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The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

Psychosocial Care has been an integral part of the overall treatment in pediatric oncology for 25 years. The need for it and its effectiveness are well documented in several reputable studies and psychosocial service has proved its worth in everyday clinical settings. In order to secure comparable quality standards and in consequence of reorganisations within the health-care system a position paper has been prepared and adopted by the Psychosoziale Arbeitsgemeinschaft in der Pädiatrischen Onkologie und Hämatologie (PSAPOH), the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH). The following article gives a short survey of this position paper and provides insight into the goals, conditions and outcomes of psychosocial care in pediatric oncology and hematology.

The influence of demographic parameter, the number of different drugs or the frequency of the single doses on the reliability of compliance was subject in different studies. The goal of this investigation was to examine the influence of the drug package information paper on the compliance of neurological-psychiatric patients. 951 patients of one quarter of a neurological-psychiatric practice were given a questionnaire, which examined the income behavior and the estimate of the meaning of the drug package information paper. 352 patients answered the questionnaires. Only 15.6 % refused it to answer the questionnaire. The remaining were not able to answer because of different reasons (dementia, aphasia, acute psychiatric disorders, foreign language origin, immobility, etc.). 98.1 % considered the drug package information paper to be important. Older patients and patients with lower education degree judged the drug package information paper to be too extensive. Only few patients (11.5 %) let the physician explain the drug package information paper. 86.3 % of the patients assumed the medication prescribed by the physician to be correct. 58.1 % of the patients however were not satisfied with the information by the physician. Patients with neuroses were particularly dissatisfied over the clearing-up by the physician (77.3 %). 73.3 % of the patients were deterred from taking in their medicines occasionally or frequently by the side effects described in the drug package information paper. 59.9 % of the patients would take the medicine, if the physician insisted on it. Independently of the influence of the drug package information paper 57.5 % of the patients forgot to take their medicines occasionally or frequently. Patients with epilepsies and M. Parkinson were most compliant. In summary the investigation showed that the clearing-up only by the drug package information paper in contrast to the clearing-up by the physician leads to more non-compliance.

To date, positron emission tomography (PET) is the most powerful method for the in-vivo investigation of human brain metabolism. Besides extensive application of this technology in the neurosciences, PET is also being increasingly used as a clinical tool. However, despite its acceptance in clinical practice a major obstacle is its high costs. The present article reviews the literature on the clinical use of PET in neurology, neurosurgery, and psychiatry in order to substantiate the clinical indications for PET in these specialties as established by an interdisciplinary conference.

Aim: In this paper we review the current literature on the clinical problem that some patients do not achieve response after adequately conducted psychotherapy. We explicate our understanding of nonresponse and treatment resistance including the operational definitions, summarize the theoretical explanations and empirical studies and put forward possible study designs and treatment options., Methods: Literature search using PubMed and Web of Science., Results: For the domain of psychotherapy, the term treatment resistance does not seem appropriate; instead, we use the more descriptive terms nonresponse and recurrent nonresponse. Generally, this topic is far less represented in psychotherapy than in pharmacotherapy. Controlled switching studies with a switch from pharmacotherapy to psychotherapy are rare and those switching from one psychotherapeutic approach to another are nearly nonexistent. Building on clinical considerations, we propose a flow-chart for clinical decision making after nonresponse in psychotherapy., Discussion: Learning from errors is highly beneficial. This principle should be more consistently followed up in psychotherapy research as well as in supervision and training. Guidelines should include consensual and evidence-based advice on how to deal with nonresponse and recurring nonresponse., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The interdisciplinary care of children and adolescents with mental disorders requires services from various German codes of social law and-within the medical care system-enclosing inpatient and outpatient services. The increasing demand, the increase in severity of disorders, and the general shortage of staff in social services put pressure on the structures of the interdisciplinary service networks resulting in long waiting periods, long distances, and regionally insufficient care. The medical field of child and adolescent psychiatry and psychotherapy (CAPP) plays the central and coordinating role within the cooperative care for children and adolescents with mental disorders. The CAPP is in clear need of reforms; however, these are markedly different from the reform needs of the German somatic medical care system and differ substantially from those of the (adult) psychiatry, psychotherapy, and psychosomatics disciplines. This discussion paper describes the reform requirements, the specifics of the CAPP structures, and suggestions to overcome sectors of service provision, enhance networking, intensify telemedicine, and develop evidence-based prevention and early recognition of child mental disorders., (© 2024. The Author(s).)

