Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients

Objective. To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. Methods. This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient­Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. Results. Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06) over seven days interval. Conclusion. The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.

Objetivo. Evaluar la efectividad de la terapia Milieu en la reducción de las tasas de conflicto y contención entre los pacientes con esquizofrenia. Métodos. Este estudio utilizó un diseño cuasi experimental con grupo control no equivalente y evaluación pre y posintervención. Cien pacientes con esquizofrenia hospitalizados en salas psiquiátricas en un hospital público en Karnataka (India) se asignaron de forma no aleatoria a los grupos experimental (n=50) y control (n=50). El grupo experimental recibió la terapia de Milieu, además del tratamiento hospitalario de rutina. La terapia de Milieu incluyó la modificación ambiental y la estructuración de las actividades de la sala, el establecimiento de una interacción efectiva con el paciente y la enseñanza a los cuidadores sobre el manejo del comportamiento conflictivo del paciente. El grupo control recibió solamente el tratamiento de rutina en el hospital. Las medidas de resultado (tasas de conflictos y de contención) se evaluaron en ambos grupos en los días de inicio, 2º, 3º y 15º posadmisión. El Patient­Staff Conflict Checklist Shift Report (PCC-SR) se utilizó para la recolección de la información acerca de las tasas de conflicto y contención. Resultados. En comparación con el grupo de control, los participantes del grupo experimental mostraron una disminución en el comportamiento agresivo, el comportamiento de autolesión y el comportamiento de incumplimiento de las reglas generales al inicio y al segundo, tercer y décimo quinto día (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06). Conclusión. Los hallazgos del presente estudio proporcionaron evidencia de la efectividad de la Terapia Melieu en la reducción de comportamientos conflictivos en el paciente esquizofrénico hospitalizado en fase aguda. La Terapia Milieu debe considerarse como una parte integral en los entornos de atención de estos pacientes.

Objetivo. Avaliar a eficácia da terapia Milieu na redução das taxas de conflito e contenção entre pacientes com esquizofrenia. Métodos. Este estudo utilizou um desenho quase-experimental com um grupo controle não equivalente e avaliação pré e pós-intervenção. Cem pacientes com esquizofrenia hospitalizados em salas psiquiátricas em um hospital público de Karnataka (Índia) foram designados não aleatoriamente para os grupos experimental (n = 50) e controle (n = 50). O grupo experimental recebeu terapia Milieu, além de tratamento hospitalar de rotina. A terapia de Milieu incluiu modificação ambiental e estruturação das atividades da enfermaria, estabelecendo uma interação efetiva com o paciente e ensinando os cuidadores sobre o gerenciamento do comportamento conflitante do paciente. O grupo controle recebeu apenas tratamento hospitalar de rotina. As medidas de resultado (taxas de conflito e contenção) foram avaliadas em ambos os grupos nos dias de início, 2, 3 e 15 após a admissão. O Relatório de Mudança de Lista de Verificação de Conflitos entre Pacientes e Funcionários (PCC-SR) foi usado para coletar informações sobre taxas de conflitos e contenção. Resultados. Comparados ao grupo controle, os participantes do grupo experimental mostraram uma diminuição no comportamento agressivo, no comportamento autolesivo e no não cumprimento das regras gerais no início e no segundo, terceiro e décimo quinto dia (F = 4,61, p <0,004, η2 = 0,04; F = 11,92, p <0,001, η2 = 0,11; F = 6,94, p <0,001, η2 = 0,06). Conclusão Os achados do presente estudo forneceram evidências da eficácia da Terapia Melieu na redução de comportamentos conflitantes no paciente esquizofrênico hospitalizado na fase aguda. A terapia Milieu deve ser considerada como parte integrante do ambiente de atendimento desses pacientes.

