What About Us? Experiences of Relatives Regarding Physician-Assisted Death for Patients Suffering from Mental Illness: A Qualitative Study

Physician-assisted death (PAD) for patients suffering from mental illness is legally permitted in the Netherlands. Although patients’ relatives are not entrusted with a legal role, former research revealed that physicians take into account the patient’s social context and their well-being, in deciding whether or not to grant the request. However, these studies focussed on relatives’ experiences in the context of PAD concerning patients with somatic illness. To date, nothing is known on their experiences in the context of PAD concerning the mentally ill. We studied the experiences of relatives with regard to a PAD request by patients suffering from mental illness. The data for this study were collected through 12 interviews with relatives of patients who have or had a PAD request because of a mental illness. We show that relatives are ambivalent regarding the patient’s request for PAD and the following trajectory. Their ambivalence is characterised by their understanding of the wish to die and at the same time hoping that the patient would make another choice. Respondents’ experiences regarding the process of the PAD request varied, from positive (‘intimate’) to negative (‘extremely hard’). Some indicated that they wished to be more involved as they believe the road towards PAD should be a joint trajectory. To leave them out during such an important event is not only painful, but also harmful to the relative as it could potentially complicate their grieving process. Professional support during or after the PAD process was wanted by some, but not by all.

Psychological peculiarities of mental patient with the comorbid somatic pathology

The paper presents the results of a comprehensive psychodiagnostic study of the psychological characteristics of psychotic patients with schizophrenia with somatic disorders. Based on the results of the study, the features of the representation of mental and somatic illness in the minds of schizophrenic patients with somatic disorders were identified. It has been proven that an important role in the pathogenesis of the formation of psychiatric comorbidity in schizophrenia is played by the categories of self-esteem, awareness, perception and attitude to mental and somatic illness. It was revealed that patients with schizophrenia with cardiovascular disease (CVD), with low assessments of all health parameters, assessed themselves as mentally sicker than physically, and patients with schizophrenia with diabetes mellitus type 2 (DM 2) and obesity, with low assessments of all health parameters, assessed themselves as physically sicker than mentally. In addition, patients with CVD and obesity were more aware of the need for treatment of mental illness, while patients with DM 2 were more aware that their environment would consider it necessary to treat a mental disorder. It was also found that patients with schizophrenia with somatic diseases have significantly higher indicators of the level of threat of mental disorder than patients without somatic burden. The results of the study of attitudes towards somatic illness revealed that patients with schizophrenia were characterized by a predominance of maladaptive forms of attitudes toward the disease: anxious, hypochondriac and melancholic (in schizophrenia with CVD), anosognosic and dysphoric (in schizophrenia with diabetes mellitus and obesity), as well as apathetic (in schizophrenia with obesity). It is advisable to use the obtained results as specific targets of psycho-education and psychotherapeutic work and to take into account when developing complex programs for the treatment of schizophrenic patients with comorbid somatic disorders.

Association between psychosocial functioning, health status and healthcare access of asylum seekers and refugee children: a population-based cross-sectional study in a German federal state

Background The mental health condition and healthcare needs of asylum seeking and refugee (ASR) children may go unrecognized if barriers to healthcare access exist accompanied by exclusive focus on somatic illness. We analysed the relationship between psychosocial functioning, health status and healthcare access of ASR children. Methods During 2018, 560 ASR adults in 58 collective accommodations in Germany’s 3rd largest federal state were randomly sampled and assessed. The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess child psychosocial functioning. SDQ dimensions (Emotional, Conduct, Peer, Hyperactivity, Prosocial, Total) were compared by demographics (sex, age, region of origin, time since arrival, subjective social status), health status (long-lasting illness, physical limitation, pain) and healthcare access (utilization: paediatrician, specialist, dentist, psychologist, hospital/emergency department, prescribed medicines; and unmet needs: for paediatrician/specialist, reduced spending to cover healthcare cost). Age and sex-adjusted odds ratios (AOR, 95%CI-Confidence Intervals) for scoring in borderline/abnormal ranges in SDQ dimensions were estimated through logistic regression depending on children’ health status and healthcare access. Results We analysed parents’ answers pertaining to 90 children aged 1–17 years old, 57% of which were girls and 58% with (Eastern or Western) Asian nationality. Scoring in the borderline/abnormal range of the SDQ Total Difficulties score was associated with feeling bodily pain (compared to no pain, AOR, 95%CI = 3.14, 1.21–8.10) and with an unmet need for a specialist during the previous year (4.57, 1.09–19.16). Borderline/abnormal SDQ Emotional scores were positively associated with a long-lasting illness (5.25, 1.57–17.55), physical limitation (4.28, 1.49–12.27) and bodily pain (3.00, 1.10–8.22), and negatively associated with visiting a paediatrician (0.23, 0.07–0.78), specialist (0.16, 0.04–0.69), and the emergency department (0.27, 0.08–0.96). Conclusion Poor psychosocial functioning among ASR children is associated with somatic problems, unmet medical needs, and lower healthcare utilisation. Somatic clinical encounters with ASR should include children’ mental health symptomatology assessment, especially in those with worst physical health conditions.

