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In the present study, we tested whether processing information in the context of an ancestral survival scenario enhances episodic memory performance in older adults and in stroke patients. In an online study (Experiment 1), healthy young and older adults rated words according to their relevance to an ancestral survival scenario, and subsequent free recall performance was compared to a pleasantness judgment task and a moving scenario task in a within-subject design. The typical survival processing effect was replicated: Recall rates were highest in the survival task, followed by the moving and the pleasantness judgment task. Although older adults showed overall lower recall rates, there was no evidence for differences between the age groups in the condition effects. Experiment 2 was conducted in a neurological rehabilitation clinic with a sample of patients who had suffered from a stroke within the past 5 months. On the group level, Experiment 2 revealed no significant difference in recall rates between the three conditions. However, when accounting for overall memory abilities and executive function, independently measured in standardized neuropsychological tests, patients showed a significant survival processing effect. Furthermore, only patients with high executive function scores benefitted from the scenario tasks, suggesting that intact executive function may be necessary for a mnemonic benefit. Taken together, our results support the idea that the survival processing task - a well-studied task in the field of experimental psychology - may be incorporated into a strategy to compensate for memory dysfunction., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy for a set of neurological and psychiatric conditions and especially movement disorders such as Parkinson's disease, essential tremor and dystonia. Recent developments have improved the DBS technology. However, no unequivocal algorithms for an optimized postoperative care exist so far. The aim of this review is to provide a synopsis of the current clinical practice and to propose guidelines for postoperative and rehabilitative care of patients who undergo DBS. A standardized work-up in the DBS centers adapted to each patient's clinical state and needs is important, including a meticulous evaluation of clinical improvement and residual symptoms with a definition of goals for neurorehabilitation. Efficient and complete information transfer to subsequent caregivers is essential. A coordinated therapy within a multidisciplinary team (trained in movement disorders and DBS) is needed to achieve the long-range maximal efficiency. An optimized postoperative framework might ultimately lead to more effective results of DBS., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to evaluate the concordance between the assessments SINGER and FIM, both measurements for detecting functional disabilities in activities of daily living (ADL)., Methods: 301 rehabilitants were assessed with FIM and SINGER in the beginning and at the end of an inpatient rehabilitation program. Correla­tion coefficient, regression analysis, and Kappa statistics were applied to examine the relationship and the concordance between the 2 ADL scales., Results: The assessments were highly correlated (rPearson=0.94). The regression analysis lead to the formula SINGERpred=− 0.004FIM2+1.363FIM – 15.871 with a model fit of R2=0.896. After fixing the limits for a classification due to the functional status, Inter-Rater Reliability (Kappa) was κ=0.69., Conclusion: Both measurements can be used for quality assurance, therapy monitoring, and to classify patients considering their functional disability. Criteria are presented to decide which assessment should be selected., (© Georg Thieme Verlag KG Stuttgart · New York.)

Evidence is accumulating that cerebral laterality appears to be an important feature in the regulation of the stress response with the right hemisphere being closely linked to stress-regulatory systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Although some animal and human data support this hypothesis, studies on brain damaged patients yet failed to substantiate laterality effects on cortisol secretion. The aim of this study was to examine whether unilateral stroke differentially affects tonic and phasic response characteristics of the HPA axis, and to evaluate the impact of intrahemispheric lesion location. Basal morning cortisol levels and phasic responses towards a mentally challenging task were examined in 32 stroke patients with left-sided (LH; n=18) or right-sided (RH; n=14) infarctions and 30 healthy controls matched for age and gender. Only LH, but not RH patients displayed increased morning cortisol levels when compared to controls. In contrast, phasic reactions were blunted in the combined patient group with RH patients showing the most distinct decline. More anterior located lesions were associated with reduced phasic, but not tonic cortisol measures. This relationship appeared to be particularly pronounced in RH patients. Results support the conclusion that the central regulation of cortisol secretion is under excitatory control of the right hemisphere and can be interpreted within a framework of asymmetrical regulation of the stress response. Left- and right-sided strokes may differentially affect response patterns of the HPA axis, a stress-regulatory system that is associated with effective protection against disease and external challenges.

