Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies.

BACKGROUND: The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life. METHODS: A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review. RESULTS: Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care. CONCLUSIONS: Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.

[Depression Symptoms of Mothers and Fathers of Persons with Schizophrenia]. / Die Depressivität von Müttern und Vätern von Schizophreniekranken.

OBJECTIVE: The purpose of the present study was to investigate if depression symptomatology of patients' parents is predicted by the symptoms of schizophrenia. METHODS: 101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. Parents filled in the "Beck Depression Inventory". Patients were assessed by means of the "Positive and Negative Syndrome Scale". For statistical analyses a Multidimensional Random Coefficients Multinomial Logit Model was applied. RESULTS: We found a significant positive association between negative symptoms and depression severity of fathers and mothers. Further, a significant positive association between positive symptoms and depression severity of fathers, but not of mothers was found. CONCLUSION: Our results show that depression of mothers and of fathers is associated with symptoms of schizophrenia even when controlling for potential predictors.

[Burden of mothers and fathers of persons with schizophrenia]. / Die Belastung von Müttern und Vätern von Schizophreniekranken.

OBJECTIVE: Most studies about the burden of schizophrenia carers included only one care-giving relative, usually the patients' mothers. The present study intended to analyse differences of the level of burden between mothers and fathers of the same patients. METHODS: 101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. They were assessed by means of the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia". RESULTS: Mothers showed significantly higher scores than fathers regarding the subscores "Tensions" and "Urging". Multiple linear regression analyses showed positive associations between the frequency of mothers' as well as fathers' unmet needs and dimensions of caregiver involvement. CONCLUSION: Unmet needs among mothers and fathers have negative effects on their burden. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work.

Volunteering in the care of people with severe mental illness: a systematic review.

BACKGROUND: Much of the literature to date concerning public attitudes towards people with severe mental illness (SMI) has focused on negative stereotypes and discriminatory behaviour. However, there also exists a tradition of volunteering with these people, implying a more positive attitude. Groups with positive attitudes and behaviours towards people with SMI have received relatively little attention in research. They merit further attention, as evidence on characteristics and experiences of volunteers may help to promote volunteering. The present paper aims to systematically review the literature reporting characteristics, motivations, experiences, and benefits of volunteers in the care of people with SMI. METHODS: In November 2010, a systematic electronic search was carried out in BNI, CINAHL, Embase, Medline, PsycINFO, Cochrane Registers and Web of Science databases, using a combination of 'volunteer', 'mental health' and 'outcome' search terms. A secondary hand search was performed in relevant psychiatric journals, grey literature and references. RESULTS: 14 papers met the inclusion criteria for the review, with data on a total of 540 volunteers. The results suggest that volunteers are a mostly female, but otherwise heterogeneous group. Motivations for volunteering are a combination of what they can 'give' to others and what they can 'get' for themselves. Overall volunteers report positive experiences. The main benefit to persons with a psychiatric illness is the gaining of a companion, who is non-stigmatizing and proactive in increasing their social-community involvement. CONCLUSIONS: The evidence base for volunteers in care of people with SMI is small and inconsistent. However there are potential implications for both current and future volunteering programmes from the data. As the data suggests that there is no 'typical' volunteer, volunteering programmes should recruit individuals from a variety of backgrounds. The act of volunteering can not only benefit people with SMI, but also the volunteers. Further research may specify methods of recruiting, training, supervising and using volunteers to maximise the benefit for all involved.

Effectiveness of home treatment for elderly people with depression: randomised controlled trial.

BACKGROUND: There is little evidence available about what service models are effective in the treatment of elderly people with depression. AIMS: To test the effectiveness of home treatment for elderly people with depression living independently. METHOD: In a randomised controlled trial, 60 out-patients aged over 64 years with major depression were allocated to a home treatment model over a 1-year period or to conventional psychiatric out-patient care. The primary outcome was the level of depressive symptoms after 3 and 12 months. The secondary outcomes were global functioning, subjective quality of life (SQOL), admissions to nursing homes, duration of psychiatric hospital treatments and the cost of care. RESULTS: Individuals receiving home treatment had significantly fewer symptoms of depression, better global functioning and a higher SQOL at 3 months and at 12 months. Over 1 year they had fewer admissions to nursing homes, spent less time in psychiatric in-patient care and the cost of care was lower. CONCLUSIONS: Home treatment appears an effective and cost-effective service model for elderly people with depression.

