[Assessment of quality indicators with routine data: Presentation of a feasibility test in ten specialist clinics for psychiatry and psychotherapy]. / Erhebung von Qualitätsindikatoren anhand von Routinedaten : Darstellung eines Machbarkeitstests in 10 Fachkliniken für Psychiatrie und Psychotherapie.

BACKGROUND: Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data. METHODS: The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods. RESULTS: In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO. CONCLUSION: An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.

[From pathophysiology to the development of guidelines and new therapeutic strategies in schizophrenia]. / Von der Pathophysiologie zur Entwicklung von Leitlinien und neuen Behandlungskonzepten der Schizophrenie.

Mental illnesses show an annual prevalence of up to 4% and are therefore comparatively frequent. Schizophrenia substantially adds with direct as well as indirect costs (sick leave) to the overall burden of health costs caused by mental illness. The unfavourable prognosis of schizophrenia is caused by its negative symptoms and cognitive deficits. The underlying pathophysiological mechanism can most likely be regarded as a disorder of regenerative capacities of the human brain. The implementation of guidelines, quality indicators and treatment pathways improves the treatment quality in schizophrenia patients, but should, however not be abused as a tool for cost-cutting measures. A stratification in the long-term course as well as the development of biomarkers in the fields of genomics and imaging may help to promptly improve the treatment options for schizophrenia.

[Brain development before onset of the first psychotic episode and during outcome of schizophrenia]. / Die Gehirnentwicklung vor der psychotischen Erstmanifestation und im weiteren Verlauf der Schizophrenie.

A circumscribed association between copy number variations and the diagnosis of schizophrenia or autism but not bipolar disorder supports the notion of schizophrenia and autism principally representing a disturbed brain development. Data of multiply affected families show certain brain structural (e. g. hippocampal) changes to also be present in their first-grade relatives without leading to psychopathological abnormalities. It thus can be concluded that there exist regional fronto-temporal changes in schizophrenia due to genetically early determined primary vulnerability. The transition of this vulnerability into a prodrome to the point of the fully developed disease is triggered by relevant environmental factors. Hippocampal brain structural changes do not base on neuronal loss, for which reason the underlying mechanism might be a reduction of neuropil and thus a disturbance of synaptic processes or even regenerative mechanisms. Thus, disturbed regenerative mechanisms might be linked to the course of schizophrenic psychosis: the more pronounced the negative symptoms, the more evident the impaired synaptic or neuronal plasticity. Based on initial data we speculate the disturbed synaptic/plastic processes to result from an impaired epigenetic regulation. This could explain how relevant environmental factors (pregnancy and birth complications, early childhood abuse or cannabis abuse) via risk genes might lead to a destabilized neuronal network which in the end could trigger schizophrenia symptoms on the behavioral level.

[Developmental process of DGPPN quality indicators]. / Entwicklungsprozess der DGPPN-Qualitätsindikatoren.

BACKGROUND: Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia). MATERIAL AND METHOD: The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators. RESULTS: Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed. CONCLUSION: It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.

Managing sensitive phenotypic data and biomaterial in large-scale collaborative psychiatric genetic research projects: practical considerations.

Large-scale collaborative research will be a hallmark of future psychiatric genetic research. Ideally, both academic and non-academic institutions should be able to participate in such collaborations to allow for the establishment of very large samples in a straightforward manner. Any such endeavor requires an easy-to-implement information technology (IT) framework. Here we present the requirements for a centralized framework and describe how they can be met through a modular IT toolbox.