[Multifamilygroups as a Psychosocial and Contextoriented Intervention for Somatic Illness and Disability]. / Multifamiliengruppen als psychosoziales und kontextorientiertes Angebot bei somatischer Erkrankung und Behinderung.

Multifamilygroups as a Psychosocial and Contextoriented Intervention for Somatic Illness and Disability This paper provides a detailed description of a multi-family group (MFG) intervention designed for children with disabilities or chronical somatic disease and their families based on a systemic model. A mixed-methods study examines the perspectives of the participating family members regarding specific intervention components and the therapeutic process and its outcomes of this heterogeneous, closed MFG. Problem-centered interviews and questionnaires were used. Attendance of and satisfaction with the group were high. Specific intervention components such as the provided therapeutic environment and the mutual support that was facilitated by offering different opportunities for contact with families in similar situations are highlighted as particularly helpful. Increased feelings of parental togetherness and competence were reported. Results suggest that this MFG for families of children with chronic diseases or disabilities is highly feasible for these families.

[Multi-family group therapy in Germany]. / Multifamilientherapie in Deutschland.

Multi-family therapy, common group therapy with several families per one index patient, has been gaining popularity recently. This has occasioned an exploratory study of the status of implementation and common factors in all multi-family therapy programs in Germany. In a survey conducted across Germany, all providers of multi-family therapy interventions were requested to give a detailed description of their intervention. Quantitative data were analyzed with descriptive statistics, and verbal data were summarized categorically with qualitative content analysis. Of the 25 intervention programs examined 21 are directed at emotionally disturbed children and young people and their families; mainly with disturbances in social behavior. Over 4,000 families per year are treated in multi-family therapy, and five programs were systematically evaluated. MFT is characterized by systematically oriented group therapy methods. Those surveyed traced the effect of this form of intervention back to activating problems in the group, activating resources, changing perspective, learning models, experiencing self-efficacy, and the therapeutic relationship. Systematic studies of multi-family therapy in evaluations and in random controlled study designs are recommended.

Anxiety, depression, and life satisfaction in parents caring for children with cystic fibrosis.

OBJECTIVE: To assess the prevalence of symptoms of anxiety and depression and the extent of life satisfaction in parents caring for children with cystic fibrosis (CF) in Germany. METHODS: The study included 650 caregivers of 564 children with CF ages 0-17, who completed the Hospital Anxiety Depression Scale (HADS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Questions on Life Satisfaction (FLZ(M) ). RESULTS: More than one-third (37.2%) of parents showed elevated levels of anxious symptoms, compared to 18.9% of a population sample (P≤0.001) and significantly more parents reported elevated levels of depressive symptoms compared to a community sample (28% vs. 21%, P=0.01). Higher levels of anxious and depressive symptoms were associated with lower life satisfaction (P<0.001). CONCLUSIONS: High levels of anxious and depressive symptoms among parents of children with CF suggested that annual symptom screening is warranted. This will facilitate identification of those at risk and provide referrals and intervention for those who are in need of it.

Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders.

BACKGROUND: The EQ-5D is a generic questionnaire which generates a health profile as well as index scores for health-related quality of life that may be used in cost-utility analysis. AIMS OF THE STUDY: To examine validity and responsiveness of the EQ-5D in patients with anxiety disorders. METHODS: 389 patients with anxiety disorders completed the EQ-5D at baseline and 6-month follow-up. Subjective measures of quality of life (WHOQOL-BREF) and psychopathology (BAI, BDI-II, BSQ, ACQ, MI) were used for comparison. Validity was analyzed by assessing associations between EQ-5D scores and related other scores. Responsiveness was analyzed by calculating effect sizes of differences in scores between baseline and follow-up for 3 groups indicating more, constant or less anxiety. Meaningful difference scores for shifting to less or more anxiety were derived by means of regression analysis. RESULTS: 88.4% of respondents reported problems in at least one of the EQ-5D dimension at baseline; the mean EQ VAS score was 63.8. The EQ-5D dimension most consistently associated with the measures used for comparison was 'anxiety/depression'. EQ VAS and EQ-5D index scores were highly correlated (|r|>0.5) with scores of the WHOQOL-BREF dimensions 'physical', 'mental' and 'overall' as well as BAI and BDI-II. The EQ-5D index tended to be the most responsive score. Standardized meaningful difference scores were not significantly different between EQ VAS, EQ-5D index and measures used for comparison. CONCLUSIONS: The EQ-5D seems to be reasonably valid and moderately responsive in patients with anxiety disorders. The EQ-5D index may be suitable for calculating QALYs in economic evaluation of health care interventions for patients with anxiety disorders. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15716049.

