de dados e n=100 instrumentos preenchidos na Fase 3 do estudo, tendo sido aplicados cinco diferentes critérios estatísticos, entre eles: o coeficiente Kappa e a correlação de Spearman. O Instrumento para Classificar o Nível de Dependência na Enfermagem Psiquiátrica foi considerado confiável com índices satisfatórios de concordância e o constructo foi validado, determinando o grau de dependência do paciente portador de transtornos mentais, internado aos cuidados da equipe de enfermagem psiquiátricaThe shortage of publications about personnel dimensioning in psychiatric nursing motivated the development of an instrument to Classify the Dependence Level in Psychiatric Nursing, initial stage to the establishment of an ideal number of professionals in the Nursing Crew of the specialty. In order to make public a Patient Classification System, the researcher must guarantee the validity of the content and of the construct, besides the reliability of the tool, allowing to the scientific community its adoption as a method, or even, as a reference material in the development of new models. Thus, the instrument was built and had its content validated in a previous study. Thus, its purposes aimed at the clinical validation by reliability and construct validity tests, besides the checking of its applicability in the managing practice of the nurse. Two samples were used, being n=40 pairs of instruments filled in Stage 1 of data collection and n= 100 instruments filled in Stage 3 of the study, five different statistical criteria were applied, among them, the Kappa coefficient and the Spearman correlation. The instrument to Classify the Dependence Level in Psychiatric Nursing was considered reliable with good indicators of agreement and the construct was validated, determining the degree of dependence of the patient bearing mental disorders, interned under the cares of the psychiatric nursing crew
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Van, den Berg Marjan D. "Depression in the elderly : a study from the perspective of diagnostic classification, etiology, biological correlates and remission /". Online version, 2001. http://bibpurl.oclc.org/web/22627.
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VERMEERSCH, SYLVIE. "Un enfant, un regard : a propos de la classification francaise des troubles mentaux de l'enfant et de l'adolescent". Lille 2, 1993. http://www.theses.fr/1993LIL2M197.
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Demazeux, Steeves. "Le lit de Procuste du DSM-III : classification psychiatrique, standardisation clinique et ontologie médicale". Paris 1, 2011. http://www.theses.fr/2011PA010533.
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Cette étude porte sur l'histoire et les fondements théoriques du Manuel diagnostique et statistique des troubles mentaux, troisième édition (DSM-III). La publication de cette classification standardisée de la pathologie mentale, par l'American Psychiatric Association en 1980, a constitué une véritable « révolution nosologique », qui a exercé une influence durable dans la psychiatrie américaine, aussi bien sur la prise en charge des malades mentaux que sur les programmes de recherche scientifique. Le DSM-III a imposé un nouveau style de pensée en psychiatrie, le « néo-kraepelinisme », qui met l'accent sur l'objectivité descriptive du diagnostic et relève l'importance des outils standardisés d'évaluation et des données épidémiologiques pour le progrès des connaissances en psychopathologie. Cette classification, qui reposait sur un pari d' « a-theorisme », n'a toutefois pas porté tous les fruits escomptés. La nosologie psychiatrique, aujourd'hui, connaît une grave crise théorique illustrée par l'opposition de deux modèles aux présupposés ontologiques radicalement différents : le modèle médical, qui défend une approche catégorielle des troubles mentaux ; le modèle psychologique, qui défend une approche dimensionnelle s'appuyant principalement sur les travaux autour des traits de personnalité. L'ontologie «grise» du DSM-III est en grande partie responsable de cette crise.
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Koch, Andrea, Anke Vogel, Marco Holzmann, Andrea Pfennig, Hans Joachim Salize, Bernd Puschner i Matthias Schützwohl. "MEMENTA—‘Mental healthcare provision for adults with intellectual disability and a mental disorder’. A cross-sectional epidemiological multisite study assessing prevalence of psychiatric symptomatology, needs for care and quality of healthcare provision for adults with intellectual disability in Germany: a study protocol". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-148191.
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Introduction: The study ‘Mental healthcare provision for adults with intellectual disability and a mental disorder’ (MEMENTA) is a cross-sectional epidemiological study carried out in three different regions of Germany. Its main aim is to assess the prevalence of mental disorders in adults with intellectual disability (ID) as well as quality of mental healthcare for this population. Methods and analysis: The target population are persons aged between 18 and 65 years with a mild or moderate ID. The study population will be recruited through service providers. A representative sample is realised by two-stage sampling. First, institutions providing services for people with ID (sheltered workshops) are selected in a stratified cluster sampling, with strata being (1) types of service-providing non-governmental organisations and (2) sizes of their sheltered workshops. Then persons working in selected sheltered workshops are selected by simple random sampling. An estimated number of 600 adults with ID will be included. Information will be obtained from the group leaders in the sheltered workshops, informal carers or staff members in sheltered housing institutions and the person with ID. Besides the main outcome parameter of psychiatric symptomatology and problem behaviour, other outcome parameters such as needs for care, quality of life, caregiver burden, health services utilisation and costs for care are assessed using well-established standardised instruments. If a comorbid mental disorder is diagnosed, quality of mental healthcare will be assessed with open questions to all interview partners and, in addition, problem-focused interviews with a small subgroup. Analyses will be carried out using quantitative and qualitative methods. Ethics and dissemination: Approval of all three local ethics committees was obtained. Research findings will add much needed empirical information in order to improve services provided to this vulnerable group of patients.
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Tantisatirapong, Suchada. "Texture analysis of multimodal magnetic resonance images in support of diagnostic classification of childhood brain tumours". Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5811/.
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Primary brain tumours are recognised as the most common form of solid tumours in children, with pilocytic astrocytoma, medulloblastoma and ependymoma being found most frequently. Despite their high mortality rate, early detection can be facilitated through the use of Magnetic Resonance Imaging (MRI), which is the preferred scanning technique for paediatric patients. MRI offers a variety of imaging sequences through structural and functional imaging, as well as providing complementary tissue information. However visual examination of MR images provides limited ability to characterise distinct histological types of brain tumours. In order to improve diagnostic classification, we explore the use of a computer-aided system based on texture analysis (TA) methods. TA has been applied on conventional MRI but has been less commonly studied on diffusion MRI of brain-related pathology. Furthermore, the combination of textural features derived from both imaging approaches has not yet been widely studied. In this thesis, the aim of the research is to investigate TA based on multi-centre multimodal MRI, in order to provide more comprehensive information and develop an automated processing framework for the classification of childhood brain tumours.
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Lolo, Berthe Elise. "Entre symbolique et imaginaire : le champ des positions subjectives : les catégories nosographiques en psychiatrie revisitées en regard de la psychanalyse". Paris 7, 2006. http://www.theses.fr/2006PA070019.
