[Importance of Psychiatric Outpatient Clinics in Primary Care of Somatic Disorders]. / Die Bedeutung Psychiatrischer Institutsambulanzen in der somatischen Grundversorgung.

OBJECTIVE OF THE STUDY: General practitioners are mainly responsible for primary health care. Patients with mental disorders, in particular patients with complex or multiple needs, use these services infrequently in case of somatic complaints. Psychiatric outpatient clinics have to deal with these patients and have perhaps an additional role in diagnosing and treating somatic co-morbidities. This should be evaluated. METHODS: Physicians in outpatient clinics of the Centre of Psychiatry Suedwuerttemberg were asked about their attitude towards somatic co-morbidities, somatic co-treatment and prescribing somatic drugs. In addition, data of the outpatient clinic documentation were evaluated with respect to the treatment by general practitioners and somatic diagnosis. RESULTS: 72% of all patients said that they have a general practitioner. Physicians in outpatient clinics said that they had a high responsibility for somatic co-treatment especially for those patients who did not have a general practitioner. The frequency and type of a somatic co-morbidity was different in patients from general psychiatric, geriatric psychiatry and addiction outpatient clinics. CONCLUSIONS: Our results demonstrate that psychiatric outpatient clinics play a crucial role in diagnosing and treating somatic disorders. Their extent depends on the type of the psychiatric and the somatic disorder but also on the financing of the outpatient clinic.

A Systematic Review of Dissociation in Female Sex Workers.

We analyze the empirical evidence for the association between the occurrence of dissociation and acting as a female sex worker (FSW). The ten screened databases included original research papers looking at the association between various abusive relationships and dissociation. From the initial 5942 records, we screened 554 full-text articles from which eleven studies met the inclusion criteria. Dissociation was mainly described as a strategy to cope with work related experiences, persisting from an early age in cases affected by childhood sexual abuse (CSA). Only one study investigated the occurrence of dissociative disorders. The other studies showed that the FSW population frequently exhibits dissociative symptoms. Most study participants were street FSW characterized by high rates of revictimization, a history of childhood sexual abuse, and of trauma-related and substance use disorders. Due to the selectivity of the study samples, conclusions cannot be generalized. Our findings disclose an important research gap. Further research on mental health among FSW should cover all fields of the sex industry in order to understand the roots of sex work (SW) and its sequelae. This could help develop and implement targeted interventions.

[Inpatient-Equivalent Treatment - How does it Work? Implementation Strategies from Eight Specialised Psychiatric Hospitals and Departments in Germany]. / Stationsäquivalente Behandlung ­ Wie geht das? Umsetzungsstrategien aus acht psychiatrischen Fachkliniken und -abteilungen in Deutschland.

To get information about different ways inpatient equivalent treatment (IET) is implemented and organized eight specialized psychiatric hospitals and departments in Germany were asked to report on implementation details. OUTCOME: Organization and treatment processes depend on local conditions and existing structures. Legal barriers complicate the implementation process, however patients as well as team members report very positive experiences.Current data only give first hints but aren't sufficient to draw viable conclusions. Consequential issues will be picked up within the AKtiV-Study of the Innovationsfonds.

[Narrative Exposure Therapy in a Refugee with Severe PTSD within the Inpatient Standard Care]. / Narrative Expositionstherapie bei einem Flüchtling mit schwerer PTBS in der stationären Regelversorgung.

Forms of Posttraumatic stress disorder (PTSD) with chronical course hamper the psychosocial integration of refugees. We here report the successful treatment according to the approach of Narrative Exposure Therapy (NET) of a severely affected 42-year-old refugee from Central Africa, facilitated by an inpatient care setting. The treatment course underlines the effectiveness and necessity of the intervention even in more complex cases.

[Effects of implementation of psychiatric out-patient clinics ("institutsambulanzen") on hospital admissions]. / Auswirkungen der Einrichtung von Institutsambulanzen auf die Inanspruchnahme stationärer Behandlung.