Cost-effectiveness of a primary care model for anxiety disorders.

BACKGROUND: Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care. AIMS: To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care. METHOD: In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up. RESULTS: No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio

[Demographic change in psychiatry and psychotherapy--relevance of the age-relation]. / Demografischer Wandel in Psychiatrie und Psychotherapie--Relevanz des Altersbezuges.

The demographic change will lead to new challenges for the German social and health system in the near future, because it will be accompanied with a large increase of gerontopsychiatric disorders, such as dementia or depression. Age as socio-demographic variable is of high impact in psychiatric and psychotherapeutic research. We aimed to analyze the use of age as sample characteristic or explanatory variable in all publications of the journals "Psychotherapeut" and "Psychiatrische Praxis" in 2007 and 2008. Furthermore, we examined the inclusion of age groups addressed by studies to evaluate the representation of old age studies in German general psychiatric and psychotherapeutic journals. Most studies used age as sample characteristic, but not as explanatory variable in additional analyses. 10 percent of studies addressed old age subjects, especially early detection and diagnosis of dementia. In view of the future population ageing and the associated increasing relevance of mental disorders in old age, more effort in research and publication related to prevention and treatment of mental disorders in old age is required.

[Social psychiatry in the field of contrasting context between psychiatry and Social Medicine]. / Sozialpsychiatrische Forschung im Spannungsfeld zwischen Psychiatrie und Sozialmedizin.

OBJECTIVE: There has been a discussion going on that Social Psychiatry has entered a state of crisis in terms of its socio-scientific roots. Little is known, however, about its relationship to Social Medicine. The question is whether Social Psychiatry, having grown apart from Sociology, has also lost its scientific relation to Social Medicine. METHOD: A systematic literature analysis of all works published in "Psychiatrische Praxis" - PP and "Das Gesundheitswesen"--GHW in the years 2004/2005 was done. All works concerning Social Psychiatry were analysed. The same procedure was applied to all abstracts, posters and presentations for the annual meetings of the German Society of Social Medicine and Prevention (DGSMP). RESULTS: 10 % off all articles published in GHW and 97 % in PP address issues of Social Psychiatry. Apart from similarities in terms of their theoretical, practical and institutional background and the research methods applied, there are a number of differences. CONCLUSIONS: Social Psychiatry has not lost its scientific relation to Social Medicine, however, the scientific cooperation between the two needs to be intensified.

Adherence to medication and quality of life in people with schizophrenia: results of a European multicenter study.

Quality of life is often severely impaired in people with schizophrenia, and adherence to antipsychotic medication has been consistently found to be low in this population. Although there is a considerable amount of evidence on these two variables in schizophrenia research, there is only limited knowledge on how they relate to one another. The aim of this study is to develop a meaningful model of the relationship between quality of life and adherence that includes mediating variables. A multicenter randomized controlled trial recruited 409 subjects in London, Verona, Amsterdam, and Leipzig. Baseline interviews obtained data on adherence, quality of life, and other variables. We used graphical modeling to investigate the relationships between the variables. No direct relation could be discerned between subjective quality of life and adherence to medication. Mediating variables, most importantly symptomatic impairment, global functioning, and medication side effects, were identified by the model. It can be concluded that, when aiming at the improvement of quality of life in people with schizophrenia, variables other than adherence, i.e., symptomatic impairment, global functioning, and medication side effects, should be targeted.

Medication adherence in schizophrenia: exploring patients', carers' and professionals' views.

