[Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy]. / Indizierte Stressprävention bei Jugendlichen im Gruppensetting ­ Manual für einen Akzeptanz- und Commitment-Therapie-basierten Ansatz.

Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.

[Multimorbid Patients in Forensic Psychiatry: Chances of Being Discharged]. / Entlasschancen multimorbider Patienten im psychiatrischen Maßregelvollzug.

OBJECTIVE: to determine the chances of discharge of forensic psychiatric patients (section 63 of the German Legal Code) diagnosed with comorbid psychiatric and somatic disorders. METHODS: N = 364 patients were evaluated. Diagnostic groups were compared with regard to types and frequencies of comorbid diagnoses, and treatment duration. RESULTS: Both personality disorders as main diagnoses and comorbid personality disorders were associated with prolonged inpatient treatment. Substance dependence in addition to a personality disorder was an aggravating factor. Comorbid somatic disorders affected treatment duration of patients diagnosed with a psychotic disorder. CONCLUSIONS: Somatic comorbidity may negatively interact with the treatment of psychiatric problems in schizophrenic patients and thus affect the prospects of discharge in this patient group.

[Family Burden in the Case of Intellectual Disability and a Comorbid Mental Disorder]. / Das Belastungserleben naher Angehöriger von Erwachsenen mit geistiger Behinderung und komorbider psychischer Störung.

Objective: Within the MEMENTA-study informal caregivers of grown-up persons with an intellectual disability (ID) with and without a comorbid mental disorder were interviewed. Main outcomes were family burden, quality of life, psychiatric symptomatology and problem behavior. Methods: The sample consisted of 123 informal caregivers. Results: Problem behavior was associated with a higher family burden than psychiatric symptomatology. Conclusion: Rather than mental disorders, problem behavior seemed to be more relevant for the experience of family burden.

Proxy and self-reported Quality of Life in adults with intellectual disabilities: Impact of psychiatric symptoms, problem behaviour, psychotropic medication and unmet needs.

Proxies often underestimate the subjective Quality of Life (QoL) of adults with intellectual disability (ID). However, little is known about the reasons for these differences. Accordingly, the purpose of the present study is to, firstly, compare the self-reported QoL of adults with ID with proxy reports from staff of sheltered working and housing facilities, and, secondly, to identify possible differences of the impact of four potential predictor variables. Data of 102 adults with ID were collected as part of the MEMENTA study ('Mental health care provision for adults with ID and a mental disorder'). Results show that self-report QoL scores ranged from 72.6 to 86.8. Both proxies consistently reported lower QoL scores and agreement between self and proxy ratings was predominantly poor. Unmet needs and psychotropic medication were identified as the most important predictors of reduced self-rated QoL, whereas an increase of psychiatric symptoms, problem behaviours, and psychotropic medication best predicted the reduced QoL proxy ratings. To conclude, proxies still have to strive for a more holistic approach in surrogate QoL assessments and according to adults with ID, service providers should focus on a reduction of unmet needs and psychotropic medication to further improve QoL.

Service provision for mentally disordered homeless people.

PURPOSE OF REVIEW: Mentally ill homeless persons are among the most neglected or marginalized patient groups. Their needs for mental healthcare are widely unmet. The current economic crisis probably accelerates the social decline and deterioration of physical and mental health in high-risk groups worldwide and increases the need for appropriate treatments, services, and prevention strategies. RECENT FINDINGS: Research on service provision for mentally disordered homeless people (from 2010 to 2012) covers the following issues: epidemiology of mental ill health among homeless persons, service delivery and healthcare utilization, specific treatments, specific high-risk groups among homeless persons, and subjective experience with mental health service provision. SUMMARY: The number of studies published on these issues between 2010 and 2012 may suggest an awareness for the need for adequate service provision of this marginalized clientele. Research evidence is still not sufficient. The majority of studies are from the United States. The methodological quality of the studies is still moderate, being descriptive in nature or applying qualitative approaches to small samples. Included are usually easy to access patients from inner-city regions. There is an encouraging trend to focus on younger age groups that supports the focus on primary or secondary prevention strategies for homelessness and mental disorders.