Relations between patients in psychiatric and psychotherapeutic inpatient care: a literature review and conclusions for clinical practice and research.

OBJECTIVE: In psychiatric inpatient units patients live closely together, which facilitates mutual interactions. Patient relations are part of the therapeutic milieu, which is an important factor in helping patients to recover. Types of patient relations are nonbinding superficial encounters, working alliances, personal relations like close partner relationships, or sexual contacts. Intimate relations between patients are scientifically and in clinical practice, a rather, neglected topic. METHODS: A data search was conducted using the PubMed/MEDLINE databases with the key terms "patient relations" or "intimate relations between patients". RESULTS: Depending on the type of relation and inpatient unit, prevalence rates of 1.5-30% for intimate relations between patients in psychiatric hospitals are reported. Such relations can have beneficial effects, like the feelings of bonding or being liked, but also negative consequences, like burdening, worsening of the illness, treatment complications, or direct harm to the patient. CONCLUSION: Only a few units have development guidelines. It is the responsibility of the therapeutic staff and the hospital management to support a helpful therapeutic milieu, including positive patient interactions, and to protect as far as it is possible patients from negative encounters.

[Interpersonal patterns in obese patients]. / Interpersonelle Muster bei Adipositaspatienten.

In the last decades the number of obese and pre-obese patients in Western industrial nations increased. Obese patients have been largely unsuccessful in losing weight over time, but the causes of their difficulties and the causes of their obesity have remained unclear. We examined whether the attachment style and its interaction with interpersonal processes would shed light on this question. We analyzed 107 obese or pre-obese patients before the start of a weight loss intervention program. We used the Adult Attachement Prototype Rating (AAPR)-interview and related questionnaires (Helping Alliance Questionnaire (HAQ), Inventory of Interpersonal Problems (IIP-D), Brief Symptom Inventory (BSI)). According to the AAPR-rating 54% of the patients were secure and 46% insecure attached. The results suggest that insecure attachment style has an impact on psychic strain in obese patients unrelated to weight, gender and age. Additionally the insecure attachment style influences the therapeutic alliance experienced by patients and the therapist.

Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery.

Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12-17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.