OBJECTIVE: In the German federal state Baden-Wuerttemberg psychiatric out-patient clinics ("Institutsambulanzen") have been implemented since 2002, later than elsewhere. The effects of these new out-patient services on the use of in-patient services should be examined in a defined catchment area. METHOD: Data on the use of in-patient services 2002 - 2011 was recorded from psychiatric hospitals and day hospitals in a catchment area of 862 000 inhabitants as well as data from the corresponding out-patient clinics. RESULTS: While the number of patients in the out-patient clinics increased from 1986 in 2002 to 7925 in 2011, the number of hospitalised patients increased only moderately, from 4452 in 2002 to 4930 in 2011. An increasing percentage of patients in the out-patients clinic did not use in-patient services in the respective year. This concerned particularly patients with adjustment and personality disorders, who do not find other appropriate psychotherapeutic care as out-patients. CONCLUSIONS: The implementation of out-patient clinics had no significant effect on the number of hospitalisations and occupied beds.

Participating in mobility: People with schizophrenia driving motorized vehicles.

Participation of people with schizophrenia in individual mobility is an important aspect of inclusion according to the UN convention of human rights of persons with disabilities. However, driving motorized vehicles can be dangerous due to positive, negative, and cognitive symptoms, side effects of antipsychotic drugs and concomitant substance abuse. The objective of this study was to explore the patterns of individual mobility in a representative patient population, to determine predictors for active use of motorized vehicles, and to compare the results with data of the general population in the respective region. We interviewed N=150 participants with schizophrenia or schizoaffective disorder, 66 in-patients and 84 out-patients, in different types of out-patient services. A questionnaire developed for this purpose was used in interviews. 64% of the participants had a driving licence, 32% had driven a motorized vehicle in the past year, 31% owned a car, 2% a motor bike. The driving licence had been withdrawn from 24.7% of participants, 32.7% reported having been involved in a road accident. Participants drove considerably less in time and distances than the general population. Significant variables determining the chance of active use of motorized vehicles in a logistic regression model were Global Assessment of Functioning (GAF) (OR 1.04 per each point), number of previous admissions (OR 0.52 per admission), and history of driving under alcohol or drugs (OR 0.18).

Skills-based medication training program for patients with schizophrenic disorders: a rater-blind randomized controlled trial.

BACKGROUND: The long-term course of schizophrenia is often characterized by relapses, induced by poor medication adherence. Early nonadherence after discharge is frequent. OBJECTIVE: To evaluate a skills-based inpatient training program for medication intake. METHODS: We developed a manual-based inpatient medication training program to be carried out by nurses and focusing on practical skills enabling autonomous intake of medication. Medication adherence was measured by three different methods: pill count, determination of serum levels, and self-assessment by the patient. The raters were blinded. RESULTS: Four weeks after discharge, 98% of the patients in the intervention group (N=52) were rated as adherent by pill count versus 76% in the control group (N=50; P<0.01). By measurement of serum level, 88.5% versus 70% were adherent (P<0.05). CONCLUSION: The inpatient medication training program carried out by nurses seems to be an effective intervention for enhancing medication adherence after hospital discharge.

[Implementing models of cross-sectoral mental health care (integrated health care, regional psychiatry budget) in Germany: systematic literature review]. / Systematische Literaturübersicht zur Implementierung der sektorübergreifenden Versorgung (Regionalbudget, integrierte Versorgung) in Deutschland.

OBJECTIVE: Cross-sectoral integrated health-care and the regional psychiatry budget are two models of cross-sectoral health care (comprising in-patient and out-patient care) in Germany. Both models of financing were created in order to overcome the so-called fragmentation in German health care. The regional psychiatry budget is a specific solution for psychiatric services whereas integrated health care models can be developed for all areas of health care. The purpose of this overview is to elucidate both the current state of implementation of these models and the results of evaluation research. METHODS: Systematic literature review, additional manual search. RESULTS: 28 journal articles and 38 websites referring to 21 projects were identified. The projects are highly heterogenuous in terms of size, included populations and services, aims, and steering-function (concerning the different pathways of care). CONCLUSIONS: The projects yield innovative models of mental health care capable of competing with the co-existing traditional financing systems of in-patient and out-patient services. The future of mental health care organisation in Germany is currently open and under political discussion.

