Needs of forensic psychiatric patients with schizophrenia in five European countries.

AIMS: The purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff. METHODS: Patients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants' needs were assessed using the Camberwell Assessment of Needs-Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs. RESULTS: In this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS. CONCLUSIONS: Staff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients' self-assessments of needs yield important information for providing sufficient help and support.

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial.

AIMS: As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. METHODS: Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. RESULTS: Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). CONCLUSIONS: The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.

Effects of media stories featuring coping with suicidal crises on psychiatric patients: Randomized controlled trial.

BACKGROUND: Accumulating evidence suggests beneficial effects of media stories featuring individuals mastering their suicidal crises, but effects have not been assessed for psychiatric patients. METHODS: We randomized n = 172 adult psychiatric patients (n = 172, 97.1% inpatients) to read an educative article featuring a person mastering a suicidal crisis (n = 92) or an unrelated article (n = 80) in a single-blind randomized controlled trial. Questionnaire data were collected before (T1) and after exposure (T2) as well as 1 week later (study end-point, T3). The primary outcome was suicidal ideation as assessed with the Reasons for Living Inventory; secondary outcomes were help-seeking intentions, mood, hopelessness, and stigmatization. Differences between patients with affective versus other diagnoses were explored based on interaction tests. RESULTS: We found that patients with affective disorders (n = 99) experienced a small-sized reduction of suicidal ideation at 1-week follow up (mean difference to control group [MD] at T3 = -0.17 [95% CI -0.33, -0.03], d = -0.15), whereas patients with nonaffective diagnoses (n = 73) experienced a small-sized increase (T2: MD = 0.24 [95% CI 0.06, 0.42], d = 0.19). Intervention group participants further experienced a nonsustained increase of help-seeking intentions (T2: MD = 0.53 [95% CI 0.11, 0.95], d = 0.19) and a nonsustained deterioration of mood (T2: MD = -0.14 [95% CI -0.27, -0.02], d = -0.17). CONCLUSIONS: This study suggests that patients with affective disorders appear to benefit from media materials featuring mastery of suicidal crises. More research is needed to better understand which patient groups are at possible risk of unintended effects.

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis.

AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers. METHODS: We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason. RESULTS: We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = -0.71; 95% confidence interval [CI] -1.01 to -0.41; I2 = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = -1.02; 95% CI -1.52 to -0.51; I2 = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = -1.05; 95% CI -1.55 to -0.56; I2 = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life. CONCLUSIONS: Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.

Parent-reported behavioural and emotional problems in Albanian Kosovar children.

AIMS: Because no epidemiological study has been conducted of children's mental health problems in Kosova, which experienced a traumatic war in 1998-99, we conducted the first national epidemiological survey of children's mental health ever undertaken in Kosova. METHODS: Participants were 1374 Kosovar children ages 6-18 recruited through schools (60% from urban areas). Parent-reported behavioural and emotional problems were assessed using the Child Behaviour Checklist (CBCL/6-18). Kosovar findings were compared with findings from five other Central and Eastern European societies (Poland, Romania, Lithuania, Serbia and Croatia), plus the US. RESULTS: Confirmatory factor analysis (CFA) indicated that the CBCL 8-syndrome model manifested good fit to the Kosovar data. Mean item ratings and Cronbach's alphas were very similar to those of the other six societies. Kosova's mean Total Problems score fell in the middle of the range of the seven societies compared. CBCL scores were higher for adolescents (12-18), urban children, and those whose parents had limited education compared with younger (6-11), rural, and more socially advantaged children. CONCLUSIONS: Strong consistency was found between Kosovar findings and those for neighbouring countries with respect to CFA results, mean item ratings, alphas and problem score levels. Results of this epidemiological survey highlight the utility of the CBCL for identifying Kosovar Albanian children with mental health service needs.

[Consensus statement "Dementia 2010" of the Austrian Alzheimer Society]. / Konsensusstatement "Demenz 2010" der Osterreichischen Alzheimer Gesellschaft.

The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.

Prevalence of depressive symptoms and syndromes in later life in ten European countries: the SHARE study.