Schizophrenia and Healing Environment

Treatment of schizophrenia is one of the most challenging areas in the field of psychiatry. There has been much improvement in psycho-pharmacotherapy, and at present, psycho-pharmacotherapy along with milieu therapy and social rehabilitation is the standard first-line treatment for schizophrenia. Healing environment, a concept which has arisen from the architectural field, has similarities in meaning to milieu therapy in psychiatry. In other words, healing environment may be an encountering point between psychiatry and architecture. In this encountering, each field can understand each other and expand its concept to aid the treatment of schizophrenia and to plan the build-up of the entire environment considering its social and psychological effects. In this paper, we aim to establish the basic concept of healing environment to alleviate the psychopathologies in schizophrenic patients. We worked under the premise that physical setting affects human behavior and mind, and that physical setting should play a role as a medium with therapeutic potential for patients with medical problems. The aims of this paper are as follows. First, theoretical discussion of the concept and the constructs of healing environment : second, understanding of the schizophrenic symptoms that may be affected by supporting environment : and third, discussion of supporting environment that may alleviate the symptoms of schizophrenia.

[New nurses' clinical learning experience in the critical coronary care units [CCCU]]

Learning is the core of human identity showing social participation. Socio-cultural factors have a great impact on learning experiences of new nurses in critical coronary care units [CCCU]. The aim of this study was to explore new nurses' clinical learning experience in the critical coronary care units" [CCCU]. In this qualitative study we used purposive sampling with maximum variation. We interviewed 18 participants with open-ended questions from 2012 to 2013 in Semnan, Iran. The main method of data collection was semi-structured interviews. The interviews were recorded digitally and immediately transcribed and then analyzed by conventional content analysis method. Based on the data analysis, we extracted four themes which indicated clinical learning experiences of new nurses in the CCCU. The themes included "challenges of basic education", "self-directed learning", "equal protection" and "effective supervision". These themes were influenced by the environment and the nurse's role in clinical learning experiences. The main theme was "situational learning". The new nurses learned clinical experience by combining themes in CCCU. The results of this study are valuable for the recognition of learning strategy in the area of knowledge, attitude and practice of new nurses in CCCU. Based on the results of this study, nurse managers, supervisors and trainers can improve nursing education by motivation of personal learning; creating supportive environments and enhanced supervision to provide better clinical learning for new nurses entering CCCU

Pratique de la psychothérapie institutionnelle en Côte d'Ivoire : exemple du Centre de Santé Victor Houali de Trinle-Diapleu

La pratique de la Psychotherapie Institutionnelle au centre de sante Victor Houali de Trinle-Diapleu est une experience complexe qui tente d'articuler depuis vingt-deux ans environ; les soins de sante mentale et les soins de sante primaire dans une structure villageoise. Cette experience tres originale s'appuie sur une demarche de recherche action integrant psychotherapie institutionnelle; chimiotherapie et contexte socioculturel africain. Elle peut d'ailleurs servir de reference au developpement de la psychiatrie communautaire et a la necessaire decentralisation des soins psychiatriques en Cote d'Ivoire

Gravidez e maternidade de adolescentes de periferias sociais e urbanas: reflexöes à luz da pscicologia ambiental / Pregnancy and motherhood in poor teenagers belonging to social and urban outskirts

Sob a ótica de Psicologia ambiental, apresenta reflexöes sobre a procriaçäo de adolescentes de periferias sociais e urbanas de grandes cidades do Estado de Säo Paulo. É feita uma revisäo de contribuiçöes da psicologia ambiental e um estudo de inventário sobre vida sexual, com ênfase em aspectos de procriaçäo, com jovens moradores de favela, participantes de um projeto cultural e profissionalizante na área musical. Naquelas condiçöes sócio-ambientais, a gravidez parece diretamente associada a carências advindas de modelos existentes que apresentam necessidades que aquelas adolescentes näo podem prover. A procriaçäo de adolescentes pobres numa sociedade globalizada, com desafios de busca de uma forma de desenvolvimento que seja sustentável, é entendida como um fenômeno psicossocial, que deve ser tratado de forma interdisciplinar, já que alcança âmbitos maiores, de ordem ética e política

Saúde e ambiente terapêutico na reabilitação de mulheres mastectomizadas / Health care and therapeutic settings in the rehabilitation of women with a mastectomy

O estudo objetivou analisar os benefícios de um ambiente terapêutico com mulheres mastectomizadas. Entrevistou-se de 10 das 17 mulheres integrantes de um grupo de auto-ajuda. Os benefícios da atividade de grupo foram relacionados a mudanças na aparência física, nos cuidados pessoais, mudanças de atitudes frente às situações estressantes, aumento da independência funcional, melhoria da qualidade de vida. Os fatores influenciadores foram a socialização e a comunicação desenvolvida no grupo. Diante dos achados, compreendeu-se que aconteceram mudanças significativas na vida das mulheres em relação à auto-imagem e auto- estima...

