Showing papers in "Social Psychiatry and Psychiatric Epidemiology in 1970"

A survey of 1,200 agoraphobics in Britain features associated with treatment and ability to work

Abstract: 1. Nationwide members of an agoraphobic club were surveyed for characteristics associated with treatment and ability to work. One-thousand five hundred questionnaires about psychiatric and social status were sent out, and 80% of these were returned completed. Interviews of members and relatives confirmed the picture obtained from questionnaire replies. Non-responders were similar to responders regarding age, age of onset of phobias, percentage who were male, and marital status. More non-responders had not had treatment. 2. Ninety-five percent of the sample were women, 80% were married, mean age was 42, mean symptom duration 13 years. Less than a fifth had relatives with similar phobias. Only 5% of responders have never sought medical aid for their phobias, 95% had seen G.P.'s and 67% had seen psychiatrists for their phobias. Three groups of symptoms dominated the clinical picture-agoraphobic type phobias, associated psychiatric symptoms, and social fears. 3. Lack of medical treatment was associated more with personality than with illness variables. Untreated phobies appeared to fail to seek medical aid because they were too shy or anxious to ask help of anybody. They confided less in intimates and strangers, scored high on social timidity and social anxiety, and were less comforted by the presence of other people. 4. Psychiatric treatment was a function more of illness than of social or personality variables. Past psychiatric treatment was associated with increased severity both of phobias and of associated symptoms. Past inpatient admission was correlated with the greatest severity and handicap of all. 5. Fewer agoraphobic women were employed than in the general population. Employment was associated with an extroverted, sociable, independent personality, younger age, low income, residence in large towns, being single, and having few children. Employment was not associated with more fears of being alone. 6. Sixty percent of the women said they wanted to work but couldn't. These were more extroverted, sociable and independent than contented housewives, but were also more severely ill, younger, with lower income. Desire to work seemed a function both of added frustration which the restrictions of phobias caused in a lively personality, and of increased severity of illness.

Sociopsychological predictors of affiliation with alcoholics anonymous a longitudinal study of “treatment success”

Abstract: Alcoholics Anonymous represent one of the fewclearly successful treatment approaches for alcoholism. In an attempt to delineate the dynamics of this approach, six propositions were derived from previous research on A. A. and tested in a longitudinal study of post-discharge A. A. affiliation among 378 white males treated for alcoholism in a state hospital. Unlike previous studies, the present effort employed full-fledged affiliation with A. A. as the criterion for “success” in this post-discharge maintenance regimen. Through stepwise multiple regression, 24 variables emerged from a battery of 81 possible social and psychological predictors as the set of significant predictors. Propostions were tested by comparison with this set, indicating (1) affiliative needs, (2) experience of intensive labeling as an alcoholic, (3) physical stability previous to treatment, and (4) proneness to guilt to be significant predictors of successful affiliation. Propositions not supported by the data were (1) ego strength and self reliance, (2) social stability previous to treatment, and (3) middle class background and experience. Results indicate the predictive prominence of psychological predispositions to be greater than social attributes, implying the importance of relatively fixed psychological traits in accounting for success in a sociotherapeutic regimen.

The value of work in psychiatric rehabilitation

Abstract: Work has many uses in the treatment, rehabilitation and care of psychiatric patients. So far its use has been largely empirical but if we can understand its psychological and social nature, we shall begin to understand how it can help the psychiatric patient. We shall also be able to use work more intelligently in the treatment and rehabilitation of patients. Work can provide the psychiatrically ill with an opportunity for socially productive behaviour. It fosters social interaction and, by recognising a sick person's capacities, reduces the sense of social incompetence which he may experience as a patient. It helps him to structure his time usefully. By developing skills it prevents the development of secondary disabilities and prepares him to return to an acceptable position and function in society. But for all patients and for all of us, work seems to have even greater importance. Jaques says that “working for a living is one of the basic activities in a man's life. By forcing him to come to grips with his environment, with his livelihood at stake, it confronts him with the actuality of his personal capacity—to exercise judgment, to carry responsibility, to achieve concrete and specific results. It gives him a continuous account of the correspondence between outside reality and the inner perception of that reality, as well as an account of the accuracy of his appraisal of himself. ... In short, a man's work does not satisfy his material needs alone. In a very deep sense, it gives him a measure of his sanity”. [4]

