The "DGPPN-Cohort": A national collaboration initiative by the German Association for Psychiatry and Psychotherapy (DGPPN) for establishing a large-scale cohort of psychiatric patients.

The German Association for Psychiatry and Psychotherapy (DGPPN) has committed itself to establish a prospective national cohort of patients with major psychiatric disorders, the so-called DGPPN-Cohort. This project will enable the scientific exploitation of high-quality data and biomaterial from psychiatric patients for research. It will be set up using harmonised data sets and procedures for sample generation and guided by transparent rules for data access and data sharing regarding the central research database. While the main focus lies on biological research, it will be open to all kinds of scientific investigations, including epidemiological, clinical or health-service research.

The cross-sectional GRAS sample: a comprehensive phenotypical data collection of schizophrenic patients.

BACKGROUND: Schizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia) data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS). This approach is different from and complementary to the genome-wide association studies (GWAS) on schizophrenia. METHODS: For this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected. RESULTS: The corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail. CONCLUSIONS: The GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.

Relationship between nocturnal urinary cortisol excretion and symptom severity in subgroups of patients with depressive episodes.

INTRODUCTION: The aim of this naturalistic study was to gain more information about the elevation of basal hypothalamic-pituitary-adrenal (HPA) activity in relationship to symptom severity in specific subtypes of depressive episodes. METHOD: Hamilton Depression Rating Scale scores and aggregated nocturnal urinary cortisol excretion were measured in 4 groups of inpatients with depressive episodes (n = 48; monopolar nonpsychotic, monopolar psychotic, bipolar nonpsychotic and bipolar psychotic) at the beginning and at the end of inpatient treatment. RESULTS: The initial elevation of nocturnal urinary cortisol excretion was most pronounced in psychotic patients. At the end of treatment, the Hamilton Depression Rating Scale scores had decreased significantly in all patients to comparable levels, whereas the nocturnal cortisol excretion values were still relatively elevated in mono- and bipolar psychotic patients compared to mono- and bipolar nonpsychotic ones. CONCLUSION: The observation that the basal HPA activity remains elevated even after remission of symptoms in patients with psychotic depression supports the concept that a dysfunctional regulation of the HPA system is possibly a trait- rather than a state-related feature.

Bipolar affective disorders and suicide during psychiatric in-patient treatment.

On the basis of the known literature and our own results on patients' suicide, reflections are made with regard to the group of suicide cases with bipolar affective illnesses that commit suicide during inpatient psychiatric treatment. In our own studies, we diagnosed mania in as many as 8% of all suicide cases. Risk factors for suicidal behavior in bipolar affective disorder are discussed, especially in terms of psychopathology, and the social consequences of the disease are discussed.

[Reorganisation of the diagnostic and therapeutic courses in the psychiatric care centre--from the analysis to implementation]. / Neuorganisation der diagnostischen und therapeutischen Abläufe im psychiatrischen Versorgungszentrum--von der Analyse zur Umsetzung.

Under current conditions psychiatric-psychotherapeutic inpatient care can not be sustained in its present form for much longer. Therefore, our main priority must be to adapt the care structures to the changes in society and psychiatry under consideration of the patients' needs. Cooperation, integration, and interlocking of cross-sectoral and interdisciplinary treatment provision are the challenge of the next decade. They will require networked organisation forms of high complexity as well as new mindsets and approaches. Significant steps and instruments of a structural transformation in the overall therapeutic services are elucidated using the example of a psychiatric care centre and discussed in connection with the introduction of a new reimbursement system for psychiatric and psychosomatic facilities in 2013. New cross-sectoral concepts could ensure care, particularly in regions with lacking or inadequate outpatient structure. Management competences combined with holistic thinking can help to create patient-centred alignments in this context.

[Legal aspects of delegation and reorganisation of medical services in the psychiatric field]. / Rechtliche Aspekte von Delegation und Neuorganisation ärztlicher Tätigkeiten im psychiatrischen Fachgebiet.

