The study aimed to determine rates and types of patient restraint, and their relationship to age, gender and immigrant background. The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period. Each patient is only counted once in this period, controlling for readmission. Of 960 admitted patients, 14% were exposed to the use of restraints. The rate was significantly higher among patients with immigrant background, especially in the younger age groups. Most commonly used were mechanical restraint alone for native-born patients and a combination of mechanical and pharmacological restraints for patients with immigrant background. The use of restraints decreased when patients reached 60 years. Both patients' age and immigrant background seem to have an impact on the use of restraint.
Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations.
In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version.
Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations.
More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
In the light of experiences from the Psychosocial Team for Refugees in Norway, the authors describe factors of importance for understanding the personal meaning of the exile. We point to the implication of different traumatic events associated with flight and exile, and to the psychosocial consequence of such traumatization. We consider this to be important basic knowledge for doctors and other health workers engaged in preventive and curative work with refugees.
The social networks of Vietnamese refugees and predictors of their intra- and inter-ethnic social contact after 3 years in Norway were studied. An unselected community cohort of Vietnamese boat refugees was personally interviewed, first on arrival in Norway (n = 145) and again after 3 years (n = 130). By the time of the second interview, the refugees had to a large degree reconstructed social networks and 54% had good contact with other Vietnamese. Only 17% had equally good contact with Norwegians. Female gender, further education after resettlement and having a close confidant on arrival were related to good inter-ethnic social contact. The latter was the only predictor of good intra-ethnic social contact. Competency in the Norwegian language, surprisingly, did not predict good social contact with Norwegians. The refugees were largely successful in re-establishing a social platform in relation to their own ethnic group in their new environment. It was much more difficult to establish good social contact with Norwegians. Educational institutions appear to be important social arenas in this respect. The personal capacity for close attachments during a period of psychosocial transition is also important.
The reorganization in 1981 of a general hospital psychiatric ward in Oslo, Norway, to achieve a more suitable treatment milieu for patients with schizophrenia resulted in a change in patients' perceptions of the ward atmosphere. Reduced group participation and increased individualized support from staff led patients to perceive of the ward as having a low level of anger and aggression and a high level of order and organization. This study examined whether the reorganization was associated with improved treatment outcome.
Psychiatrists retrospectively examined the charts of all patients with a DSM-III-R diagnosis of schizophrenia or schizophreniform disorder who were admitted to the ward the year before and the second year after the reorganization. Multiple regression analyses were used to examine treatment outcomes for both groups. Outcome was measured indirectly by length of stay, level of functioning at discharge, and whether the patient was rehospitalized during the following seven years.
Patients treated after the reorganization had significantly shorter stays with no reductions in either level of functioning at discharge or length of community tenure after discharge. Differences in demographic characteristics, illness history, or psychopharmacological treatment could not account for differences in outcome.
The results supported the hypothesis that the organization and milieu of brief-stay wards influence the short-term outcome of inpatient treatment of patients with schizophrenia.
BACKGROUND: Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample. METHOD: A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables. RESULTS: It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM-III-R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression. CONCLUSIONS: The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.
BACKGROUND. The prevalence and course of mental disorders among Vietnamese refugees were studied, using a model including variables from different research traditions. METHOD. A consecutive community cohort of 145 Vietnamese boat refugees aged 15 and above were personally interviewed on their arrival in Norway and three years later. RESULTS. Three years later, there was, unexpectedly, no decline in self-rated psychological distress (SCL-90-R), almost one in four suffered from psychiatric disorder and the prevalence of depression was 17.7% (Present State Examination). Female gender, extreme traumatic stress in Vietnam, negative life events in Norway, lack of a close confidant and chronic family separation were identified as predictors of psychopathology. CONCLUSIONS. The effects of war and persecution were long-lasting, and compounded by adversity factors in exile. A uniform course of improvement in mental health after resettlement cannot be expected in all contexts. The affected refugees need systematic rehabilitation.
On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims.
To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS).
A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS.
There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL = 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (ß = 1.7), witnessing injured/dead (ß = 2.0), perceived threat (ß = 1.1), perceived obstruction in rescue work (ß = 1.6), lower degree of previous training (ß = -0. 9) and being unaffiliated volunteers (ß = 8.3) were significantly associated with PTSS.
In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.
OBJECTIVE: The study assessed the level of reintegration into the community of patients with schizophrenia in Oslo, Norway, a country with a well-developed social welfare system and low unemployment rates. METHODS: Eighty-one patients with a DSM-III-R diagnosis of schizophrenia treated in 1980 and in 1983 in a short-term ward of a psychiatric hospital were followed up after seven years. Seventy-four of 76 patients alive at follow-up agreed to participate. Social functioning was measured by the Strauss-Carpenter Level of Functioning Scale and the Social Adjustment Scale. RESULTS: At follow-up 78 percent of patients lived independently, 47 percent were socially isolated, and 94 percent were unemployed. Thirty-four percent had lost employment in the follow-up period. A poor outcome in terms of social functioning and community reintegration was associated with loss of employment. A good outcome was predicted by short periods of inpatient hospitalization, high levels of education, being married, male gender, and not having a late onset of psychosis. CONCLUSIONS: The level of homelessness among these patients with schizophrenia was encouragingly low, which may have been expected in a high-income welfare society. However, insufficient efforts were aimed at social and instrumental rehabilitation, and the level of unemployment was alarmingly high.
Eighty-eight patients were admitted to the acute ward of a catchment area suffering from the following functional psychoses: schizophrenia (S; n = 41), affective disorder (AD; n = 22), other disorders (OD; n = 25). Follow-up data were obtained for 97%. Ten patients were dead at follow-up, 8 due to suicide. Sixty-five were personally interviewed. While nearly all the patients had only brief periods of rehospitalization, most had used neuroleptics during the follow-up period. Compared to other samples, functioning at follow-up was fairly good for the AD and OD patients, but rather poor for the S patients.