Hippocampal and cerebellar atrophy in patients with Cushing's disease.

OBJECT Cushing's disease (CD) may cause atrophy of different regions of the human brain, mostly affecting the hippocampus and the cerebellum. This study evaluates the use of 3-T MRI of newly diagnosed patients with CD to detect atrophic degeneration with voxel-based volumetry. METHODS Subjects with newly diagnosed, untreated CD were included and underwent 3-T MRI. Images were analyzed using a voxelwise statistical test to detect reduction of brain parenchyma. In addition, an atlas-based volumetric study for regions likely to be affected by CD was performed. RESULTS Nineteen patients with a mean disease duration of 24 months were included. Tumor markers included adrenocorticotropic hormone (median 17.5 pmol/L), cortisol (949.4 nmol/L), and dehydroepiandrosterone sulfate (5.4 µmol/L). The following values are expressed as the mean ± SD. The voxelwise statistical test revealed clusters of significantly reduced gray matter in the hippocampus and cerebellum, with volumes of 2.90 ± 0.26 ml (right hippocampus), 2.89 ± 0.28 ml (left hippocampus), 41.95 ± 4.67 ml (right cerebellar hemisphere), and 42.11 ± 4.59 ml (left cerebellar hemisphere). Healthy control volunteers showed volumes of 3.22 ± 0.25 ml for the right hippocampus, 3.23 ± 0.25 ml for the left hippocampus, 50.87 ± 4.23 ml for the right cerebellar hemisphere, and 50.42 ± 3.97 ml for the left cerebellar hemisphere. CONCLUSIONS Patients with untreated CD show significant reduction of gray matter in the cerebellum and hippocampus. These changes can be analyzed and objectified with the quantitative voxel-based method described in this study.

[A Police Perspective on the Interaction with Individuals with Mental Disorders]. / Die Interaktion mit verhaltensauffälligen Menschen aus polizeilicher Perspektive.

OBJECTIVE: Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer. METHODS: N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances. RESULTS: Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge. CONCLUSION: Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.

Effectiveness of a contact-based anti-stigma intervention for police officers.

INTRODUCTION: Police force interaction rates with individuals with mental health conditions are on the rise. International research reveals that the presence of a mental health condition increases the risk for detention and use of force by police officers. Stigmatization of individuals with mental health conditions as dangerous and unpredictable is assumed to have an impact on the likelihood of police use of force. The following study examines a trialogical intervention to reduce stigmatization of individuals with a diagnosis of schizophrenia in a police officer sample. METHOD: 1318 police officers participated in a trialogical contact-based intervention with the aim to reduce stigmatizing attitudes and beliefs. Emotional reactions, stereotypes and social distance were assessed prior to and after the intervention in a one-group design. RESULTS: Negative stereotypes were positively associated with social distance in individuals with a diagnosis of schizophrenia and were positively associated with anxiety. Dependent sample t-test revealed reduced anxiety towards individuals with a diagnosis of schizophrenia, less negative stereotypes, and less social distance post intervention. All results were significant, and all effect sizes showed a small to moderate effect. CONCLUSIONS: Trialogical contact-based, short-term anti-stigma interventions appear to reduce stigmatizing attitudes towards individuals with mental health conditions in a large police force sample. A missing control group is a key study limitation. Further research is needed to examine the effectiveness of the intervention in a randomized-controlled trial. However, the results clearly suggest that anti-stigma interventions could be beneficially introduced into police training.

Police Officers' Ability in Recognizing Relevant Mental Health Conditions.

The recognition of certain mental health conditions is important as this requires police officers to communicate and behave in an adjusted manner with affected individuals. The objective of the present study was to test police officers' knowledge about mental health symptoms as a component of their mental health literacy (MHL) and to examine if police officers' perceived knowledge corresponds with their actual knowledge. A questionnaire was used to assess for MHL representing mental health conditions which occur frequently in police requests (schizophrenia, bipolar disorder, depression, post-traumatic stress disorders, and emotionally unstable personality disorder). Furthermore, the questionnaire assessed the frequency of police requests, the officers' perceived knowledge regarding mental disorders and their sense of feeling sufficiently trained to deal with these kinds of requests. Eighty-two police officers participated in the study. Police officers' actual knowledge about mental health conditions did not correspond with their perceived knowledge. Participants revealed a moderately high level of overall knowledge which differed with regard to symptoms of each of the five mental health conditions. The mental status of a paranoid schizophrenia was best identified by the police officers and the majority correctly allocated the symptoms. Post-traumatic stress disorders and manic episodes were only identified by a minority of police offers. Police training geared to prepare for requests involving individuals with mental disorders should expand this limited knowledge transfer and focus on a broader variety of mental health conditions that police officers frequently encounter in requests.

[Interdisciplinary Inpatient Treatment for Adolescents and Young Adults (16 - 25 Years) with Mental Illness in Adolescent Psychiatry]. / Alters-, diagnose- und fachübergreifende stationäre Behandlung für Jugendliche und junge Erwachsene (16 ­â€Š25 Jahre) in der Adoleszenzpsychiatrie.

