[Use of Mental Health Service Among Young Adults on Unemployment Benefit Before and after Receiving Counseling at a Psychiatric Liaison Department]. / Inanspruchnahme des psychosozialen Hilfesystems bei jungen, psychisch erkrankten Arbeitslosengeld-II-Empfängern vor und nach Nutzung eines psychiatrisch-psychologischen Beratungsangebotes.

OBJECTIVE: To determine mental health service utilization before and after consultation of a psychiatric liaison service ("Support 25") among youths aged 16-24 years suffering from mental disorders and receiving unemployment benefits. METHODS: Longitudinal registration of mental health service use over a 9-month period (N=148); measurement of possible moderators with questionnaires and rating scales. RESULTS: Mental health service utilization increased from initially 22% to 40% and 47.5% 3 and 6 months after receiving individual treatment recommendation. Low-threshold psychosocial counseling was frequented more often than specific psychiatric or psychotherapeutic treatment. Subjects who contacted mental health services showed a trend towards a lower level of psychosocial functioning than subjects who did not seek treatment. Stigma-related factors did not hinder mental health service use. CONCLUSIONS: Despite a high degree of psychiatric morbidity, the surveyed sample of unemployed youths had problems to successfully enter mental health services. Although a substantial increase in service use was observed after receiving psychoeducational information at a psychiatric liaison service, the use of low-threshold counseling predominated. This finding suggests that the mental health system should adapt better to the specific needs of young unemployed, for example, by expanding low-threshold psychiatric pre-treatment offers at vocational centers.

[Psychiatric interventions for the unemployed]. / Psychiatrische Interventionen für Arbeitslose.

Unemployment is related to a higher risk for psychological distress and mental disorders, which cause individual suffering and socioeconomic costs for society in general. This selective review surveys the relationship between unemployment and psychological well-being and mental disorders. The most important programs for the improvement of the mental health of the unemployed are summarized: 1. Interventions for the unemployed with the aim of improving coping strategies reduce the risk of developing depressive symptoms. 2. The SUPPORT liaison outpatient unit collaborates closely with the unemployment agency and offers a low-threshold screening for mental disorders for unemployed subjects as well as counseling for those in need of treatment. 3. A group training based on cognitive behavioral therapy improves the psychological well-being of unemployed participants. 4. Supported employment is an effective means of placing severely mentally ill patients in a work-place accompanied by an extensive professional support.

DSM-IV-TR Axes-I and II mental disorders in a representative and referred sample of unemployed youths--results from a psychiatric liaison service in a job centre.

OBJECTIVES: Increased levels of anxiety, depression and alcohol abuse are associated with unemployment. This study compares both DSM-IV-TR Axis-I and Axis-II mental disorders between a representative and a referred sample of unemployed youths aged 16.0 to 24.9. METHODS: One hundred subjects were randomly recruited on the premises of the vocational services centre in the urban region of Essen, Germany (representative sample, RS). One hundred and sixty-five subjects constituting the 'clinical sample' (CS) were preselected and referred by case managers to the on-site psychiatric liaison service. Structured Clinical Interviews for DSM-IV (SCID-I and -II), measures of psychopathology and health service utilization were administered. RESULTS: Ninety-eight percent and 43% of CS and RS subjects fulfilled DSM-IV criteria for mental disorders. Mood-, anxiety- and substance-related disorders were the most common Axis-I disorders in both samples. Personality disorders were diagnosed significantly more frequently in the CS. Despite the more severe psychopathology in subjects with mental disorders from the CS compared to the RS, no differences were found for recent mental health service utilisation. CONCLUSION: Because the sample of unemployed youths referred by case managers was significantly more disturbed in psychiatric terms, such a pre-selection is deemed useful in conjunction with a psychiatric liaison service on the premise of a job centre.

Differences in drug consumption, comorbidity and health service use of opioid addicts across six European urban regions (TREAT-project).

OBJECTIVES: This comparative study investigated consumption patterns, comorbidity and treatment utilization of opioid addicts in six European cities (Athens, Essen, London, Padua, Stockholm, Zurich). SUBJECTS AND METHODS: Data were collected by structured face-to-face interviews. The representative sample comprises 599 addicts (100 patients per centre, 99 in London) at the start of a treatment episode. RESULTS: Patients were dependent on opioids for about 10 years. Regional differences were significant regarding the patients' drug consumption pattern and their method of heroin administration (up to a fourth of the patients in Essen, London and Zurich usually smoke heroin). Concomitant use of benzodiazepines, cannabis and alcohol was common in all regions with the German and English samples showing the highest level of polydrug use. The prevalence of major depression was high in all regions (50%). Stockholm and London patients worry most about their physical health. Differences in the amount of needle sharing and especially in the use of public health service were prominent between the sites. Opioid addiction was a long-term disorder associated with a high burden of comorbidity and social problems in all cities. CONCLUSION: The results of the study show significant interregional differences of opioid addicts which might require different treatment strategies in European countries to handle the problem.

[New approaches for understanding borderline personality disorder]. / Neuere Ansätze zum Verständnis der Borderline-Persönlichkeitsstörung.

The concept of Borderline Personality Disorders was developed from North-American psychiatric and psychoanalytic thought. During recent years different contributions on this disorder emerged from several psychological paradigms. Four current trains of research are reviewed: Approaches based upon the five-factor-model of personality, Linehan's behavioristic approach, interpersonal concepts as shown by Benjamin and a self-developed subject-centered approach focussing on the patients' subjective theories of illness. These models converge into a concept which interprets Borderline Personality Disorders as disturbances of personal identity. The patients fail when attempting to overcome the tension between being a person and being a subject in their interpretation of the world and themselves. At the end of the article consequences for therapy are highlighted.