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Le but du travail est de montrer que les positions subjectives ne peuvent se réduire ni à une collection de traits observés empiriquement, ni à un paramétrage mécanique. Elles sont essentiellement diverses, mais cette diversité même doit être appréhendée à partir des registres de l'Imaginaire, du Symbolique et du Réel. Ce triple enregistrement donne sens à la différence des sujets, des sexes et des générations. Il permet de faire place à la singularité sans se noyer dans la hiérarchisation. Nous soutiendrons que cette façon d'appréhender les positions subjectives permet de discerner des positions qui n'ont pas ou peu été mises en évidence dans les nosographies classiques, qui n'ont pas pu non plus être complètement oubliées (comme l'indique la destinée de cette catégorie ancienne et pourtant non épuisée des " paraphrénies ") ou qui se révèlent même encore largement impossibles à "dire" théoriquement, bien qu'elles se rencontrent dans la pratique clinique. Ré-envisager ainsi les positions subjectives peut conduire -c'est là un but certainement ambitieux- à redessiner tout l'espace des classes nosographiques, en ouvrant des perspectives de prise en compte d'expériences quotidiennes jusque là ignorées ou déformées par la rigidité acquise des systèmes de diagnosticThe aim of this study is to show that subjective states cannot be reduced to an empirically observed collection of traits, or mechanical parameters. Although they are diverse, this diversity can be perceived from records of the Imaginary, Syrabolism and the Actual. This triple perception, explains the differences of subjects, sexes and of différent generations. This allows for particularities without subverting the notion of the hierarchy. We support the notion that this method of perceiving subjective states, allows to recognise clinical entities, which have not been described in the classical nosography, have not been completely forgotten (as suggested by this otherwise unavailable category of "paraphrenias") and which, although thought to be impossible theoretically, are still found in clinical practice. If considered in this way, subjective conditions may lead to a redesign of nosographic classes, taking into account daily experiences which, until now were ignored or distorted by pre-established diagnostic criteria
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Daubner, Sigrid. "Einführung des betrieblichen Gesundheitsmanagements an einem Fachkrankenhaus für Neurologie und Psychiatrie". Bachelor's thesis, Dresden International University, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-183245.
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In dieser Arbeit wird ein Konzept für das betriebliche Gesundheitsmanagement an einem Fachkrankenhaus für Neurologie und Psychiatrie erstellt. Hierbei werden zunächst allgemeine Grundlagen sowie die Entwicklung und Teilbereiche des betrieblichen Gesundheitsmanagements dargestellt. Darauf basierend wird anschließend am praktischen Beispiel eines Fachkrankenhauses für Neurologie und Psychiatrie mit Hilfe einer Mitarbeiterbefragung sowie einer Literaturrecherche ein organisatorisches und inhaltliches Konzept für das betriebliche Gesundheitsmanagement entworfen. Inhaltlich umfasst dieses die alters- und berufsgruppenspezifisch bedarfsorientierte Entwicklung von Maßnahmen und Angeboten an zwei Gesundheitstagen jährlich, sowie die dauerhafte Etablierung verschiedener Angebote zur Förderung der Gesundheit und Prävention von Erkrankungen der Mitarbeiter. Weiterhin werden die notwendigen organisatorischen Determinanten erarbeitet, die zur Einführung, Weiterentwicklung und Überprüfung der Wirksamkeit des BGM erforderlich sind. Im abschließenden Fazit erfolgen eine aktuelle Bewertung der Konzeption und ein Ausblick in die Zukunft.
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FERRARO, HAMICI ROSA. "La dichotomie unipolaire - bipolaire : interet actuel de cette classification ; etude retrospective chez 50 patients suivis dans le service de psychiatrie generale du centre hospitalier regional de lille". Lille 2, 1992. http://www.theses.fr/1992LIL2M251.
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Martin, Toni. "The development and pilot testing of a programme combining Bandura's Theory of Self-Efficacy with the International Classification of Functioning, Disability and Health (ICF), for caregivers of people with dementia". Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/370403/.
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Nutt, David, Christer Allgulander, Yves Lecrubier, T. Peters i Hans-Ulrich Wittchen. "Establishing non-inferiority in treatment trials in psychiatry - guidelines from an Expert Consensus Meeting". Technische Universität Dresden, 2008. https://tud.qucosa.de/id/qucosa%3A26701.
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Comparing the efficacy of different treatments in psychiatry is difficult for many reasons, even when they are investigated in `head-to-head' studies. A consensus meeting was, therefore, held to produce best practice guidelines for such studies. This article presents the conclusions of this consensus and illustrates it using published data in the field of antidepressant treatment of generalized anxiety disorder.
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Thomas, Jérôme. "Dire(s) d’urgence : la psychiatrie d’urgence comme structure de médiation : statut de la parole et de la communication à l’hôpital". Thesis, Lyon 2, 2010. http://www.theses.fr/2010LYO20076/document.
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Cette thèse vise à montrer que la psychiatrie d’urgence, intervenant dans le cadre de l’hôpital général, constitue une structure de médiation. Bien que les services d’urgence soient le lieu d’expression de la crise et de la catastrophe, ils mettent en œuvre des processus symboliques et imaginaires qui visent à redonner du sens à l’irreprésentable. A partir d’une enquête ethnographique par observations participantes, la thèse analyse les différents aspects de la communication mise en œuvre lors de l’accueil des patients. En s’inspirant de la psychanalyse et de l’anthropologie, cette recherche aboutit à une sémiotique de l’urgence psychiatrique qui articule les dimensions réelle, imaginaire et symbolique du phénomène à partir de la notion de flottance de l’urgence, que nous forgeons en partie.Cette approche interdisciplinaire, ancrée dans le champ des sciences de l’information et de la communication, permet de comprendre combien les services d’urgence psychiatrique constituent des espaces de renouage du contrat social. Cette thèse décrit et analyse les conditions de l’articulation de la clinique au politique, du singulier au collectif. A ce titre, ces services constituent des lieux d’interrogation et d’invention du politique dans la mesure où chaque sujet qui y a recours vient problématiser de façon singulière, inédite et imprévisible, l’articulation du désir et de la norme en exigeant, de la part de l’institution, qu’elle énonce de nouvelles formules de ce nouage.Sur le plan épistémologique, cette recherche est une invitation faite aux études portant sur la communication d’inclure dans leurs réflexions la catégorie du réel qui désigne la limite du symbolique et du représentable. Cette thèse montre qu’il est fructueux de penser les faits de communication à partir de l’impossible à communiquer, de penser la médiation à partir, précisément, des ruptures de la médiation et, finalement, de penser le contrat social à partir de ses limites, de ce qu’il est contraint de refouler pour se maintenirThis thesis aims at showing that psychiatric emergency, when it takes place in general hospital, plays the role of a structure of mediation. Even if the emergency wards are places where crisis and catastrophe are conveyed, they implement symbolic and imaginary processes which aim at giving back meaning to situations which get unthinkable. Starting from an ethnographic investigation through observations, the thesis analyses the different aspects of the communication brought into play when patients are received. This thesis which is based on psychoanalysis and anthropology leads to a semiotic analysis of psychiatric emergency which is centred round the Real, the Symbolic and the Imaginary dimensions of the phenomenon.This interdisciplinary approach, rooted in the fields of information and communication sciences, enables the understanding of how psychiatric emergency wards are places where the social contract can exist again. This thesis describes and analyses the conditions of articulation between the clinical side and the politics. Emergency wards are places where Politics is questioning and invented. Indeed, each subject who turns to the emergency ward questions the compromise between the norm and the desire in a singular, original and unforeseeable way. Furthermore, this subject expects the institution to enounce new formulations of this compromise.On the epistemological level, this thesis invites studies on communication to include in their reflexions the category of the Real which refers to the limits of the Symbolic. This thesis shows that it is relevant to think of communication facts by considering the impossibility to communicate, to think of mediation precisely through the mediation breaking points, to think of the social contract by considering its limits
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Pringault, Sarah. "Le sujet « Alzheimer » : de l’objet d’étude au sujet de l’inconscient". Thesis, Rennes 2, 2020. http://www.theses.fr/2020REN20035.