Objective: Discrimination can have a negative impact on mental health and thus can play a crucial role in the context of psychotherapy. This paper outlines the potentials and the relevance of an (intersectional) privilege awareness of psychotherapists for a discrimination-sensitive psychotherapy. The aim of this study was to assess the privilege awareness of psychotherapists in Germany for the first time as well as its thematization in the training of psychotherapists. In addition, the connection between belonging to a marginalized group and the privilege awareness was investigated., Methods: 270 psychotherapists (in training) based in Germany participated in an online survey (2022). Privilege awareness was assessed with an adapted version of the Awareness of Privilege and Oppression Scale-2, translated into German, regarding the following axes of discrimination: heterosexism, classism, and racism. Three self-written items additionally surveyed the thematization of discrimination and privilege in psychotherapy training. The relationship between belonging to a marginalized group and privilege awareness was examined using linear regression analysis., Results: Nearly 65% (N=270) of participants felt unprepared or somewhat unprepared to deal with patients' experiences of discrimination, with approximately 40% (N=270) indicating that discrimination was not addressed in training. Privilege was addressed much less frequently. Belonging to a marginalized group was associated with higher privilege awareness (B=0,47, 95%-confidence interval: 0,27-0,67, F(2, 267)=15,41, p<0,001)., Conclusion: There is a need to include the impact of discrimination and privilege on mental health and the therapeutic relationship as an integral part of psychotherapy training to enhance its quality as well as the quality of future psychotherapies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

For children and adolescents in need of psychiatric and psychotherapeutic care, outpatient, day patient, and inpatient facilities are provided. A new development is called "inpatient equivalent treatment" that consists of home visits by a multiprofessional team. This paper depicts the landscape of Child and Adolescent Psychiatry (CAP) Services, covering its historical development and the structural, care policy, and financing backgrounds. Until 2014, there was free choice of private practice locations in the outpatient sector, leaving rural areas and marginalized neighborhoods partially undersupplied until today.The number of beds in the hospital sector decreased significantly between 1991 and 2004. It later rose again in favor of improved regional access and smaller units, with an additional 50% of day patient places. Inpatient equivalent treatments are equally effective, but not yet established nationwide; only a few innovative models have been negotiated. Regional networks of all social support systems, aiming for child psychiatric supply networks, are limited due to the pillarization of the social system. In conclusion, an imperative cooperation between all services of the Social Security Code and enabling true cross-sectoral services would benefit CAP patients., (© 2023. The Author(s).)

In recent years, efforts in the field of public mental health have increased that seek to promote mental health and mental health literacy at population level and yield advances in the prevention, treatment and care of mental health conditions. This paper provides an overview of contemporary conceptualisations of indicators and determinants of public mental health as well as population-based intervention strategies from an international perspective. Current conceptual and methodological challenges of so-called high-risk, whole-population and vulnerable population strategies are critically discussed. Future efforts in research, policy and practice need to address fundamental causes of social and health inequalities, drawing on all societal fields, to contribute to improving population mental health., (© 2023. The Author(s).)

Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group., (© 2023. The Author(s).)

This article summarizes four studies of process and outcome research on family outreach therapy (ATF) with multi-problem families (MPF). We examined the relationship between different "patterns of of collaboration" and outcome variables in the treatment of MPF. Furthermore, we examined the relationship between childhood adversity factors and protective factors for the development of child psychiatric symptoms, and evaluated catamnesis data (follow-up 3 years). The paper summarizes four naturalistic studies of pre and post values and follow-up data in children aged 4-18 years, participating in an integrative, structural family therapy with (X = 115 sessions in 28.8 months, SD = 19.2). The data n = 1,031 show large effect sizes (ES) (d) (thirteen parameters, mean = 1.04, range 0.34 - 2.18). The outcome values correlate most strongly with the pattern "Improving Alliance", i. e. the improvement of the working alliance in the pre-post comparison (d = 0.64). Empirical studies on childhood adversity and protective factors showed significantly higher stress factors and significantly fewer protective factors in children from MPF compared to the non-clinical sample (95.7 % of children from MPF had a psychopathological diagnosis). The follow-up data showed stable treatment effects (three years of follow-up).The empirical research on the treatment of MPF requires further empirical studies in the sense of the treatment aptitude research on the question "what works for whom?".

