When, what, and why? Psychopharmacotherapy and other treatments in schizophrenia

Chinese inpatients' subjective experiences of the helping process as viewed through examination of a nurses' focused, structured therapy group

AIMS AND OBJECTIVES

This study examined Chinese inpatients' views on what aspects of a nurses' focused, structured therapy group worked to help their psychological and interpersonal problems and what traditional Chinese cultural values influenced their viewpoints.

METHODS

Nine Chinese inpatients with mental illness participated in the four-session nurses' focused, structured therapy group. After they completed the last session of therapy, they were invited to participate in a structured interview and a semi-structured interview regarding their perceptions of the change mechanisms in nurses' focused, structured group therapy. The semi-structured interviews were recorded and transcribed to be further analysed according to the principal of content analysis.

RESULTS

The results indicate that (i) all patients believed that a nurses' focused, structured group psychotherapy enhanced their interpersonal learning and improved the quality of their lives, (ii) traditional Chinese cultural values--those emphasizing the importance of maintaining harmonious interpersonal relationships--influenced the Chinese inpatients' expression of negative emotions in the group and their motivation on interpersonal learning.

CONCLUSION

In conclusion, we found that transcultural modification for applying Western group psychotherapy in Chinese culture was needed. The modification included establishing a 'pseudo-kin' or 'own people' relationship among group members and the therapists, organizing warm-up exercises and structured activities, applying projective methods and focusing on the issues of interpersonal relationships and interpersonal problems.

RELEVANCE TO CLINICAL PRACTICE

The small sample size of the present study raises questions regarding how representative the views of the sample are with respect to the majority of Chinese inpatients. Nevertheless, this preliminary study revealed a cultural aspect in nursing training that requires significant consideration in order to work effectively with Chinese patients.

Treatment programme and long-term outcome in chronic schizophrenia

Antipsychotic drug treatment is usually started during an acute episode or exacerbation of a pre-existing psychosis. Although the medication has marked therapeutic benefit for most patients, ther is considerable heterogeneity in drug response. A variety of factors may influence this response, but at present we have no well-established predictors which would help targeting specific pharmacological treatments. The continuation of antipsychotic drug treatment to control persistent symptoms and to prevent further exacerbations or relapse has become a mainstay in the long-term treatment of schizophrenia. There are various considerations which come into play in deciding which patients should receive such treatment, at what dose, and for how long. Research in recent years has attempted to identify strategies to minimize the risks associated with long-term treatment (particularly tardive dyskinesia). In addition, other factors influencing long-term outcome have been better studied in combination with controlled drug treatment.

Electroconvulsive therapy in general hospital psychiatry: a focus on new indications and technologies

This paper documents the recent dramatic shift towards the delivery of psychiatric services in the general hospital setting and outlines the increasing number of special indications for electroconvulsive therapy (ECT). These include: delusional depression; depressions which are not responsive to antidepressants; affective illness in geriatric populations, depression, mania or schizophrenia in patients who cannot tolerate medication side effects, and drug-refractory Parkinson's disease. Such technological advances as nondominant unilateral placement of electrodes, brief pulse electrical stimulation, and simultaneous ictal monitoring of EEG and EKG have increased the safety while reducing the side effects of the procedure. In that comparative studies show ECT to have safety and efficacy superior to antidepressant agents in the treatment of severe depressive illness, the author encourages physicians to consider this treatment which is becoming increasingly available through our general hospital services.

Compulsory admissions in a London borough: I. Social and clinical features and a follow-up

This study examines the role that clinical and social factors play in compulsory admissions to hospital in a London borough. 150 patients compulsorily admitted under a section of the Mental Health Act 1959 were compared with 100 informally admitted patients. Significant differences in social-demographic and clinical characteristics are described as well as differences in outcome on follow-up. A long-term unwillingness on the part of the compulsory patients to engage in follow-up services was evident. These differences still held when the compulsory patients were compared with a group of informal patients matched for age, sex and diagnosis. Patients referred by the police and admitted under Section 136 of the Mental Health Act showed those features associated with compulsory admission in general to the most severe degree.

The trauma of being psychotic: a neglected element in the management of chronic schizophrenia?

A hypothesis is put forward in regards to what is called "chronic schizophrenia" that those observations which suggest a continuing disease process may turn out not to be intrinsic facets of schizophrenia as a neurochemical instability but rather neurotic reactions to the acute schizophrenic process. The hypothesis goes on to suggest that this reaction to the acute psychosis is such as to constitute a traumatic neurosis and that while controlling the psychosis with an "umbrella" of major tranquilizers, it is possible to resolve this neurosis. Resolution of the neurosis requires a particular approach to therapy. This is a hypothesis which is very much open to experimental examination and one which may, if proven, markedly affect the postpsychosis management of schizophrenia.