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping. Concept mapping is a structured qualitative method and was performed in 4 European countries. Participants were 27 patients with schizophrenia, 29 carers, and 28 professionals of patients with schizophrenia. Five clinically relevant themes were identified that affect adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects, and attitudes toward medication. Importance ratings of these factors differed significantly between professionals and carers and patients. Professionals, carers, and patients do not have a shared understanding of which factors are important in patients' medication adherence behavior. Adherence may be positively influenced if professionals focus on the positive aspects of medication, on enhancing insight, and on fostering a positive therapeutic relationship with patients and carers.

Sex differences in the subjective tolerability of antipsychotic drugs.

In recent years, research efforts have been directed to better characterize the subjective experience of taking psychotropic drugs. This study investigated the sex difference in the subjective tolerability of antipsychotic drugs. Participants were recruited from patients under the care of psychiatric services serving geographical catchment areas in Croydon (UK), Verona (Italy), Amsterdam (Netherlands), and Leipzig (Germany). Clinically unstable patients with a clinical diagnosis of schizophrenia and a research diagnosis of schizophrenia, established using the Item Group Checklist of the Schedule for Clinical Assessment in Neuropsychiatry, were enrolled. Antipsychotic subjective tolerability was rated by means of the Liverpool University Neuroleptic Side Effect Rating Scale. During the recruitment period, 245 men and 164 women with schizophrenia were recruited. In both sexes, the most frequently reported side effects were difficulty in concentrating, tiredness, and weight gain; these side effects occurred in approximately 50% of men and in up to 70% of women. Extrapyramidal and anticholinergic reactions were reported more often by women, whereas men reported sexual problems more often. After background group differences were controlled for, sex was the strongest determinant of the subjective tolerability of antipsychotic drugs. We therefore conclude that sex differences in the subjective tolerability of antipsychotic drugs should be taken into account in the pharmacological management of patients with schizophrenia. Studies should no longer consider men and women as a homogeneous group, given that the subjective tolerability of antipsychotic drugs substantially differs between sexes.

[Compliance in the treatment of schizophrenia -- results of an expert survey in Saxony and Saxony-Anhalt]. / Compliance in der Schizophreniebehandlung: Ergebnisse einer Expertenbefragung im Raum Sachsen und Sachsen-Anhalt.

OBJECTIVE: To report attitudes of psychiatrists and neurologists towards compliance with regard to medication-taking behaviour of patients suffering from schizophrenia. METHOD: A questionnaire was sent to psychiatrists and neurologists practising in Saxony and Saxony-Anhalt. Out of a total of 120, 54 completed questionnaires were returned. RESULTS: Most of the experts defined compliance as the degree of fidelity to treatment recommendations and patient cooperation. In the experts' view, a positive attitude towards treatment, insight into illness, and accurate perception of the symptoms correlate strongly with compliance, whereas the association between sociodemographic characteristics and compliance was seen as moderate. A majority of experts considered there were changes in compliance over time. DISCUSSION: With regard to the improvement of compliance, the importance of the doctor-patient-relationship is supported by the results of our study. As ratings of doctors suggest, compliance is a broadly determined behaviour which is variable over time. Future research on medication-related compliance in patients suffering from schizophrenia should take into account these findings.

[Effects of interventions to improve compliance with antipsychotic medication in people suffering from schizophrenia-results of recent reviews]. / Compliance-Interventionen in der medikamentösen Behandlung Schizophrenieerkrankter - Befunde aktueller Ubersichtsarbeiten.

BACKGROUND: Non-compliance (or non-adherence) with antipsychotic pharmacotherapy occurs frequently. In addition, there is overwhelming evidence that it constitutes a major risk factor for psychotic relapse. Compliance substantially affects course and treatment of schizophrenia. During the last decades, a large body of research on compliance with antipsychotic medication has been accumulated. METHOD: The authors provide an overview of meta-analyses. Reviews published since 1990 on effects of interventions aiming at increasing compliance with medication in people suffering from schizophrenia are summarized. RESULTS: We found eight reviews which reported empirical findings on the efficacy and effectiveness of interventions with the goal of improving compliance. Interventions have shown limited (psychoeducation) to moderate (cognitive-behavioral and combined interventions) effects. Other relevant findings are summarized and discussed.