[Community mental health approaches for avoidance of patient placement in closed psychiatric facilities-a positioning]. / Gemeindepsychiatrische Ansätze zur Vermeidung der Unterbringung in geschlossenen Heimen ­ eine Positionsbestimmung.

BACKGROUND: In many cases the placement of people with mental disorders in closed residential homes is an expression of the lack of alternative care options. In the area of tension between the need for security in the case of chronically self-endangering behavior, recurrent acute psychiatric crisis interventions and a lack of perspective to establish a permanent therapy, in many places a placement in a closed facility approved under care law is carried out. OBJECTIVE: What alternatives are there to closed institutional care in the psychiatric care system in Germany? METHODS: A trialogical discussion process was carried out in an expert panel taking the relevant literature into consideration and with the participation of organizations of those affected and their relatives. RESULTS: The community psychiatric care system in Germany is extremely heterogeneous. The fragmented sociolegal and financing systems makes cross-sectoral and continuous care planning and service provision difficult. Precisely tailored and individualized services that could prevent the persons concerned from being placed in a closed home exist in Germany only at a few locations and in the form of individual model projects. CONCLUSION: The structural and sociolegal deficits addressed require a reform of the institutional framework and a redirection of all actors involved, including the clinics. Alternative approaches to the care of people with severe mental disorders are outlined. These include the Wedding model, binding community psychiatric structures, the basic functional model and assistance services under the German Social Code IX following the revision of the Federal Participation Act.

[The experience of being admitted to a psychiatric clinic: part 1: development of a questionnaire (QAE-P)]. / Das Erleben der Aufnahme in eine psychiatrische Klinik : Teil I: Entwicklung eines Fragebogens (FEA-P).

BACKGROUND: The aim of the present study was to develop a questionnaire to assess the perception and evaluation of admission to a psychiatric hospital from a patient's perspective (QAE-P). MATERIAL AND METHODS: Based on existing literature and a preparatory pilot study, a questionnaire consisting of 126 items was developed, and 708 inpatients based in 6 psychiatry and psychotherapy clinics were asked to answer the items. The resulting data were split into two data sets. In the first subset, exploratory factor analysis was used to help determine the number of scales and provide the basis for item reduction. The resulting questionnaire was validated by means of confirmatory factor analyses (CFA) in the second data subset. RESULTS: The resulting questionnaire comprises 33 items in 7 scales, which assess: (1) helpful, positive relations with staff members; (2) offering of medical explanations to patients and their involvement in treatment planning; (3) evaluation of rooms and clinical environment; (4) dissatisfaction with doctors and staff members; (5) evaluation of handling of ward rules by staff; (6) perception of ward atmosphere; and (7) negative perception of other inpatients. The plausibility of this factorial structure was supported by the results of the CFA. CONCLUSIONS: The QAE-P is a short and feasible questionnaire that meets the criteria of classic test theory and assesses different dimensions of the patient's experience of admission to a psychiatric hospital.

[The experience of being admitted to a psychiatric clinic: part 2: comparative analyses of patient and hospital characteristics]. / Das Erleben der Aufnahme in eine psychiatrische Klinik : Teil II: Vergleichende Analysen von Patienten- und Klinikmerkmalen.

BACKGROUND: The purpose of this study was to investigate associations of patient's scores in the newly constructed questionnaire on patients' psychiatric admission experiences (QAE-P) and individual, institutional, and situational factors. PATIENTS AND METHODS: Data of 708 patients and 6 participating hospitals were analyzed. Patient characteristics between clinics were compared and univariate as well as multivariate analyses were applied to examine associations of QAE-P total score and individual as well as institutional variables (t tests, univariate and multivariate analyses of variance, correlation analyses, and effect sizes of significant associations). RESULTS: There was little variance of patient characteristics between hospitals. Multiple univariate associations with small to medium effect sizes were found between total QAE-P scores and demographic and clinical variables of the patients, institutional variables, and (non-independent) situational views of the patients. After multivariate analyses were applied, these associations remained significant for gender, age, diagnosis, the personal decision to be admitted, and for previous planning of admission with the outpatient doctor. The hospital variables shown to be associated with total QAE-P scores were open versus closed ward, disorder-specific organization of the ward, and the number of other patients being treated under the German Mental Health Act. CONCLUSION: Principally the QAE-P seems to be a suitable instrument of quality management. A number of factors were identified that show associations with the subjective evaluation of admission as reported by the patients. Some of these variables are within the control of the clinical management.

