['NischE - Nicht von schlechten Eltern' - Evaluation of a Multidisciplinary Teamwork Approach to Support Children in Families with Mentally Ill Parents]. / "NischE ­ Nicht von schlechten Eltern" ­ Evaluation eines Kooperationsprojektes zur Unterstützung von Kindern in Familien mit psychisch- oder suchtbelasteten Eltern.

Objective: Evaluation of a project offering low-threshold anonymous counseling services jointly by mental health services and child and youth services to support children in families with mentally ill parents Methods: Evaluating performance data and completed questionnaires returned by parents included in the project. Results: Between 2011-2014, 150 families received up to 10 sessions of family-oriented counseling. The survey results indicate a high level of satisfaction with the services of the cooperation project. The vast majority of respondents said that they would recommend this service to others or would themselves take advantage of the services again. Conclusion: A collaboration of service providers from psychiatry and child and youth welfare department resulting in continuous availability of counseling with a common family medical perspective represents a forward-looking model for families with a mentally ill parent.

[The experience of being admitted to a psychiatric clinic: part 1: development of a questionnaire (QAE-P)]. / Das Erleben der Aufnahme in eine psychiatrische Klinik : Teil I: Entwicklung eines Fragebogens (FEA-P).

BACKGROUND: The aim of the present study was to develop a questionnaire to assess the perception and evaluation of admission to a psychiatric hospital from a patient's perspective (QAE-P). MATERIAL AND METHODS: Based on existing literature and a preparatory pilot study, a questionnaire consisting of 126 items was developed, and 708 inpatients based in 6 psychiatry and psychotherapy clinics were asked to answer the items. The resulting data were split into two data sets. In the first subset, exploratory factor analysis was used to help determine the number of scales and provide the basis for item reduction. The resulting questionnaire was validated by means of confirmatory factor analyses (CFA) in the second data subset. RESULTS: The resulting questionnaire comprises 33 items in 7 scales, which assess: (1) helpful, positive relations with staff members; (2) offering of medical explanations to patients and their involvement in treatment planning; (3) evaluation of rooms and clinical environment; (4) dissatisfaction with doctors and staff members; (5) evaluation of handling of ward rules by staff; (6) perception of ward atmosphere; and (7) negative perception of other inpatients. The plausibility of this factorial structure was supported by the results of the CFA. CONCLUSIONS: The QAE-P is a short and feasible questionnaire that meets the criteria of classic test theory and assesses different dimensions of the patient's experience of admission to a psychiatric hospital.

[The experience of being admitted to a psychiatric clinic: part 2: comparative analyses of patient and hospital characteristics]. / Das Erleben der Aufnahme in eine psychiatrische Klinik : Teil II: Vergleichende Analysen von Patienten- und Klinikmerkmalen.

BACKGROUND: The purpose of this study was to investigate associations of patient's scores in the newly constructed questionnaire on patients' psychiatric admission experiences (QAE-P) and individual, institutional, and situational factors. PATIENTS AND METHODS: Data of 708 patients and 6 participating hospitals were analyzed. Patient characteristics between clinics were compared and univariate as well as multivariate analyses were applied to examine associations of QAE-P total score and individual as well as institutional variables (t tests, univariate and multivariate analyses of variance, correlation analyses, and effect sizes of significant associations). RESULTS: There was little variance of patient characteristics between hospitals. Multiple univariate associations with small to medium effect sizes were found between total QAE-P scores and demographic and clinical variables of the patients, institutional variables, and (non-independent) situational views of the patients. After multivariate analyses were applied, these associations remained significant for gender, age, diagnosis, the personal decision to be admitted, and for previous planning of admission with the outpatient doctor. The hospital variables shown to be associated with total QAE-P scores were open versus closed ward, disorder-specific organization of the ward, and the number of other patients being treated under the German Mental Health Act. CONCLUSION: Principally the QAE-P seems to be a suitable instrument of quality management. A number of factors were identified that show associations with the subjective evaluation of admission as reported by the patients. Some of these variables are within the control of the clinical management.

