Who benefits from clinical supervision and how? The association between clinical supervision and the work-related well-being of female hospital nurses.

AIM AND OBJECTIVES: The aims of this study were (1) to identify which nurses benefitted most from clinical supervision and (2) to explore whether they were healthier and more satisfied with their work than their peers who did not attend clinical supervision. BACKGROUND: To maintain quality nursing, there is currently a social call to improve the well-being of nurses at work. Restoring nurses' well-being is one of the main purposes of clinical supervision. However, research evidence on the effects of clinical supervision is scarce. DESIGN: Survey. METHODS: Questionnaires were distributed to female hospital nurses (n=304), about a half of whom (48.7%) had attended clinical supervision. Perceptions of work and health among the nurses who gave the best evaluations of clinical supervision (n=74) were compared with those of their peers who gave the worst evaluations (n=74) or who had not attended clinical supervision (n=156). RESULTS: The nurses who received efficient clinical supervision reported more job and personal resources and were more motivated and committed to the organisation than their peers. However, professional inefficacy was the only burnout dimension on which they scored lower than other nurses. CONCLUSIONS: Clinical supervision can be conceptualised as an additional job resource associated with other job and personal resources, which mutually reinforce each other, promoting well-being at work. Efficient clinical supervision is probably both an antecedent as well as a consequence of well-being at work. RELEVANCE TO CLINICAL PRACTICE: The results of this study advocate management planning to provide formal support for health care providers. Medical-surgical nurses are interested in clinical supervision. Reflecting on practice in clinical supervision generates new ideas about how to improve the quality of care and the psychosocial work environment. However, clinical supervision may be viewed as a preventive method rather than a treatment for burnout.

Who attends clinical supervision? The uptake of clinical supervision by hospital nurses.

AIM: The aim of the present study was to identify which nurses decide to participate in clinical supervision (CS) when it is provided for all nursing staff. BACKGROUND: Clinical supervision is available today for health care providers in many organisations. However, regardless of evidence showing the benefits of CS, some providers decide not to participate in the sessions. METHODS: A baseline survey on work and health issues was conducted in 2003 with a 3-year follow-up of the uptake of CS by the respondents. Background characteristics and perceptions of work and health were compared between medical and surgical nurses who had undertaken CS (n=124) and their peers who decided not to undertake it (n=204). RESULTS: Differences in the perceptions of work and dimensions of burnout were found between the two groups. CONCLUSIONS: Nurses attracted to CS form a distinctive group in the unit, standing out as self-confident, committed and competent professionals supported by empowering and fair leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Facilitating clinical supervision for committed and innovative nurses may be seen as part of the empowering leadership of the nurse manager.

Serotonin-transporter-linked promoter region polymorphism and serotonin transporter binding in drug-naïve patients with major depression.

AIMS: Both the serotonin transporter and its genetic regulation by the serotonin-transporter-linked polymorphic region have a role in the pathophysiology of depression. Most of the previous studies have found no influence of serotonin-transporter-linked polymorphic region allelic variation on serotonin transporter binding in healthy controls or patients with major depression. Due to the inconsistency of the previous findings, we compared single photon emission computed tomography imaging with the serotonin-transporter-linked polymorphic region genotype in patients with major depressive disorder. METHODS: A total of 23 drug-naïve patients with major depressive disorder were genotyped and brain imaged with ([123I])nor-beta-CIT single photon emission computed tomography. The severity of depression was evaluated with the 17-item Hamilton depression rating scale. RESULTS: Depressed patients homozygous for the short allele had lower ([123I])nor-beta-CIT binding in the medial prefrontal cortex, but not in the midbrain, compared with the other genotypes. CONCLUSION: The decreased medial prefrontal cortical serotonin transporter binding in the patients homozygous for the short allele may be linked to altered function of the serotonin-transporter-linked polymorphic region gene expressed in these patients, especially in the medial prefrontal cortex.

