[Waiting for Asylum: Psychiatric Diagnosis in Bavarian Admission Center]. / Warten auf Asyl: Psychiatrische Diagnosen in der zentralen Aufnahmeeinrichtung in Bayern.

INTRODUCTION: In 2014, 15% of about 140,000 asylum seekers were distributed to Bavaria. The Bavarian State Ministry of Labour and Social Affairs, Family and Integration promoted a project under which, first, the frequency and nature of psychiatric diagnoses among asylum seekers in the ZAE Zirndorf should be examined and, secondly, recommendations on psychiatric-psychological care of asylum seekers should be carried out. METHODS: A total 283 asylum seekers were examined. The sample was composed of 2 sample groups: self-referrals and a randomized group. A structured diagnostic interview and several self- and external assessment scales were used (MINI, BSI, MADRS, WHO-5, ETI, PSQI). RESULTS: In 180 (63,6%) asylum seekers, one or more psychiatric diagnoses were made. The most common diagnosis was posttraumatic stress disorder (F43,1) followed by depressive, recurrent depressive episodes (F32, F33), adjustment disorder (F43,2) and chronic insomnia (51,0 F). Suicidal thoughts were explored in 26% of self-referrals and only in 6% in the random sample. CONCLUSION: We recommend a low-threshold psychiatric emergency care for asylum seekers in the central refugee reception facility. This should not be done on voluntary basis, but must be regulated by law. For comprehensive care by national healthcare physicians, the social welfare law on asylum seekers (1993) must be revised.

[The assessment and course of development of cognitive abilities in the elderly]. / Diagnostik und Verlauf von kognitiven Fähigkeiten bei älteren Menschen.

BACKGROUND: The assessment of the appropriate level of development in children belongs to the standard duties of physicians in the public health system. Due to a steady increase of dementia in Germany the assessment of cognitive abilities of the elderly is becoming more and more the focus of future activities. Such an assessment of cognitive functioning reveals whether the respective person is aging normally or whether the impaired cognitive functioning is probably based on a pathological process. OBJECTIVE: The aim of the present study is to present cognitive changes in the aged and 2 psychometric tests for the assessment of cognitive functioning: the Wechsler Adult Intelligence Scale (WAIS-IV) and the Short Cognitive Performance Test (SKT), a test for the assessment of memory impairments and impairment of attention. In addition, similarities and dissimilarities are presented. METHODS: As part of a multi-centre study in German-speaking countries the data of 504 cognitively healthy persons between the age of 60 and 90 were tested with the WAIS-IV and the SKT. RESULTS AND CONCLUSION: The results revealed a significant cognitive decline in the fluid and crystal intelligence depending on age. Only 2 subtests of the WAIS-IV (General Information and Block Design) showed no significant variation due to age. The SKT scores of memory and attention correlated significantly with almost all subtests of the WAIS-IV. The highest correlations were between the SKT attention score and the WAIS-IV subtests for processing speed, perceptual reasoning and working memory. The decline in cognitive abilities is mainly due to reduced capacities in speed of information processing and working memory.

The role of alcohol use disorder and alcohol consumption in suicide attempts--a secondary analysis of 1921 suicide attempts.

BACKGROUND: It is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts. METHODS: Data on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis. RESULTS: In 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often. CONCLUSIONS: Individuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.

[Comparison of patient therapy adherence of two structural different memory clinics]. / Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur.

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

The Alzheimer's disease activities of daily living international scale (ADL-IS).

