[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. / Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB : Interdisziplinäre Task-Force der DGPPN.

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

[Quality Indicators for Integrated Care in Patients with Schizophrenia - Results from a Feasibility Study]. / Qualitätsindikatoren für die Behandlung von Menschen mit Schizophrenie ­ Ergebnisse einer Anwendungsstudie.

Objective The study aimed to evaluate the applicability of a set of quality indicators to assess models of integrated care for patients with a diagnosis of schizophrenia. We report first values for these indicators in routine care in Germany. Methods The study is based on a cohort of adult patients with schizophrenia insured by one large German statutory health insurance company, which were assessed two times and gave consent to evaluate their routine claims data. The study tried to use 12 basic and 22 quality indicators from claims data. Results It was possible to estimate most structural indicators using available data, but only half of the quality indicators. This means that while assessment of quality indicators is feasible in general, routine claims data needs to be supplemented by additional (primary) data. Four of the calculated quality indicators had clear targets or red-flag values, which were not met in our cohort in all four indicators. None of the patients had an outpatient mental health related contact within one week (target > 90 %). The readmission rate within 30 days (21 %) was twice as high as the proposed red-flag value of 10 %. Similar figures were seen for antipsychotic polypharmacy (25 %, red-flag value > 10 %) and the proportion of patients with compulsory treatment (15 %) exceeded the red-flag value by 5 %. Conclusion The study shows that it is possible to measure quality indicators, but also demonstrates considerable limitations. There is a need to validate indicators in routine care.

Perfil clínico-epidemiológico de pacientes atendidos em ambulatório psiquiátrico / Perfil clínico y epidemiológico de pacientes atendidos en ambulatorio psiquiátrico / Clinical and epidemiological profile of patients treated in psychiatric outpatient

Introdução: caracterizar os usuários com transtornos mentais nos diversos serviços de saúde é de extrema importância para o planejamento e implementação de mudanças na política assistencial. Objetivo: descrever o perfil clínico-epidemiológico de pacientes atendidos em ambulatório psiquiátrico. Métodos: foram analisados 97 prontuários de pacientes do anexo psiquiátrico de um hospital general do município de Jequié, Bahia, Brasil. Os dados foram coletados utilizando-se um formulário, processados através do software SPSS, versão 15.0, e analisados através da estatística descritiva simples. Resultados: 54,6 porcento dos pacientes são do sexo masculino; 29,9 porcento estão na faixa etária de 30-39 anos; 56,8 porcento faziam uso de antipsicóticos neurolépticos; 54,6 porcento evoluíram com orientação durante as consultas; 94,1 porcento das variáveis apresentaram incompletude das informações. Conclusão: os pacientes têm sido beneficiados com o tratamento ambulatorial e a terapêutica farmacológica, evoluindo com remissão dos sintomas psicopatológicos, necessitando de utilização de estratégias alternativas para complementar o tratamento. O registro adequado e organizado dos prontuários é fundamental para subsidiar o direcionamento na produção do cuidado, possibilitando o planejamento das ações e gestão de políticas de saúde mental(AU)

Introducción: caracterizar los usuarios con trastornos mentales en diferentes servicios de salud es muy importante para la planificación e implementación de cambios en la política asistencial. Objetivo: describir las características clínicas y epidemiológicas de pacientes tratados en ambulatorios psiquiátricos. Métodos: fueron analizados 97 prontuarios de pacientes del anexo psiquiátrico de un hospital general del municipio de Jequié, Bahia, Brasil. Los datos fueron recogidos mediante un formulario, procesados ​​a través del software SPSS, versión 15.0, y analizados con estadísticas descriptivas simples. Resultados: el 54,6 por ciento de los pacientes eran hombres, 29,9 por ciento tenían entre 30 y 39 años, 56,8 por ciento usaban antipsicóticos neurolépticos, 54,6 por ciento directrices elaboradas durante las consultas. El 94,1 por ciento de las variables presentaron incompletud de las informaciones. Conclusiones: los pacientes se han beneficiado con el tratamiento ambulatorio, la terapéutica farmacológica y el uso de estrategias alternativas para complementar el tratamiento, evolucionando con remisión de los síntomas psicopatológicos. El registro correcto y organizado de los prontuarios es fundamental para subsidiar el direccionamiento en la producción del cuidado, posibilitando la planificación de acciones y la gestión de políticas de salud mental(AU)