At present, there are no German guidelines regarding suicidal behaviors in adulthood despite their relevance to public health and the well-established evidence about their prevention. This paper first describes the history and background of working with guidelines. The current status of guidelines for mental illness in Germany is presented and examined for suicide-preventive content. The need for evidence-based suicide prevention and a specific guideline for suicide prevention in adults is discussed.Only via targeted suicide prevention strategies and interventions for the respective risk groups, and by paying particular attention to age and gender specificity in the outpatient as well as inpatient sector, can a high level of care for all patients be ensured. Such strategies have to pay specific attention to the interface between the individual care sectors and need to take comprehensive, easily accessible, needs-based, and affordable sustainable medical care into account. This applies to the outpatient and inpatient sectors as well as to their interfaces. Suicidality is a cross-diagnosis syndrome that occurs in different care contexts and requires complex treatment; therefore, intersectoral and multiprofessional aspects must particularly be addressed in the guideline. Scientific evidence and interdisciplinary expert consensus on the management of suicidal behavior in medical care can help reduce morbidity and mortality associated with suicidality. In August 2021, the funding of an S3 guideline "Management of Suicidality" was approved by the Federal Joint Committee., (© 2021. The Author(s).)

Objective: Peer support is playing an increasing role in the treatment of severely mentally ill people. International findings are available on its effectiveness. However, little is known about knowledge, use and benefit assessment in Germany. This paper addresses this question and presents results from an observational study with 10 participating clinics in southern Germany., Methods: As part of the observational cross-sectional study with people with severe mental illness (IMPPETUS, N=359), sociodemographic and illness- and treatment-associated data were collected by trained study staff between March 2019 and September 2019. Binary logistic regression was used to analyse a possible association with peer support use., Results: 38% (N=138) of respondents reported knowledge about the possibility of peer support; 15% (N=55) affirmed its use. Use of peer support varied across sites (between 6.5 and 37.5%) and was associated with household income. Significantly less frequent use of peer support was among those with high versus low household income (OR=0.20 [95% CI: 0.06-0.68], p=0.01). Of respondents with peer support use (N=55), 78% reported perceiving peer support to be helpful or highly helpful., Discussion: Peer support not only proves to be effective under study conditions with regard to various outcomes, but is also assessed as beneficial under routine conditions in a defined care region by the majority of users. However, only a few respondents knew and used the possibility of peer support., Conclusion: In order to implement peer support more strongly, information about this kind of service should be provided more effectively and a dialogue about successful implementation experiences should be initiated on a regional level., Competing Interests: Stephan Heres hat in den zurückliegenden drei Jahren Vortragshonorare der Firmen Johnson & Johnson und Otsuka/Lundbeck erhalten, ferner Honorare für wissenschaftliche Beratertätigkeit in klinischen Studien der Firmen TEVA, ROVI und KYE.Darüber hinaus liegt kein Interessenkonflikt vor., (Thieme. All rights reserved.)

