[Clinical and social risk factors for the readmission of patients with schizophrenia to psychiatric inpatient care: a long-term analysis]. / Klinische und soziale Risikofaktoren für Wiederaufnahmen in die stationäre Psychiatrie bei Patienten mit Schizophrenie: Eine Langzeitanalyse.

BACKGROUND: In recent years, admission rates to psychiatric inpatient care have steadily increased, whilst the number of beds has progressively decreased, at least in german-speaking countries. A better understanding of risk factors concerning psychiatric readmissions is indispensable in order to avoid unnecessary inpatient treatment. The aim of our study was to test the influence of various clinical and social factors on the time to readmission. METHOD: We analysed data of an observational study considering especially vulnerable patients with schizophrenia (N = 103). We applied multivariate time-hazards models (survival analysis) to examine the predictors of the time to readmission within 12 months. Independent variables were either time-varying (e.g. Needs for care Assessment Scale (NCA)) or time-invariant (e.g. age). RESULTS: About 50% of the patients were readmitted during the observation period, many of them within the first few weeks. In the final models clinical needs, and a social need increased the risk of readmission, whereas the use of neuroleptic medication reduced the risk. There was an interaction effect between social support and time. CONCLUSIONS: Both, clinical and social factors influence the risk of psychiatric readmission. Therefore, the prevention of readmissions should focus on the patients' skills to manage his/her illness and on the social support that the patients receive.

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research.

The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System's underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored.