Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward

<b><i>Background:</i></b> Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation. <b><i>Objectives:</i></b> The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward. <b><i>Materials and Methods:</i></b> The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score &#x3c;21 and the diagnosis of dementia were included in the study. <b><i>Results:</i></b> A significant reduction of agitation in the OASS could be shown when the dog was present (<i>p</i> = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (<i>p</i> = 0.65), root mean square of successive differences (<i>p</i> = 0.63), and high frequencies (<i>p</i> = 0.27) nor in serum BDNF concentrations (<i>p</i> = 0.42). <b><i>Discussion:</i></b> Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

Bridge over Troubled Water: Patients’ Opportunities for Collective Participation in Substance Use Institutions through Research Circles

This study explores patients’ opportunities for collective participation in an institution for people with substance use disorder. Patients and staff from the treatment institution cooperated with researchers to make changes in the treatment practice, using a research circle as a model for the project. In the article, we discuss the following research questions: How and in what areas did patients have the opportunity to participate collectively in the treatment institution? How did the patients experience participation in the research circle? Data consist of minutes from meetings, seminars, and focus-group interviews. The participants analysed the material together, and the authors carried out a thematic analysis after the project. The participants chose to explore how milieu therapy could build a bridge from treatment in the institution to life after treatment, a “Bridge over troubled waters”, to quote Simon and Garfunkel. Findings show that activities in the research circle led to changes at the institution, e.g., regular Sunday afternoon meetings, a weekly quiz, and less controlling procedures of substance use, and that the institutional culture in general became based more on participation and equality. Patients, staff, and researchers participated in a partnership; mutual recognition promoted cooperation and fellowship in the research circle. We conclude that the project provided the participants with opportunities for collective participation in the institution. In addition, the patients experienced partnership and empowerment in the research circle. Our attempts to change institutional practices yielded some improvements but also met with structural and cultural barriers. Thus, the project experienced challenges and obstacles mostly related to limitations in the institutional system and culture.

Milieu therapy as a method for improving the quality of life of the old people

Relevance Nowadays, both in developing countries and in industrialized countries, there is a process of increasing life expectancy, which together with the problem of low birth rates leads to the phenomenon of “aging population”. Providing care to the elderly is not only a purely medical problem, but the social aspect is equally important. An important component of the lifestyle of an elderly person is recreation - the processes of restoring vitality, relieving mental stress and recovery, carried out in various forms of recreation, nutrition, active or passive leisure. Modern society and the health care system face three most important tasks: continuing an active life with minimal losses from the disorders inherent in old age, combating high morbidity in old age and ensuring a dignified end to the lives of aging people. Although the provision of medical and social assistance to the elderly is organized and provided as needed, ensuring the accessibility and sufficient presence in their lives of the social aspect and its communicative component is not supported in our country at the state level and is not regulated by law Purpose The purpose of the work is to improve the quality of life of the elderly through the organization of the social component of life by arranging their leisure. Results To achieve this goal, it was proposed to use the principles and methods of milieu therapy, which means “treatment by the environment”. Most often, milieu therapy refers to a form of psychotherapy that involves the use of therapeutic communities. Considering the goal, milieu herapy fully covers and meets the goals of rehabilitation of the elderly, and as a social technology allows to create an active living environment that encourages older people to “independent actions”, self-sufficiency, withdrawal from dependent moods and hyperprotection. Milieu therapy allows to activate the living environment of such people in accordance with their needs, interests, psychophysical condition, rehabilitation potential; and to optimize the work of staff in the direction of improving the efficiency of activities that will have a direct impact on quality of life. On the example of other countries, examples of the use of the principles of milieu therapy in the organization of daytime activities in the elderly are provided. Conclusions Providing leisure for the elderly will be able to improve their quality of life, reduce the prevalence of somatic diseases and the risk of developing psychosomatic conditions in them, and thus reduce the burden on health care facilities. And the use of the principles of milieu therapy to solve problems will allow to organize it as effectively as possible.

Millieu Therapy Metode Kreasi Seni Modifikasi Lingkungan Terhadap Tingkat Harga Diri Remaja

Adolescence is a transition period between childhood and adulthood. Massive changes from childhood to adulthood are common at ages 13 to 20 years. Previous research discusses the difficulties of social interaction with peers, social relationships with groups, and difficulty communicating with a social new environment. Some students expressed stress with the number of Islamic boarding school rules, controlled and far from parents. At the same time, 32% of people agreed that they were not confident, sad, anxious, afraid of intimidation, and decreased learning enthusiasm. People who looked down on trust would have an external and internal impact. The external consequence is difficulty reaching academic achievement and social relations. The internal consequence is difficulty reaching internal self-concept, unclear, complicated, uncertain self goals, and pessimistic in the future challenge. This study aimed to know the level of self-esteem of students after being given milieu therapy with environmental modification art creation. The study design uses pre-experimental with pre-post test design of one group. The sampling technique was purposive sampling. Samples were taken as many as 24 respondents and divided into 4 groups of 6 people in each group. The intervention was given for 3 weeks. In this study, measuring instruments used a questionnaire using Rosenberg and data analysis using the Wilcoxon test signed a ranking test. The statistical analysis showed the results of p = 0.030 <α. There was a milieu effect of therapeutic methods of environmental modification art creation on students' level of self-esteem living in the dormitory. Milieu therapy can increase awareness and self-confidence between peers with the approval of self-confidence and commitments agreed between friends.

Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth

Background and Goals: The role of milieu therapy on inpatient treatment has become more prominent due to the changing landscape of hospital care, with shorter length of stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual psychotherapy with the psychiatrist or therapist, and more milieu and group based treatment that emphasizes acute stabilization. Methods: The authors share some of the core domains that provide the basic framework for milieu treatment within an acute care setting when working with adolescents and transitional age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer practical ideas for implementation in clinical practice. Discussion: The therapeutic milieu and collaboration of an interdisciplinary team has a significant impact on hospital treatment. Considerations for milieu therapy implementation in an inpatient unit include developmentally informed concepts related to milieu treatment of adolescents and TAY patients in a hospital setting.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients

Objective. To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients.Methods. This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient–Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment.Results. Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p<0.004, η2=0.04; F=11.92, p<0.001, η2=0.11; F=6.94, p<0.001, η2=0.06) over seven days interval.Conclusion. The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients. How to cite this article: Bhat S, Rentala S, BN Raveesh, Chellappan XB. Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients. Invest. Educ. Enferm. 2020; 38(1):e06.

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

Background Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion. Methods This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis. Results The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff’s sincere desire to provide good treatment and the patients’ behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice. Conclusion Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.