Who shall be excluded: The influence of personal attributes in community reaction to the mentally ill

Abstract: This study tests three hypotheses concerning types of individuals who are likely to be excluded from a community for mental illness. An “exclusion index” is developed, based on the ratio of involuntary to voluntary commitments to mental hospitals with high ratios indicating high rejection or low community tolerance of deviance. The patient sample consists of 14,304 first admissions to the three State Mental Hospitals in Washington State, for the period 1957–1964.1. Communities have a greater propensity to exclude for deviance lower class persons and members of low status racial-ethnic groups. The findings indicate a substantially higher propensity to isolate nonwhite deviants. In addition, the community tendency to exclude members of six major racial-ethnic groups in the state (Caucasians, Chinese, Indians, Filipinos, Japanese, and Negroes) varied directly with a group's social distance from the dominant Caucasian population. 2.Those who lack close social ties in the community are more likely to be excluded for deviance than those with such ties. Persons who lived alone or with non-relatives had higher exclusion rates than persons living with their own families. The nonmarried are more likely to be excluded than the married, and persons not in the labor force are more likely to be excluded than those in the labor force.3. Communities have a greater propensity to exclude males for deviance than females. The current findings have implications for at least three current etiological theories of mental illness: the “social isolation hypothesis” the “socioeconomic deprivation hypothesis”; and the “sociocultural fit hypothesis”. Differential community reaction to mental deviance may account for at least some of the observed excess incidence of hospitalized mental disorders among the socially isolated, the economically deprived as well as among culturally different members of the community.

Female attitudes to menopause

Abstract: The universal phenomenon of climacterium in women has received little attention from psychiatrists, except in the case of extreme emotional reactions, the “involutional psychoses”. This study was intended to explore the responses of a broad range of women to the changes of climacterium. As a pilot study, it was guided only by the general expectation that a woman's response to menopause would be influenced by her response to earlier psychosexual events. Fifty-five women of diverse ethnic origins participated in semistructured psychiatric interviews. The interview focused on the subject's attitude toward her femininity, her psychosexual history, menopause, and toward the family and social problems associated with this age.

Towards a social systems model of therapeutic groups

Abstract: Three distinct group therapeutic models are described and discussed in this paper, and an attempt is made to suggest a more inclusive, unitary model of the therapy group The group models are 1) a member to therapist group, 2) a group to therapist group and 3) a member to member group Each model carries specific implications about the focus of therapy and dominant group themes Each model ignores much to which the other models attend A systems theory model of group therapy which encompasses the three models is outlined In this systems theory the therapist is conceptualized as a central regulatory figure whose behavior is critical in defining the boundary between the group and its environment The therapist's definition of the group's task and boundary has important implications for the relationships of group members Modifications in therapists' regulatory behavior will lead to predictable modifications in intra-group behavior

A retrospective study of case attrition in a child psychiatric clinic

Abstract: The purpose of this study was to determine whether there are identifiable demographic and clinical factors which differentiate between cases which drop out of a child psychiatry clinic and those which do not. A portion of the study reported here is one in which a large number of charts of cases which did drop out were analyzed by several raters independently for the presence of 22 items of demographic information and 18 clinical factors. The results of this analysis were compared by statistical methods for the same 40 items with a control sample which did not drop out. Pre-therapy and therapy populations were considered separately. Although the findings do support several previously held tenets concerning factors contributing to attrition, there are several other beliefs which were not corroborated by the data. Although the clinic charts seemed basically adequate for retrospective study of the activity of the referral source and of the child and family, they revealed too little information, in most instances, about the activity of the professional people which may have contributed to attrition. On the basis of the presumptive findings, several recommendations are made both for restructuring clinic service and for additional necessary studies in this area.

Biases in a Swedish social register of alcoholics

Abstract: A sample of 153 men with alcohol abuse drawn from a population census study was divided in one group of men whose abuse was officially registered (0-group) and another where the abuse was known from other sources (A-group). The two groups have been compared in respect of a number of social and medical variables. There were significantly more psychotic and probably fewer “asthenic” persons in the 0-group. In other respects the 0-group was representative for all alcohol abusers in the sample. The implications of the findings are discussed.

