Effectiveness of supported housing versus residential care in severe mental illness: a multicenter, quasi-experimental study.

PURPOSE: Up to now there are only few studies and no RCT comparing efficacy or effectiveness of supported housing (SH) versus residential care (RC) in severe mental illness (SMI) without homelessness. Here we present an observational follow-up study in SMI subjects, who entered SH or RC, to compare clinical and functional outcomes 2 years later. METHODS: In this prospective study in more than 30 locations throughout a German federal state, we included SMI subjects, who entered SH (n = 153) or RC (n = 104). About one quarter suffered from each substance use, psychotic, affective, or other disorders. To avoid sampling bias, we used the propensity score matching method to establish a quasi-experimental design. Outcome measures were social functioning (SFS), the number of psychiatric hospitalisations, psychopathology (SCL-9-K), and quality of life (MANSA). Apart from descriptive methods we analysed primarily using repeated-measures ANOVAS. RESULTS: Our analyses revealed significant effects of time for all outcomes in both study groups. However, there were not any group differences of outcome measures, i.e., not any significant effects of group or interactional effects of group x time. Moreover, these results hold true for intent-to-treat and per-protocol sample analyses. CONCLUSION: The results show, that SH and RC for non-homeless people with SMI achieve the same clinical and psychosocial outcomes across a 2-year period. Taking into account the users' preferences, the present findings should give reason to ensure the availability of affordable housing and to support the expansion of supported housing approaches.

Investigating biases of attention and memory for alcohol-related and negative words in alcohol-dependents with and without major depression after day-clinic treatment.

This study aimed to investigate attentional and memory biases in alcohol-dependents with and without major depression compared to healthy controls. We assumed that both groups of alcohol-dependents would show attentional and memory biases for alcohol-related words. For the alcohol-dependents with depression, we additionally expected both types of biases for negative words. Alcohol-dependents without co-morbidity (Alc) and alcohol-dependents with major depression (D-Alc) as well as control participants with a moderate consumption of alcohol (Con) completed an alcohol Stroop task and a directed forgetting paradigm using word stimuli from three categories: neutral, negative, and alcohol-related. Stroop effects showed that not only alcohol-dependents but also control participants were more distracted by alcohol-related than by negative words. In the directed forgetting procedure, all participants showed a significant effect for each word-category, including alcohol-related and negative words. The D-Alc-group memorized more alcohol-related than negative to-be-remembered words. The results do not corroborate the hypothesis of more pronounced attentional and memory biases in alcohol-dependents. However, in alcohol-dependents with depression a memory bias for alcohol-related material was found, suggesting that this group may be more pre-occupied with alcohol than patients without such co-morbidity.

The individualized alcohol Stroop task: no attentional bias toward personalized stimuli in alcohol-dependents.

This study aimed to investigate attentional bias in alcohol-dependent patients and control participants with regard to individualized (specific) and nonindividualized (general) alcohol-related words. First, it was assumed that alcohol-dependents rather than control participants are more distracted by alcohol-related words, particularly individualized alcohol-related words, than by non-alcohol-related words. Second, words which are derived from participants' individual drinking experiences were assumed to induce the highest Stroop interference over all participants. Alcohol-dependent patients (Diagnostic and Statistical Manual of Mental Disorders IV, n = 39) and healthy control participants with a moderate consume of alcohol (n = 33) completed a modified alcohol Stroop task based on word stimuli derived from four categories: neutral versus negative and specific versus general alcohol-related words. While alcohol-dependents showed similar RTs in the different word categories, control participants showed the slowest reactions after presentation of specific alcohol-related words. Generally, alcohol-dependents had slower RTs than controls did. The results do not corroborate the hypothesis of increased interference caused by specific alcohol-related words in alcohol-dependents-instead, this presumption seems to apply to the control participants only. As we did not find any special impact of personally relevant alcohol-related words outclassing the influence of preselected alcohol-related words in the patient group, the benefit of individualized stimuli should be reconsidered. Our results do not support the relevance of attentional retraining programs.

[Motivational interviewing and brief interventions by general practitioners]. / Motivierende Gesprächsführung und Kurzinterventionen in der ärztlichen Praxis.

Several studies have shown that brief interventions by general practitioners are a powerful tool for initiating changes in patients' substance consumption patterns and related behaviour. Based on a general-practice case study (of a patient with harmful patterns of alcohol consumption) the principles and most important strategies of brief motivational interviewing are presented. These are: the clarifying of the GP's own position, the giving and receiving of feedback, the highlighting of the patients responsibility, the estimating of the limits of counselling and the degree of motivation to change behaviour shown by the patient, the specifying of the goals of change and the creation of agreement on concrete strategies, the identifying of barriers to change and the developing of coping skills, thereby enhancing self-efficacy. The article relates these strategies to the stages of change.