OBJECTIVE: The investigation of clinical characteristics of patients in adolescence psychiatry relevant for transition medicine. METHODOLOGY: Sociodemographic and clinical data (SCID I/II, SIPS/SOPS, SPI-A, GAF, CGI) were consecutively taken from the interdisciplinary inpatient treatment centre for adolescents and young adults with mental disorders (N = 229, aged 16 - 25). RESULTS: Average age was 19 years (38 % male, 23 % migration background). A high proportion of early mental illnesses and comorbidities (66 %), psychosis risk syndromes (20 %) and suicidality (54 %), treatment discontinuation (33 %) with daily-life, social and family stress factors (52 % positive family history, 34 % trauma) were observed and a persistently high level of support and treatment was needed despite a significant clinical improvement (p < 0.001). CONCLUSION: The results support the need for an interdisciplinary collaboration for the joint development of care structures in transition medicine.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.

The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required. TRIAL REGISTRATION: Clinical Trial Registration Number: NCT01888627.

Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III).

AIM: The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS: This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS: Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION: To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.

[Early Detection and Integrated Care in Adolescents and Young Adults with Severe Psychotic Illnesses]. / Früherkennung und integrierte Versorgung von Jugendlichen und jungen Erwachsenen mit schweren psychotischen Erkrankungen.

This is a prospective 1-year follow-up study comparing a combined intervention consisting of multidimensional early detection strategies with age- and interdisciplinary integrated care (intervention group, n = 120) with standard care (historical control group, n = 105) in adolescents and young adults within the early phase of psychosis. Data at study entry indicate a high complexity and severity of illness. Primary outcome is the 6-month rate of combined symptomatic and functional remission at study endpoint.

The assessment of quality of life in clinical practice in patients with schizophrenia.

The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.

El objetivo del presente artículo es revisar las escalas de calidad de vida (CdV) utilízadas en estudíos que ínvestigan pacientes con esquizofrenía durante los últimos cínco años y resumir los resultados de la evaluación de la CdV en la práctica clínica en estos pacientes. Se identificó la literatura disponible en la base PubMed entre enero de 2009 y díciembre 2013 utilizando las palabras clave "calídad de vida" y "esquizofrenía" y en una búsqueda de referencias cruzadas para artículos especialmente relevantes. Un total de 432 estudios emplearon 35 escalas diferentes de CdV tanto genéricas como específicas estandarízadas en pacientes con esquizofrenía. Los príncípales obstáculos para la mejoría de la CdV en pacientes con esquizofrenía fueron los síntomas afectivos. Aunque los síntomas posítivos, los síntomas negativos y el funcíonamiento cognítivo pueden considerarse como parámetros en gran medída independientes de la CdV subjetiva-especialmente en ensayos transversales-, los estudios a largo plazo confírmaron un gran ímpacto de la mejoría precoz de la CdV en la remisión sintomática y funcional a largo plazo, como de la respuesta síntomática y funcional a largo plazo, como de la respuesta síntomática precoz en la CdV a largo plazo. Los resultados de la presente revisión sugieren que la CdV es un criterio de resultado válido y útil en pacíentes con esquizofrenía. Como tal debe ser aplicada sistemáticamente en ensayos clínicos. Es importante la comprensión de la relación entre síntomas y funcionamiento con la CdV, ya que las intervencíones que se enfoquen solo en los síntomas de la psicosis o en el funcíonamiento puede que no mejoren la CdV subjetiva en el mismo nivel. Sin embargo, la falta de consenso sobre las escalas de CdV díficulta la investigación sobre su validez predictiva. A futuro la investigación requiere encontrar un consenso acerca del concepto y medíciones de la CdV y comprobar si ésta predice mejores resultados para la remisión y la recuperación tomando en cuenta las diferentes aproximacíones terapéutícas en pacientes con esquizofrenía.

Cet article évalue les échelles de qualité de vie (QdV) utilisées dans des études de patients schizophrènes ces 5 dernières années et résume les résultats de l'évaluation de la QdV en pratique clinique chez ces patients. Une recherche sur PubMed utilisant les mots clés « qualité de vie ¼ et « schizophrénie ¼ et une recherche de références croisées pour des articles très pertinents ont permis de sélectionner la littérature disponible de janvier 2003 à décembre 2013. Au total, 432 études utilisent 35 échelles de QdV standardisées différentes, spécifiques et génériques, chez les patients schizophrènes. Les symptômes affectifs constituent un obstacle très important à l'amélioration de la QdV chez ces patients. Les symptômes positifs, négatifs et le fonctionnement cognitif sont considérés comme des paramètres en grande partie indépendants de la QdV subjective, surtout dans les études croisées, mais les études à long terme confirment l'impact essentiel d'une amélioration précoce de la QdV sur la rémission fonctionnelle et symptomatique à long terme et d'une réponse symptomatique précoce sur la QdV à long terme. D'après les résultats de cet article, la QdV est un critère de résultat valable et utile chez les patients schizophrènes. À ce titre, les études cliniques devraient l'employer régulièrement. Il est important de comprendre la relation entre les symptômes et le fonctionnement par l'intermédiaire de la QdV car les traitements qui ne s'intéressent qu'aux symptômes de la psychose ou qu'au fonctionnement seul peuvent ne pas réussir à améliorer la QdV subjective de la même façon. L'absence de consensus sur les échelles de QdV entrave néanmoins la recherche sur leur validité prédictive. À l'avenir, la recherche doit trouver un consensus sur le concept et les mesures de QdV et vérifier si la QdV prédit de meilleurs résultats en ce qui concerne la rémission et la guérison en examinant les différentes approches thérapeutiques chez les patients schizophrènes.