The spatial distribution of treated mental disorders in Chicago

Abstract: In this paper, ecological patterning has been looked at for the various major psychiatric diagnostic groupings. Due to many changes in social composition, land use and other geographic changes, patterning is not as clearcut as it was whenFaris andDunham did their study. Communities are no longer as homogeneous or stable as they were in the twenties and thirties. Intercity expressways and industrial development have changed the geography of many community areas. We have presented a number of maps showing ecological patterning by place of residence of unduplicated admissions to fortyfour public and private mental institutions by City of Chicago people from July 1, 1960 to June 30, 1961. In general, the patterning is not clearcut. However, patterning for the unduplicated schizophrenic admissions was quite pronounced and in agreement with the patterning reported byFaris andDunham. When we looked at first admission schizophrenics, no definite pattern could be found which implies that first admissions come from all over the city. Further analysis is needed into the patterns of hospital utilization of first admissions in comparison to readmissions.

Social disorganization and completed suicide

Abstract: It has been found in Edinburgh, Scotland that the incidence of completed suicide is very common in areas of the city where there is a high degree of social disorganization, such as overcrowding and juvenile delinquency. A study in the city of Buffalo in the United States failed to replicate this finding. It appears possible, therefore, that the types of people who kill themselves (at least as determined by ecological studies) may differ considerably in Edinburgh and in Buffalo. The implications of this study are important since preventative measures for suicide would have to differ for the two countries were this true. Overcoming social disorganization would be expected, for example, to have an ameliorative effect on suicidal behavior in Edinburgh but not in Buffalo.

Early to bed ...

Abstract: In a survey of 114 long-stay psychiatric patients, most suffering from schizophrenia, it was found that there was an abnormally long duration of sleep. Several factors appeared to be involved, including the type and severity of illness, social withdrawal, phenothiazine drugs, the bedtime to which patients had become accustomed at their previous hospital, and the influence of the patients' own subculture.

Dependency, social isolation and mental health in a disabled population

Abstract: The general hypothesis tested was that the degree of physical limitation, the dependency status resulting from that limitation and social isolation each have a negative effect upon the mental health of an impaired individual The hypothesis was tested in a study population of former applicants for social security disability benefits Mental health was measured through the use of an index composed of six psychiatric symptoms which correlated highly with clinically diagnosed mental illness in another context Physical limitation was measured by the degree of physical mobility of study subjects Dependency was measured by the need for the help of others required in personal care as well as in terms of economic independence Isolation was measured with respect to the degree of social contact that study subjects had with others on a visiting basis Physical limitation, dependency and social isolation were all found to be associated with poor mental health Control tables suggested that each exerted an independent influence on the mental health of disability claimants included in this analysis

A census of psychiatric patients in an urban community

Abstract: The background and purpose of the Salford Psychiatric Case Register are described. Initial results are presented of the census in which all Salford adults and children receiving care from hospital or local authority psychiatric and subnormality services on the 1st January, 1968, were enumerated. The distribution by age, sex and type of care, the length of stay of hospital in-patients and the contact of patients with medical and social work psychiatric personnel discussed. Comparison is made with data from case registers in other areas.

Camberwell psychiatric case register. Part II. Basic data required for planning.

Abstract: A Psychiatric Case Register for the Camberwell area of south-east London yields detailed information on the workings of the mental health services in the locality. This paper presents some of the findings from the first three years' data. — The characteristics of a cohort of long-stay in-patients from Camberwell are discussed in some detail. The number of such patients is found to be falling over time, but at a slower rate than that forecast in official publications. — Figures are presented concerning patients who have shorter in-patient spells, but who may have several periods in hospital during the course of their illness. Admissions for organic psychosis show the highest retention rate over time, and those for reactive depression the lowest. A conscious replanning of short- and medium-term in-patient beds has been initiated in Camberwell, and changes in the functions of the local in-patient agencies are being examined using Register material. — The final section of the paper contains data on out-patient services, provision of which is higher for Camberwell than nationally, due largely to the several teaching hospitals in London which have out-patient departments. — The likely direction of future developments in the Camberwell area, and the importance of a Case Register in monitoring such developments, are discussed.

