Physiological causes of depression in the elderly.

Depression represents the most common psychiatric disorder in the elderly. Physiological processes can often cause depressive symptoms. The psychiatric nurse provides an important role in assisting the depressed elderly client through interventions, such as talking, exercise, touch, and relaxation.

Death from auto-erotic asphyxiation in a long-term psychiatric setting.

Death from auto-erotic asphyxiation is a startling phenomenon that is on the rise both in the general population and within psychiatric facilities. While these auto-erotic behaviors may lead to death, it is seldom the client's intention to do harm; rather, the intent is to heighten masturbatory sensations. After describing this phenomenon, the authors discuss implications for nursing care.

A day in the life of an inpatient: an experiential game to promote empathy for individuals in a psychiatric hospital.

The attitudes of hospital staff toward individuals with mental illness have been investigated, described in the literature, and discussed at national conferences. It has been suggested that attitudes are the precursors or determinants of behavior. Although the precise effect of staff attitude on patients is unclear, attitudes of the staff do appear to be related to their behavior and to have an impact on patients and their subsequent recovery. There are few precise answers on how to promote positive attitudes. While hospital policies and procedures can prescribe behaviors of staff, attitude cannot be dictated. Some studies have evaluated the effect of training and participation in milieu programs on the attitude of psychiatric staff. Simulation games recently have been explored as a possible way to influence the attitude of staff toward those with mental illness. This article describes an attempt at one state psychiatric hospital to influence in a positive way the attitude of the staff by using a simulation game called, A Day in the Life of an Inpatient. Adapted from Into Aging by Hoffman and Reif (1978), the game used by the authors provides a microcosmic experience for staff of a hospitalized patient's ward experience.

The water-intoxicated patient.

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.

Could it be Ganser's syndrome?

The term, "Ganser's syndrome," was identified by Sigbert J. Ganser, a German psychiatrist, near the turn of the century. Ganser's syndrome, defined as an hysterical reaction, was often used to describe prisoners who appeared to be trying to escape prosecution. Today, Ganser's syndrome is debated by both psychiatric and judicial systems. This paper addresses these issues by identifying guidelines for assessment and recognition of common malingering behaviors displayed by Ganser's syndrome patients. Psychiatric nurses who practice in both psychiatric and legal systems need an understanding of Ganser's syndrome to adequately assess the patient, plan effective treatment, and complete an evaluation of care. This understanding will enable the nurse to answer the important question, "Could it be Ganser's syndrome?" With the increase of crime and the prison population, the use of "Insufficient Comprehension to Stand Trial" may be a legal option for defendants. If they are exhibiting inappropriate behavior and are a danger to themselves or others, a psychiatric evaluation may be ordered by the court. It is then the responsibility of a psychiatric facility to assess, treat, and evaluate Ganser's syndrome patients in an attempt to return them to competency. The patients may return to court following the psychiatric evaluation if they are found competent to stand trial.