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Cette thèse a pour visée de démontrer que le diagnostic « Alzheimer » provoque injustement le rejet de la personne et la forclusion du sujet de l’inconscient dans notre société occidentale. La place de celui qui est diagnostiqué, évalué, mais également expliqué selon les théories scientifiques est questionnée à travers la référence à une variété de disciplines, ainsi que l’analyse psychopathologique de six cas cliniques. Je relève l’hypothèse selon laquelle l’entité « Alzheimer » repose sur un phénomène de pathologisation de la vieillesse, sous-tendu par des enjeux économiques et politiques et reflétant le modèle biomédical de notre société. Elle conduit à l’exclusion et à la stigmatisation. Je démontre des réductionnismes cognitivistes et neuroscientifiques : les phénomènes de l’esprit ne peuvent être totalement cernés par l’objectivité alors que la clinique démontre la singularité et la contingence à l’origine des manifestations démentielles. Une analyse psychanalytique des cas cliniques permet d’entendre une cohérence – une logique fantasmatique – dans les modifications mnésiques, ainsi que les processus psychiques inconscients constitutifs du sujet et de sa réalité, dans les modifications du rapport au temps. Se décaler d’une interprétation scientifique permet d’entendre à travers ces manifestations les questions fondamentales du sujet et sa détermination symbolique. Contre l’exclusion, la stigmatisation de nos aînés par l’entité nosologique « Alzheimer », considérés à tort comme des « sans esprit », des vieux « déficitaires », il est une nécessité éthique d’entendre chez eux toute la dimension subjective et humaine pour leur réattribuer place et dignitéThis thesis aims to show that the diagnosis "Alzheimer" unjustly causes the rejection of the person and the foreclosure of the subject of the unconscious in our Western society. The place of the one who is diagnosed, evaluated, and also explained according to scientific theories is questioned through reference to a variety of disciplines, as well as psychopathological analysis of six clinical cases. I note the hypothesis that the "Alzheimer's" entity is based on a phenomenon of « pathologization » of old age, underpinned by economic and political logic and reflecting the biomedical model of our society. It leads to exclusion and stigma. I demonstrate cognitive and neuroscientific reductionism : the phenomena of the mind cannot be fully comprehended by objectivity while the clinic demonstrates the singularity and contingency at the origin of démentia’s manifestations. A psychoanalytic analysis of clinical cases allows us to hear a coherence - a fantasy logic - in the mnemonic changes, as well as the unconscious psychic processes constituting the subject and his reality, in changes in the relationship to time. Shifting from a scientific interpretation allows us to hear through these manifestations the fundamental questions of the subject and its symbolic determining. Against the exclusion, the stigmatization of our elders by the nosological entity "Alzheimer", wrongly regarded as "spiritless", olds in "deficit", it is an ethical necessity to agree in them to the whole subjective and human dimension to reassign them place and dignity
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Nowak, Lisa Rebecca. "Philosophical perspectives on the stigma of mental illness". Thesis, University of St Andrews, 2018. http://hdl.handle.net/10023/13193.
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This thesis is concerned with philosophical perspectives on the stigma of mental illness, with each chapter exploring different philosophical issues. Chapter one delineates the central concept around which the rest of the work revolves: the stigma of mental illness. It provides an outline of the stigma mechanism, how it applies to mental illness, why it is such a large public health concern and what has been done so far to combat it. Chapter two is concerned with the application of recent literature in the philosophy of implicit bias to the topic of mental illness. It suggests that we have hitherto been preoccupied with explicit formulations of the stigma mechanism, but argues that there are distinctive issues involved in combatting forms of discrimination in which the participants are not cognisant of their attitudes or actions, and that anti-stigma initiatives for mental illness should take note. Chapter three applies the philosophical literature concerning the ethics of our epistemic practices to the stigma of mental illness. It contains an analysis of how epistemic injustice- primarily in the forms of testimonial injustice and stereotype threat- affects those with mental illnesses. The fourth chapter brings in issues in the philosophy of science (particularly the philosophy of psychiatry) to explore the possibility of intervening on the stigma process to halt the stigma of mental illness. The first candidate (preventing labelling) is discounted, and the second (combatting stereotype) is tentatively endorsed. The fifth chapter is concerned with how language facilitates the stigma of mental illness. It suggests that using generics to talk about mental illness (whether the knowledge structure conveyed is inaccurate or accurate) is deeply problematic. In the former, it conveys insidious forms of social stereotyping. In the latter, it propagates misinformation by presenting the category as a quintessential one.
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Neumann, Anne, Enno Swart, Dennis Häckl, Roman Kliemt, Stefanie March, Denise Küster, Katrin Arnold i in. "The influence of cross-sectoral treatment models on patients with mental disorders in Germany: study protocol of a nationwide long-term evaluation study (EVA64)". BioMed Central, 2018. https://tud.qucosa.de/id/qucosa%3A33821.
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Background
Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016.
Methods/design
A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm.
Discussion
The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond.
Trial registration
This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).
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Chen, Beichen, i Amy Jinxin Chen. "PCA based dimensionality reduction of MRI images for training support vector machine to aid diagnosis of bipolar disorder". Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-259621.
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This study aims to investigate how dimensionality reduction of neuroimaging data prior to training support vector machines (SVMs) affects the classification accuracy of bipolar disorder. This study uses principal component analysis (PCA) for dimensionality reduction. An open source data set of 19 bipolar and 31 control structural magnetic resonance imaging (sMRI) samples was used, part of the UCLA Consortium for Neuropsychiatric Phenomics LA5c Study funded by the NIH Roadmap Initiative aiming to foster breakthroughs in the development of novel treatments for neuropsychiatric disorders. The images underwent smoothing, feature extraction and PCA before they were used as input to train SVMs. 3-fold cross-validation was used to tune a number of hyperparameters for linear, radial, and polynomial kernels. Experiments were done to investigate the performance of SVM models trained using 1 to 29 principal components (PCs). Several PC sets reached 100% accuracy in the final evaluation, with the minimal set being the first two principal components. Accumulated variance explained by the PCs used did not have a correlation with the performance of the model. The choice of kernel and hyperparameters is of utmost importance as the performance obtained can vary greatly. The results support previous studies that SVM can be useful in aiding the diagnosis of bipolar disorder, and that the use of PCA as a dimensionality reduction method in combination with SVM may be appropriate for the classification of neuroimaging data for illnesses not limited to bipolar disorder. Due to the limitation of a small sample size, the results call for future research using larger collaborative data sets to validate the accuracies obtained.Syftet med denna studie är att undersöka hur dimensionalitetsreduktion av neuroradiologisk data före träning av stödvektormaskiner (SVMs) påverkar klassificeringsnoggrannhet av bipolär sjukdom. Studien använder principalkomponentanalys (PCA) för dimensionalitetsreduktion. En datauppsättning av 19 bipolära och 31 friska magnetisk resonanstomografi(MRT) bilder användes, vilka tillhör den öppna datakällan från studien UCLA Consortium for Neuropsychiatric Phenomics LA5c som finansierades av NIH Roadmap Initiative i syfte att främja genombrott i utvecklingen av nya behandlingar för neuropsykiatriska funktionsnedsättningar. Bilderna genomgick oskärpa, särdragsextrahering och PCA innan de användes som indata för att träna SVMs. Med 3-delad korsvalidering inställdes ett antal parametrar för linjära, radiala och polynomiska kärnor. Experiment gjordes för att utforska prestationen av SVM-modeller tränade med 1 till 29 principalkomponenter (PCs). Flera PC uppsättningar uppnådde 100% noggrannhet i den slutliga utvärderingen, där den minsta uppsättningen var de två första PCs. Den ackumulativa variansen över antalet PCs som användes hade inte någon korrelation med prestationen på modellen. Valet av kärna och hyperparametrar är betydande eftersom prestationen kan variera mycket. Resultatet stödjer tidigare studier att SVM kan vara användbar som stöd för diagnostisering av bipolär sjukdom och användningen av PCA som en dimensionalitetsreduktionsmetod i kombination med SVM kan vara lämplig för klassificering av neuroradiologisk data för bipolär och andra sjukdomar. På grund av begränsningen med få dataprover, kräver resultaten framtida forskning med en större datauppsättning för att validera de erhållna noggrannheten.