[Personality, personality disorders and depression]. / Persönlichkeit, Persönlichkeitsstörungen und Depression.

Personality is one of most frequently investigated fields in depression research and, despite changes in research paradigms, has not lost its relevance. Numerous results concerning the conceptualization of conspicuous personality traits, their aetiopathogenetic significance, and their effect on treatment and course have contributed to a better understanding of depression. Genetics and neurobiology provide new incentives for research in this field. We present an overview of aspects relevant to personality research in depression including personality types, personality traits, temperament factors, and personality disorders. Especially results on personality factors' effect on treatment and course of depression, integrating these results with different personality models in depression, and their consequences to treatment and further research of personality traits in depression are discussed.

[Treatment utilisation of a psychoeducational group for relatives of patients with affective disorders]. / Inanspruchnahme eines psychoedukativen Gruppenangebotes für Angehörige von Patienten mit affektiven Störungen.

The relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.

[Effect of personality factors and structure on the course of major depression]. / Einfluss von Persönlichkeitsfaktoren und -struktur auf den Verlauf der Major-Depression.

The extent to which personality characteristics predict the course of severe depression has been controversially discussed. In a sample of 50 depressed inpatients, the significance of personality characteristics for the prediction of relapse was studied prospectively over 2 years. More than half of the patients studied suffered relapses within this period. Well-known predictors such as the number of previous episodes were confirmed. The personality characteristics studied showed different predictive effects at 1- and 2-year follow-up. Neurosis proved predictive of the 1-year course and outcome but not the 2-year course. In the 2nd year of follow-up, a melancholic personality structure was associated with favourable outcome. This personality type therefore seems to be more appropriate as a predictor of long-term outcome. Comparison with predictive factors described earlier showed that in this study, personality traits influence outcome independently and were not confused by other predictors. Implications for relapse prevention and psychotherapeutic management are discussed.

[The family emotional involvement and criticism scale]. / Der Fragebogen zur familiären emotionalenInvolviertheit und wahrgenommenen Kritik (FEIWK) - Ein Verfahren zurErfassung von Expressed Emotion1 -

The construct of expressed emotion is regarded as one of the most important predictors of the course of schizophrenia and has also proven to be a predictor of the course of depressive disorders, psychosomatic disorders and physical illness. Despite its clinical significance, the utility of the EE-construct has been limited since measurement by interview is time-consuming, and to date only applicable to psychotic illness. Questionnaires as a practicable alternative to the structured interview are also mostly applicable solely to psychotic disorders. One exception is the Family Emotional Involvement and Criticism Scale (FEICS, Shields et al.). This questionnaire allows a general assessment of EE and thus a practical application of EE to the general area of family research. In a sample of n = 202 patients, the German version of this instrument proved to be reliable in our research. The two-factor structure of the original American version was replicated. We found good correlation between the measured factors, and clinical and other diagnostic markers particular to family pathology. This questionnaire is therefore a brief, reliable and valid instrument for measuring EE in many disorders.

Family perception of interpersonal behavior as a predictor in eating disorders: a prospective, six-year followup study.

This study assessed family perception patterns of interpersonal behavior in families with a daughter diagnosed with an eating disorder 6 years after treatment that used a prospective design. Family perception patterns of patients found to have a poor outcome at followup (n = 15) were compared with patients with a good outcome (n = 23), as well as a control group (n = 36). Using the system of multiple level observation of groups (SYMLOG), all 238 family members evaluated themselves and each other. The index patients with a poor outcome perceived themselves as friendlier and more positive than they were perceived by their families. In comparison to parents of daughters with a good outcome and the control group, parents of daughters in the poor outcome group perceived themselves to be less friendly than their partners perceived them to be. A rigid polarization of the perception of the index patient by family members and a discrepancy in this perception between the index patient and the rest of the family were found to be indicative of a poor prognosis. Implications for treatment based on family perception patterns of interpersonal behavior are discussed.