The study aimed to analyze the benefits of a therapeutic atmosphere in women who did undergo a mastectomy. We interviewed 10 out of a 17 women support group. The benefits of the group activity showed changes in the physical appearance, personal care, attitudes in front of stressful situations, and improvement in their autonomy, and all together contributed to independence, and to quality of life. The main influential factors in this group were socialization and communication. We understood that significant changes happened in the womenÆs life in relation to the self-image and the self-esteem...

El objetivo del estudio qué analizar los beneficios de un entorno terapéutico en mujeres mastectomizadas. Se entrevistó de 10 de las 17 mujeres integrantes de un grupo de autoayuda. Los beneficios de la actividad de grupo fueron relacionados a cambios en la apariencia física, cuidados personales, cambios de actitudes frente a las situaciones de estrés, aumento de la independencia funcional y mejora de la calidad de vida. Los factores influenciadores fueron la socialización y la comunicación desarrollada en el grupo. Frente a estos resultados, entendimos que ocurriron cambios significantes en la vida de las mujeres en relacion a la auto- imagen y auto - estima...

Situation of treatment of epilepsy in population in Ho Tay province

Study on patients with epilepsy in 11 communes in Ho Tay has shown that 43% of patients with epilepsy were treated (of which treatment in provincial level 37%). The rate of patients with epilepsy received a treatment in cities, and delta was higher than this in mountain region. The efficacy of the treatment was not high, 42% patients treated as stopping the crisis.

The situation of operation in the Surgical Department in Cao Bang Hospital during 3 months of the summer-autumn 2000

A study on the surgical pathology of the Cao Bang hospital in the summer- autumn, 2000 has shown that the emergency operation: included the digestive operation (mainly) folowings were traumatic, cardiovascular operations, cranial and cerebral operation and urological operation(rarely). The schedule operations comprised the thyroid disease, plastic surgeries and the digestive operation. The results suggested that it should strengthen the medical equipments for the digestive operation theatre and traumatic operation theatre.

Fatores ambientais que influenciam a plasticidade do SNC / Enronmental factors that influence CNS plasticity

O SNC possui uma rede neural complexa, com células altamente especializadas, que fazem milhares de conexões a todo momento e determinam a sensibilidade e as ações motoras, traduzindo-as em comportamento. Na presença de lesões, há um desarranjo nesta rede neural e o SNC inicia seus processos de reorganização e regeneração. A plasticidade neural refere-se à capacidade que o SN possui em alterar algumas das suas propriedades morfológicas e funcionais em resposta às alterações do ambiente. A análise dos aspectos plásticos do SNC permite-nos relacioná-los a vários fatores, como a influência do meio ambiente, o estado emocional, o nível cognitivo, entre outros, que interferem direta ou indiretamente na plasticidade do SNC e, conseqüentemente, na reabilitação do paciente neurológico. Assim, por meio da revisão da literatura, procuramos uma fundamentação teórica, a qual trará bases para a prática clínica, buscando uma nova visão sobre as perspectivas de reabilitação do paciente neurológico adulto.

Situation of using the radioactive resource and the safe current radioactive situation of Vietnam

An evaluation of the situation of the country’s nuclear medicine department and the use of radioactive resources in Vietnam was implemented. Currently Vietnam has 200 equipments for X-ray generation, 28 radioactive resoureces; 7 centres and 22 facilities of the nuclear medicine which served millions patients everyear. This study also evaluated the networks of X-ray machines and other related medical equipment. From which the orientation and solutions for use of the radioactive resources and radioactive safety in Vietnam were recommendated

Colocación de clavos bloqueados femorales sin fluroscopia / Situation of interlokings mails femorals out fluroscopy

