Development and implementation of quality indicators in a group of nine psychiatric hospitals.

Quality indicators (QI) are becoming increasingly important in mental healthcare in Germany. QI can be used for various purposes, such as for creating transparency as well as for benchmarking between hospitals. QI themselves are subject to high quality standards.

Prevention of First-Episode Psychosis in People at Clinical High Risk: A Randomized Controlled, Multicentre Trial Comparing Cognitive-Behavioral Therapy and Clinical Management Plus Low-Dose Aripiprazole or Placebo (PREVENT).

Background: There is limited knowledge of whether cognitive-behavioral therapy (CBT) or second-generation antipsychotics (SGAs) should be recommended as the first-line treatment in individuals at clinical high risk for psychosis (CHRp).

Hypothesis: To examine whether individual treatment arms are superior to placebo and whether CBT is non-inferior to SGAs in preventing psychosis over 12 months of treatment.

Study Design: PREVENT was a blinded, 3-armed, randomized controlled trial comparing CBT to clinical management plus aripiprazole (CM + ARI) or plus placebo (CM + PLC) at 11 CHRp services.

[Revised S3 guidelines on schizophrenia : Developmental process and selected recommendations].

Schizophrenia is one of the most severe mental diseases and leads to significant personal and social impairments for affected persons. The illness is characterized by frequent relapses, results in increased mortality and is associated with the highest socioeconomic costs of all diseases. Moreover, patients with schizophrenia are often stigmatized in everyday life and also in most treatment settings.

Depressive symptoms, resilience, and personality traits in dry eye disease.

Purpose: Dry eye disease (DED) is a multifactorial disease of the ocular surface that leads to symptoms of discomfort and reduces quality of life. Several studies have shown an association with depression. We investigated the prevalence of depressive symptoms and their severity in DED patients and examined whether depressive symptoms correlate with signs, symptoms, or subtypes of DED or with psychological factors (resilience, premorbid personality, and subjective well-being).

[Return-to-Work after depression - evaluation of a retrospective case-control study of an operational integrated care model].

Unlabelled: The objective of the study was to evaluate an operational integrated care model (IC) aiming at optimized treatment of depression. It consisted of cooperation between a company and an external clinic with respect to early recognition of the disorder, early access to treatment and support for return to work.

Method: A retrospective group comparison of patients with depression receiving IC in a psychiatric outpatient clinic (N=64) and a control group with standard care in the same clinic (N=64) was performed.

Predictors of treatment response to psychological interventions in people at clinical high risk of first-episode psychosis.

Aim: Psychological interventions, such as cognitive behavioural therapy (CBT) and supportive counselling (SC), are used to treat people with schizophrenia and people at clinical high risk (CHR) of psychosis. However, little information is available on predictors of treatment response. This study aims to identify such predictors of psychological interventions in CHR.

Negative schemata about the self and others and paranoid ideation in at-risk states and those with persisting positive symptoms.

Background: The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation.

Methods: A risk-based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first-episode psychosis and those with full-blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211).

Prevalence of metabolic syndrome in female and male patients at risk of psychosis.

Metabolic Syndrome (MetS) is one of the most common factors underlying the high rate of mortality observed in patients with schizophrenia. Recent research on this topic revealed that many of the patients studied were, in fact, in a medicated state. As such, it is unclear whether MetS is causally associated with the disorder itself or the medication used to treat it.

[Neuropsychological Functioning as a Predictor of Treatment Response to Psychoeducational, Cognitive Behavioral Therapy in People at Clinical High Risk of First Episode Psychosis].

Objective: Investigate whether treatment response in people at clinical high risk of psychosis (CHR) is predicted by their cognitive performance.

Method: 128 CHR outpatients were randomized into two treatment groups, one receiving integrated psychological intervention (IPI), including psychoeducation, the other receiving supportive counselling (SC) for 12 months. Multiple regression analysis was used to identify neurocognitive predictors of treatment response in a subgroup of n = 105, measured by symptomatic and functional improvement at 1-year follow-up.

[Assessment-Based Home Treatment for People with Severe Psychotic Disorders].

Objective: Although there is growing evidence for clinical effectiveness of crisis resolution teams (also called Home Treatment Teams) for patients with severe psychotic disorders, a lot of studies suffer from poor model fidelity, which leads to an ignorance of specific effective factors.

Methods: Here we present the implementation of an assessment-based Home Treatment in Germany. Assessment-derived therapeutic tasks are shared between team members by a manualized process.

Clinical high risk for psychosis: gender differences in symptoms and social functioning.

Aim: Schizophrenia is a heterogeneous disorder that presents differently in men and women: men show a higher propensity to negative symptoms, lower social functioning, earlier age at onset and co-morbid substance abuse, whereas women display more affective symptoms. It is unknown whether these differences extend to subjects at high risk (HR) of psychosis. Thus, the aim of the present study was to address this question.

[High utilisers with affective and schizophrenic disorders in the psychiatric health care system: a comparison between Eastern and Western Germany].

Objective: High utilisers of psychiatric services are defined as a group of patients showing a great amount of service use, especially inpatient care, consequently causing immense costs. There is a lack of studies investigating differences between East and West Germany.

Methods: Service use and psychopathology were examined in 350 high utilisers receiving inpatient treatment in one East German and three West German psychiatric hospitals.

Coping as a predictor of treatment outcome in people at clinical high risk of psychosis.

Aim: The concept of coping is relevant to recent models of psychosis, and people with established psychotic disorders have been found to predominately use maladaptive coping strategies. This study aimed to examine the general coping patterns of people at clinical high risk of psychosis (CHR) and to investigate whether pre-therapy coping behaviour plays a role in predicting responsiveness to early interventions.

Methods: One hundred twenty-eight help-seeking CHR outpatients were randomized into two treatment groups: either receiving integrated psychological intervention (IPI), including cognitive behaviour therapy, or supportive counselling (SC) for 12 months.

[Antipsychotic polypharmacy in high-utilising patients with schizophrenia].

Objectives: Although guidelines usually recommend monotherapy, in clinical practice, antipsychotic polypharmacy is common especially with chronically ill patients. We therefore assessed the current practice of antipsychotic polypharmacy in "high-utilising" patients with schizophrenia in Germany.

Methods: Antipsychotic medication was assessed using a representative sample of 638 patients with schizophrenia from two multi-centre studies.

[A needs-oriented discharge planning intervention for high utilisers of psychiatric services: quality of the implementation and opportunities for improvement].

Objective: Process evaluation of a needs-oriented discharge planning and monitoring (NODPAM) intervention for patients with severe mental illness with high utilisation of inpatient psychiatric care (within a RCT showing lack of evidence of superiority over treatment as usual).

Methods: Analysis of intervention drop-outs vs. intervention group patients participating in the intervention; analysis of the impact of intervention characteristics on unmet needs over time.

Rationale and baseline characteristics of PREVENT: a second-generation intervention trial in subjects at-risk (prodromal) of developing first-episode psychosis evaluating cognitive behavior therapy, aripiprazole, and placebo for the prevention of psychosis.

Antipsychotics, cognitive behavioral therapy (CBT), and omega-3-fatty acids have been found superior to control conditions as regards prevention of psychosis in people at-risk of first-episode psychosis. However, no large-scale trial evaluating the differential efficacy of CBT and antipsychotics has been performed yet. In PREVENT, we evaluate CBT, aripiprazole, and clinical management (CM) as well as placebo and CM for the prevention of psychosis in a randomized, double-blind, placebo-controlled trial with regard to the antipsychotic intervention and a randomized controlled trial with regard to the CBT intervention with blinded ratings.

[Benchmarking in psychiatric acute care--a demonstration project in a hospitals network].

The aim of this project was to improve treatment processes and results in acutely ill inpatients within a network of nine psychiatric state hospitals of the Landschaftsverband Rheinland by introducing a benchmarking process. The project was based upon pre-existing measures of quality management. Patient groups were selected that were characterised by a severe clinical development or a high demand for mental health care services (alcohol abuse, depression of the elderly, schizophrenia).

[RCT on discharge planning for high utilisers of mental health care: conduct and quality of the intervention].

Objective: To evaluate feasibility of a structured discharge planning intervention for high utilisers of mental health care developed in a multicentre RCT.

Methods: Data of N = 241 participants (discharge and 3-month follow-up) allocated to the intervention group are analysed with regard to the intervention's quality of implementation, acceptance, and changes in needs.

Results: The intervention was well accepted among patients and staff.

Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany.

The goal of this study was to prevent rehospitalizations and thus to optimize satisfaction with treatment and quality of life in patients suffering by schizophrenia or schizoaffective disorder. A complex intervention with improved cooperation between in- and outpatient services was applied to 46 "high utilizing" patients after discharge from inpatient care during an intervention phase of 6 months. The study was controlled by a matched group of 47 patients receiving treatment as usual.

Mental health quality, outcome measurement, and improvement in Germany.

Purpose Of Review: The German mental healthcare system is currently undergoing discussions regarding the assessment of mental healthcare quality and the identification of potentials for optimizing mental healthcare. Quality assurance projects play an important role in the optimization of the care for the mentally ill in Germany. This review describes the most recent results of quality assurance programs from Germany as identified by a systematic literature search covering the time span 1 January 2008 until 1 June 2009.

Mental illness stigma and disclosure: consequences of coming out of the closet.

The present study investigated disclosure patterns among mental health consumers (N = 500) and examined the relationships among disclosure, perceived stigmatization, perceived social support, and self-esteem. Results suggest that selective disclosure optimizes social support and limits stigmatization. Perceived stigmatization has a detrimental impact on self-esteem, especially for those who are relatively open about their mental disorder.

[Prevalence and diagnosis of depression in primary care. A critical comparison between PHQ-9 and GPs' judgement].

Objective: Up to 50 % of patients suffering from major depression are not recognised by their general practitioners. On the other hand general practitioners do rate some of their patients as depressive despite the fact that psychiatric diagnostic instruments do not. In this study we wanted to not only analyse the number and proportion of concordant diagnoses between GP and an established psychiatric diagnostic instrument (PHQ-9), but also to analyse the modalities of non-concordant diagnostic classifications.

Randomized controlled multicentre trial of cognitive behaviour therapy in the early initial prodromal state: effects on social adjustment post treatment.

Aim: Improvement of social adjustment is a major aim of indicated prevention in young people at risk of developing psychosis. The present study explores the effect of specific cognitive behaviour therapy (CBT) as compared with supportive counselling (SC) on social adjustment in people in a potential early initial prodromal state of psychosis (EIPS) primarily defined by self-experienced cognitive thought and perception deficits (basic symptoms).

Methods: A total of 128 help-seeking outpatients in the EIPS were randomized to receive either specific CBT or SC for 12 months.

Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders.

Rationale: Short- and long-term compliance to prescribed antipsychotic drugs is of particular concern in regard to medication choice and treatment outcome in the care of psychotic disorders.

Objective: We evaluated patient-related and treatment-related factors associated with medication compliance in inpatients with a diagnosis of schizophrenia, schizoaffective disorder, or other psychotic disorder.

Methods: Within a naturalistic study in seven psychiatric hospitals, individuals with a psychotic disorder were assessed weekly on mental state, social functioning, side effects, and medication compliance.