Depression in patients in a somatic hospital

The aim of this work was to assess the prevalence and risk factors for depression in patients in a somatic hospital in the city of Izhevsk. The study group (94 adult patients) was compiled by the method of continuous sampling. The Russian version of M. I. N. I. 5.0.0 interview, Depression Scale were used for the diagnosis of depression. The prevalence of current depressive disorders was 19,1 %. Depression was more often diagnosed in patients with chronic somatic diseases (47,0 %), women (45 %), widowed or divorced patients (63,6 %), patients with psychological problems in the family (100 %). In patients with acute somatic illness, the current depressive episode correlated with the influence of psychological factors. In 64,2 % of patients with chronic somatic diseases with an identified depressive episode at the time of examination depression had a previous history. None of the patients with identified depression sought medical help or received antidepressant therapy.

ASSESSMENT OF THE PSYCHOLOGICAL IMPACT OF AN EPIDEMIC SITUATION (COVID-19) ON THE QUALITY OF LIFE OF A VULNERABLE POPULATION: EXPERIENCE AMONG MOROCCAN ELDERLY

Background: The pandemic coronavirus (Covid-19) currently represents both physical and psychic major risk to public health. The elderly people (aged 60 plus) are the most vulnerable to the coronavirus from the rest of the population. They are in fact more exposed to complications, atypical clinical presentation and therapeutic difficulties. However, this epidemic situation generates stress added to the stress related to their clinical condition, which could negatively affect their quality of life. Objective: specify if the pandemic Covid-19 and its consequences had a short- and medium-term impact on mental health and quality of life of elderly patients after the introduction of containment measures. Methods: We conducted an online survey from 09 May to 9 June 2020 through a questionnaire published on social networks using Google Forms and comprising several items, student demographics, overall health, and the elements of the SF-12 quality of life scale. Results: The study population consisted of 135 elderly subjects. The average age was 65.3 years, 53% were male. 6.7% had a psychiatric history, 61.5% had a somatic illness and 42.2% reported having sleep disorders since the starting of lockdown. In our study, participants had an average scores of physical and mental health (40.62 and 38.63) significantly lower than that of the general population (= 50). Mental health was statistically more impaired in subjects having somatic illness, those who were not used to staying at home. Female gender was associated with physical health impairment. The presence of sleep disturbances has been statistically associated with impaired mental and physical health. Conclusions: Infection with the Covid-19 is particularly serious in elderly patients with a high risk of death and a negative psychological impact affecting their quality of life. Particular attention should be brought to this vulnerable population and the implementation of various programs to reduce the negative psychological impact and offer them a better quality of life.

Alexithymia, Emotional Distress, and Perceived Quality of Life in Patients With Hashimoto’s Thyroiditis

Emotion-processing impairment represents a risk factor for the development of somatic illness, affecting negatively both health-related quality of life (HRQoL) and disease management in several chronic diseases. The present pilot study aims at (i) investigating the associations between alexithymia and depression, anxiety, and HRQoL in patients with Hashimoto’s thyroiditis (HT); (ii) examining the association between these three psychological conditions together with HRQoL, and thyroid autoantibodies status as well as thyroid echotexture in patients with HT; and (iii) comparing the intensity of all these clinical psychological features in patients with HT versus controls. Twenty-one patients with serologically or ultrasonographically verified HT and 16 controls with non-toxic goiter or postsurgical hypothyroidism were recruited for this study. Serum thyrotropin (TSH) and free thyroxine, as well as thyroid autoantibodies (thyroglobulin antibodies and thyroid peroxidase antibodies), were assayed. Alexithymia, depression, anxiety, and HRQoL were assessed with Toronto Alexithymia Scale; Beck Depression Inventory, second edition; Hamilton Anxiety Rating Scale; and Health Survey Short-Form 36, respectively. A negative relationship between the difficulty to describe feelings and the cognitive component of depression was found (r = -0.46, p = 0.04). Besides, patients with seronegative HT had lower somatic anxiety than patients with HT who tested positive (r = -0.68, p = 0.01 and r = -0.59, p = 0.04, respectively). Besides, no statistically significant difference was found between patients with HT and controls with regard to somatic anxiety. The present study suggests the relevance of alexithymia in patients suffering from HT, which may be intertwined with a possible state of underreported depression that is mainly expressed through physical complaints. Promoting the capability to describe and communicate feelings could contribute to psychological elaboration and coping with the disease and, consequently, to the improvement of self-management and perceived HRQoL.

