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ID naloge: 69 Letnik: 1999 Predmet: psihiatrija
Vzroki in vrste oviranosti dolgotrajno hospitaliziranih psihiatricnih bolnikov
Avtor: Tina Vesel, Tomaž Tajnšek
Mentor: doc. dr. sc. Vukosav Žvan, dr. med
Somentor: doc. dr. sc. Mojca Zvezdana Dernovšek, dr. med
V vsaki psihiatricni bolnišnici je del bolnikov hospitaliziranih vec kot eno leto. Razlogi dolgotrajne hospitalizacije so bolezenske in socialne narave, dodatno pa povzroci dolgotrajno življenje v bolnišnicnem okolje spremembe na mnogih podrocjih bolnikovega življenja. Govorimo torej o posebnem pojavu dolgotrajno hospitaliziranih bolnikov (DHB).
Ugotovitev raziskav o DHB iz drugih držav ne moremo neposredno prenesti k nam. Pri nas namrec obravnava bolnikov z duševnimi motnjami temelji na bolnišnicni in ambulantni oskrbi in nimamo razvitih vseh oblik zunajbolnišnicnih dejavnosti, medtem ko so obstojece oblike nezadostne.
Namen raziskave je ugotoviti število in znacilnosti DHB na Psihiatricni kliniki v Ljubljani, dolociti ucinkovitost bolnikov, njihovo kakovost življenja ter vzroke in stopnje oviranosti.
Postavili smo delovno hipotezo, da socialni, demografski in bolezenski dejavniki vplivajo na oviranost in s tem na vrsto oskrbe DHB.
Raziskava je presecne narave in je zajela vse bolnike, ki so bili na indeksni dan (ID) 1.1.1998 hospitalizirani vec kot eno leto. Intervjuvali smo bolnike, negovalno osebje, svojce in zdravnike. Pri zbiranju podatkov smo uporabili naslednje standardizirane lestvice: Standard of Living-I (SOL-I), Brief Psychiatric Rating Scale (BPRS), Krawiecka Scale, Global Assessment Scale (GAS), Quality of Life Scale (QoL), Clinical Global Impression (CGI), World Health Organization - Psychiatric Disability Assessment Schedule (WHO/DAS). Dodali smo vprašanja o možnosti odpusta oziroma drugacne vrste oskrbe DHB ter podatke o nekaterih bolezenskih znacilnostih DHB.
Podatke smo obdelali s SOLO 4.0 statisticnim racunalniškim programskim orodjem. Uporabili smo naslednje statisticne teste: hi- kvadrat, t- test, ANOVA s Fisherjevim testom najmanjših znacilnih razlik.
Na ID je bilo v bolnišnici 117 DHB (45 moških, 72 žensk). V dnevni oskrbi je bilo 27% DHB, v celodnevni oskrbi-odprti oddelek 53% in na varovanih oddelkih 20% .
DHB so imeli nizke ocene kakovosti življenja in samostojnosti in ucinkovitosti. Oviranost je bila povezana z vrsto oskrbe. DHB so najpogosteje imeli diagnozo shizofrenije. Bolniki v dnevni oskrbi so imeli vsaj enega clana primarne družine, bili so najpogosteje hospitalizirani zaradi socialnih razlogov. Diagnosticna skupina duševne manjrazvitosti je bila pomembno zastopana v dnevni oskrbi. Imeli so najboljše ocene kakovosti življenja in samostojnosti in ucinkovitosti, splošnega klinicnega vtisa in najmanj moteno obnašanje ter najvec stikov z zunanjim svetom.
V celodnevni oskrbi-odprti oddelek so DHB pogosteje od ostalih odklonili anketo, osebje je ocenilo, da so v primerjavi z drugimi pogosteje verbalno agresivni.
Diagnosticna skupina organskih, vkljucno simptomatskih, duševnih motenj je bila pomembna med DHB na varovanih oddelkih. Ti bolniki so bili pogosteje od ostalih nepogovorljivi, imeli so najbolj izražene nekatere znake bolezni, najslabše ocene samostojnosti in ucinkovitosti ter klinicnega vtisa. Niso sodelovali v nobeni od terapevtskih dejavnosti. Osebje je ocenilo, da so pogosteje fizicno nasilni.
Na vrsto oskrbe torej vplivajo predvsem bolezenske znacilnosti DHB ter v manjši meri socialni dejavniki, medtem ko vpliva demografskih dejavnikov nismo potrdili.
Podatke bomo uporabili pri nacrtovanju izboljšane oskrbe DHB
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[Abstract / English version]
Causes and degree of disability of long stay psychiatric in-patients
Author: Tina Vesel, Tomaž Tajnšek
Mentor: doc. dr. sc. Vukosav Žvan, dr. med
Co-mentor: doc. dr. sc. Mojca Zvezdana Dernovšek, dr. med
In every psychiatric hospital some patients stay longer than one year. The reasons of the long stay may be social and disease-related, while on the other hand long stay in hospital setting influences many areas of patient's life. This phenomenon is called "long stay patients" (LSP). Results of the studies on LSP obtained in other countries can not be used in our setting. In Slovenia the management of mental disorders is mostly based on hospital and outpatients care, while other forms of community care are not developed or are insufficient.
Our aim is to find out the number and characteristics of LSP in University Psychiatric Hospital in Ljubljana, Slovenia, to assess their social functioning, quality of life and the cause and degree of their disabilities. Main hypothesis is that social, demographic and disease related characteristics influence the disability and care of LSP.
A cross-sectional study included all patients who were on index day (ID) (January 1, 1998) hospitalised for more than a year. We have interviewed the patients, nursing staff, patient's relatives and psychiatrists. The following instruments were used: Standard of Living-I (SOL-I), Brief Psychiatric Rating Scale (BPRS), Krawiecka Scale, Global Assessment Scale (GAS), Quality of Life Scale (QoL), Clinical Global Impression (CGI), World Health Organization - Psychiatric Disability Assessment Schedule (WHO/DAS). Data on alternatives to current care or planned discharge were collected. Chi square, t test and ANOVA with Fisher's least significant difference post-test were used. All analyses were done with SOLO 4.0 statistical package.
On ID there were 117 LSP (45 males, 72 females). Twenty seven percents of LSP were in day hospital, 53% on open wards and 20% on locked wards. All LSP had low scores on QoL and GAS scales. The degree of disability was related to the type of care. The most frequent diagnosis was schizophrenia.
Patients in day hospital had at least one member of their primary family, were mostly hospitalised due to social reasons. In this group of patients mental retardation was also frequent. These patients had better scores on QoL, GAS and CGI scales and less disturbed behaviour and more frequent contacts with outside world.
LSP on open wards have more frequently refused to participate in the interview. Nursing staff more frequently rated them as verbally aggressive. Among LSP on locked wards organic mental disorder was important. The LSP on locked wards were more frequently unable to participate in interview due to more pronounced symptoms, low scores on GAS and CGI scales. In fact these patients did not participate in any therapeutic activity. Nursing staff more frequently rated them as physically aggressive.
The type of care is therefore influenced mostly by disease-related characteristics of LSP and, to a lesser degree social factors, while the influence of demographic factors was not proved. Our results will be used in planning of the improved care of LSP.
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