The disculturation hypothesis and the chronic patient syndrome

Abstract: Goffman (1961) and others have hypothesized that the experience of being a patient in the traditional type of mental hospital leads to negative consequences for the personality system of the inmate. Rather than being seen as purely a manifestation of internal psychopathological processes, patient behavior is seen, from this perspective, as a response to a peculiar sort of social environment. This environment is seen as disruptive of a positive sense of self in the individual and also as conducive to regressive behavior in several dimensions, including the adoption of a passive, dependent orientation towards the institution. — From a population of psychiatric crisis patients seen at the Emergency Room of Yale-New Haven Hospital, some are sent to the Emergency Treatment Service of the Connecticut Mental Health Center. A small, short term treatment facility, the E.T.S. was designed to avoid many of the negative features of the traditional hospital environment. The small size of the unit leads to a situation where some patients, considered by the reviewing resident to be appropriate E.T.S. candidates, cannot be accommodated because the unit is frequently filled to capacity. A high percentage of these cases are sent to State, a traditional type of public mental hospital. By taking measures on a sample from each of these groups at admission and discharge, it would seem possible to determine the impact of the hospital environment on certain aspects of patient personality and self-image. — The major findings of the study indicate that the traditional hospital environment does, in fact, engender and encourage dependency but that there is a complex interrelation between institutional demands and personality predispositions. Individuals who become long-term mental patients seem to be characterized by a high degree of dependency and a negative definition of self. The hospital environment is thus congruent with certain of their personality demands while it also may serve to emphasize these particular demands from a broader possible range of personality components. Conversely, autonomous individuals seem not to be easily “molded” by the hospital demands and seem able to vacate the patient role very quickly.

Early and late effects of imprisonment in Nazi concentration camps

Abstract: This paper explores some of the disagreements in the literature on prisoner behavior in the Nazi concentration camps. It also cites wide differences in the findings of early observers of imprisonment effects. Conflicting views of psychoanalysts on the “symptom-free interval” are noted. A high degree of agreement on the pattern of late effects known as the “CC syndrome”, is indicated. The paper reports that there is apparent acceptance of the limited evidence available that clinical records of survivors of Nazi persecution who lived in hiding but were not in camps also fit the “CC syndrome”. Studies are reviewed which suggest that a narrowly psychodynamic or neurobiological emphasis leads to defective interpretations. In this connection disagreements over the importance of the guilt factor (“existential”, “survival”, or “survivor guilt”) are examined. Finally, the paper considers some probable relationships between duration of CC experience, the factor of stress, and early and late sequelae of NCC experience.

Disability of psychiatric patients

Abstract: In Sweden, all inhabitants over 16 years of age are covered by compulsory insurance and registered by the public insurance funds. Earlier investigations of Swedish National Health Insurance materials have shown that mental disorder is a common cause of disability pension and long term sickness benefit. The purpose of the present study was to estimate the magnitude of disability in persons with a history of psychiatric contact. — The material consisted of a geographically defined subsample of a randomized series of psychiatric patients. The local National Health Insurance records were used for estimating the rate of sickness. The amount of sickness benefit given to 194 patients (74 men and 120 women) treated at a department of psychiatry in 1962 was studied during the subsequent four years. Controls matched for sex, age and domicile were obtained from the local branches of the National Health Insurance Service. Disability pension was granted to 9 men and 15 women in the patient group, and to 4 men and 1 women in the control group. The average number of sickness benefit days per year was 4.9 times larger for male patients and 3.4 times larger for female patients, than for the corresponding controls. The higher sickness reporting in men was due to both psychiatric and physical illness. In women only sickness reporting because of psychiatric illness was significantly increased.

Helpseeking behavior of male college students with emotional problems

Abstract: The subjects in this study were 125 male college sophomores in a large midwestern university. About one-third of the students had been “Users” of the facilities of the free Mental Health Clinic on campus, while the remainder, the “Non-users”, had not utilized any such facilities. Mailed questionnaires covered the following topics: demographic data, background factors and current life on campus, opinions and attitudes and perceptions of counseling and therapy, and diverse aspects of the students' adjustment and mental health.