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Trautmann, S., L. Goodwin, M. Höfler, F. Jacobi, J. Strehle, P. Zimmermann i H. U. Wittchen. "Prevalence and severity of mental disorders in military personnel: a standardised comparison with civilians". Cambridge University Press, 2017. https://tud.qucosa.de/id/qucosa%3A70725.
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Aims. Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders.
Method. 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples.
Results. Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5–0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1–0.6; NS: OR: 0.2, 95% CI: 0.1–0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3–0.6; NS: OR: 0.5, 95% CI: 0.3–0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4–5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3–8.0) were observed in DS with high combat exposure compared with civilians.
Conclusions. Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.
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Sebold, Miriam, Lorenz Deserno, Stefan Nebe, Daniel J. Schad, Maria Garbusow, Claudia Hägele, Jürgen Keller i in. "Model-Based and Model-Free Decisions in Alcohol Dependence". Karger, 2014. https://tud.qucosa.de/id/qucosa%3A71627.
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Background: Human and animal work suggests a shift from goal-directed to habitual decision-making in addiction. However, the evidence for this in human alcohol dependence is as yet inconclusive. Methods: Twenty-six healthy controls and 26 recently detoxified alcohol-dependent patients underwent behavioral testing with a 2-step task designed to disentangle goal-directed and habitual response patterns. Results: Alcohol-dependent patients showed less evidence of goal-directed choices than healthy controls, particularly after losses. There was no difference in the strength of the habitual component. The group differences did not survive controlling for performance on the Digit Symbol Substitution Task. Conclusion: Chronic alcohol use appears to selectively impair goal-directed function, rather than promoting habitual responding. It appears to do so particularly after nonrewards, and this may be mediated by the effects of alcohol on more general cognitive functions subserved by the prefrontal cortex.
38
Fraunholz, Uwe, i Hagen Schönrich. "Wahnhaftes Erfinden". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-156131.
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Hochfliegende Raumfahrt-, Atom- und Automatisierungsvisionen revitalisierten seit den 1950er Jahren die Popularisierung von Zukunftstechnik. Selbst die Psychiatrische Landesanstalt Hubertusburg blieb von diesen Zeitströmungen nicht unberührt:
Karl Hans Janke (1909–1988) entwarf in den fast vier Jahrzehnten, die er in Wermsdorf wegen "chronisch paranoider Schizophrenie" verbrachte, tausende Fahr- und Flugzeuge, Raumschiffe und Triebwerke, Energiekonzepte und elektrische Geräte. Der begabte Zeichner und Konstrukteur bastelte zahlreiche Modelle und arbeitete an einer alternativen Entwicklungsgeschichte des Menschen, die er in seine Kosmologie einbettete. Dazu hielt er Vorträge und korrespondierte mit Betrieben und staatlichen Stellen.
39
Lo, Kuo-Chin, i 羅國菁. "A pilot study of psychiatric patient''s classification system". Thesis, 1995. http://ndltd.ncl.edu.tw/handle/87834175156641292512.
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Fehr, Paige. "Psychiatry and eugenics: the classification and diagnosis of female patients in British Columbia’s psychiatric institutions, 1918-1933". Thesis, 2017. https://dspace.library.uvic.ca//handle/1828/8529.
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Between 1918 and 1933, the eugenic notion of “defective heredity” was central to psychiatric practice in British Columbia. Public and medical professionals’ concerns were heightened by an apparent increase in “insane” and “mentally deficient” individuals in the province. Using the annual reports for the asylums and the case files of women who were admitted to the Public Hospital for the Insane and to Essondale between 1918 and 1933, this thesis examines the relationship between psychiatric practice and eugenics, specifically how eugenically-minded asylum physicians classified and diagnosed female patients. Asylum physicians used admissions forms, patient interviews, observation, and inference to make diagnoses. Often, despite a lack of evidence, they concluded that patients had inherited a predisposition to mental disease. Women admitted to B.C.’s Public Hospital for the Insane and to Essondale were more likely than their male counterparts to have their mental condition linked to heredity. Any “eccentric” or “abnormal” behaviour or personality in the patient or their family was considered by asylum physicians to be evidence of a predisposition to mental disorder. Within the population of female asylum patients, racialized women were the most likely to be labeled as having “defective heredity.” Widespread racial discrimination in the province, combined with the fact that eugenic discourse targeted non-white citizens as being biologically and culturally inferior, shaped and influenced the asylum physicians’ classification and diagnoses of mental illness among racialized women. The experiences of these women during their incarceration were also shaped by racialized discourse and their behaviour was negatively stereotyped by asylum staff.Graduate
2018-08-17
41
Oosthuizen, Rika. "An evaluation of the PIE classification system in psychiatric social work". Thesis, 2012. http://hdl.handle.net/10210/6162.
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M.A.This study is born from the motivation to empower psychiatric social workers in South Africa with a classification system that compares well to classification systems used by other disciplines in the psychiatric setting. The classification system in question is the Person-in-Environment Classification System (PIE) and therefore this study sets out to investigate and report on the value the PIE might have for psychiatric social work in South Africa. Another objective then is to highlight what problems were experienced in using the PIE which will form the foundation for recommendations on further research and possible adaptations. The first part of this dissertation sets out the motivation and objectives of this study, where the second part gives a thorough description of psychiatric social work, the ecological approach in psychiatric social work, classification systems and the PIE itself. The research process is described whereafter the results of the data are explained. The results are discussed within the framework of three evaluative factors, namely image, applicability and structure which gives an indication of the value the PIE has for psychiatric social work. The conclusion can be drawn from this study that the PIE has definite value in all three evaluative factors. It can be concluded that the PIE can serve as an empowering tool in establishing and defining psychiatric social work's unique contribution to South African psychiatry.
42
Κοψαύτης, Νικόλαος Ι. "Independent component analysis of evoked potentials for the classification of psychiatric patients and normal controls". Thesis, 2006. http://nemertes.lis.upatras.gr/jspui/handle/10889/1389.
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The last twenty years presented increased interest for the study of cerebral processes caused by external events (stimuli). One of the most significant endogenous components of Evoked Potentials is the P600 component. The P600 component may be defined as the most positive peak in the time window between 500 and 800 msec after an eliciting stimulus. This component is thought to reflect the response selection stage of information processing. P600 component is usually less pronounced compared to other components, such as the N100 or the P300. Frequently the P600 component appears as a not-easily discernible secondary peak overlying the ascending negative-going slope of the P300 waveform. In our study we used ERP data from various groups of patients and healthy controls. Patients were recruited from the outpatient university clinic of Eginition Hospital of the University of Athens. The controls were recruited from hospital staff and local volunteer groups. The aim of the study is the implementation of classification systems for these groups, using P600 features. This is usually not achieved well using as features the ERPs amplitude and latency. So for that reason, in our study, we want to extract new features using advanced techniques for processing the original ERPs, such as the Independent Component Analysis (ICA) method. However as a precursor of ICA, is considered the Principal Component Analysis (PCA) method, which we used for comparison reasons to ICA.