BACKGROUND: The EURO-D, a12-item self-report questionnaire for depression, was developed with the aim of facilitating cross-cultural research into late-life depression in Europe. AIMS: To describe the national variation in depression symptoms and syndrome prevalence across ten European countries. METHOD: The EURO-D was administered to cross-sectional nationally representative samples of non-institutionalised persons aged > or =50 years (n=22 777). The effects of age, gender, education and cognitive functioning on individual symptoms and EURO-D factor scores were estimated. Country-specific depression prevalence rates and mean factor scores were re-estimated, adjusted for these compositional effects. RESULTS: The prevalence of all symptoms was higher in the Latin ethno-lingual group of countries, especially symptoms related to motivation. Women scored higher on affective suffering; older people and those with impaired verbal fluency scored higher on motivation. CONCLUSIONS: The prevalence of individual EURO-D symptoms and of probable depression (cut-off score > or =4) varied consistently between countries. Standardising for effects of age, gender, education and cognitive function suggested that these compositional factors did not account for the observed variation.

The criterion validity of the Geriatric Depression Scale: a systematic review.

OBJECTIVE: The objective was to provide a systematic review of the screening accuracy of both versions of the Geriatric Depressions Scale (GDS-30, GDS-15). METHOD: An electronic search was performed by using Medline, Embase, Cinahl, Psyndex and the Cochrane library. The selection and examination of papers were performed by two reviewers independently. RESULTS: Among the 42 papers included, important methodological aspects such as sampling methods or blinding of research workers often were not reported. For both GDS versions, similar validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using comparative studies based on the identical samples, both GDS versions showed significantly better validity indices than the 'Yale-1-question' screen, but were similar to the 'Center for Epidemiological Studies Depression scale' (CES-D). CONCLUSION: The GDS does not show a better criterion validity than the CES-D, but methodological limitations of primary studies hamper the generalizability of pooled analyses.

Prevalence of dementia in the elderly in Europe.

Dementia is an important public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality. This review on dementia is restricted to European Union countries where the overwhelming majority of studies have been undertaken, and will also refer to the EURODEM publications which may be considered to be the principal European reference point in this area. In subjects aged over 65, crude prevalence rates for dementia varied between 5.9% and 9.4%. We discuss the major problems limiting the use of these estimations, limits which may differ according to the area of application, be it etiological research or care provision.

[Epidemiology of dementia]. / Die Epidemiologie der Demenzen.

Because of the increasing life expectancy during the next decades the number of demented will steeply rise. The estimated number of people suffering from dementia in Austria will increase from 90,500 persons in the year 2000 to 233,800 persons in the year 2050. During the same period the estimated number of those developing a dementia within one year will rise from 23,600 to 59,500. In contrast, in the next five decades, the population being in an employable age will decrease to 77%. Thus, the proportion of demented in relation to employable people will considerably increase. While in year 2000 there were 56 employable persons per one demented person, in the year 2050 there will be only 17 employable persons per one demented person. Dementing disorders are a main reason for being admitted to nursing homes. In Austrian nursing homes 63.5% of those newly admitted suffer from dementia. Despite of the fact that a large proportion of dementia sufferers are being cared in nursing homes, the majority lives in their private households supported by their family members. Relatives of demented persons experience a large amount of burden, and need more professional help than is available today. The costs of dementing disorders are high and a large proportion is paid by the patients family. In the future, in Austria more specialized day care facilities for the demented and more nursing homes are necessary.

["I am a Misunderstood Being on Earth" - Concept of illness of patients suffering from schizophrenic psychosis before and after psychoeducational treatment]. / "Ich bin ein unverstandenes Wesen auf Erden" - Krankheitskonzepte von PatientInnen mit der Diagnose Schizophrenie vor und nach Psychoedukation.

OBJECTIVE: To determine the effects of a psychoeducational intervention on the individual concepts of illness of patients suffering from schizophrenia. METHOD: 27 patients with a diagnosis of schizophrenia according to ICD-10 were interviewed with open ended questions about their concept of illness at admission to a day hospital and after 10 weeks of attending a psychoeducational program. Questions concerned terminology, diagnosis, prognosis, interventions and aetiology. A qualitative analysis of these data is presented. RESULTS: The terms used to describe the illness were mostly colloquial. Highly individualized and heterogeneous concepts of illness, aetiology and helpful interventions and a positive view regarding prognosis prevailed. Changes over time were limited and arbitrary. CONCLUSIONS: The concepts offered by professionals were adopted in a very limited way, which can be understood in the context of highly individualized ways of coping with diagnosis and illness.

[Projections in the incidence of dementia in Austria for the years 1951 to 2050]. / Die Entwicklung der Demenzerkrankungen in Osterreich in den Jahren 1951 bis 2050.