The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.

Purpose and Methods: One of the outcomes of reforming mental health care in Germany has been the establishment of a range of community mental health services. However, current evidence for the effectiveness of these services is slight. Based on a literature search this article provides a systematic overview of empirical research in this sphere. In detail, social psychiatric services, crisis centres, psychosocial contact points, day care centres, and various models of supported housing and work/employment are assessed. Available results on effectiveness are classified according to their level of scientific evidence., Results: The current state of research is characterised by the situation that effectiveness of the care approach provided by social psychiatric services and some types of supported housing and work/employment has been demonstrated at a medium level of scientific evidence. In contrast, the evidence level of mental health care provided in crisis centres, psychosocial contact points, and day care centres is poor., Conclusion: The major reasons for this lack of research are: heterogeneity of care models and staffing levels in the different community mental health services, lack of standardised documentation and reporting system in these services, and lack of research culture to utilise routine outcome data. The consequences of aiming at increasing the level of scientific evidence in this sphere would be to intensify funding of research projects and to implement high quality research designs such as randomised controlled trials.

Objective: Within the deinstitutionalization process of a large psychiatric hospital, the development of two cohorts of patients with chronic schizophrenia is compared over a two-year period: patients living in the hospital's nursing-home area (n = 50) vs. patients already released to two social therapeutic hostels (n = 51). Results of the cohort study were compared with assessments of nurses working in the nursing home (n = 55), focusing on their subjective views of the deinstitutionalization process and its impact on their working conditions., Methods: Patients are assessed through yearly home-visits in their place of residence. The instruments used measure several outcome parameters: psychopathology, social disabilities, subjective quality of life, and normative needs for care. Concurrent staff assessments were conducted using standardized survey instruments focusing on current working conditions and quality of teamwork. Nineteen nurses participated in qualitative interviews evaluating the deinstitutionalization process., Results: For all measures, patients living in the nursing home show significantly worse outcomes. Furthermore, during the study period 34 % experienced a change in their living situation with which they were dissatisfied. Needs for care and the number of areas of "unmet" need increased significantly for this subgroup. Patients living in social therapeutic hostels demonstrate stable levels of psychopathological symptoms, social disabilities, and needs for care. Assessments indicating a deterioration in patients' subjective quality of life focus mainly on areas important for social contacts. Regarding "personal concerns" and "insecurity at work", ratings from nursing home staff were significantly worse than those of a reference group from several other health care institutions (n = 224). Staff showed a tendency to give higher ratings for their opportunities to participate in decisions, in contrast with the low ratings for chances to improve their knowledge in the workplace, a result which may indicate a lack of prospects. In general, staff faces the conundrum of being asked to adopt a new mental health care paradigm while organisational structures are being eliminated and insecurity about career opportunities is increasing., Conclusion: To adequately manage deinstitutionalization of care, all participating parties must be involved in the process as early as possible to clarify expectations and to demonstrate commitment to future opportunities in the new system.

Background: Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care., Methods: This study focuses on a 4 1/2-year prospective assessment of normative needs for care in a cohort (initially N = 115) living in the Dresden care region (Germany). At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS)., Results: The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of "unmeetable needs" increased. Consistently, 70-80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities. Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 4 1/2-year community treatment., Conclusion: The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.

