[Depression and aggression in Amish persons]. / Depression und Aggression bei Amischen.

The Old Order Amish are a conservative, anabaptistic religious community of Swiss origin in the USA. They practise absolute pacifism and lead a life free of hostility and aggression. Depression, however, is as much as three times more frequent in Amish populations. In order to study the possible relationship between hostility and depression, we investigated 43 Amish people, using the Buss-Durkee Hostility Inventory and the Beck Depression Inventory. As expected, the total hostility score was significantly lower and the depression score significantly higher in comparison to the normal population. The positive correlation between the two scores (0.45; p < or = 0.002) indicates that the hypothesized reciprocal relationship between hostility and depression is unlikely in the Old Order Amish.

Differences between long-stay and short-stay inpatients and estimation of length of stay. A prospective study.

To find possible differences between new long-stay inpatients and patients with shorter lengths of stay, a prospective study of 340 inpatients in the 4th week of hospitalization was carried out. The new long-stay patients differed from the others in diagnoses, symptoms, duration of prior hospitalizations, and socio-demographic data. On the basis of the data assessed in the 4th week of hospitalization, we tried not only to predict future new long-stay patients, but also to estimate the length of stay for all 340 patients. A time-function model was employed with length of stay as a continuous variable, and this resulted in correct allocation to the quartiles in 38-48% of the cases. Six variables proved to be important for estimating length of stay: emotional withdrawal, blunted affect, mannerisms, duration of previous hospitalizations, living conditions (prior to admission), and marital status.

[Disorders of pain perception in schizophrenia]. / Gestörtes Schmerzempfinden bei Schizophrenie.

Starting from a case of marked pain insensitivity in a patient suffering from catatonic schizophrenia we state in this paper that analgesia seems to be an ubiquitous phenomenon which is not only caused by physical disorders of the central nervous system. Different models of interpretation as to be found in scientific literature are reviewed. On the basis of today's physiological knowledge, five hypotheses on causal explanation of pain insensitivity in schizophrenics are discussed: Hypalgesia and analgesia are an expression of motorial inability to react; a consequence of a disorder of consciousness; an analgetic effect of neuroleptic drugs; a basic deficit in schizophrenia and; a result of a disturbed psycho-physiological development.

On characterizing new psychiatric long-stay patients.

In order to characterize new long-stay patients at the Psychiatric Clinic of Berne University, a comparison of all new long-stay patients of a 12-months period (n = 44) with a random sample of hospital admissions (n = 58) was carried out. Demographic data, circumstances of admission and illness data were recorded. Psychiatric symptoms were documented by means of the Brief Psychiatric Rating Scale (BPRS), intelligence from the Progressive Matrices Test (PMT) and inadequate behaviour based upon a modified "Check List of Nonfunctional Behaviors". As expected, findings show that new long-stay patients differ from the control group not only in diagnoses, symptoms and inadequate behaviour but also in physical illnesses, education, intelligence and social status.

[Patients with senile dementia--a group of new long-term patients]. / Patienten mit seniler Demenz--eine Gruppe der neuen Langzeitpatienten.

A research project is under way at the Department of Psychiatry of the University of Berne, Switzerland, on predictors for new long-term patients, i.e. patients treated on an inpatient basis for more than a year. In a part study all new long-term patients admitted during one year (n = 44) were compared (on the basis of socioeconomic data, disease records, level of intelligence (PMT), psychiatric signs and symptoms pattern (BPRS) and nonadjusted behaviour) with random samples taken from the hospital admissions (n = 58). The overall total of the individual results shows that the new long-term patients originate from two different populations. About 60 per cent are chronically mentally ill patients--mainly schizophrenics--who are additionally under disability in many respects. The remaining two-fifths of the new long-term patients are represented by senile demented patients. It seems that they become permanent psychiatric patients only due to the progressive course of their disease. The article discusses the ways and means to cope with the 50% increase in this patient group that we must anticipate by 2000 A. D. as a result of present age development trends.

[New long-term patients--demographic and diagnostic peculiarities]. / Neue Langzeitpatienten--demographische und diagnostische Besonderheiten.

This paper presents results of a study which was done as part of an investigation on predictor variables for new long-stay patients. Using easily accessible data, e.g. age, sex, diagnosis, etc., 145 new long-stay patients of the Psychiatric Department of Berne University (PUK Bern) admitted from 1979 to 1982 were compared with all in-patients and 396 old long-stay patients of the same clinic, as well as with British and German case-register populations. A total of 3.1% of all admissions in this four-year-period received in-patient treatment for more than one year; this proportion is similar to those reported from British and German case-registers. Older patients tend to have more long stays in hospitalizations; only 25% in the PUK new long-stay population were aged 65 and over. The sex ratio men: women was 1:1, whereas there are twice as many women as men among new long-stay patients in Great Britain. Looking at marital status we found, as could be expected, only very few married people (15%), compared with 62% unmarried and 23% widowed or divorced. The diagnostic composition showed that organic brain syndromes, schizophrenia, personality disorders, and mental retardation were over-represented in the new long-stay population. The diagnostic comparison between new and old long-stay patients showed substantial differences which proved to be congruent with the results of other investigators.

[Patient characteristics, length of stay and readmission rates--indicators of the development of inpatient psychiatric treatment?]. / Patientenbestand, Aufenthaltsdauer und Wiederaufnahme-Raten--Indikatoren der Entwicklung in der stationären psychiatrischen Behandlung?