In the application of ICA we achieve the decomposition of the recorded signals in ICs, supposing temporally independent components and propose ICs selection techniques in order to recompose the P600 component. The next stage was the use of a classification method based on the features extracted using the original data, data extracted through PCA processing and ICA-processed data. First we applied Kolmogorov-Smirnov test to check the normality of the distribution of the features, then we used the Logistic Regression method for classification and finally we have done two implementations of classification using Probabilistic Neural Networks. The first implementation was done with the creation of 15 features from the P600 peak amplitudes from the subjects’ data and the second implementation was done with the creation of four meta-features from the subjects’ P600 amplitude data.
The results show that the application of ICA, combined with the logistic regression classification technique, provides notable improvement, compared to the classification performance based on the original ERPs. The main merit of the application is that classification is based on single parameters, i.e. amplitude of the P600 component, or its latency or its termination latency, which are directly related to the brain mechanisms related to ERP generation and pathological processes.Τα τελευταία 20 χρόνια παρουσιάζεται αυξημένο ενδιαφέρον για την μελέτη εγκεφαλικών επεξεργασιών που προκλήθηκαν από εξωτερικά γεγονότα (ερέθισμα). Ένα από τα πιο σημαντικά ενδογενή συστατικά των Προκλητών Δυναμικών είναι το συστατικό P600. Το συστατικό P600 μπορεί να οριστεί σαν η πιο θετική αιχμή στο χρονικό διάστημα μεταξύ 500 και 800 msec μετά από ένα εκλυτικό ερέθισμα. Το συστατικό αυτό θεωρείται ότι απεικονίζει το στάδιο επιλογής απόκρισης της επεξεργασίας πληροφορίας. Το συστατικό P600 είναι συνήθως λιγότερο έντονο συγκρίνοντας το με άλλα συστατικά, όπως το N100 ή το P300. Συχνά το συστατικό P600 εμφανίζεται ως μια δυσδιάκριτη δεύτερη αιχμή, επικαλύπτοντας την ανοδική αρνητική κλίση της κυματομορφής του P300. Στη μελέτη μας χρησιμοποιήσαμε δεδομένα ΠΔ από ποικίλες ομάδες ασθενών και υγιών μαρτύρων. Οι ασθενείς συλλέχθησαν από τη πανεπιστημιακή κλινική του Αιγηνήτειου Νοσοκομείου του Πανεπιστημίου Αθηνών. Οι υγιείς συλλέχθησαν από το προσωπικό του νοσοκομείου και ομάδες εθελοντών. Ο σκοπός της μελέτης είναι η εφαρμογή συστημάτων ταξινόμησης για αυτές τις ομάδες, χρησιμοποιώντας χαρακτηριστικά του P600. Αυτό συνήθως δεν επιτυγχάνεται καλά χρησιμοποιώντας σαν χαρακτηριστικά το πλάτος και τον λανθάνοντα χρόνο των ΠΔ. Για αυτό το λόγο, στην μελέτη μας, θέλουμε να εξάγουμε νέα χαρακτηριστικά χρησιμοποιώντας προηγμένες τεχνικές για επεξεργασία των αρχικών ΠΔ, όπως τη μέθοδο Ανάλυσης Ανεξαρτήτων Συνιστωσών (ICA). Εντούτοις ως πρόδρομο της ICA, θεωρείται η μέθοδος Ανάλυσης Κύριων Συνιστωσών (PCA), την οποία χρησιμοποιήσαμε για συγκριτικούς λόγους με την ICA. Στην εφαρμογή της ICA προχωρήσαμε στην αποσύνθεση των καταγραφόμενων σημάτων σε Ανεξάρτητες Συνιστώσες και διερευνήσαμε τρεις τεχνικές επιλογής ανεξαρτήτων συνιστωσών μέσω των οποίων επανασυνθέσαμε το συστατικό P600. Το επόμενο βήμα ήταν η χρήση μεθόδου ταξινόμησης βασισμένης στα χαρακτηριστικά που εξάχθηκαν χρησιμοποιώντας τα αρχικά δεδομένα, τα δεδομένα με επεξεργασία PCA και τα δεδομένα με επεξεργασία ICA. Πρώτα εφαρμόσαμε το τεστ Kolmogorov-Smirnov για τον έλεγχο της κανονικότητας της κατανομής των χαρακτηριστικών, μετά χρησιμοποιήσαμε τη μέθοδο Λογαριθμικής Παλινδρόμησης (Logistic Regression) για ταξινόμηση και τελικά πραγματοποιήσαμε δύο εφαρμογές ταξινόμησης χρησιμοποιώντας Πιθανοκρατικά Νευρωνικά Δίκτυα (Probabilistic Neural Networks). Η πρώτη εφαρμογή έγινε με την δημιουργία 15 χαρακτηριστικών από τα πλάτη των αιχμών του P600 από τα δεδομένα των ομάδων και η δεύτερη εφαρμογή έγινε με την δημιουργία τεσσάρων μετά-χαρακτηριστικών από τα δεδομένα των πλατών των ομάδων. Τα αποτελέσματα δείχνουν ότι η εφαρμογή της ICA, συνδυασμένη με την τεχνική ταξινόμησης λογαριθμικής παλινδρόμησης, παρέχει αξιοσημείωτη βελτίωση, συγκριτικά με την απόδοση ταξινόμησης βάση των αρχικών ΠΔ. Η κύρια αξία της εφαρμογής είναι ότι η ταξινόμηση πετυχαίνει ποσοστά μεγαλύτερα του 80% βασιζόμενη σε μία μόνο κάθε φορά παράμετρο, π.χ. το πλάτος του συστατικού P600, ή τον λανθάνοντα χρόνο του ή τον λανθάνοντα χρόνο τερματισμού του, οι οποίες σχετίζονται άμεσα με τους μηχανισμούς του εγκεφάλου σχετικούς με την παραγωγή ΠΔ και τις παθολογικές διαδικασίες.
43
Richter, Elisabeth. "Johann Christian August Heinroth (1773-1843) als forensischer Psychiater". Doctoral thesis, 2011. https://ul.qucosa.de/id/qucosa%3A11439.
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Die vorliegende Publikationspromotion setzt sich mit dem forensisch-psychiatrischen Werk und Schaffen des ersten abendländischen Lehrstuhlinhabers für Psychiatrie und Begründers der Leipziger Universitätspsychiatrie Johann Christian August Heinroth (1773-1843) zu Beginn des 19. Jahrhunderts auseinander. Die Schwerpunkte dabei sind dessen eigene Gutachtertätigkeit und sein Konzept der Zurechnungsfähigkeit.
Anhand ausgewählter Schriften wurde eine textnahe Lektüre durchgeführt, um Heinroth losgelöst von Kontexten und Kategorien direkt verstehen zu können.