BACKGROUND: Activities of daily living (ADL) deficits are integral components of dementia disorders, and ADL measures are among the most robust markers of the course of Alzheimer's disease (AD). Despite this acknowledged importance, no clearly useful ADL instrument for cross-cultural application in pharmacologic trials in the early stages of AD had been available. METHOD: An international effort was launched to develop an ADL scale for pharmacologic trials in early AD. Steps taken from 1990 to the present included: (1) international scientific working group meetings and reviews, (2) reviews of existing measures, (3) collating of existent, nonredundant items, (4) querying experts for new items, (5) interviews with informants and subjects in the USA, France, and Germany, toward the identification of potential new items, (6) identification of an item pool based upon these procedures, (7) creation of a trial instrument, (8) piloting of this instrument, and (9) refinement of the scale based upon statistical analysis of the pilot data. Final item selection was based upon: (1) relevance for > or = 80% of subjects in severity-stratified USA and German samples; (2) absence of gender and national biases; (3) significant (p <.05) discrimination between (a) normal versus mildly impaired and (b) mildly impaired versus moderately to moderately severely impaired subjects; and (4) Global Deterioration Scale (GDS) scores accounting for > or = 12% of variance in the item after controlling for age and gender. RESULTS: An ADL scale consisting of 40 items that correlate with the global and cognitive progress of AD is developed for international usage in pharmacologic trials in incipient, mild, moderate, and moderately severe AD. The scale contains 40 items falling within 13 ADL categories. The 40-item scale is shown to have .81 correlation with GDS staging, .81 with mental status assessment (Mini-Mental State Examination), and .81 with a psychometric test (the SKT) (p values < .001). CONCLUSION: This scale can be used to measure therapeutic response in AD.

The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries.

The Bayer-Activities of Daily Living Scale (B-ADL) is a 25-item, informant-rated questionnaire which was developed as a brief and internationally applicable instrument for assessing functional disabilities. The scale's target group are elderly patients suffering from mild to moderate dementia or cognitive impairment. To investigate the reliability and validity of different language versions, the B-ADL was administered in the UK, Germany, and Spain to a total of 1,433 subjects with a wide range of cognitive decline. The results from the three country samples were very similar, with internal consistency being above 0.98 (Cronbach alpha). A factor analysis revealed that a one-factor solution accounted for most of the variance. The B-ADL total score significantly increased between adjacent Global Deterioration Scale (GDS) stages 1 to 5. A second factor analysis entering additional variables (GDS stage, Mini-Mental State Examination or MMSE subscores, age, years of education, gender, and country) revealed that all B-ADL items loaded on the same factor, "dementia severity", and that they were not related to age, education, gender, or country. In the identification of subjects with clinically manifest dementia symptoms (GDS stages 4 and 5), the B-ADL proved to be as efficient as the MMSE in the UK and German samples and superior to the MMSE in the Spanish sample.

[Loss of activities of daily living function (ADL) and cognitive impairment in various stages of dementia. A comparison of ADL informant ratings, ADL self ratings and psychometric test results]. / Beeinträchtigungen der Alltagsaktivitäten (ADL) und der kognitiven Leistungsfähigkeit in unterschiedlichen Demenzstadien. Ein Vergleich von ADL-Fremdbeurteilungen, ADL-Selbsteinschätzungen und einem psychometrischen Leistungstest.

In addition to cognitive performance tests, the assessment of activities of daily living (ADL) is becoming increasingly important in diagnosing and following up dementia. Therefore, we compared results obtained from ADL informant and self reports and from the SKT short test for assessing deficits of memory and attention. Data were available from a total of 193 elderly subjects in different stages of cognitive decline (GDS stages 1-5). First, we determined for each GDS group separately the numbers of subjects assessed as being impaired by each of the three methods alone as well as in combination. Furthermore, the contribution of the two ADL measures, the SKT total score, age, depression and education in the prediction of the global severity assessment according to GDS was evaluated. Finally, the influence of the latter three variables on the ADL and SKT results was estimated by existing correlations. In GDS stage 2, ADL self rating was the only approach revealing impairment with a majority of patients. The number of patients assessed as being impaired by ADL informant ratings and the SKT only increased after GDS stage 2. Analyses of patterns of impairment showed that 66% of subjects in GDS stage 1 were rated as unimpaired by each of the three methods. Of patients classified as GDS 4 and 5, 85% and 92% respectively were unanimously rated as impaired. In GDS stages 2 and 3 a great heterogeneity of patterns was found. In a logistic regression model predicting clinically manifest dementia symptomatology (GDS 4 + 5 vs GDS 1 + 2 + 3) the SKT and ADL informant ratings were included. In a second model predicting membership in a group without cognitive impairment (GDS 1 + 2) or in a group suffering from mild cognitive impairment (GDS 3) self-rated ADL and age were additionally entered. Especially for an early diagnosis of dementia, on the basis of the study results the usage of different assessment methods (ADL informant rating, ADL self rating, psychometric test) is suggested.