Chronic disability following mental illness in an English city

Abstract: The total prevalence of chronic disability associated with mental illness, within and outside hospital, was assessed in the North English city of Salford in September 1966. The criteria for chronic disability were specified failures in major social roles, for a minimum period of one year. The prevalence rate was 5.8 per 1,000 total population. Women had a higher overall rate than men, but men had higher rates below 50 years of age. Schizophrenia accounted for about half of all diagnoses. The single, and the divorced or separated, had much higher rates than the married or widowed, and persons of low-status occupations had higher rates than those of higher status occupations. The rates for chronic disability rose regularly with age and differed from the bimodal distribution shown by inceptions of mental illness in the same town at about the same time. A further analysis of marital state showed that compared with the general population, the excess of the single, and of the divorced and separated, was much greater at the stage of chronic disability than at the stage of inception. Similarly for occupation, the excess of low status jobs was greater at the stage of chronic disability than at the stage of inception. The findings are discussed and interpreted.

Outpatient Psychiatry in a Nigerian University General Hospital 1958–63

Abstract: This study reviews the experiences of the first out-patient unit in a Nigerian Teaching General Hospital from the inception of the Unit to the end of a five year period, after which it acquired hospital beds and a Chair of Psychiatry. The coordination with a Mental Hospital is mentioned. Important findings in this analysis of data include (a) male-female ratio of 2 to 1, (b) the over-representation of a student population, (c) the large number of the patients from the ethnic group in whose area the hospital is situated. Atypical psychoneurosis accounted for a large proportion of the cases, probably not unrelated to difficulty in diagnosis. Problems arising from cultural difficulties and limitations by the language affected both the therapist and the patient. There was neither a record of suicidal thoughts or attempts, nor of obsessive-compulsive phenomena. Personality disorders and organic brain syndromes were underrepresented. A finding of improvement rate of 80% is higher than observations in other countries and may be specific for this unit. This study was done with the specific aim of reducing impressionistic observation in a developing country to factual statistical data.

Assessment of instruments for studying the prevalence of mental disorder

Abstract: A sample from the population of El Cerrito was assessed for mental disorders by means of the Health Opinion Survey questionnaire filled in by respondents, a check list completed by an informant and, in a sub-sample, a psychiatric interview. The mean H.O.S. score does not differentiate between the mentally disordered (assessed at interview) and others, nor give a clue as to diagnosis. However, the mean score of the mentally disordered is significantly lower than that of the well. The check list does identfy a small proportion of the mentally ill individuals but gives no information about type of disorder. A second psychiatrist agreed with the diagnosis of the first (using the same collected material) in a satisfactory number of cases, but the two psychiatrists did not agree on the indication for psychiatric treatment.

Health care planning for low income urban residents

Abstract: The purpose of this paper has been to provide a framework for conceptualizing the health care needs of economically disadvantaged urban residents. The need to approach health problems in a comprehensive manner was stressed. It is felt that a broad framework such as the one outlined is needed in the area of medical activity currently referred to as social psychiatry. The kinds of data systems that are needed in order to effectively plan for health care needs were reviewed. The ideas presented constitute an orientation and a rationale that can be followed when attempting to develop ways of dealing with the health care needs of the economically disadvantaged population sector. In this orientation, behavioral science constructs and methods are brought to bear on medical phenomena, the latter viewed generically. Ways of combining differing types of needs in order to arrive at an index that reflects the relative need of the community was discussed.