Es ließ sich rekonstruieren, dass Heinroth durch philosophisches Denken und ganzheitliche Problemlösungsstrategien nicht nur der in seiner Zeit verbreiteten Exkulpationsneigung und der Instrumentalisierung psychischer Erkrankungen entschieden entgegen tritt, sondern auch, wenngleich er dieselben nicht überwindet, dennoch konstruktive Lösungsansätze für forensisch-psychiatrische Debatten findet und damit eine Bereicherung auch für aktuelle neurowissenschaftliche Diskussionen darstellt.
Durch die Tiefendarstellung eines Zeitgenossen wird so ein Beitrag zur Vervollständigung der Geschichte der Forensischen Psychiatrie geleistet.
44
Wilson, Diane C. "Reliability and validity evidence for the dual-disorder treatment fidelity scale". Thesis, 2005. http://hdl.handle.net/10125/11878.
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Trefflich, Friederike. "Charakteristika der allgemeinen Internetnutzung psychiatrischer Patienten". Doctoral thesis, 2015. https://ul.qucosa.de/id/qucosa%3A13086.
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Die Arbeit befasst sich mit der Internetnutzung von psychiatrischen Patienten. Das Angebot an Therapien für Patienten mit psychiatrischen Erkrankungen steigt seit Jahren. Auch die Menge an Informationen, welche vor allem online zu bekommen sind, wird immer größer. Allerdings gibt es nur wenige Informationen zur Internetnutzung von psychiatrischen Patienten im Vergleich zur Gesamtbevölkerung. Sind psychiatrische Patienten bezüglich Zugang zum Internet und Nutzung von Internetinformationen und -therapien benachteiligt?
46
Slade, Tim. "Using epidemiology to inform classification in psychiatry /". 2002. http://www.library.unsw.edu.au/~thesis/adt-NUN/public/adt-NUN20030715.113132/index.html.
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Brest, Sharna. "On the efficacy of the DSM-IV-TR, in the diagnosis of children with attention deficit hyperactivity disorder (ADHD). A survey of medical practitioners' perceptions". Thesis, 2009. http://hdl.handle.net/10539/5979.
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There has been an increase of attention placed on the diagnosis of Attention Deficit
Hyperactivity Disorder (ADHD), within South Africa. This has led to a number of
controversies surrounding the legitimacy of ADHD diagnoses. And how effective the
systems of categorising and diagnosing disorders are in aiding a number of practitioners
in formulating a disorder. There is a substantial agreement within the literature that the
understanding of ADHD is limited, the focus is mainly on the symptoms of disorders.
This study explores the perceptions practitioners in the field, in identifying the
effectiveness of the Diagnostic and Statistical Manual for Mental disorders (DSM) is for
diagnosing ADHD. It became evident throughout this study that there is no consensus
around the efficacy of the DSM. Furthermore, ADHD is not completely understood and
therefore creates serious implications for the treatment and diagnosis of the disorder.
48
"Quality of life of schizophrenic outpatients in the community". 2001. http://library.cuhk.edu.hk/record=b5890911.
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by Iu Wai-yu.Thesis (M.Phil.)--Chinese University of Hong Kong, 2001.
Includes bibliographical references (leaves 138-146).
Abstracts in English and Chinese.
ACKNOWLEDGMENTS --- p.i-ii
abstract --- p.iii-iv
ABSTRACT (Chinese version) --- p.v-vi
TABLE OF CONTENTS --- p.vii-xii
LIST OF FIGURES --- p.xiii
LIST OF TABLES --- p.xiv-xvi
LIST OF APPENDICES --- p.xvii-xviii
Chapter CHAPTER 1 --- INTRODUCTION --- p.1
Research problem --- p.2-6
Purpose and objectives of the study --- p.7
Hypothesis --- p.8-9
Operational definitions --- p.9
Significance of the study --- p.10-13
Overview of the thesis --- p.13
Chapter CHAPTER 2 --- LITERATURE REVIEW
Introduction --- p.14
Definition of QOL --- p.15-18
Measurement of QOL --- p.18
The use of objective and subjective QOL Measurement --- p.19-23
Generic vs. Specific instruments --- p.23-24
Studies on QOL on mentally ill clients --- p.25-29
Factors influencing QOL --- p.29-33
Conceptual framework of the study --- p.34-37
Summary --- p.37
Chapter CHAPTER 3 --- METHODOLOGY
Introduction --- p.38
Research design --- p.38-39
Method --- p.39-41
Sampling --- p.41-44
Measurements --- p.45-51
The Brief Psychiatric Rating Scale --- p.45-46
The WHOQOL-BREF-HK --- p.47-48
The Lehman QOLI-brief version --- p.48-51
Demographic data sheet --- p.51
Pilot study --- p.52
Data collection --- p.53-54
Ethical consideration --- p.55-56
Data analysis --- p.56-58
Summary --- p.58
Chapter CHAPTER 4 --- RESULT
Introduction --- p.59
Sociodemographic characteristics of the participants --- p.59-65
Clinical characteristics of the participants --- p.66-70
Results from QOLI --- p.71-79
Results from WHOQOL --- p.80-81
Different perception of QOL in different groups --- p.81-94
Difference in perception of QOL between different gender --- p.82
Difference in perception of QOL between among different age ranges --- p.83-85
Relationships between employment status and perception of QOL --- p.86-87
Relationships between mental status and perception of QOL --- p.88-90
Relationships between years of onset of mental illness and perception of QOL --- p.91
Relationships between number of hospitalization and one's QOL --- p.91-92
Relationships between CPNS and perception of QOL --- p.93
Relationships between attending DH and perception of QOL --- p.94
Predictors of QOL --- p.95-98
Summary --- p.99
Chapter CHAPTER 5 --- DISCUSSION
Introduction --- p.100
Sociodemographic and clinical characteristics of the participants --- p.100-104
Perception of QOL --- p.104-109
Social relationships --- p.109-111
Family relationships --- p.111-112
Sexual relationships --- p.113
Environment --- p.113-114
Financial situation --- p.114-115
Mental status and QOL --- p.115-116
Service utilization and QOL --- p.117-118
Predictors of QOL --- p.118-120
Objective indicators and subjective perception of QOL --- p.121
Summary --- p.122
Chapter chapter 6 --- conclusion and implications
Introduction --- p.123
Summary of the study --- p.123-124
Implications to health care policy --- p.125-130
Implications to nursing practice --- p.130-134
Implications for future research --- p.135-136
Limitations of the study --- p.137
references --- p.138-146
appendices --- p.147-178
49
Steinmetz, Marie Rosa Hilde. "Eine Werkbiografie über Christa Kohler (1928-2004): Psychotherapeutische und sozialpsychiatrische Forschung und Praxis in der DDR". Doctoral thesis, 2013. https://ul.qucosa.de/id/qucosa%3A12946.