Suicide risk in schizophrenia: learning from the past to change the future.

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.

Midbrain binding of [123I]nor-beta-CIT in atypical depression.

BACKGROUND: Altered serotonin (SERT) and dopamine transporter (DAT) densities have been recorded in major depression. Atypical depression (ATD) has been suggested to be connected to decreased serotonergic transmission, but no studies have been published on the association between brain serotonin transporter density and ATD. METHODS: PATIENTS with depression (n=29) were divided into three groups according to DSM-IV criteria: atypically depressed, melancholic patients, and "undifferentiated" patients. Depressive symptoms were evaluated with the 29-item Hamilton Depression Rating Scale (HAM-D-29). Single photon emission computed tomography (SPECT) with [(123)I]nor-beta-CIT was used to evaluate serotonin transporter density (SERT) in the midbrain and dopamine transporter density (DAT) in the striatum of patients and healthy controls (n=18). RESULTS: All subgroups except those with undifferentiated depression had lower SERT densities compared to controls. No significant differences were found in the densities between the subgroups. Atypical scores of HAM-D-29 were associated with SERT densities in the midbrain (beta=-0.40, t=-2.3, p=0.03), even after adjustment for age, gender and HAM-D-21 scores (beta=-0.39, t=-2.32, p=0.03). CONCLUSIONS: The association between atypical scores of HAM-D-29 and midbrain SERT densities suggests a relationship between serotonergic dysfunction and ATD.

An outcome of psychodynamic psychotherapy: a case study of the change in serotonin transporter binding and the activation of the dream screen.

We explored the outcome of psychodynamic psychotherapy of a female patient with major depression using clinical evaluation and serotonin transporter (SERT) binding assessed with [123I]nor-beta-CIT SPECT. The psychotherapy process was analyzed with special emphasis on the change that was recognized in the dreaming process. The activation of the dream screen in transference seemed to form a turning point during the psychotherapy. Normalization of SERT binding at the midbrain level was found on 12-month follow-up. Major alleviation of depressive symptoms assessed by rating scales was evident only six months after SERT normalization.

Elevated midbrain serotonin transporter availability in mixed mania: a case report.

BACKGROUND: Results obtained from brain imaging studies indicate that serotonin transporter (SERT) and dopamine transporter (DAT) densities are altered in major depression. However, no such studies have been published on current mania or hypomania. CASE PRESENTATION: In this single photon emission computed tomography (SPECT) study with [123I]nor-beta-CIT we present a case with simultaneous symptoms of major depression and hypomania. She had an elevated serotonin transporter availability (SERT) in the midbrain and elevated dopamine transporter availability (DAT) in the striatum, which normalised in a one-year follow-up period during which she received eight months of psychodynamic psychotherapy. CONCLUSIONS: To our knowledge, this is the first report on SERT and DAT associated with mania. In our case the availability of both SERT in the midbrain and DAT in the striatum were elevated at baseline and declined during psychotherapy, while the SERT and DAT of the depressed controls increased during psychotherapy. Symptoms of hypomania in the case were alleviated during psychotherapy. Clinical recovery was also reflected in the Hamilton Depression Rating Scale (HDRS) scores.

Dream screen phenomenon in psychotherapy and artistic work.

The aim of this article is to offer a point on the meaning of the dream screen phenomenon in psychotherapy and artistic work. Some current theories of early ego development, the formation of the dream screen and dream imagery seem to match the theories of symbol formation, artistic and literary creativity. In actual dreaming, the dream screen can exist in the form of empty sheets of paper, but also in the form of a landscape, hills or mountains. The activation of the dream screen is presented in the light of the psychotherapy of two depressed patients. Dreams implying activation of the dream screen have been interpreted to signify a turning point during psychotherapy. Dream screen can be considered as a phenomenon with different elements. Examples of dream screen symbols in Aleksis Kivi's poems and in Paul Cézanne's paintings are presented.