In the provision of mental health care for chronic schizophrenic patients, the specific problems and requirements of long-term community care of suicidal behavior is an area of research not yet fully explored. This study focuses on a 4 1/2-year prospective assessment of normative and subjective needs for care related to this specific area for a cohort living in the Dresden region (Germany). One significant result of this study shows the constant high level of needs for care in the area of suicidal behavior imposed on community services by 30-40% of this diagnostic group. Furthermore, the study identified a special high-risk subgroup for suicides as well as specific needs for care. This subgroup is characterized by clinical reasons for the index hospitalization (suicidal risk or attempt) as well as by psychopathological features (suicidal thoughts and higher levels of anxiety/depression) 1 month after release from index hospitalization. Four items of care were rated as potentially effective for addressing suicidality in the community setting: clinical assessment, increased supervision or systematic recording of (suicidal) behavior, medication, and a sheltered environment. Because these care measures are provided, the percentage of unmet normative needs for the area of suicidal behavior was rather low. Due to limitations of the instrument used for assessment of normative needs, the Needs for Care Assessment (NFCAS), the care measures most frequently provided do not define a quality standard of community care for this problem. A subjective needs assessment differing from the normative approach has to be integrated in establishing guidelines for effective community care.

In the Federal Republic of Germany, rebuilding the structures of complementary care in the newly formed eastern states created the opportunity to provide at-home care in the community as a low-threshold flanking measure for chronically mentally ill individuals generally capable of living independently. For a group of patients with chronic schizophrenic disorders (ICD-10: F20) living on their own in the community with at-home mental health care ( n=83), a study of data focusing on psychopathology, social disability, need for psychiatric care, and (subjective) quality of life demonstrates that the principle of need-oriented care has not yet been realized consistently. This applies especially to the provision of community services of varying treatment intensity based on the differing severities of psychopathological symptoms and social disabilities of individual clients. Furthermore, the results of the study show that the severity of psychosocial impairments is associated with a rather negative assessment of the subjective quality of life, whereas the living arrangement has no influence on satisfaction with life. The conclusion for organizing community mental health care is to establish flexible provision of services oriented to standardized individual analyses of needs for care.

This study aims to assess the extent of needs for mental health care of patients with schizophrenia living in different residential settings and to evaluate the quality of care in these types of complementary services recently established in the East German region of Dresden. Survey data from the first wave of a longitudinal study of five patient subgroups (N=244) living in (1) a psychiatric nursing home, (2) social therapeutic hostels, (3) sheltered community residential care, (4) at home in the family and (5) alone in one's own home are reported. Normative individual needs for care were assessed using the needs for care assessment (NCA). The patient groups show clear differences in the extent of needs for care, especially in the social NCA section. Patients in the psychiatric nursing home and in the social therapeutic hostels exhibit the highest numbers of areas of need. Positive psychotic symptoms, negative symptoms and neuroleptic side effects are the most prominent clinical areas of need in all subgroups. Patients are most frequently socially disabled in terms of managing household affairs, recreational activities and household chores. Deficits in the need status could be found in the NCA areas of 'negative symptoms,' 'recreational activities,' and 'communication.' The basic needs for mental health care of patients with schizophrenia are met in the established sheltered residential settings. Current deficiencies in providing psychological and educational interventions focusing on coping strategies and social skills training should be minimised in order to decrease the identified deficits in the need status.

Background: The present study is part of a public health research project that evaluates restructured psychiatric community care for chronic patients in Saxony after the German reunification. It focuses on the analysis of the individual (expert-based) normative needs for mental health care of chronic schizophrenic patients in the Dresden region., Method: A cohort of ICD-10 chronic schizophrenic patients (n = 115) was examined at 1, 6 and 12 months after hospital release using the Needs for Care Assessment., Results: Schizophrenics' normative needs for care in the clinical sector are dominated by positive and negative symptoms, psychopharmacological side effects and psychosocial distress. In the social realm, problems dealing with the management of household affairs, recreational activities, household chores, occupation and communication skills are the most frequent areas of need. In the Dresden region, considerable deficits apparently persist in the subsections "recreational activities" and "occupational and communication skills", which can be ascribed to the lack of appropriate institutions of care in the area. Schizophrenic patients' normative needs for care cannot be determined simply on the basis of a few, quickly identifiable markers. Individualized analysis is needed that incorporates variables pertaining to psychopathology, subjective coping, social competence, and the course of the disorder. The development of the needs for care over the period of 1 year can be predicted by trends in the social realm that are already visible within the first months., Conclusions: Community-based care offers available for schizophrenic patients in the studied region are by no means generally insufficient. Identified deficits in focal fields of social skills and rehabilitation must be minimized to meet international standards. This is of special importance because social impairments/disabilities predominate over the entire spectrum of schizophrenics' normative needs for psychiatric care.