Because of the increasing life expectancy it is generally assumed that the number of demented individuals will steeply rise in the next decades. Dementia is a main reason for requiring extensive nursing care. Therefore, estimations of the future number of demented subjects in Austria are necessary for planning appropriate services. Since the age structure of the Austrian population has already changed during the last decades, the development of the number of demented individuals during the last five decades is compared with the estimations for the next five decades. These estimations are based on the population projections for Austria and on all available international meta-analyses of prevalence and incidence surveys. Estimations of the number of people suffering from dementia and of those developing dementia within one year are presented for the period between 1951 and 2050. In 1951, the number of dementia sufferers was 35,500; by 2050 this number will increase to 233,800. At present, 90,500 elderly people with dementia live in Austria. Thus, in the next decades, the number of people suffering from dementia will rise more steeply than the in the past. If the projected life expectancy leads to a prolonged duration of illness the number of dementia sufferers will be markedly higher. On the other hand, the working force will decrease in the next decades. Therefore, while in 1951 there were 120 employable persons per demented person, in 2050 there will be only 17 employable persons per demented person. Extensive planning of the future care of demented people is an urgent necessity.

Does psychiatric comorbidity increase the length of stay in general hospitals?

Several studies reported that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well. But their methods are often limited because other predictors of length of stay were excluded from statistical analyses. Using the Clinical Interview Schedule, research psychiatrists interviewed 993 patients of medical, surgical, gynecological, and rehabilitation departments in Austria. Using several multiple regression analyses, the influence of psychiatric comorbidity and other variables on length of stay was analyzed. 32.2% of all patients suffered from psychiatric morbidity. Of all psychiatric cases, 6.2% received more than one psychiatric diagnosis. Presence of psychiatric disorders, age, a diagnosis of neoplasms, number of all somatic diagnoses, and the number of previous non-psychiatric hospital admissions predicted length of stay. Patients with dementia, with substance abuse disorders, and with alcohol- and drug-related psychiatric disorders showed a significantly increased length of stay, while other psychiatric diagnoses did not differ from the mentally well. Even after controlling for confounding variables, dementia and substance related diagnoses increase the length of hospital stay. It is important to investigate interventions for early recognition and treatment of these disorders.

30-item General Health Questionnaire in general hospitals: selecting items using a stepwise hierarchical procedure.

An attempt was made to improve the validity of the 30-item General Health Questionnaire by excluding items. This exclusion was performed by using correlations of sum-scores with an external case criterion. This hierarchical approach based on subsets of items (stepwise hierarchical variable selection) resulted in a 9-item questionnaire whose discriminating performance was significantly better than that of the original version.

Recognition of psychiatric disorders in nonpsychiatric hospital wards.

OBJECTIVE: Although many studies have reported that many psychiatric cases are missed by their nonpsychiatric physicians, their methods are often limited because ward physicians' recognition has been assessed from potentially unreliable sources such as medical notes. The aim of the present study was to assess recognition by using direct questions to ward physicians. METHODS: Five hundred five (505) nonpsychiatric in-patients were interviewed using the Clinical Interview Schedule. Ward physicians' recognition of psychiatric disorders was assessed using a rating form for every patient. RESULTS: The psychiatric prevalence of the total sample was 37.3%. Overall, ward physicians' diagnostic sensitivity was 54.5%, but their sensitivity varied for the different diagnoses (31.3-89.5%). In addition to psychiatric symptoms and abnormalities, intake of psychotropics before admission significantly predicted identification of psychiatric disorders. CONCLUSIONS: In our study, physicians' sensitivity was higher than that reported from surveys based on medical notes. The fact that nearly half of all psychiatric disorders were missed by ward physicians suggests that better psychiatric training for nonpsychiatric doctors is necessary.

[Prevalence of psychiatric disorders in elderly inpatients of medical and surgical departments]. / Prävalenz seelischer Erkrankungen unter älteren Patienten an internen und chirurgischen Stationen.

OBJECTIVE: The aim of the present survey was to study the psychiatric prevalence among elderly patients of medical and surgical wards in Austria. METHODS: 244 inpatients, 60 years and above, were investigated by research psychiatrists using the Clinical Interview Schedule. RESULTS: The prevalence was found to be 38.7% in medical departments, and 33.0% in surgical departments. According to DSM-III-R criteria, dementia (20.9%) and minor depression (7.0%) were the most frequent psychiatric categories, followed by substance abuse disorders (4.5%). Among those suffering from psychiatric disorders, 68.5% received psychotropics. Only a quarter of these drugs were prescribed by consulting psychiatrists, while about three quarters were ordered by ward physicians. CONCLUSIONS: These facts underline the importance of an intensive cooperation between specialists for somatic medicine and psychiatrists.