Soziostruktur und Jugenddelinquenz in einer iranischen Großstadt

Abstract: 497 kindliche und jugendliche Delinquenten, die in einem Zeitraum von 18 Monaten sich vor dem Jugendgericht in Isfahan zu verantworten hatten, wurden in Hinblick auf Alter und in bezug zu Delikt, Schulbildung, Berufsstand und Herkunftsort untersucht. Die soziostrukturellen Gegebenheiten der Stadt und der Provinz Isfahan schienen besonders geeignet fur eine solche Untersuchung: auf der einen Seite zahlt Isfahan zu den streng konservativen Statten des Landes — Traditionsgebundenheit und Wahrung des Alt-uberkommenen charakterisieren seine Einwohner in ganz besonderer Weise. Andererseits hat sich die Stadt in den vergangenen Jahren zu einer der bluhendsten Industriestadte des Iran entwickelt und ist, mit der Verdoppelung seiner Einwohnerzahl, zur zweitgrosten Stadt des Landes vorgeruckt. Die junge Generation wachst so heran in einem „Spannungsfeld“ von rapidem Fortschritt, Konfrontation mit neuen, meist westlichen Einflussen und Verpflichtung und Gehaltensein an uberlieferte Gebrauche, ehrwurdige Tradition. Jedoch ist der soziale Raum des Heranreifenden, bestimmt durch enge Clanverbundenheit der Grosfamilie, noch weitgehend intakt: der Familienverband verhindert oder entscharft viele der moglichen Entladungen der unruhigen Krisenzeit. Deliktzahl und Deliktwahl der Probanden — das eine fur westlichen Vergleich erstaunlich niedrig, das andere uberraschend „harmlos“ — bestimmen sich mit aus diesem — trotz rapider Urbanisierung — noch ungebrochenem Sozialgefuge. Zeiten besonderer „Anfalligkeit“ wahrend der Maturation — zwischen 12 und 16 Jahre — fuhren zum Anschwellen der Delinquenzrate: ein kurzdauernder Durchbruch und Ausbruch aus dem „Sozialgehege“. Dem „positiven“ Aspekt des sozialen Raumes unserer jugendlichen Delinquenten — eine Art „Huterfunktion“ — stellt sich gegenuber der negative: Frustrationen der baren Bedurftigkeit, mangelnde Wertgeltung — daraus resultierend Unsicherheitsgefuhle, Gefuhle der Ungeborgenheit: Angste der mannigfachsten Art, Aggression. Schlieslich: die „tabus“ dieser noch ungebrochenen Gesellschaft beschranken den einzelnen ebenso wie bestimmte Gruppen — sie sind aber auch ihr Schutz: die kaum ins Gewicht fallende niedrige Delinquenzrate weiblicher Jugendlicher zeugt fur die Machtigkeit gesellschaftlich fest verankerter Vorstellungen und Verhaltensweisen.

Psychiatric morbidity in 50 juvenile delinquents in Addis Ababa

Abstract: A study of 50 juvenile delinquents in a Training Centre in Addis Ababa revealed that psychiatrically disturbed children are found in such an institution, while they are conspicuously absent in out-patient populations. The broken family background of these boys did not bear a clear relationship to the presence of psychiatric disorder and appears to be a normal pattern of life in Ethiopia.

The social prognosis of persons who attempt suicide

Abstract: There is a lack of information on the social prognosis of persons who have been admitted to hospital following a suicidal attempt. This paper attempts to investigate relationships between demographic, clinical and precipitating factors and social change as assessed by a psychiatric social worker four months after the attempt. — Younger patients, those with extant marriages, fair work records or living in their own home had social improvement more frequently than others. Those, who cut, strangled or attempted to suffocate themselves had poor prognoses; those employing salicylates on the other hand did well. Where psychiatric disturbance was present at the time of the attempt the social prognosis tended to depend upon the remission or alleviation of the illness. Patients with no psychiatric illness and those with character disorders alone, had more social problems and a poor social prognosis. Immediate precipitants of the attempt were not related to social change. Many such precipitants are longstanding pressures and some of them, in this latter capacity, do predict future behaviour. — Changes in the behaviour of key individuals in the patients' lives were related to social change; the most important relationship was between improvement in the patient's behaviour and improvement in social state. These results are discussed with relation to the body of clinical and psychological information available on similar patients from the same parent population.