Specifics of the Body Image of Adolescents with Scoliosis: A Case of Being Labeled as ‘A Scoliotic’

The body image is to be reconstructed during adolescence, which is more difficult in the case of somatic illness and social stigma. This research aimed to study adolescents' body image with scoliosis, students of a special educational institution in Ukraine socially identified with stigma as 'a school for scoliotics'. The participants (n=104) of the research were adolescents (13-15 years old) with scoliosis from the institution mentioned above (n=52, 24 males, 28 females) and adolescents without scoliosis from the same city (n=52, 24 males, 28 females). Two methods were used to collect the data: (1) Self-portraits; (2) Dembo-Rubinstein Self-Assessment Scale. The adolescents with scoliosis and labeled as 'scoliotics' face additional obstructions in their psychic body development compared to their peers. For instance, they tend to overinvest in the desired image of a healthy body and do not feel able to get it. We found the markers of four different ways to cope with the situation by the adolescents with scoliosis: (a) identification as 'a scoliotic' instead of hope to be cured soon; (b) psychological distancing from the others to preserve the desire of a more attractive body image; (c) repression or denial of the body parts which could relate to scoliosis; (d) infantilization, aimed to slow down the discovery of their maturing corporeality. Consequently, adolescents with scoliosis affected by stigma experience the gap or conflict between their current, desired and perceived realistic body image.

Kognitív epidemiológia – Az intelligenciaszint prospektív összefüggése a szomatikus és pszichiátriai betegségrizikóval

A kognitív epidemiológia az intelligencia és az egészségi állapot összefüggésének tudo- mánya. A modern, sokszor több százezer fős, teljes populációkon végzett kognitív epide- miológiai vizsgálatok eredményei alapján a magasabb premorbid intelligencia gya- korlatilag valamennyi mentális betegség, illetve pszichiátriai probléma alacsonyabb kockázatával függ össze. A magasabb premorbid intelligencia a halálozás, a szív- és ér- rendszeri betegségek, a metabolikus betegségek, a rossz egészség-magatartás és számos kisebb népegészségügyi jelentőségű betegség előfordulásával is negatívan függ össze; a légzőszervi betegségekkel és a dohányzáshoz nem köthető daganatokkal azonban gyen- ge vagy hiányzik az összefüggés. A mentális betegségekkel való összefüggést nem, a szo- matikus betegségekkel és a mortalitással való összefüggést azonban részben mediálják a felnőttkori szocioökonómiai státusz mutatói. A speciális vizsgálati elrendezések – úgymint ikerkontroll-vizsgálatok, pszeudoexperimentális vizsgálatok, valamint a mendeli ran- domizáció módszerét használó molekuláris genetikai vizsgálatok – eredményei arra utal- nak, hogy az intelligencia és az egészség közötti kapcsolat jelentős részét genetikai ténye- zők közvetítik, de a szomatikus egészségre a magasabb intelligencia következményeként elérhető jobb szocioökonómiai státusz is szerény hatást gyakorol.Cognitive epidemiology is the science of the relationship between intelligence and health. Modern studies of cognitive epidemiology, often with samples of several hundreds of thousands of individuals, have revealed that higher premorbid intelligence is associated with a lower risk of virtually all of mental illnesses and psychiatric problems. Higher premorbid intelligence is also associated negatively with the incidence of mortality, circulatory illness, metabolic illness, poor health behavior and many diseases of lower epidemiological significance, but its relationship to respiratory illness and non-smoking related cancers is weaker or non-existent. Indicators of adult socioeconomic status do not mediate the association between intelligence and mental illness, but they do partially mediate the relationship with somatic illness and mortality. Studies with special designs -twin control studies, pseudo-experimental studies and molecular genetic studies using Mendelian randomization – suggest that the relationship between intelligence and health is heavily mediated by genetic factors, but somatic health may be modestly but causally improved by better social status as a consequence of higher intelligence.

‘A transverse scar on the neck’ – psychosomatic approach in the differential diagnosis and surgical treatment of hyperthyroidism in post-war Finland

In the Finnish medical discussion during the middle decades of the twentieth century, the challenging differential diagnostics between hyperthyroidism and various neuroses was perceived to yield a risk of unnecessary surgical interventions of psychiatric patients. In 1963, the Finnish surgeon Erkki Saarenmaa claimed that ‘the most significant mark of a neurotic was a transverse scar on the neck’, a result of an unnecessary thyroid surgery. The utterance was connected to the complex nature of thyroid diseases, which seemed to be to ‘a great extent psychosomatic’. Setting forth from this statement, the article aims to decipher the connection between hyperthyroidism, unnecessary surgical treatment and the psychosomatic approach in Finnish medicine. Utilising a wide variety of published medical research and discussion in specialist journals, the article examines the theoretical debate around troublesome diagnostics of functional complaints. It focuses on the introduction of new medical ideas, namely the concepts of ‘psychosomatics’ and ‘stress’. In the process, the article aims to unveil a definition of psychosomatic illness that places it on a continuum between psychological and somatic illness. That psychosomatic approach creates a space with interpretative potential can be applied to the historiography of psychosomatic phenomena more generally. Further inquiry into the intersections of surgery and psychosomatics would enrich both historiographies. It is also argued that the historical study of psychosomatic syndromes may become skewed, if the term ‘psychosomatic’ is from the outset taken to signify something that is all in the mind.

Bumpy road: implementing integrated psychiatric and somatic care in joint-specialty emergency departments: a mixed-method study using Normalization Process Theory

PurposeLife expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.Design/methodology/approachA single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.FindingsImplementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.Practical implicationsThis study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.Originality/valueIn 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.