Objective: The proportion of peoples living in cities or urban areas will increase till 2050 enormously. The present paper investigated the effect of urbanization on mental health., Methods: We systematically searched electronic databases (Medline, Health Evidence and Google Scholar) for systematic reviews and single studies., Results: Analyzed findings showed mostly increased incidence or prevalence ratios for the occurence of schizophrenia, other psychotic disorders and depression. The relationship between urbanisation and mental health among immigrants (migration: country to city) is not clearly established. Sociodemographic and economic factors have a moderating effect. Urbanization is not conceptualised in a uniform way., Conclusion: Further research is needed with standardized and consistent approaches of urbanization as well as focusing current birth cohorts., Competing Interests: Die Autorinnen/Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The COVID-19 pandemic has a significant impact on mental health. On the one hand, fears about one's economic situation, own health and the health of others can lead to psychosocial consequences. On the other hand, social isolation through physical distancing can affect mental health. Finally, the infection itself can lead to psychiatric and neuropsychiatric symptoms as part of a systemic manifestation. In this paper, different mechanisms are presented, which can lead directly or indirectly to neuropsychological and psychopathological symptoms in the context of the COVID-19 pandemic., Competing Interests: Der Autor erklärt, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The Development of Medication and Psychotherapy from 1952 to 1957 in the Child and Adolescent Psychiatric Clinics Weissenau and Gütersloh Abstract. As a result of recent discussions concerning the misuse of medication in children in postwar Germany, the paper analyzes the treatment methods, especially psychopharmacotherapy, as well as therapeutic approaches employed in two German child and adolescent psychiatric hospitals (Weissenau and Guetersloh). We investigated the progression of prescription and the administration of psychotropic and experimental drugs between 1952 and 1957. Objective: As a result of recent discussions concerning the misuse of medication in children in postwar Germany, the paper analyzes the treatment methods, especially psychopharmacotherapy, as well as therapeutic approaches employed in two German child and adolescent psychiatric hospitals (Weissenau and Guetersloh). We investigated the progression of prescription and the administration of psychotropic and experimental drugs between 1952 and 1957. Methods: In total, 966 health records were extensively studied for the time period in question. Results: The use of psychotropic drugs was similar in both hospitals, yet even at that time the use of already established psychotropic drugs differed depending on the concept. Medication-induced fever and shock therapy via insulin were still in use in 1957. Occasionally, initial concepts of a therapeutic treatment approach were observed. Both institutions administered experimental drugs, albeit not in systematic clinical trials. Conclusion: The varying methods of treatment and medication strategies reflect the different setup and concept of the respective hospitals. Indications of dangerous medication trials were not detected. Keywords: child and adolescence psychiatry, psychotropic drugs, neuroleptics, experimental drugs, treatment methods.

Background: The COVID-19 pandemic requires containment measures such as contact restrictions and hygiene requirements. It is accompanied by psychological problems and the fear of infection or of a severe course of the disease. This paper examines the relationship between fear of infection and adherence to rules of hygiene as well as the utilization of medical services., Methods: 1005 patients (20-79 years, 626=62.4% female) were interviewed by online questionnaire before starting a psychosomatic rehabilitation program. Data are presented descriptively and analysed by variance analyses., Results: 68.6% were rarely/sometimes afraid and 17.9% were always afraid of contracting coronavirus or of a severe course of the disease. Those who were afraid intended to wash their hands more frequently (97.2%) than those who were not afraid. Regardless of any change in their physical and mental health status, participants felt it to be risky to seek medical care., Conclusion: The intention to follow hygiene rules in people with pre-existing mental illness depends on a fear of infecting oneself or others with the coronavirus or of contracting a severe form of the disease. Especially mentally or psychosomatically affected individuals need to be informed adequately about the coronavirus and the necessary individual protective measures in order to reduce resistance and to increase willingness to seek medical help., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Overweight/Obesity of Children and Adolescents and its Association with Internalising and Externalising Disorders Research in child and adolescent psychiatry increasingly deals with the association between mental disorder and weight. This paper provides an overview of national and international studies on the relationship between body composition and mental illness in children and adolescents, with a focus on the representation of individual internalizing and externalizing disturbance patterns. The majority of studies in this area are based on the so-called one-compartment model of body composition in terms of the Body Mass Index (BMI) or on the classification as "overweight" or "obese". Associations between mental disorders and body composition were described in two directions: On one hand, both externalising and internalising symptoms are associated with obesity, and on the other hand there are also more psychopathological symptoms among overweight children and adolescents. Longitudinal studies suggest effects in both directions. While externalising symptoms and weight are thought to be related from infancy on, this connection seems to be evident for internalising disorders not earlier than for early school age. It is also known from the literature that psychopharmacological medication affects weight and body growth - especially with psychostimulants, but also with neuroleptics and antidepressants. We found only a few studies describing the relationship between body composition and psyche in more complex models with two or more compartments.

Objective: In various places around the world, crises respites (CR) are being implemented as an alternative to psychiatric treatment, and to offer mutual, short-term residential support by people with lived experience. In this paper, it is examined, how CR are structured, and how - using which approaches and leading to which results - they have been evaluated., Methods: A systematic scoping review of the international literature was carried out. Studies were included, also from the "grey" literature, if they were based on empirical material., Results: 12 articles, relating to 10 CR, were selected. The organisational structures of the included CR were found to be quite heterogeneous. Further, different approaches were used for evaluation (RCT, qualitative, mixed methods)., Conclusion: CR are no substitute for psychiatric care, but a distinct, effective form of support. The influence of people with lived experience is crucial to the implementation and evaluation of CR to preserve their distinctiveness., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Severe mental illnesses are often associated with substantial impairments of psychosocial functioning and a high risk of social exclusion. Along with somatic and psychotherapeutic treatment approaches, psychosocial interventions are an integral component of treatment. Psychosocial therapies aim to improve participation and enable patients to live self-determined lives as far as possible., Objective: This paper provides an overview of the structure and recommendations of the German S3 guidelines "Psychosocial therapies for severe mental illnesses" of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)., Material and Methods: In the DGPPN S3 guidelines psychosocial therapies are systematically described for the first time and recommendations are formulated on the basis of a systematic processing of scientific evidence and a formalized consensus process., Results: The evidence-based and consensus-based guidelines formulate a total of 33 recommendations and 12 statements. For many psychosocial interventions there is a broad evidence base. In the field of individual interventions psychoeducation, social skills training and health-promoting interventions have been given the highest recommendation strength (A). In the field of system level interventions, team-based, multiprofessional community psychiatric approaches, supported employment and self-determined housing with mobile support (supported housing) are given A level recommendations. For other interventions, the current evidence base is less robust., Conclusion: The successful implementation of guidelines depends not only on the quality but also on the dissemination. Therefore, in addition to the treatment guidelines a short version, a patient version and a waiting room version were developed.

Psychopathology is the scientific exploration of abnormal mental experiences and behaviour that, for more than a century, has provided a Gestalt for psychiatric disorders and, thereby, the basis of psychiatric nosology. Having guided clinical and scientific progress in modern psychiatry, in consequence of considerable technical progress, psychopathology has been increasingly marginalised by neurobiological research. Albeit the precise, careful and qualified assessment of psychopathology has been a core skill of mental health professionals, today's curricula pay increasingly less attention to its training. However, because neurobiological models still have to prove their diagnostic superiority and despite all prophecies that psychopathology was doomed, psychiatric diagnoses in both DSM-5 and ICD-11 continue to rely exclusively on psychopathology. Their categorical nosology is also challenged by advances in computational psychiatry and an increasingly advocated personalised symptom-based approach to precision psychiatry. The current paper reviews the objectives of psychopathology and nosology, and the recent debate on their role in future precision psychiatry - from guiding neurobiological research by relating neurobiological changes to patients' experiences to giving a framework to the psychiatric encounter. It concludes that contemporary psychiatry does not need less but rather a more differentiated psychopathology and a likely reformed, possibly more dimensional nosology in order to develop approaches that adequately integrate patients' experiences and professional knowledge., Competing Interests: Die Autorinnen erklären, dass keine Interessenskonflikte bestehen., (Thieme. All rights reserved.)

Background: According to estimates, between 337,000 and 650,000 people in Germany live without a permanent residence. They are highly deprived in terms of health. Studies on the health situation are rare and methodologically heterogeneous. Previous reviews have focused on mental illness., Objectives: The aim of this paper is to provide an overview of current research on somatic diseases of homeless people in Germany., Methods: Based on a systematic literature review for the years 2009-2019, the methodological approaches, sample access, recruitment, and health aspects reported in the studies are compared., Results: By means of a systematic literature search, eight peer-reviewed journal articles were identified. Often the term "homelessness" was not operationalised. The average age of homeless participants was between 40.9 years and 67 years, and the proportion of women was between 0 and 35.3%. Frequently the sample was taken from accommodation and medical services for homeless people. One recruitment strategy was "respondent-driven sampling" in conjunction with incentives. The respondents most frequently reported cardiovascular diseases (17%-37.2%), musculoskeletal diseases (≥20%), and respiratory diseases (7%-24%). Depending on the recruitment site, infectious diseases were common (tuberculosis, hepatitis B and C)., Conclusion: Somatic health studies of homeless people are often selective. Older men with lower educational backgrounds living in large German cities appear to be overrepresented, and there is no uniform use of the term "homelessness." Compared with representative population data for Germany, increased risks of somatic illness were observed; cohort characteristics can explain these to a limited extent. Biographical and intersectional approaches are needed to capture multiple and cumulative exposure situations in homelessness.

Objective: This paper seeks to illustrate current implementation of and the stakeholders' experiences with Home Treatment (=HT) according to §64b of the German Social Code Book V (=SGB V)., Methods: 381 Patients from 8 hospitals were questioned about their experiences and evaluation of HT using a standardized questionnaire (SEPICC-Scale). Further interviews and focus groups with 37 participants (including users, carers and employees) were thematically analysed. In addition, structural and performance data were collected from participating hospitals and HT teams., Results: HT according to §64b SGB V is implemented quite heterogeneously, especially between rural and urban catchment areas. It provides a long-term, cross-sectoral care, which seems to strengthen the integration of patients' everyday life, treatment flexibility and continuity of care. After having experienced HT once, it is generally rated better., Conclusion: An important strength of HT (§64b SGB V) is its adaption to the users' needs and to regional distinctions. Implications for the implementation of outreach services on a larger scale in Germany can be drawn., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Modern psychiatry needs to implement novel mental health care systems in order to address recent developments in diagnostics and treatment of psychiatric patients. In this context, it is necessary to take into account recent ethical and certain legal aspects which explicitly seek to reduce coercive treatment. The so-called "track-unit" is a promising strategy in order to achieve these goals. The "track-unit" seeks to enhance and improve patients' autonomy, setting-overlapping team continuity, compliance and adherence to treatment as well as to reduce time of patients in hospital as inpatients by more flexible intervention. Although there are many interfaces between normal wards and the "track-unit", implementation into daily routine should be done gradually. The first part of this paper will focus on required changes taking as an example the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health in Mannheim. In the second part, we will describe corresponding helpful constructional measures. In part three, we will discuss the socio-economic aspects and benefits of "track-units". In conclusion, the implementation of "track-units" in a German psychiatric department is a personnel and economic endeavor to improve the link and coordination between diagnostics and treatment throughout all stages of mental illness., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

There is a long paternalistic tradition in psychiatry and medicine in general. With a view on that, the law has been changed in order to strengthen patients' autonomy and personal rights and also to reduce coercion and violence. Nowadays, medical and therapeutic actions have to take place within stricter and narrower boundaries and the balance between therapists' provision of care and patients' rights of autonomy had to be renegotiated. In the present paper organisational, structural and legal factors which foster the emergence of coercion and violence in psychiatric treatment will be reported along with factors lying within therapists themselves. Individual factors of therapists that foster the emergence of coercion and violence are amongst other factors suggested by partly tremendous differences in prevalence rates of coercion and violence between hospitals and regions. Aggression coming from therapists can be frequently observed in clinical practice and are also reported in the literature. However, this issue nevertheless is a kind of taboo amongst therapists. Aggression, coercion and violence coming from therapists can be explained by their personality, attitudes, level of training and knowledge and also by their individual biography and involvement in cultures and traditions of clinical teams and hospitals. Despite changes in law the prevalence of coercion and violence in psychiatry is still too high. Amongst other factors, also individual factors of therapists can be made responsible for this situation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue., Method: Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives., Results: A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards., Discussion: Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.

Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents Abstract. Socioeconomic status (SES) is an important risk factor for psychiatric disorders in children and adolescents. Various SES parameters are included in research efforts. This paper investigates the predictive value of different individual SES measures and the combination thereof regarding internalizing and externalizing disorders in children and adolescents. Objective: Socioeconomic status (SES) is an important risk factor for psychiatric disorders in children and adolescents. Various SES parameters are included in research efforts. This paper investigates the predictive value of different individual SES measures and the combination thereof regarding internalizing and externalizing disorders in children and adolescents. Method: We used data from N = 381 8- to 14-year-olds who had been recruited in child and adolescent psychiatric facilities and in the general population. Based on a diagnostic parent interview (K-SADS-PL), we divided the sample into internalizing and externalizing groups and a healthy control group. The SES data of both parents were collected. Education, occupational status, and income were integrated as single factors as well as combined factor to form the SES index. Additionally, we assessed unemployment. Results: Using multivariate analyses, we controlled for age and sex. All single factors turned out to be significant risk factors for internalizing and externalizing disorders. Occupational status was the most important single factor. The explained variance for the SES index was as high as for occupational status. Unemployment was not predictive when examined simultaneously with the SES index. Conclusion: Future studies should integrate the SES as risk factor and use the SES index or occupational status as single factor. The integration of unemployment is not necessarily needed.

Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes mellitus are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes mellitus has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.

This article provides an analysis of the content of 15 letters and postcards written by the Leipzig neurologist Paul Julius Möbius to his Zurich-based colleague Auguste-Henri Forel between 1889 and 1902. Moreover, they are set in the context of the works of the two correspondence partners. The 15 documents preserved at the University of Zurich Medico-Historical Institute and Museum comprise one half of the correspondence, whereas the letters Forel sent in response do not seem to have been preserved. So far, biographic research has neglected the letters analyzed here. Hypnotism and medical suggestion as well as their effects and efficiency in treating and maybe healing certain nervous and mental disorders, primarily psychoneuroses but also certain somatic disorders, formed the bond that connected Möbius and Forel. The exchange was less concerned with discussing details or concepts of hypnosis. Möbius seemed to be more interested in studying the practical application with Forel. Moreover, Möbius and Forel shared the view that contemporary, largely brain-biologically oriented conventional psychiatry had largely neglected or at least underestimated the psychological component of both nervous and mental disorders. Both shared the notion that electrotherapy, widely used at the time, had a strong suggestive component. The letters revealed that both correspondents requested reviews or discussion of their own papers from each other. Forel invited Möbius to consider writing for his Zeitschrift für Hypnotismus (Journal for Hypnotism). The correspondence also revealed that their harmony in certain views did not prevent them from refusing requests made by the other. The letters discussed in this article enrich the knowledge on these two prominent neurologists of the late nineteenth and early twentieth centuries.

Antitest Revolt? On the Pros and Cons of Psychological Testing With regard to international student assessments, efforts of inclusion in society, as well as social and economic participation, this article deals with fundamental arguments against the use of psychological tests. Taking into account the antitest revolt of the 1960s to 1980s in the US and Europe the author ventilates Anne Anastasis classical paper Psychology, psychologists, and psychological testing of 1967. Anastasis point of view is illustrated by means of seven objections against psychological testing as a basis of selection decisions. It becomes clear that a critique of tests as a means of obtaining information has to be clearly distinguished from the ends - the purpose and objective of diagnostics - and the general framework.

Objective: This paper investigates the subjective needs of psychiatric patients in relation to the housing conditions with an additional focus on inclusion and participation. Furthermore, it examines differences in clinical and socio-demographic parameters, self-measured quality of life, stage of recovery., Methods: In this quantitative cross-sectional study, we compared 50 patients in a psychiatric acute ward setting, who were looking for a residence in a sheltered housing facility with 50 patients in a sheltered housing facility using structured interviews., Results: Patients living in a sheltered housing facility reported less unmet needs. However, no differences regarding inclusion and participation were found. More unmet needs were associated with poorer quality of life, and less social inclusion in both groups., Conclusions: Patients in sheltered housing facilities report less unmet needs. Nevertheless, more efforts are needed to regarding inclusion of these patients. A "supported inclusion"-approach should be considered.

Background: On the basis of mental health law, which differs between the federal states in Germany, courts can order the involuntary commitment of people with severe mental disorders in psychiatric hospitals, if they present a danger to themselves or to others. Due to decisions of the highest courts, these laws have been subject to revision since 2011. The aim of this paper is to analyze and compare the results of the revision processes in order to define the need for action for federal and state legislature., Material and Methods: Research of the current status of the revision processes in the federal states and a comparative analysis. The state laws were compared on the basis of selected particularly relevant areas with respect to human rights and treatment., Results: In spite of the revisions the state laws are extremely heterogeneous and in many states do not fully comply with the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) or the highest courts' decisions., Conclusion: The state laws should be harmonized, particularly where they restrict basic and human rights, e. g. regarding prerequisites and objectives of involuntary commitment and coercive measures.

Background: In recent years public and research interests focused more and more in lifestyle as a key factor for health. Particularly lifestyle of people with severe mental illness in combination with modifiable risk factors and adverse effects of the antipsychotic medication is especially critical. The present paper investigated the effect of multimodal healthy lifestyle interventions concerning weight and BMI reduction., Methods: We systematically searched electronic databases (Medline, EMBASE, PsycINFO, Cochrane Library) for reviews and RCTs., Results: Six systematic reviews and three single RCTs met inclusion criteria. Analyzed lifestyle interventions, mostly combined approaches of nutrition and sports, showed short and medium term effects in weight and BMI reduction compared with controls., Conclusion: Lifestyle interventions appear effective for treating overweight among people with serious mental illness. Further research is needed for evaluating long-term effects of the lifestyle interventions as well as focusing special components of the interventions with especially high user benefit., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Mental health of preschool foster care children: How do foster families influence the way children cope with trauma? Abstract. Parents and other significant persons have an important role when preschool children develop or cope with psychological symptoms following traumatic experiences. The underlying mechanisms of the interaction between traumatic experiences and influences of the foster family are still unclear. This study investigates foster parents' stress levels and parenting styles as moderators or mediators in the context of trau- matic experiences. Foster parents of 286 children between three and seven years participated in an online or paper-and-pencil survey. The results suggest a connection between the traumatic experiences of foster children and the stress levels as well as the parenting styles of their foster parents. While verbosity and laxness as parenting styles moderated the impact of traumatic experiences on externalising symptoms, stress levels mediated the impact of traumatic experiences on children's internalising and externalising symptoms. The results underscore the necessity of standardized preparation of and support for foster parents in order to avoid deterioration of psychological symptoms following traumatic events.

Perspectives for the Electroencephalogram in Psychiatry Abstract. The electroencephalogram (EEG) is a non-invasive and cost-effective method to monitor spontaneous neuronal activity over time. Pathologies in EEG recordings indicate with high sensitivity but low specificity abnormal functional brain states. The main psychiatric indications for EEG recordings include atypical clinical symptoms of a neuropsychiatric syndrome or atypical reactions to medication as well as a baseline diagnostic before starting treatment with specific drugs or stimulation modalities. In recent research the EEG continues to be a valuable tool not only in diagnostics but also for the prediction of treatment success. The following paper focuses on basic electrophysiological understanding of EEG recordings, the diagnostic value of EEG recordings in different clinical entities, and new research attempts in diagnostic and treatment prediction.

School Attendance of Children with Mental Health Problems School can support a child's resilience as well as be a risk to the child's mental health. However school is an indicator of social participation, an aspect that flourished especially in the debate about inclusion. In this paper assistance opportunities are being discussed that are established to support children with a psychological disease in school. Three of the different concepts of funding priorities for special educational needs in the German system will be presented: "Förderschwerpunkt emotionale und soziale Entwicklung" (special needs in emotional and social development), "besonderer Förderbedarf "(special needs) and "Schulbegleitung" (school assistants). Also, the conditions for students of schools in hospitals and clinics will be analyzed and the reintegration process back to home school will be considered. It becomes unequivocal that there is little data about special assistance opportunities and that law structures in the federal states of Germany differ from each other and are partly unclear. The involvement of the three systems school, child and youth welfare service and child and youth psychiatry demands solid structures of communication and cooperation and a common continuous work across systems' borders during the child's school years.

Exclusion of individuals with mental disorders is common, especially exclusion from the work force. This paper investigates the role of work and the reintegration into the workforce of patients with mental illness from the mental health professional's perspective. Within a qualitative study design, 44 mental health professionals from different settings and regions in Germany were interviewed. The material was transcribed verbatim and a content analysis was conducted. It can be shown that work and inclusion in the workforce is an important topic and that occupational status is discussed early in the treatment process. However, the roles of mental health professionals in different settings vary considerably. Within treatment settings, specific concepts and structured cooperation facilitating the reintegration of patients with mental illness into the workforce are largely lacking., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In the light of historical and modern criticism of the discipline of psychiatry and psychotherapy as a medical subspecialty, this paper deals with aspects of the theory of medicine as postulated by the physician and philosopher Wolfgang Wieland. According to his contributions medicine is a practical science aiming at establishing rational action. Central to this model is a diagnosis, which helps to subsume individual cases under general principles from which essential therapeutic options can be derived. Hence, psychiatry and psychotherapy become a medical subspecialty by adopting the basic model of medical reasoning and action as described by Wieland. Nevertheless, the limits of such an approach must be taken into consideration. Especially in a psychiatric and psychotherapeutic context it is of particular importance that even when being guided by general principles the responsibility for the personality of each individual patient should be adequately met. Furthermore, attention should be paid to the limits of the subspecialty of psychiatry and psychotherapy as a medical discipline, which also requires a critical analysis of the concept of psychiatric illness.

This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.