Risperidone for non-cognitive symptoms of dementia.

A case of a 95-year-old man suffering from dementia and additional noncognitive symptoms is reported. Sleep disturbances and restlessness were treated with several psychotropics including polycyclic antidepressants and conventional neuroleptics without success. Receiving this treatment, the patient became increasingly confused and markedly aggressive. In addition, he developed marked extrapyramidal side-effects and became severely sedated during the day. Swtiching to risperidone resulted in a reduction of many of these symptoms. Finally, receiving risperidone, all non-cognitive symptoms and all side-effects completely disappeared. Further, this case shows the importance of an adequate psychopharmacologic training for non-psychiatric physicians who often treat elderly mentally ill in nursing homes and general hospitals. ( Int J Psych Clin Pract 2000; 4: 249 - 251).

[Does psychiatric comorbidity increase length of stay in medical, surgical and gynecological departments?]. / Sind die Aufenthaltsdauern von psychisch Kranken an internen, chirurgischen und gynäkologischen Abteilungen länger?

Several studies from Anglo-American countries indicate that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well, while in Austria and Germany, until now, no studies concerning this question exist. Therefore, we investigated the influence of psychiatric comorbidity on the length of stay in 608 patients of medical, surgical and gynecological departments in Vienna and Tyrol. Based on the Clinical Interview Schedule, 28.1% of the patients in this sample suffered from psychiatric disorders. The presence of psychiatric disorders, as well as type of hospital department (medical department), higher age, more previous non-psychiatric treatment periods, and more somatic diagnoses predicted a longer duration of inpatient treatment. To avoid the influence of cofounding variables, psychiatric cases were matched with psychiatric non-cases. The mentally ill group was treated for a markedly longer period as inpatients than the mentally well. Patients with a diagnosis of dementia or of substance abuse showed a significantly increased length of stay, while we could not confirm this for other psychiatric diagnoses.

Use of anxiolytics and hypnotics in gynecological, surgical and medical departments of general hospitals.

While several surveys have shown that patients in nonpsychiatric hospital departments frequently receive anxiolytics or hypnotics during hospitalization, and also receive discharge prescriptions for these drugs, as yet none has investigated the start of intake of these drugs during hospitalization in conjunction with an assessment of all types of psychiatric disorders. Therefore, we studied 728 patients in medical, gynecological, and surgical departments of two non-university general hospitals in Austria for the prevalence of anxiolytic and hypnotic drug use during hospitalization as compared to discharge prescriptions for such drugs. Altogether, 50.4% of all admitted patients were treated with anxiolytics or hypnotics during their stay in hospital, and 42.8% of those who had not taken such drugs before admission. Of the patients using these medications during hospitalization, 26.1% also received discharge prescriptions. The significant associations between psychiatric variables and both drug use during hospitalization and prescriptions at discharge, suggest that anxiolytic and hypnotic drugs are used aptly. However, considering that about half of the patients suffering from substance abuse disorders received discharge prescriptions, the risk of continued substance abuse must not be neglected. Overall, fewer patients received anxiolytics or hypnotics at discharge than had used them before admission.

Use of psychotropic drugs in gynecological, surgical, and medical wards of general hospitals.

OBJECTIVE: The purpose of the present study was to investigate the prevalence of psychotropic drug use and the predictors of use during hospitalization. METHOD: We investigated 728 patients admitted to medical, gynecological, and surgical wards of two non-university general hospitals in Austria for psychotropic drug use, psychiatric morbidity, and sociodemographic characteristics. RESULTS: The use of psychotropics was highest in medical wards (67.6%), followed by surgical (59.3%), and gynecological wards (37.8%). Older age, psychiatric caseness, consultation by psychiatrists and use of psychotropics before admission were predictors for psychotropic drug use. Psychotropics were given for a longer duration to psychiatric cases than to non-cases. Anxiolytics were prescribed most often (39.6%), followed by hypnotics (16.9%), neuroleptics (10.7%), and antidepressants (7.0%). CONCLUSIONS: The fact that psychiatric illness is a significant predictor of psychotropic drug use suggests that these drugs were prescribed aptly. The longer duration of use among psychiatric cases supports the idea of appropriate prescriptions.