Contribution l'tude de la psychiatrie ambulatoire: IIe Partie. Comparaisons l'intrieur de la clientle d'un service ambulatoire

Abstract: Ce travail constitue la 2eme partie d'une etude d'epidemiologie psychiatrique dans le canton de Vaud (Suisse). Dans la 1ere partie nous avons aborde l'etude comparative entre la population du canton et la clientele ambulatoire d'un Service psychiatrique (Policlinique psychiatrique universitaire). Dans cette 2eme partie nous approfondissons l'etude de cette clientele d'apres les mmes criteres epidemiologiques (sexe, origine, domicile, âge, etat civil, religion) en y ajoutant la profession. Nous avons egalement etudie les particularites cliniques de notre clientele (diagnostic, mode de venue, motif de venue et type d'activite deployee a son egard), en les mettant en relation avec les facteurs epidemiologiques cites plus haut. Nous avons aussi effectue une comparaison entre la clientele de notre service et celle des psychiatres prives. Nous formulons des hypotheses a partir des resultats obtenus.

Industrial rehabilitation of psychiatric patients in open industry and in special workshops

Abstract: The comparison of industrial rehabilitation of psychiatric patients under various socio-economic conditions enables us to draw the following conclusions: 1. The main precondition of successful industrial rehabilitation of the mentally ill in a country is the correct attitude of society and of state in regard to the problems of rehabilitation of the disabled, the presence of well-organized rehabilitation therapy in hospitals and of restoration therapy in transitional extra-mural institutions (dispensaries, restoration centres, therapeutic workshops, day hospitals, etc.). 2. It is suggested that the rehabilitation of psychiatric patients in open industry is more successful under socialist economic conditions when there is no unemployment, and when dispensary observation and permanent control of the correct fulfillment of medical recommendations is possible. 3. In recent years, the conditions for industrial rehabilitation of the mentally ill have been achieved by co-operative societies of the disabled and by special state administrations creating special workshops with sheltered conditions. 4. Free extra-mural psychiatric assistance to the population is a general precondition of industrial rehabilitation in a country as well as the work of an integrated centre co-ordinating the activities of different departments, state, community or private organizations involved in this field of medical and communal assistance.

Le logement des malades d'un service psychiatrique ambulatoire

Abstract: Au cours d'une enqute menee aupres d'un echantillon de la clientele de la Policlinique psychiatrique universitaire de Lausanne, nous avons etudie certaines caracteristiques du logement de nos patients. Nous avons notamment envisage le genre, l'emplacement et la dimension du logement, la facon dont il a ete amenage et le degre de satisfaction du locataire. — Nous avons etabli des correlations entre ces donnees et d'autres renseignements concernant les malades (sexe, diagnostic psychiatrique, facteurs d'ordre socio-culturel tels que scolarite, formation professionnelle, activite professionnelle). — Les differences entre les logements des malades de la Policlinique psychiatrique et ceux de l'ensemble de la population de l'agglomeration lausannoise ne sont pas frappantes. A l'interieur de l'echantillon nous avons l'impression qu'il existe davantage de correlations entre logement et sexe et logement et facteurs socio-culturels qu'entre logement et type de troubles psychiques.

Retention rates of schizophrenia: A comparison of shock therapy and psychopharmacological eras and of closed and open door policies

Abstract: By means of comparison of the retention rates of cohorts of schizophrenic patients admitted to a regional mental hospital at different periods and using neurotic patients as controls, it was found, (1) the retention rates were maximal in schizophrenic patients in the shock treatment period and with a closed door policy, (2) retention rates were minimal during the period of psychopharmacotherapy and with the open door system (3) retention rates during the period of psychopharmacotherapy and closed door policy were distributed between both extremes just mentioned. (4) Corresponding to the marked decrease of bed utilisation during the open door system era down to the lowest administratively tolerated degree, a slight non-significant elevation of retention rates was observed. In females (5) an interesting but non-significant reversal of the trend found for males was observed in the first three months of stay. (6) The relation of the subsequent retention rates was similar to that of the male samples, though the only significant difference between cohorts was of greater retention during the closed door period of 1957 in comparison with 1964 during which both the open door system and the psychotropic drugs were in use. (7) The effect on the cohorts of the factors mentioned above, as well as their homogenity in respect to sex, age and clinical diagnosis, may be considered as adequately demonstrated. On the other hand, differences between the cohorts on other parameters that might have influenced the duration of the hospitalization were not analysed.