Current psychiatric-psychotherapeutic in-patient care takes place in an area of tension between increasing treatment requirements and the persistent lack of qualified staff. The optimisation of the diagnostic-therapeutic procedures in a clinic helps to reduce existing care deficits or to generate resources for future developments. The subject of delegation and substitution of medical services is considered in this context. Inadequate knowledge of the legal situation on the part of the decision makers impairs the indispensable trustful cooperation among the professions and adds to the uncertainty of all those concerned. The present paper outlines the legal, organisational and health policy aspects of delegation and the reorganisation of medical activities in the field of psychiatry.

[Definition of the core area of medical services in the psychiatric-psychotherapeutic field--the prerequisite for any delegation]. / Definition des Kernbereichs ärztlicher Tätigkeit im psychiatrisch-psychotherapeutischen Fachgebiet--Voraussetzung für jede Delegation.

Based on legal jurisdiction, knowledge of the psychiatric-psychotherapeutic field and insight into the necessity of a new allocation of responsibilities in the overall therapeutic service of a clinic, the core areas of medical activities are defined for the first time, innovative organisational approaches to the reorganisation of therapeutic service are presented and discussed against the background of qualified staff deficit, introduction of an OPS coding for inpatient psychiatry and economic constraints.

[Shortage of doctors in psychiatric hospitals--providing for the future by reorganizing medical services]. / Ärztemangel im psychiatrischen Krankenhaus--Zukunftssicherung durch Neuordnung des ärztlichen Dienstes.

Increasing psychiatric disorder treatment need, increased work load, changes in the working hour regulations, the nation-wide shortage of physicians, efficiency principle and economisation can necessitate a reorganisation of medical services. The essential steps and instruments of process optimisation in medical services for a psychiatric clinic are elucidated and discussed in the context of demographic changes, generation change, and a new concept of values.

[The development of utilisation of psychoneurotic in-patients in hospitals for psychiatry and psychotherapy of the so-called "new" Federal States of Germany]. / Zur Entwicklung der Inanspruchnahme von stationären psychotherapeutischen Leistungen an vollversorgenden Abteilungen und Fachkrankenhäusern für Psychiatrie und Psychotherapie in den neuen Bundesländern.

OBJECTIVE: Up to now psychotherapeutic treatment naturally is part of treatment strategies of mental hospitals and departments of psychiatry at general hospitals. Actually there is a controversial debate in this issue. The aim of this study was to evaluate the development of the utilization of these hospitals by patients with "psychogenic disorders" in the new federal states of eastern Germany. METHOD: We studied the changes in the utilization in hospitals of psychiatry and psychotherapy in Thuringia 1993 up to 1999 by patients with ICD-9-diagnoses 300 - 1 and 306 - 9 and compared these data with these of other clinics in East und West Germany. RESULT: The utilization of psychotherapy patients increased in all hospitals. The increase in Thuringia was highest, in the other eastern German it was higher as in western clinics. Reasons of admissions for in-patient psychotherapeutic treatment were suicide ideations and attempts, aggression against others and prepsychotic agitation. CONCLUSIONS: These results can be seen as a sign of a similar necessity of this care in the eastern as in western population under similar psychosocial conditions.

[Long-term psychosocial outcome of young adult inpatients after a first manifestation of "neurotic" symptoms]. / Katamnese zur psychosozialen Entwicklung von erstmals im jungen Erwachsenenalter an neurotischen Störungen manifest erkrankten, stationär behandlungsbedürftigen psychiatrischen Patienten.

OBJECTIVE: It is often assumed that there is a predictive relationship between the onset of psychiatric disorder in young adulthood and the severity of their course. Because the significance is rather contradictive and poorly backed by empirical data, we have investigated this issue by a catamnestic approach. METHOD: From 96 inpatients aged between 18 to 25 years with a first manifestation of a "psychogenetic" disorder 54 % were studied 8.6 +/- 1.5 year later. RESULT: In general there was a positive development as well psychopathological as social, although complete normalisation was not reached. CONCLUSIONS: This result is almost identical with catamnestic findings with comparative studies on older patients . Our findings do not support the concept of negative predictive value of first manifestation of psychogenetic disorder in early adulthood.

[Differentialdiagnostic problems of frontotemporal dementia--a case study]. / Differenzialdiagnostische Uberlegungen zur frontotemporalen Demenz anhand einer Kasuistik.

A case study on the clinical picture of frontotemporal dementia and the differential diagnostic problems will be described.