Antidepressive response of inpatients with major depression to adjuvant occupational therapy: a case-control study.

BACKGROUND: Despite marked costs and limited evidence regarding effectiveness, occupational therapy (OT) is widely applied in psychiatric settings and financed by health insurance companies in European countries. This pilot study investigated the antidepressive effects of adjuvant OT for patients with major depression in a 6-week inpatient setting, stratified for females and males. METHODS: A total of 114 inpatients with major depression were assigned to either a standard OT group (using basic handcraft) or an active control group that played board games (2 h daily, 5 days a week). HAMD-21 scores were assessed as the primary outcome parameter after 3-6 weeks. RESULTS: The OT intervention was not superior to "board game" (BG) activities in reducing depressive symptoms. However, significant interaction effects were found in favor of the OT group regarding anxiety measures and other variables. Male participants displayed more significant interaction effects than female participants. CONCLUSIONS: OT as an adjuvant short-term treatment for inpatients with major depression may be more efficacious than game interventions in terms of reducing anxiety and other symptoms, particularly in males. Trial registration The study was registered in the EU Clinical Trials Register as a multicenter trial (EudraCT Number 2009-016463-10; https://www.clinicaltrialsregister.eu/ctr-search/trial/2009-016463-10/DE#A) However, because of the elaborate setting requirements, the original study design with four centers was transformed into a solution with those two centers facilitating the pertinent resources. Furthermore, "mono-therapy with mirtazapine" was changed into "preferably mono-therapy with any antidepressant drug".

Voluntary versus involuntary hospital admission in child and adolescent psychiatry: a German sample.

Involuntary psychiatric admission is a central issue in mental health care, especially in the treatment of children and adolescents. Its legal regulations do not only differ between European countries, but also on a federal level. Only few studies so far dealt with rates of involuntary admission (RIA), mainly focusing on adults, rather than children and adolescents. None of the studies analyzed this topic in a large cohort. The aim of this regional cross-sectional study was to compare voluntary and involuntary admissions in child and adolescent psychiatry (CAP) regarding personal and admission characteristics. Furthermore, risk factors and predictors of involuntary admission should be identified. A retrospective analysis of hospital admission registers from three major German CAP hospitals over a period of 6 years (2004-2009) was conducted (N = 10,547 inpatients). Group comparisons between involuntarily and voluntarily treated minors and a logistic regression to determine predictors of legal status were performed. Information on harm to self or others prior to the admission, medication and clinical outcome was not available due to data structure. 70.8 % of patients were voluntarily and 29.2 % involuntarily admitted. Both subsamples comprised more males. The RIA decreased consistently over the years, ranging from 25.7 to 32.4 %. The strongest predictor of being admitted involuntarily was suffering from mental retardation (OR = 15.74). Adolescence, substance abuse, psychotic disorders and admission on duty time were also strongly associated (OR > 3). In this first large cohort study on involuntary treatment of children and adolescents in Germany, about every fourth patient was treated involuntarily. Certain personal and disease-related factors increased the risk. Commitment laws and other legal instruments for regulating involuntary placements are inconsistent and a standardized description or systematic analysis is needed. The influence of demographic, institutional variables and care and health services aspects should also be investigated.

π-Stacking attraction vs. electrostatic repulsion: competing supramolecular interactions in a tpphz-bridged Ru(ii)/Au(iii) complex.

The synthesis and characterization of a mixed metal ruthenium(ii)/gold(iii) complex bridged by tetrapyridophenazine (tpphz) are described. It is isostructural and isoelectronic to the well-known photocatalysts with palladium(ii) or platinum(ii). Concentration dependent (1)H-NMR spectroscopy and XRD studies show that the electrostatic repulsion between the gold(iii) moieties exceeds the attractive π-stacking interaction. Theoretical calculations based on the new structural data confirm an increased positive charge on the bridging ligand as well as significantly altered orbital symmetry as compared to the previously investigated palladium(ii) complex. This is the first example of a tpphz ruthenium(ii) complex where π-stacking is completely inhibited. The detailed investigation of the solid-state structure showed for the first time in bimetallic tpphz bridged complexes no significant torsion within the bridging ligand itself. Although catalytic performance for proton reduction by gold(iii) is naturally not observed, its photochemical decomposition in colloidal gold particles could be shown by TEM and DLS.

Synthesis and characterization of an immobilizable photochemical molecular device for H2-generation.

With [Ru(II)(bpyMeP)2tpphzPtCl2](2+) (4) a molecular photocatalyst has been synthesized for visible-light-driven H2-evolution. It contains the ligand bpyMeP (4,4'-bis(diethyl-(methylene)-phosphonate)-2,2'-bipyridine) with phosphate ester groups as precursors for the highly potent phosphonate anchoring groups, which can be utilized for immobilization of the catalyst on metal-oxide semiconductor surfaces. The synthesis was optimized with regard to high yields, bpyMeP was fully characterized and a solid-state structure could be obtained. Photophysical studies showed that the photophysical properties and the localization of the excited states are not altered compared to similar Ru-complexes without anchoring group precursors. (4) was even more active in homogenous catalysis experiments than [Ru(II)(tbbpy)2tpphzPtCl2](2+) (6) with tbbpy (4,4'-bis(tbutyl)-2,2'-bipyridine) as peripheral ligands. After hydrolysis (4) was successfully immobilized on NiO, suggesting that an application in photoelectrosynthesis cells is feasible.

Impact of social-psychiatric services and psychiatric clinics on involuntary admissions.

BACKGROUND: Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed. METHOD: A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork. RESULTS: Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate. CONCLUSION: Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role.

Carbene based photochemical molecular assemblies for solar driven hydrogen generation.

Novel photocatalysts based on ruthenium complexes with NHC (N-heterocyclic carbene)-type bridging ligands have been prepared and structurally and photophysically characterised. The identity of the NHC-unit of the bridging ligand was established unambiguously by means of X-ray structural analysis of a heterodinuclear ruthenium-silver complex. The photophysical data indicate ultrafast intersystem crossing into an emissive and a non-emissive triplet excited state after excitation of the ruthenium centre. Exceptionally high luminescence quantum yields of up to 39% and long lifetimes of up to 2 µs are some of the triplet excited state characteristics. Preliminary studies into the visible light driven photocatalytic hydrogen formation show no induction phase and constant turnover frequencies that are independent on the concentration of the photocatalyst. In conclusion this supports the notion of a stable assembly under photocatalytic conditions.

[Negative emotions and understanding - patients' perspective on coercion]. / Negative Emotionen und Verständnis - Zwangsmaßnahmen aus Patientensicht.

OBJECTIVE: This study evaluated involuntarily admitted psychiatric patients' and their perception of coercive measures (i. e. involuntary admission and physical or pharmacological restraint) by asking retrospectively which emotions were induced during the process of coercion. METHOD: Interviews were carried out around 3 weeks after coercion. The interview consisted of 31 items categorized into demographic, nosological and coercion-related themes. Patients were also asked about their subjective experiences of the coercion. 40 patients were recruited, with 72 % suffering from psychosis-related and 21 % with affective disorders. For 22.5 % of the patients, this was their first psychiatric hospitalization. The most frequently reported emotions were rage, anger and despair. Patients who were more stable, according to the Clinical Global Impressions scale (CGI), generally evaluated the coercion as being worse. CONCLUSION: More than half of the patients were satisfied with the treatment received during hospitalization. The potential suffering caused as a result of patients' perceptions of the coercion, and the impact of this on the course of the disease should be taken into account when developing new treatment strategies.