[Stability of therapeutic outcome after child- and adolescent psychoanalytical therapy--a five-year catamnesis]. / Stabilität des Therapieerfolgs nach analytischer Kinder- und Jugendlichen-Psychotherapie--eine Fünf-Jahres-Katamnese.

In the Heidelberg study about psychoanalytic therapy with children and adolescents 133 cases have been studied in a naturalistic design. Up to now results were published on the basis of assessments of experts only. This follow-up study has investigated the stability of therapy outcomes from the perspectives of different raters. For that outcome has been rated five years after the end of treatment by experts, parents and children themselves. Good outcomes have been stabile and have shown even after five years. Single variables showed further improvement in the time of follow-up, for example the social communicative impairment with parents. Thus the high rate of successful longterm psychoanalytic therapies with children and adolescents could be confirmed from different rater perspectives.

[Critical life events during the course of 2 years of 'major depression.' A prospective study with inpatients]. / Kritische Lebensereignisse im 2-Jahresverlauf der "Major Depression." Eine prospektive Studie mit stationär behandelten Patienten.

A number of studies has shown a significant relationship between life events/life conditions and depression. However, there is only a small number of studies investigating the effect of life events/life conditions in patients with severe depression from the endogenous subtype. The results are inconsistent. The present study examines the significance of the patients' life events/life conditions for the two year outcome of the illness in a prospective study with assessments every three months. Patients are compared to healthy controls with regard to the period three months prior to the admission to the hospital at the index episode. The results confirm the importance of life events and life conditions for the long term outcome of depressed patients with endogenous subtype respectively severe major depression in-patients. Relapsers show considerably more undesirable life conditions than non-relapsers three to six months prior to their relapse. Depressed patients indicate significantly more undesirable life events and life conditions and fewer desirable life conditions in comparison to the control group for the time span three months prior to their hospitalization. Clinical implications are discussed.

["Expressed emotion", marital quality and risk of recurrence in depressed patients]. / "Expressed Emotion" (EE), Ehequalität und das Rückfallrisiko depressiver Patienten.

Long-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of martial quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.

The influence of psychopathology, personality, and marital interaction on the short-term course of major depression.

By means of an aggregated variables design the domains of 'psychopathology', 'personality', and 'social interaction' were weighted according to their impact on the 2-year course of 50 patients with unipolar major depression. Preindex course ranked highest, asthenic personality second. Variables of social interaction disappeared in the second-order logistic regression. These findings fit in well with the recent literature. They are interpreted in terms of habituation processes and residual personality changes which lower the vulnerability threshold for relapse and unfavorable course. As a consequence of this conclusion early relapse prevention would be most important.

[Utilization of ambulatory psychotherapy by patients with endogenous depression after inpatient psychiatric treatment]. / Inanspruchnahme ambulanter Psychotherapie von Patienten mit endogener Depression nach stationär-psychiatrischer Behandlung.

The long-term course of major depressive disorder is often accompanied by relapses or chronicity. Since psychosocial factors have been shown to be important predictors for the long-term outcome, psychotherapy along with drug therapy belongs to the standard methods of treatment. In spite of the effectiveness of psychotherapy, only some of the inpatients are treated with outpatient psychotherapy after hospital discharge. Within the framework of the Heidelberg depression study the authors examined what kind of, how many and for how long endogenously depressed patients sought out-patient psychotherapy after an inpatient treatment in a two-year follow-up. During the follow-up one half of patients were treated with outpatient psychotherapy. They were found to be younger, had suffered from more previous episodes, and their personality was more disturbed than those who had not undergone psychotherapy. The Expressed Emotion index did not make any further difference, whereas certain aspects of partnership quality did. The distinction between the two groups of patients is discussed regarding possible selection processes by treatment indication. It is pointed out that research on synergistic cooperation between members of the mental health services is highly desirable.