[Subjective patient experience of psychiatric admissions]. / Subjektives Erleben der Aufnahmesituation in einer psychiatrischen Klinik aus Sicht der Patienten.

OBJECTIVE: Assessment of patients' subjective experiences of an admission to a psychiatric hospital. METHODS: Subjective experiences of psychiatric admissions were recorded with a semi-structured interview in 72 fairly representative in-patients. Patients' satisfaction with treatment was recorded with the ZUF-8 questionnaire. Additionally, 52 in-patients on nine wards were interviewed in focus groups. RESULTS: From the patients' point of view, the most important aspects of the admission were staff, ward atmosphere and fellow patients. Violence and coercion played only a minor role. In the face-to-face interviews, assessments were generally positive, while in focus groups negative experiences and criticism were also reported. CONCLUSIONS: Future surveys should be conducted anonymously to minimize social desirability bias. Focus groups yield an important extension of individual interviews.

[PGI-I (patient's global impression) as an outcome and quality indicator of psychiatric in-patient treatment: results and concordance with doctor's assessments]. / PGI-I (Patient's Global Impression) als Outcome und Qualitätsindikator bei stationärer Behandlung: Ergebnisse und Übereinstimmung mit Beurteilungen der Behandler.

OBJECTIVE: To examine the Patient Global Impression Scale of Improvement (PGI) as a quality indicator in routine psychiatric in-patient treatment and to determine its concordance with doctors' assessments. METHODS: Patients treated in 2007 in 5 hospitals and 4 day-clinics were included. A set of patient and treatment characteristics (German BADO) and CGI scales were recorded in all patients. Patients were required to give a PGI rating at discharge. RESULTS: PGI ratings could be obtained in 70.3 of the patients (N = 3957). PGI and doctors' CGI-I ratings were in agreement with no more than one degree of difference on the 7-point scale of the PGI in 89.8 %. Characteristics of those patients who significantly deviated from the doctors' assessments were determined. CONCLUSIONS: The PGI scale is appropriate as a quality indicator for routine clinical treatment which can rather easily be obtained.

[Joint crisis plans in psychiatry]. / Behandlungsvereinbarungen in der Psychiatrie.

OBJECTIVE: To give an overview about definitions, practice and effects of joint crisis plans in psychiatry. METHOD: Systematic literature review. RESULTS: Different types of joint crisis plans have been emerging within the last decade mostly in North America and Great Britain. So far, scientific literature stems nearly exclusively from those countries. There is evidence from one RCT that joint crisis plans can reduce involuntary hospitalisation and involuntary treatment. In Germany, joint crisis plans are increasingly in use, but legal regulations do not exist and research is missing. CONCLUSIONS: Joint crisis plans are considered as a useful instrument by service users and some professionals. Research is needed on target groups, acceptance, implementation strategies, and outcomes in Germany.

[Social-psychiatric research in Germany--a literature review]. / Sozialpsychiatrische Forschung--Entwicklung über die letzten 10 Jahre im Spiegel deutschsprachiger Zeitschriften.

OBJECTIVE: This study aims at analysing content, authorship, type of journal and associated institution of scientific contributions on social psychiatry in 16 German-speaking journals. In order to detect development and change in respect to the aspects mentioned, two time periods are compared systematically (1997-1998/2007-2008). METHODS: The authors selected all original papers in 16 journals from German-speaking countries along common definitions of social psychiatry. These definitions are made transparent in the study. RESULTS: The systematic comparison of the named time periods resulted in equal numbers of papers contributed. The major part of the publications under study has been contributed by authors associated with universities. Content-wise, articles on matters discussed in the recent past and including topics like migration, subjectivity, parent-child care are increasing. CONCLUSIONS: Research on social psychiatry in German-speaking countries today is mainly related to research departments at university clinics. The impact of large centres of psychiatry however is declining. Content-wise, matters at stake during the reform period of psychiatry in German-speaking countries in the 1970 s and 1980 s are of less relevance today. Researches now tend to address research topics more closely related to what can be named patient-centred care.