How do General Practitioners experience providing care for their psychotic patients?

BACKGROUND: In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. METHODS: A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. RESULTS: Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase), emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. CONCLUSION: Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients

MICROPROCESSOR-CONTROLLED VECTOR SCAN DISPLAY SYSTEM FOR GENERATION OF REAL-TIME VISUAL-STIMULI

The paper describes a low-cost, versatile, widely applicable digital display system in which a high-resolution, high-intensity display unit is driven by a real-time vector scan controller. The actual online display control of this device is preceded by an offline software stimulus-frame editor, designed to create and support a library of stimulus patterns (standard frames without any timing information and without any referencing to a special display co-ordinate system). The display times can be set individually for each single frame (containing at maximum 1023 pixels) with relative ease. Display frequency is set to 1 kHz. Writing time per pixel is less than 1 μs. A graphic display system like the one presented in this paper can be applied to generate a variety of real-time optical stimuli, such as intensity modulation of single spots or distinct display areas, abrupt displacements of a certain pattern, continuous movement or onset and offset of steady motion of a patter

CIRCADIAN INPUTS INFLUENCE THE PERFORMANCE OF A SPIKING, MOVEMENT-SENSITIVE NEURON IN THE VISUAL-SYSTEM OF THE BLOWFLY

Long-term extracellular recordings from a spiking, movement-sensitive giant neuron (H1) in the third optic ganglion of the blowfly Calliphora vicina (L.) revealed periodic endogenous sensitivity fluctuations. The sensitivity changes showed properties typical of an endogenous circadian rhythm. This was true for the responses in reaction to intensity changes of visual patterns as well as for the responses elicited by pattern movement. For these two types of stimuli, the circadian fluctuations were comparable, but the envelope in the case of responses to movement was more robust. A circadian fluctuation in responses to movement is, therefore, present at the level of single elementary movement detectors. The tonic activity of the neuron was also shown to be under circadian control. In constant darkness (DD) the fluctuation was circadian, whereas in constant light it was not. The subjective light-dark (LD) transitions in the tonic activity in DD closely followed the LD transitions in the holding cages initially; that is, there was low activity at night and high activity during the daytime. The sensitivity fluctuations in response to visual stimuli led the tonic spike activity fluctuations by several hours