[Psychotherapy of depressive disorders : Procedures, evidence and perspectives]. / Psychotherapie depressiver Störungen : Verfahren, Evidenz und Perspektiven.

BACKGROUND: Depressive disorders are associated with a high burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment options for depressive disorders. OBJECTIVE: The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments. MATERIAL AND METHODS: During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, a comprehensive and systematic evidence search was conducted. The results of this search along with a systematic update are summarized. RESULTS: The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust. CONCLUSION: Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents a key element in the treatment of depressive disorders.

[Psychotherapy of depressive disorders: Evidence in chronic depression and comorbidities]. / Psychotherapie depressiver Störungen: Evidenz bei chronischer Depression und bei Komorbidität.

BACKGROUND: Psychotherapy has been shown to be an effective treatment option for depressive disorders; however, its effectiveness varies depending on patient and therapist characteristics and the individual form of the depressive disorder. OBJECTIVES: The aim of this article is to present the current evidence for psychotherapeutic antidepressive treatments for patients with chronic and treatment-resistant depression as well as for patients with mental and somatic comorbidities. MATERIAL AND METHODS: During the revision of the currently valid German S3- and National Disease Management Guideline (NDMG) on unipolar depression published in 2015, a comprehensive and systematic evidence search including psychotherapy for specific patient groups was conducted. The results of this search along with a systematic update are summarized. RESULTS: Psychotherapy has been shown to be effective in reducing depressive symptoms in patients suffering from chronic and treatment-resistant depression and in patients with mental and somatic comorbidities. The evidence is insufficient particularly for patients with mental comorbidities. CONCLUSION: Based on the current evidence and clinical expertise the NDMG recommends psychotherapy alone or in combination with pharmacotherapy to treat most of these depressive patient groups. Evidence gaps were identified, which highlight the need for further research.

[Implementation of the S3 prostate cancer guideline in daily clinical practice: results of a survey among urologists]. / Implementierung der S3-Leitlinie Prostatakarzinom im klinischen Alltag : Ergebnisse einer Umfrage unter Urologen.

BACKGROUND: Beside the quality of a guideline, the implementation in daily practice is of particular concern. The aim of this study was to determine the degree of implementation of the interdisciplinary S3 guideline on diagnostics and treatment of prostate cancer. METHODS: A questionnaire containing questions regarding the implementation of the S3 guideline was sent to 119 private practice urologists and 37 urologists working in hospitals. Comparisons were made with the χ(2) test. RESULTS: The response rate was 63%. Of the responding urologists, 93% reported that they used the guideline in the daily practice, while 95% considered the strong recommendations of the guideline as treatment standard. Urologists working in a hospital recommended the guideline less frequently to their patients as source of information (30 versus 58%, p = 0.0283), but more frequently to other physicians (95 versus 72%, p = 0.0294), than private practice urologists did. CONCLUSION: The interdisciplinary S3 guideline on diagnostics and treatment of prostate cancer is used by the vast majority of urologists in their daily practice. The strong guideline recommendations are considered as treatment standard. A more compact presentation and a propagation of the guideline outside the urologic community might improve implementation of the guideline.

Exploring the potential impact of hospital ward-based pharmacy interns on drug safety.

Clinical pharmacists play an important role in improving drug safety on hospital wards. However, little is known about the impact of pharmacy interns. The objective of our study was, therefore, to investigate the impact of hospital ward-based pharmacy interns on drug safety. This study was conducted as part of the project "P-STAT 2: Pharmacy interns on the ward" on 14 surgical wards in seven hospitals in Germany and a total of 27 pharmacy interns participated. All patients admitted to the participating wards from 1st June 2008 until 31st October 2008 and from 1st December 2008 till 30th April 2009 were included. The pharmacy interns were involved in medication reconciliation, and identifying, resolving, and preventing drug-related problems (DRPs) using the classification system APS-Doc. A total of 6,551 patients were included. Patients received on average (+/- SD) 4.4 +/- 3.9 drugs. The pharmacy interns detected a total of 4,085 DRPs and on average 0.6 +/- 1.2 DRPs per patient. Most frequently detected DRPs were potential drug-drug interactions (n = 591, 14%), missing drug strength, when different strengths were available (n = 373, 9%), and incomplete medication record (n = 296, 7%). The pharmacy interns conducted an intervention for 98% (n = 4,011) of all DRPs. According to their documentation, 74% of the DRPs (n = 3,038) were solved. Drugs which were most often related with DRPs were simvastatin, diclofenac, and ibuprofen. This is the very first study exploring the potential impact of pharmacy interns on drug safety on surgical wards in Europe. Pharmacy interns can play an important role to improve drug safety on hospital wards.

The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year.

Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n=92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.

A 12-month follow-up study of treating overweight schizophrenic patients with aripiprazole.

OBJECTIVE: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice. METHOD: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up. RESULTS: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (> or =3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean -3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean -4.4 kg). CONCLUSION: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.

A cross-sectional study of prescribing patterns in chronic psychiatric patients living in sheltered housing facilities.

OBJECTIVE: To analyze prescribing patterns of chronic psychiatric patients living in sheltered housing facilities, to identify the extent of polypharmacy and to estimate associated risks in this patient group. METHODS: In a retrospective cross-sectional study the prescription data of 323 chronic psychiatric patients (average age 48.5 years) living in sheltered housing facilities in Rotterdam, The Netherlands, were analyzed. Prescription data were obtained from pharmacy-dispensing records. RESULTS: Patients received on average 4.6 drugs (95% CI, 4.3-4.9). The most frequently prescribed drugs were as expected antipsychotics, benzodiazepines and antimuscarinic drugs. Overall 25% (n=81) of patients received two or more antipsychotic drugs. A high proportion of patients (38%, n=124) received one benzodiazepine, and 15% (n=50) received two or more benzodiazepines. CONCLUSION: Patients in our study received a worryingly high number of drugs, and a quarter of the population was subject to antipsychotic polypharmacy. This increases the risk that drug-drug interactions, adverse drug reactions and noncompliance occur. Our study indicates potentially low quality of prescribing and shows the need for reviewing and special monitoring of pharmacotherapy in this patient group.

[If drugs are not taken - how different antipsychotics influence compliance of schizophrenic patients]. / Wenn Arzneimittel nicht eingenommen werden - der Einfluss verschiedener Antipsychotika auf das Complianceverhalten schizophrener Patienten.

The effectiveness of pharmacotherapy partly depends on patients' compliance. However noncompliance with pharmacotherapy occurs frequently. It is particularly a problem in diseases requiring long-term treatment. On average chronically ill patients only take about half of their medication as prescribed. Especially patients with chronic psychiatric diseases, such as schizophrenia, are known to have low compliance rates. Atypical antipsychotics or depot medication are believed to improve compliance. In our systematic literature review we identified ten studies analysing the differences in compliance rates between atypical and typical antipsychotics. However our analyses did not show a difference in compliance rates except for clozapine. The higher compliance rates for clozapine might be explained by the regular monitoring and thus frequent patient contact. A positive effect of depot antipsychotics on compliance could be explained by the easy detection of noncompliant patients.