[Use of joint crisis plans in psychiatric hospitals in Germany: results of a nationwide survey]. / Anwendung psychiatrischer Behandlungsvereinbarungen in Deutschland : Ergebnisse einer bundesweiten Befragung.

OBJECTIVE: Joint crisis plans in psychiatry are consensus-oriented instruments for patients to state their will in case of a crisis. The aim of this survey is to determine the prevalence, practice and barriers for implementation of joint crisis plans in Germany. METHODS: In spring 2009, 366 psychiatric hospitals in Germany were asked to complete a questionnaire. RESULTS: The return rate was 46.4%; 68% of the participating hospitals offered joint crisis plans. The number of completed joint crisis plans was low (median 2.7/year per clinic). The demand did not increase according to a majority of the hospitals. The main reason for hospitals to abstain from joint crisis plans was low demand. Hospitals providing the option of joint crisis plans reported positive experiences. CONCLUSIONS: A theoretical offer of joint crisis plans is widespread in German psychiatric hospitals. Despite positive experiences, patients do not ask for them frequently.

Failure of taxol-based combination chemotherapy for malignant glioma cannot be overcome by G2/M checkpoint abrogators or altering the p53 status.

In an effort to develop more effective forms of adjuvant chemotherapy for malignant brain tumors, we sought to develop a taxol-based combination chemotherapy regimen for glioma cell lines in vitro. Here, we report that coexposure of LN-229 or T98G glioma cells to taxol and either doxorubicin, camptothecin, cytarabine, or VM26 resulted in antagonistic effects rather than additive or synergistic cytotoxicity. There were no interactions of taxol with the effects of carmustine (BCNU) or vincristine. Antagonism was more prominent in cytotoxic cell death assays than in clonogenic cell death assays and was not overcome by G2/M checkpoint abrogators such as caffeine or pentoxyfilline. Ectopic expression of mutant and wild-type p53val135 attenuated taxol cytotoxicity in both T98G cells, which are mutant for p53, and LN-229 cells, which exhibit functional wild-type p53 activity. Interestingly, wild-type p53val135 abrogated the taxol-imposed G2/M arrest in both cell lines. However, wild-type p53val135 did not promote glioma cell killing by combinations of taxol and any of the other drugs. Further, an analysis of a panel of 12 human glioma cell lines revealed no relationship between genetic or functional p53 status and taxol sensitivity. In summary, combination either with other chemotherapy drugs, with abrogators of the G2/M checkpoint, with wild-type p53 gene transfer was not a promising approach for a taxol-based combination chemotherapy regimen in malignant glioma.

[Evidence-based psychotherapy of schizophrenic disorders]. / Evidenzbasierte Psychotherapie schizophrener Störungen.

In the past, treatment of schizophrenic disorders was limited to pharmacotherapy. Psychotherapy was not regarded as evidence-based. A number of randomised clinical trials have led to a different perspective during the last two decades. This paper highlights and discusses evidence-based strategies. In particular, cognitive behavioural therapy and family intervention have recently been recommended in evidence-based treatment guidelines. Additionally, psychoeducation and social skills training showed treatment effects. Psychotherapeutic treatment requires an individual case concept. Neuropsychological testing for cognitive deficits should be included in comprehensive assessment in order to avoid overstimulation and optimise rehabilitation. Major treatment goals are to reduce persistent symptoms and relapse rates.

[Concepts in early planning for vocational rehabilitation in schizophrenia patients during acute care]. / Konzepte beruflicher Rehabilitationsvorbereitung für schizophrene Patienten während der Akutbehandlung.

The particular relevance of employment for financial independence, acquisition of social skills and, hence, an increase in self-confidence is undeniable, and has for several years now been increasingly considered an essential component of care notably in psychiatric disorders. Vice versa, unemployment is deemed a potential risk factor with regard to poorer therapeutic response and social integration as well as a higher incidence of crises in persons with mental illness. Schizophrenia is among the psychiatric disorders very often resulting in unemployment and subsequent early pensioning. Planning for vocational rehabilitation early-on during acute care therefore is considered of greatest importance especially in this patient group. This article gives a brief overview of the main concepts drawn on in preparing the vocational rehabilitation of patients with Schizophrenia, focussing in particular on their relevance for daily practice and the possibilities for evaluating their effectiveness.