ABSTRACT
To assess the rapidly changing psychological status of nurses during the acute phase of the 2003 SARS outbreak, we conducted a prospective and periodic evaluation of psychiatric morbidity and psychological adaptation among nurses in SARS units and non-SARS units. Nurse participants were from two SARS units (regular SARS [N=44] and SARS ICU [N=26]) and two non-SARS units (Neurology [N=15] and CCU [N=17]). Participants periodically self-evaluated their depression, anxiety, post-traumatic stress symptoms, sleep disturbance, attitude towards SARS and family support. Results showed that depression (38.5% vs. 3.1%) and insomnia (37% vs. 9.7%) were, respectively, greater in the SARS unit nurses than the non-SARS unit nurses. No difference between these two groups was found in the prevalence of post-traumatic stress symptoms (33% vs. 18.7%), yet, three unit subjects (SARS ICU, SARS regular and Neurology) had significantly higher rate than those in CCU (29.7% vs. 11.8%, respectively) (p<0.05). For the SARS unit nurses, significant reduction in mood ratings, insomnia rate and perceived negative feelings as well as increasing knowledge and understanding of SARS at the end of the study (all p<0.001) indicated that a gradual psychological adaptation had occurred. The adjustment of nurses in the more structured SARS ICU environment, where nurses care for even more severely ill patients, may have been as good or better than that of nurses in the regular SARS unit. Occurrence of psychiatric symptoms was linked to direct exposure to SARS patient care, previous mood disorder history, younger age and perceived negative feelings. Positive coping attitude and strong social and family support may have protected against acute stress. In conclusion, the psychological impact on the caring staffs facing future bio-disaster will be minimized with lowered risk factors and a safer and more structured work environment.
Subject(s)
Adaptation, Psychological , Nurse-Patient Relations , Nurses/psychology , Periodicity , Severe Acute Respiratory Syndrome/nursing , Stress Disorders, Post-Traumatic/epidemiology , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/psychology , Depression/diagnosis , Depression/epidemiology , Depression/psychology , Disease Outbreaks , Family/psychology , Female , Humans , Prevalence , Prospective Studies , Risk Factors , Severe Acute Respiratory Syndrome/epidemiology , Severity of Illness Index , Social Support , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Taiwan/epidemiology , Workplace/psychologyABSTRACT
Neuropsychiatric complications of human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS) may present clinically as acute or chronic organic brain syndrome, or mimic functional psychiatric diseases. Among such psychiatric diseases, mania tends to occur with increased frequency after the onset of AIDS. We report a case in which manic manifestations were noted before the diagnosis of AIDS. The patient had no past or family history of mood disorders, but had risk factors for HIV infection. He had a rapid downhill course from initial manic symptoms to depression, dementia and then death within 10 months. Such rapid cognitive deterioration into AIDS dementia after mania is consistent with previous reports. Cases like this will become more common with spread of the AIDS pandemic in Asian regions, including Taiwan. Clinicians should be mindful of HIV infection/AIDS as a differential diagnosis in patients with manic episodes and risk factors for HIV infection.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Bipolar Disorder/etiology , Dementia/etiology , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/virology , Adult , Brain/pathology , Brain/virology , Disease Progression , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Pneumonia, Pneumocystis/complications , Respiratory Insufficiency/etiology , Viral LoadABSTRACT
Because of the ageing of Taiwan society, long-term care needs increase on a daily basis. But no shift system has been introduced for long-term care, with the result that when there is an inappropriate balance of deployment of resources, acute hospital resources are being given over to long-term care patients, and a heavy burden is being placed upon long-term care patients and their families. In addition, there are developmental differences within the current system, in which many different management methods are adopted. For this reason, this article describes the difficulties that long-term care faces in Taiwan, and makes suggestions in that regard. In an ageing society, integration of policy, legislation and services, the provision of welfare to the elderly, are responsibilities of the whole of society--the elderly themselves, their families, civil society, and government. We sincerely hope that legislation on long-term care can now be passed quickly, so that a truly flawless long-term care system can be introduced.