Se realizó una revisión de todos los casos de femúr que fueron tratados con clavos bloqueados cielo abierto sin intensificador de imagen desde Abril de 1992 hasta Marzo de 1995 en los hospitales Ricardo baquero G.(periférico de catia) y Peréz de León de Petare. Se incluyeron en este estudio de 69 fracturas diaficiarias de fémur y 3 pseudoartrosis en 70 pacientes. Todos los pacientes se trataron con reducción abierta,bloqueo proximal convencional y bloqueo distal empleando una de estas dos técnicas: 1 Osteotomía en Ventana, 2 Uso de punzón iniciador, obteniendose 91,66 por ciento de resultados satisfactorios

Impacto del enriquecimiento ambiental sobre el desarrollo cerebral: interacciones sociales, nutricionales y sensoriales / Impact of the enviromental enrichment upon the cerebral development: social, nutritional and sensorial interaction

The influence of environmental enrichment during the course of early postantal development has been extensively studied. Relatively short periods of simulation, during lactation may be associated with important benefits in functional and behavioral capacities. Furthermore many authors support the idea that evolution is an adaptative response of living material to the enriched conditions present in the habitat. Recently, environmental stimulation has been reported to aid recovery from behavioral deficits associated with early post-natal malnutrition and offer similar prospects for brain lesions, some birth defects and related malformations. It has become evident in recent years that the developing cerebral cortex is sculptured by a highly sophysticated program of neuronal reorganization, influenced by social, cultural and environmental cues. These observations raise a number of questions to both, basic scientists and neurologists, as: What types of changes occur in the brain?. What is the time course of these events?. Perhaps most important, what are the functional implications of cortical reorganizations?. The porpuse of this review is to summarize the evidence, already available in an effort to improve the chances of recovering brain health after perinatal malnutrition, social deprivation or sensorial impairement. According to our results, sensorial enrichment account for a significant acceleration in the dendrogenesis of basal dentritic field in pups that were simultaneously malnourished; nutritional-environmental interactions. The mechanisms through which environment induce modifications in morphology and behaviour have not been elucidated. The most obvious prediction is that environmental influences are probably transduced as chemical expressions in the internal milieu

Características del ambiente de tratamiento: una perspectiva de 20 años en un hospital mental peruano / Characteristics of a treatment: a twenty years perspective on a Peruvian mental hospital

Se aplicó el cuestionario "Características del ambiente de tratamiento" a una muestra de 100 profesionales del Hospital Víctor Larco Herrera (Lima, Perú) con la finalidad de evaluar las peculiaridades del ambiente de tratamiento desde el punto de vista del grupo ocupacional, al mismo tiempo que comparar tales hallazgos con los obtenidos en 1967 en una muestra de 71 trabajadores del mismo hospital. Se destaca la importancia del impacto ambiental en el tratamiento de los pacientes mentales, la trascendencia de hacer estudios de largo plazo para evaluar la evolución de las instituciones y la alternativa que ofrece el diseño de investigación transcultural de los ambientes de hospitales mentales.

The questionnaire Characteristics of Treatment Environment was applied to a sample of 100 professionals of the Victor Larco Herrera Hospital (Lima, Peru) in order to evaluate the treatment environment characteristics from the point of view of their occupational groups as wells as to compare the findings with those obtained in 1968 with a sample of 71 workers of the same hospital. The relevance of the environment in the treatment of patients, the importance of long term studies in order to evaluate the institutionÆs evolution, and the transcultural research design are all highlighted in this study.

Tratamiento de los sintomas causados por desordenes congnoscitivos en la vejez. / Treatment of the symptoms caused by cognitive disorders in the aged

En este trabajo se muestra aun cuando se hagan pruebas diagnosticas apropiadas que identifiquen las causas de trastornos cognoscitivos en los ancianos, los sintomas y comportamiento habitualmente continuan, debido a la falta de tratamiento adecuado que podria, reducir o eliminar estas causas. La meta es estimular las investigaciones en esta area para determinar que modalidades de tratamiento son mas efectivas para modificar las conductas inadecuadas que acompanan al disfuncionamiento cognoscitivo. La meta final es modificar el tratamiento clinico de los ancianos afectados por un problema cognoscitivo para elevar al maximo sus niveles funcionales