The treatment in the Danish suicide prevention clinics: a clinician perspective.

Background: Few qualitative studies have focused on clinicians' perspectives regarding treatment of suicidal people. Despite limited evidence and imperfect risk-assessment tools, the psychosocial therapy at the Danish suicide prevention clinics has been linked to reductions in numbers of repeated self-harm, deaths by suicide, and other causes. This merits an investigation into how clinicians describe their practice.Methods: Using a qualitative design, 10 semi-structured interviews were conducted and analyzed to describe the psychosocial therapy.Results: The practices that the therapists described could be categorized along four dichotomous continuums. These illustrated dilemmas encountered during treatment of suicidal patients: 1) intuitive vs. specific risk assessment, 2) meaningful vs. formal, 3) patient-oriented vs. therapist-oriented and 4) direct vs. indirect approach to suicide prevention.Conclusions: Treatment in the Danish Suicide Prevention Clinics is characterized by methodological flexibility and diversity and with an emphasis on a patient-oriented approach. Furthermore, clinicians balance knowledge available by switching between a direct and an indirect approach according to the perceived suicide risk. If suicide risk was perceived as high, they would administer a direct approach and if low, an indirect approach. Finally, there seems to be differences as to how effective therapeutic methodologies work in the practice of suicide prevention.

Rorschach inkblot method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia.

BACKGROUND: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. AIMS: To describe relevant Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other outcome measures [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Strauss-Carpenter and socio-demographic variables]. METHODS: In a prospective study, 34 patients consecutively admitted to treatment for a first episode of schizophrenia were tested using Exner's Rorschach Comprehensive System at inclusion and after 2 years. RESULTS: Core variables of the Rorschach, assumed to show changes (e.g. reality testing, perceptual and thought disorders) in patients with a first episode of schizophrenia, all improved but revealed no significant changes after 2 years of treatment, while other measurements (PANSS, GAF) did. Furthermore, discrepancies were found between the Perceptual-Thinking Index (PTI) and PANSS(positive) symptoms of delusions and hallucinations. CONCLUSION: The small sample limits the conclusions, but the Rorschach variables may have problems reflecting major changes in psychotic symptoms and social functioning. With short protocols, PTI seems at risk of being unnecessarily insensitive and PTI may benefit from changes in the scoring procedures.