The Bayer Activities of Daily Living Scale (B-ADL).

The Bayer Activities of Daily Living Scale (B-ADL) has been developed on an international basis to assess deficits in the performance of everyday activities. The scale's main target group is community dwelling patients who suffer mild cognitive impairment or mild-to-moderate dementia. It comprises 25 items and takes the form of a questionnaire to be completed by a caregiver or other informant sufficiently familiar with the patient. Statistical, clinical and domain-related criteria were used to select items from among a large number of activities of daily living (ADL) questions field tested in pilot studies in the USA, Germany, UK, Russia and Greece. The items included in the B-ADL have been chosen for their sensitivity to cognitive impairment, simplicity of concept, international applicability and their relevance to patients coping with the demands of everyday life. The scale uses items which reflect a wide range of domains. On account of its brevity, it is thought especially suitable for application within a GP and primary care context for both screening a patient's ADL capacities as well as for documentation of treatment effects and the progress of dementia. This paper focuses on a description of the scale and its application.

Evidence of the cross-cultural stability of the factor structure of the SKT short test for assessing deficits of memory and attention.

Many of the psychometric instruments employed in dementia research are adapted versions of tests developed in countries different from those in which they are applied. The validity of these instruments has been established in their countries of origin; however, there is little information available regarding their validity when transferred to other cultures. The SKT, a short cognitive performance test for the assessment of memory and attention deficits developed and validated in Germany, was administered in research centers in Chile, Greece, Russia, and England. SKT raw scores were factor analyzed with regard to a prespecified target structure, i.e., the factor solution found for a large German reference sample. The cross-cultural stability of the test was assessed using a statistical method that combined the perfect congruent weights approach and the bootstrapping technique. This procedure allowed for testing the similarity between factorial solutions obtained for the different centers. Results clearly indicate the factorial stability of the SKT in the countries participating in the study.

Informant-rated activities-of-daily-living (ADL) assessments: results of a study of 141 items in the U.S.A., Germany, Russia, and Greece from the International ADL Scale Development Project.

The analyses of an international pilot study presented in this article focused on the development of a cross-nationally valid activities-of-daily-living (ADL) scale sensitive to therapeutic effects in patients with mild memory impairment and mild to moderately severe dementia. The present report, which is part of an ongoing international research project, describes field testing results for 141 informant-rated items. The comparability of samples investigated in research centers in the U.S.A., Germany, Russia, and Greece concerning cognitive decline was evaluated globally as well as psychometrically using the Global Deterioration Scale, the Short Cognitive Performance Test, and the Mini-Mental State Examination. In the participating countries, a composite ADL score discriminated well between different stages of cognitive impairment because of dementia. However, international differences between the applied measures were observed. A practical ADL scale showing therapeutic sensitivity and international utility, will be constructed from the 141 informant-rated items under investigation in this pilot work.

The SKT--a short cognitive performance test for assessing deficits of memory and attention.

The SKT is a simple and short test for assessing cognitive impairment of memory and attention. The test consists of nine subtests, each limited to a maximum performance time of 60 seconds. Thus, total testing time normally does not exceed 10 to 15 minutes. Test scoring and auditing are also accomplished within a short time and are easily learned. The test is useful for staging the severity of cognitive deficits and for assessing the benefits of therapy, especially with patients suffering from dementia. The SKT is highly accepted both by patients, who are motivated by the appealing character of the tasks and their play-like nature, and hospital clinicians and general practitioners (GPs) because of its brevity and simplicity. The SKT was introduced in Germany two decades ago and has been successfully validated. Test versions of the SKT in English and other languages have confirmed its international applicability and validity, a point of particular importance in light of the current attempts to harmonize methods for assessing the efficacy of pharmaceutical products.