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Die vorliegende Arbeit befasst sich mit dem wissenschaftlichen Werk der DDR Psychiaterin Christa Kohler (1928 – 2004). Fokussiert werden dabei ihre Habilitationsschrift zu sozialpsychiatrischen Problemen bei Neurosen und Psychosen in der zweiten Lebenshälfte sowie ihr selbstständig erarbeitetes Konzept der „Kommunikativen Psychotherapie“. Die Forschungsarbeit Kohlers wird unter Berücksichtigung von themenrelevanter Literatur, Interviews mit Zeitzeugen und Archivmaterialien analysiert und bewertet. Dabei wird auch die Person Kohlers beleuchtet und ihre Arbeit in den wissenschaftshistorischen Kontext eingeordnet.:Inhaltsverzeichnis
1. MOTIVATION FÜR DAS THEMA 4
2. AUFBAU DER ARBEIT 5
3. HISTORISCHER KONTEXT DES THEMAS 6
4. METHODE 8
5. FACHWISSENSCHAFTLICHE AUSGANGSLAGE 10
5.1 Überblick über die Geschichte der Psychotherapie 10
5.2 Psychotherapie in der DDR 15
5.3 Überblick über die Geschichte der Sozialpsychiatrie 20
5.4 Sozialpsychiatrie in der DDR 22
6. PRIMÄRQUELLEN, ARCHIVALIEN, INTERVIEWS 25
7. FORSCHUNGSFRAGEN 26
8. BIOGRAFISCHES ZUR PSYCHIATERIN CHRISTA KOHLER 28
9. PUBLIKATIONEN 33
9.1 Steinmetz M Himmerich H Steinberg H. Christa Kohlers „Kommunikative Psychotherapie“ – ein integratives Psychotherapiekonzept im biografischen, wissenschaftlichen und historischen Kontext in der Zeitschrift „Fortschritte der Neurologie Psychiatrie“ 33
9.2 Steinmetz M Himmerich H Steinberg H. Eine frühe sozialpsychiatrische Schrift in der DDR. Christa Kohlers Habilitation über Neurosen und Psychosen der zweiten Lebenshälfte 34
10. PROBLEMATISIERUNG DES KONTEXTES WISSENSCHAFT IN
DER DDR 35
10.1 Zusammenarbeit mit dem Ministerium für
Staatssicherheit (MfS) 35
10.2 Einflussnahme der SED auf die Wissenschaft und den
ärztlichen Beruf 35
10.2.1 Staatliche Vorgaben sowie Freiräume psychotherapeutischer Forschung in der DDR 39
11. BEDEUTUNG DER ARBEIT UND AUSBLICK 42
11.1 Bedeutung der Arbeit 42
11.2 Ausblick 43
12. ZUSAMMENFASSENDE THESEN 44
13. LITERATUR 49
14. ABBILDUNGSVERZEICHNIS 55
15. TABELLENVERZEICHNIS 56
16. DANKSAGUNG 57
17. EIDESSTATTLICHE ERKLÄRUNG 58
18. BIBLIOGRAPHISCHE BESCHREIBUNG 59
50
Schneeberger, Ute. "Enthospitalisierung geistig behinderter Langzeitpatienten aus dem Sächsischen Krankenhaus für Psychiatrie und Neurologie Altscherbitz". Doctoral thesis, 2010. https://tud.qucosa.de/id/qucosa%3A25561.
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Thesen
1. Die vorliegende Arbeit beschäftigt sich mit der Enthospitalisierung geistig behinderter Langzeitpatienten aus dem Sächsischen Krankenhaus für Psychiatrie und Neurologie Altscherbitz. Inhaltliche Schwerpunkte der Untersuchung sind die Lebensqualität, die soziale Integration und die Rehospitalisierungen nach der Entlassung.
2. Es wurden 65 ehemalige Patienten auf der Grundlage der Krankenakte zum Enthospitalisierungszeitpunkt (zwischen 1991 und 1999) und anhand eines persönlichen Interviews und einer Aktenanalyse zum Erhebungszeitpunkt (2003) untersucht. Zur Kerndatenerfassung wurde ein standardisierter zweiteiliger Erhebungsbogen erarbeitet. Dabei wurden neben soziodemografischen und krankheitsbezogenen Daten das Geschlecht, das Alter und die Hospitalisierungsdauer einbezogen. Darüber hinaus kam das Berliner Lebensqualitätsprofil, ein daraus abgeleiteter Score für soziale Integration, die Nurses Observation Scale for Inpatients (NOSIE) und der Fragebogen zur Erfassung des individuellen Hilfebedarfs im Bereich Wohnen (HMBW) zur Anwendung.
3. Obwohl sie einen großen Anteil der Populationen von Langzeitpatienten ausmachten, fanden die geistig Behinderten in der psychiatrischen Forschung bisher nur wenig Beachtung. Es wurden deshalb auch Erkenntnisse aus anderen Fachgebieten, wie der Geistigbehindertenpädagogik, berücksichtigt.
4. Die hier untersuchten ehemaligen Patienten unterscheiden sich bezüglich soziodemografischer, biografischer und medizinischer Daten von der sonst in psychiatrischen Enthospitalisierungsstudien erfassten Klientel mit überwiegend schizophrenen Erkrankungen. Die geistig Behinderten wurden sehr früh, 72% vor dem 20. Lebensjahr, hospitalisiert. Die durchschnittliche Verweildauer betrug 28 Jahre (Range sechs bis 67 Jahre). Über die Hälfte der Patienten verblieben beim ersten stationären Aufenthalt dauerhaft in der Klinik. 19 Patienten hatten eine leichte, 46 eine mittelgradige geistige Behinderung. In 19 Fällen bestand eine neurologisch-psychiatrische Komorbidität, darunter acht Schizophrenien und acht Epilepsien.
62 Personen befanden sich zum Erhebungszeitpunkt in stationären Heimeinrichtungen mit 24-Stunden-Betreuung, zwei lebten in einer Außenwohngruppe eines Wohnheims und ein Patient war im Maßregelvollzug untergebracht.
5. Sie wiesen in der individuellen Lebensgestaltung (Bereich Wohnen) überwiegend einen sehr geringen bis geringen Hilfebedarf auf. Unterstützung war vor allem bei der Regelung finanzieller und rechtlicher Angelegenheiten erforderlich sowie beim Umgang mit fremden Personen und der Organisation von Terminen.
6. In dieser Arbeit wurden die geistig Behinderten selbst zu ihrer Lebensqualität befragt. Dazu liegen bisher nur wenige Erfahrungen vor. Es zeigten sich überwiegend sehr hohe Zufriedenheitswerte, die im Vergleich zu anderen psychiatrischen Enthospitalisierungsstudien noch höher lagen. Niedrigere Zufriedenheitswerte wurden nur im Bereich der finanziellen Situation geäußert und einige Probanden wünschten sich mehr Kontakt zu den Angehörigen. Bezüglich der objektiven Daten fällt auf, dass ein hoher Anteil (72%) einer Beschäftigung, meist in einer WfB, nachging. Die Freizeit wurde von vielen Bewohnern aktiv verbracht, z.B. verließen 95% regelmäßig die Wohnung und waren im Jahr vor der Erhebung 91% verreist gewesen. Über die Hälfte war in Einzelzimmern untergebracht, nur noch eine Bewohnerin in einem Mehrbettzimmer. 70% bejahten die Frage nach einem guten Freund. Kontakte zu „Normalbürgern“ wurden nur von 9% angegeben.
7. Es wurden verschiedene Einflußfaktoren auf die Lebensqualität analysiert, wobei sich jeweils nur wenige signifikante Unterschiede fanden. A) Alter zum Enthospitalisierungszeitpunkt: Die unter 50jährigen Bewohner hatten häufiger Kontakt zur Familie und einem Freund. Nur in dieser Gruppe gab es Kontakte zu „Normalbürgern“. B) Zeitdauer, die nach der Enthospitalisierung vergangen ist: Die länger Enthospitalisierten (>4 Jahre) gingen häufiger einer Arbeit nach und waren in der Freizeit aktiver. Sie hatten häufiger einen Freund. In der am längsten enthospitalisierten Gruppe war die Zufriedenheit mit der finanziellen Lage und der Aussicht, noch lange in der Einrichtung zu verbleiben, geringer. C) Hospitalisierungsdauer: Die kürzer Hospitalisierten (bis 40 Jahre kumulative Dauer) unterschieden sich von den länger Hospitalisierten darin, dass sie häufiger einer Arbeit nachgingen und in der Freizeit aktiver waren, sie hatten häufiger einen Freund.