Introduction: to characterize users with mental disorders in different health services is extremely important for the planning and implementation of changes in welfare policy. Objective: to describe the clinical and epidemiological profile of patients treated in psychiatric outpatients. Methods: were analyzed medical records of 97 patients of psychiatric annex of a general hospital of Jequié, Bahia, Brazil. The data were collected using a form, processed through the SPSS software, version 15.0, and analyzed using simple descriptive statistics. Results: 54,6 percent of patients are male, 29,9 percent are aged between 30-39 years, 56,8 percent are using neuroleptic antipsychotics, 54,6 percent progressed with orientation during consultations, 94,1 percent of the variables had incompleteness of information. Conclusions: the patients have been benefited with ambulatory treatment and pharmacological therapy, evolving with remission of psychopathological symptoms, necessitating utilization of alternative strategies to complement the treatment. The appropriate registration and organized of the medical records is fundamental to subsidize the targeting in the production of care, enabling action planning and management of mental health policies(AU)

'Old' and 'new' institutions for persons with mental illness: treatment, punishment or preventive confinement?

Despite countless promises for a better life by national commissions, governments and the international community, there has evolved a vicious cycle of neglect, abandonment, indignity, cruel and inhuman treatment, and punishment of persons with mental illness. This shameful history of benign, and sometimes malignant, neglect of persons with mental illness is well understood, with the deep stigma and unredressed discrimination, the deplorable living conditions, and the physical and social barriers preventing their integration and full participation in society. The maltreatment of this vulnerable population has been reinforced by the hurtful stereotypes of incompetency and dangerousness. The belief that persons with mental illness are uniformly dangerous is an equally harmful myth. It provides policy makers with an ostensible justification to exercise control over persons with mental illness, even if they have not committed a violent offence. However, research demonstrates that the class of persons with most mental illnesses is no more dangerous than other populations, and that the vast majority of violence is committed by persons without mental illness. This article will show how this vulnerable population has been unconscionably treated. First, the gross violations of human rights that have occurred, and continue to occur, in 'old' psychiatric institutions will be examined. The deinstitutionalization movement, however, resulted in new places of confinement for this population, such as jails, prisons and homeless shelters. The second part of this paper will explore the new realities of criminal confinement of persons with mental illness. As we will see, incarceration of this vulnerable population in the criminal justice system has caused enormous suffering. If Dostoyevsky was correct that the 'degree of civilization... can be judged by entering its prisons', then by that measure, we are a deeply uncivilized society.

[Good medical care at the borderline of mental incompetence]. / Goed hulpverlenerschap aan de grens van de wilsbekwaamheid.

A 73-year-old woman with minor intellectual skills had complaints which suggested a vulvar carcinoma. Despite her refusal she was examined and admitted to hospital, on the basis of good professional care. The psychiatrist examined her and judged her incompetent. For the operation of the diagnosed vulvar carcinoma a court ordered representative was obtained. Two months later she underwent radiotherapy to prevent local complications and pain and a few weeks thereafter she died. Because medical decision-making in a doctor-patient relationship is not always possible decision-making power should be assigned to a third party. That forms the basis of proper medical care.

Reforma psiquiátrica: um processo em construçäo na prática dos enfermeiros do Rio Grande do Sul / Psychiatric reform: a construction process in nursery practices, Rio Grande do Sul, Brazil

Neste estudo, procurou-se compreender a prática dos enfermeiros inseridos em serviços de saúde mental extra-hospitalares no Rio Grande do Sul, a fim de identificar a incorporaçäo dos princípios da Reforma Psiquiátrica no trabalho que desenvolvem. A investigaçäo revelou que os enfermeiros estäo construindo nos municípios modelos de atençäo nos quais a reintegraçäo do doente mental é buscada através de sistemas que väo se constituindo em redes de atençäo, a partir de parcerias entre diversos setores e instituiçöes. O trabalho é permeado de conflitos e resistências, necessitando ser repensado em cada situaçäo. O processo de trabalho predominante entre os enfermeiros tem como objeto o sujeito na sua existência-sofrimento, tendo como finalidade a ampliaçäo da capacidade de autonomia. Como instrumental de trabalho, os enfermeiros desenvolvem um conjunto articulado de açöes individuais e coletivas no qual as singularidades säo contempladas num projeto terapêutico individualizado, intervindo no poder contratual desses sujeitos