Sinusoidal smooth pursuit eye tracking at different stimulus frequencies: position error and velocity error before catch-up saccades in schizophrenia and in major depressive disorder.

OBJECTIVE: The aim of the present study was to ascertain the extent of impairment of position error and velocity error processing in eye tracking dysfunction in schizophrenic and depressive patients. METHOD: A total of 21 schizophrenic and 19 unipolar depressive patients and 21 healthy controls were subjected to an eye tracking test with electro-oculography using horizontal sinusoidal stimuli with frequencies of 0.2-0.7 Hz. Position error and velocity error were measured over a saccade-free range of 200 ms before catch-up saccades at 50 ms intervals. RESULTS: For position error, the schizophrenia patients displayed increased values particularly compared to controls, more rarely compared to depressive patients, depending on the stimulus frequency used. The increase in stimulus frequency did not lead to an increase in position error in any group of subjects over a prolonged period. For velocity error, in contrast, the study groups differed only in a few, isolated pre-saccadic intervals. The increase in stimulus frequency, however, led to an increase in velocity error in the schizophrenia patients over the entire 200 ms interval. The depressive patients did not differ notably from the controls, neither in terms of position error nor velocity error. CONCLUSIONS: Eye tracking dysfunction in schizophrenia can be described as follows with regard to position error and velocity error: On the one hand, there is an increased position error tolerance largely independent of stimulus frequency, possibly due to an impairment of processing localization information. On the other hand, velocity processing is more severely impaired by an increase in stimulus frequency.

Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients.

Elderly people with mental health problems receive much worse outpatient care than younger people. Although the health-promoting factors are known, there are hardly any studies on effective biopsychosocial care models. A 1-year longitudinal study examined the effectiveness of the GHT presented below. For this purpose, 12 depressive and delusional patients discharged from inpatient gerontopsychiatric care received mental and social treatment and care at home for 1 year. Functionality was surveyed by means of the Global Assessment of Functioning Scale (GAF) and psychiatric symptoms by means of the Brief Psychiatric Rating Scale (BPRS). Subjective quality of life (QoL) was surveyed by means of the WHOQOL-BREF self-report questionnaire. The main findings were as follows: (1) no patient had to receive inpatient psychiatric care or be admitted to a nursing home during the study period; (2) mental QoL had improved significantly after 1 year; (3) functionality remained stable; (4) the BPRS scores did not deteriorate. We see this as confirmation that GHT is an effective instrument for extramural care of elderly people with psychiatric disorders. The limitations of the pilot study necessitate further studies to back up the findings.

[Quo vadis geropsychiatry? Perspectives for a new "state of the art"]. / Quo vadis Gerontopsychiatrie? Wege zu einem neuen "State of the Art".

The number of older geropsychiatric patients is increasing dramatically. "The Big Three -- Dementia, Depression, Delusion" are challenging our care system. Today 80 % of those affected live at home, with 5-8 % receiving care in facilities. There is very little between. What is lacking: cross-facility co-ordination, co-operation, systems of reference with overall responsibility, ease of access, particularly of clarification and consulting services, mobility of psychical support, massive support for relatives, and specialised, graduated services for various areas of life and needs. A vision of an integrated supply of services is delineated, the intertwining of private, mobile and inpatient modules adumbrated. Simultaneously the problems with transitions, education and case conferences, specialists, conference of the supporters and quantity structure of services are addressed. Solutions are suggested and the solvability of this important socio-political problem of the next decades demonstrated.

[Encountering the person in his environment--approaches to psychosocial management]. / Dem Menschen in seiner Welt begegnen--Wege zur psychosozialen Versorgung.

INTRODUCTION: Is it necessary to understand your vis a vis or is it enough to meet, to get in touch? Awareness of the different perception of reality is important. INTERINDIVIDUELL: Defined as basic requirements for getting in touch, mutual modelling and interchange were "Knowing your own world", "Being curious about the world of the other", candour and tolerance. Time makes the essential framework. GROUPS/ORGANISATIONS: Are the interindividuell parameters also practicable for groups/organizations? DISCUSSION: In the psychosocial context the subjective perception of the world is cause and cure at the same time. The basic requirements enable people, by getting in touch, to reorganize themselves.