8. Anhand des Scores für soziale Integration konnte eine Gruppe besser Integrierter und ein Gruppe schlechter Integrierter gebildet werden. Sie unterschieden sich signifikant hinsichtlich folgender Parameter: Die besser Integrierten waren jünger und kürzer hospitalisiert. Sie erreichten in der NOSIE höhere Werte für soziales Interesse und niedrigere Werte für Retardierung. Der Anteil mittelgradiger Intelligenzminderungen war höher. Sie waren länger enthospitalisiert.
9. 18 Bewohner mussten nach der Enthospitalisierung erneut stationär psychiatrisch behandelt werden, konnten aber nach Krisenintervention wieder entlassen werden. Die Rehospitalisierten unterschieden sich von den übrigen Bewohnern in folgenden Merkmalen: Die kumulative Dauer der Hospitalisierung war kürzer (23 Jahre vs. 31 Jahre). In der NOSIE wiesen sie höhere Werte betreffend das Item „Reizbarkeit“ auf.
10. Die Ergebnisse belegen, dass die Enthospitalisierung der hier untersuchten leicht und mittelgradig geistig Behinderten überwiegend erfolgreich war. Sowohl aus den hier gewonnenen Erkenntnissen, als auch in Übereinstimmung mit der psychiatrischen und sonderpädagogischen Literatur läßt sich weiterer Handlungsbedarf für Praxis und Forschung ableiten. Der Prozess der Ent-Institutionalisierung sollte zukünftig fortgesetzt und wissenschaftlich begleitet werden. Psychiatrische und sonderpädagogische Fachleute sollten hierbei im Interesse der geistig Behinderten kooperieren.:1. Einleitung 1
1.1. Geistig Behinderte in der Psychiatrie 2
1.1.1. Definition und Klassifikation der Intelligenzminderungen 2
1.1.2. Die psychiatrische Versorgung von Menschen mit Intelligenzminderungen 5
1.2. Begriffsklärung Enthospitalisierung 7
1.3. Zur Geschichte der Enthospitalisierung 8
1.3.1. Historische Entwicklung in Deutschland 8
1.3.2. Zur Situation im Bundesland Sachsen 9
1.3.3. Das Sächsische Krankenhaus für Psychiatrie und Neurologie Altscherbitz 11
1.4. Enthospitalisierungsstudien in Deutschland 12
1.4.1. Enthospitalisierungsstudien unter Berücksichtigung der Diagnose Intelligenzminderung 15
1.4.2. Untersuchungen zur Enthospitalisierung geistig Behinderter in anderen Fachgebieten: Beispiele aus der sonderpädagogischen und philosophischen Forschung 18
1.5. Schwerpunkt der Studie und Fragestellung 22
2. Methodik 24
2.1. Ein- und Ausschlusskriterien 24
2.2. Die aufnehmenden Einrichtungen 26
2.3. Beschreibung der Studienteilnehmer: Soziodemografische und medizinische Merkmale der Langzeitpatienten zum Enthospitalisierungszeitpunkt 30
2.4. Untersuchungsinstrumente 33
2.4.1. Kerndatenerfassung 33
2.4.2. Berliner Lebensqualitätsprofil 34
2.4.3. Score für soziale Integration 34
2.4.4. Nurses Observation Scale for Inpatients (NOSIE) 35
2.4.5. Hilfebedarf in der individuellen Lebensgestaltung (Bereich Wohnen) 36
2.4.6. Datenschutz 37
2.4.7. Statistische Methodik 37
3. Ergebnisse 39
3.1. Soziodemografische Daten 39
3.1.1. Alter bei Enthospitalisierung und Patientenmerkmale 39
3.1.2. Alter zum Erhebungszeitpunkt und Patientenmerkmale 39
3.1.3. Kumulative Dauer des stationären Aufenthaltes und Patientenmerkmale 40
3.1.4. Zeitdauer, die nach der Enthospitalisierung vergangen ist und Patientenmerkmale 40
3.1.5. Vergleich soziodemografischer Daten vor und nach der Enthospitalisierung 41
3.2. Lebensqualität der enthospitalisierten Patienten 44
3.2.1. Auswertung des Berliner Lebensqualitätsprofils 44
3.2.2. Lebensqualität und Alter zum Enthospitalisierungszeitpunkt 46
3.2.3. Lebensqualität und Alter zum Erhebungszeitpunkt 49
3.2.4. Lebensqualität und kumulative Dauer des stationären Aufenthaltes 50
3.2.5. Lebensqualität und Zeitspanne, die seit der Enthospitalisierung vergangen ist 51
3.3. Soziale Integration 52
3.3.1. Soziale Integration und Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 53
3.3.2. Soziale Integration und Fremdeinschätzung durch das Heimpersonal (NOSIE) 53
3.3.3. Soziale Integration in Abhängigkeit von Patientenmerkmalen 53
3.4. Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 54
3.4.1. Eingruppierung der Patienten 54
3.4.2. Hilfebedarf und soziodemografische Daten 55
3.4.3. Hilfebedarf und Lebensqualität 56
3.4.4. Hilfebedarf und Zeit, die nach der Enthospitalisierung vergangen ist 56
3.4.5. Hilfebedarf, Alter bei Enthospitalisierung und kumulative Dauer des stationären Aufenthaltes 57
3.5. Fremdeinschätzung durch das Heimpersonal (NOSIE) 57
3.5.1. Darstellung der einzelnen Items 57
3.5.2. NOSIE und Zeit, die nach der Enthospitalisierung vergangen ist 57
3.5.3. NOSIE, Alter bei Enthospitalisierung und kumulative Dauer des stationären Aufenthalts 58
3.6. Merkmale der rehospitalisierten Patienten 58
3.6.1. Soziodemografische Daten 58
3.6.2. Fremdeinschätzung durch das Heimpersonal (NOSIE) 59
3.6.3. Score für soziale Integration 60
3.6.4. Vergleich der rehospitalisierten mit den nicht rehospitalisierten Patienten 60
4. Diskussion 61
4.1. Limitierung des eigenen Untersuchungsansatzes und methodische Probleme bei der Befragung geistig Behinderter 61
4.2. Diskussion der Ergebnisse 62
4.2.1. Soziodemografische und medizinische Daten 62
4.2.2. Lebensqualität als „Erfolgsparameter“ der Enthospitalisierung 66
4.2.2.1. Einfluss des Alters bei Enthospitalisierung auf die Lebensqualität 70
4.2.2.2. Einfluss der Hospitalisierungsdauer auf die Lebensqualität 70
4.2.2.3. Einfluss der Zeitdauer, die nach Enthospitalisierung vergangen ist, auf die Lebensqualität 71
4.2.2.4. Zusammenfassung 74
4.2.3. Soziale Integration der enthospitalisierten geistig Behinderten 75
4.2.4. Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 77
4.2.5. Rehospitalisierungen 79
4.3. Schlussfolgerungen für die Praxis und Forschung 81
Literaturverzeichnis 84
Anhang
Danksagung
Eidesstattliche Erklärung
Thesen