The paper submitted deals with the shrinking number of in-patients in psychiatric institutions and proves that this downward trend is not to be explained merely by the introduction of psychotropic drugs.--The method of calculation and the term "average duration of stay" are critically discussed, with reference to other possible parameters as indicators of psychiatric in-patient facilities.--It is shown, in the light of recent and controlled studies, that short hospitalization can be at least as effective and successful as a conventional hospital treatment program, and that a shorter stay in hospital does not inevitably imply an increased risk of readmittance.--A comparison between the Psychiatrische Universitätsklinik Bern (PUK) and all psychiatric hospitals in Switzerland shows in 1980 a 50% higher rate of admissions per hospital bed, a 20% shorter duration of stay, and the extremely high average rate of 98% of beds occupied, that is approximately 10% more than the average number of beds occupied in the other clinics referred to. In spite of the comparatively short duration of stay in the Psychiatrische Universitätsklinik Bern, that is 27 days (median), a further cut in length of stay seems feasible, without provoking an increase of the low rate of 21% of readmissions per annum.

[Faculty placement - a problem in psychiatric care]. / Fehlplazierung - ein Problem der psychiatrischen Versorgung.

The article reports on different components of misplacement as an important problem in the psychiatric care. Basing on a census of all in-patients of the Psychiatrische Universitätsklinik Bern (n = 551) different methods of evaluating misplacement are discussed. Some results of the census: - two thirds of the patients suffer from psychoses, another 13% from oligophrenia: - 46% of the patients are older than 60 years; - 72% have been in hospital for more than one year, 30% even for more than 20 years; - a quarter of the patients need special care. Psychiatrists and nursing staff agree that 198 (= 36%) of the 551 patients do not need any psychiatric treatment or nursing. From this point of view these patients have to be regarded as misplaced in the Psychiatrische Universitätsklinik Bern.

[Ten years Heidelberg Day Hospital (author's transl)]. / Zehn Jahre Tagesklinik in Heidelberg.

The article reports on the patient pattern at the Heidelberg day hospital according to the following criteria: Age, sex, social status, diagnoses, etc. The number of cases treated, as well as the development of the number of patients per year, and their period of hospitalization are reviewed over a period of ten years. Basing on a small sample of patients subjected to follow-ups, possible success criteria, such as employment and social relations, are discussed.

[Diagnosis in a psychiatric case register]. / Diagnosen eines psychiatrischen Fallregisters.

This study examines the stability of psychiatric diagnosis over a five-year period and its agreement with the diagnosis of a case register. The stability of diagnosis over a period of time has two component parts: the course of the morbid process and the reliability of the diagnostic technique. We studied the importance of these components as far as the cause of disends in diagnostic changes, the discrepancy of instability in different diagnostic categories and factors which may possibly indicate instability of psychiatric diagnosis.

[Requirement and need of treatment - deliberations on psychiatric care (author's transl)]. / Bedarf und Behandlungsbedürftigkeit - Uberlegungen zur psychiatrischen Versorgung.

The article defines the terms "requirement", "need" and "need of treatment", and explains their significance in the field of psychiatric care. The fundamentals of assessing the requirement are discussed, as well as the associated problems: recording and registration of patients in need of treatment, their readiness to undergo such treatment, and possible alternatives of hospitalisation. For establishing criteria required to determine the need treatment symptoms from two semi-standardised psychiatric interviews are examined for suitability (Present State Examination and Goldberg Interview); likewise, the severity of the disease, the stress from which the patient suffers, and the impairment of social relations, are also examined for suitability. It is suggested to take these criteria as basis and to operationalise the need of treatment on these lines. Relevant studies to assess the usefulness of these criteria are under way in two research projects of the Special Research Division 166 "Psychiatric Epidemiology".

[Diagnoses in the Camberwell-register, a cumulative psychiatric register of cases]. / Die Diagnosen im Camberwell-Register, einem kumulativen psychiatrischen Fallregister.

The reported investigation indicates that the diagnostic labels applied to mentally ill patients are changed frequently. Of a sample of 100 such patients, 20 received a second diagnosis, differing from the initial one, within 4 weeks, while within 2 years the diagnostic category had been changed for over half the cases. How far these changes reflect the frequency with which psychiatric conditions succeed one another, and how far the extent to which different psychiatrists apply different names to the same clinical picture, remains an open question. It was further established that even a model psychiatric case register such as the Camberwell Register, which is well organized and has highly-experienced staff, could not monitor all diagnostic changes.

[Concepts of psychiatric diagnoses: a further investigation of the reliability of psychiatric diagnoses (author's transl)]. / Konzepte psychiatrischer Diagnosen--eine Ergänzungsuntersuchung zur Reliabilität psychiatrischer Diagnosen

A total of 128 physicians and psychologists, working in six psychiatric hospitals, were asked to allocate 10 psychiatric diagnoses on the basis of typical clinical criteria (symptoms, course of illness, etiological and anamnestic data), with which they were supplied. The correct diagnosis was made in 45.3%, while in 82% the broad diagnostic group was correctly ascribed. The respondents were divided into two groups, according to the amount of diagnostic data they had been given (though in fact the information necessary for differential diagnosis was given equally to both groups). The group which made diagnosis on the grounds of more comprehensive data (ten characteristic diagnostic items) did significantly worse them the group which had few data (six characteristic items). The stereotypes for mania, endogenous depression, obsessional-compulsive neurosis, and antisocial personality disorder were correctly defined by 75% of more of the respondents. The profiles of the remaining six diagnostic groups were associated with the corresponding diagnoses by 50% or fewer of the respondents.