Objective: After the German reunification the deinstitutionalisation of long-term hospitalised psychiatric patients and the restructuring of the complementary psychiatric care has become necessary in the "new" German states. Hereby it became possible to offer alternative residential settings and new community-oriented care programmes for the mentally disabled., Methods: Ten years after the beginning of this process we analysed the impact of the housing conditions and the subjective satisfaction of 245 chronic schizophrenic patients living in different residential care-settings or with family resp. on their own in the Dresden region. Additionally we asked for the satisfaction with the organisation of the deinstitutionalisation process., Results: The subgroups--defined by the residential setting--differ in sociodemographic variables and in the levels of psychopathology (PANSS) and social disabilities (DAS-M). It is shown how deficiencies and restrictions of the living situation and the deinstitutionalisation process are reflected in the respective judgments of the patients especially referring to autonomy and self-determination., Conclusions: Requirements for the further development of the complementary psychiatric care system are deduced.

Following reunification in Germany in 1990 the new states in the Federal Republic faced the task of restructuring and rebuilding the structures of complementary care for the chronically mentally ill. First and foremost, residential facilities had to be established that would correspond to and meet the currently high need for de-hospitalization by making different types of care and care concepts available. Five groups of patients with chronic schizophrenic psychoses (N = 245 patients) who live in different types of psychiatric care facilities (psychiatric nursing home, social therapeutic hostel, sheltered community residence) or at home, either with or without a family network, were studied. In addition to the sociodemographic data, the psychopathology and the extent of social disabilities were also surveyed, as well as data on the living situation and the subjective quality of life with an emphasis on 'social relationships', 'recreation/leisure activities', and 'general independence'. The five groups differed with regard to various sociodemographic and disorder-related variables, particularly with regard to the extent of social disabilities. Especially relevant, however, are the differences among the patient groups in the extent of daily social life and recreational/leisure activities that are partially reflected in their statements on the subjective quality of life. Primarily for the two groups of home residents, but also in part for the patients living in sheltered community care, social contacts are more or less limited to the residential situation and patients are more or less otherwise socially isolated. This is due among other things to the fact that patients who have been hospitalized for long periods do not as a rule return to their prior area of residence; thus, the available compensatory mediation of relationships with the social environment does not suffice. Demands for the further development of complementary systems of psychiatric care derive from these findings.

In a cohort of patients with chronic schizophrenic disorders (n = 115) characterized by many social deficits and a high level of psychopathology, suggestions concerning rehabilitation were examined in an exploratory way and analysed referring to their relevance for community psychiatric care. The schizophrenic patients were followed up 1 and 12 months after discharge from hospital using an extensive array of instruments (among others: Needs for Care Assessment, Berlin Inventory of Care Needs). Included was a guided interview focusing on patients' subjective views relevant for the course of the disorder and for therapeutical procedures. Using a content analysis of the verbal material received at both points of study, the following main defining elements of the term rehabilitation (or reintegration, resp.) could be identified from the patients' perspective: vocational reintegration, independent residential setting, recovery of normality, and acceptance of responsibility. The rate of individualized confirmation in each category established after the first interview was between 75% and 93% 1 year after discharge from hospital.--Results from multiple and logistic regression analyses demonstrate that a higher degree of differentiation concerning individual rehabilitation suggestions exerts influence on the extent of subjective and normative needs for (psychiatric) care at the first point of study and moreover can be identified as a predictor of the decrease in the normative needs for care during the study period. To differentiate schizophrenic patients' suggestions referring to this subject can therefore be declared a therapeutical task. Furthermore it is a must to adjust individualized expert-based and subjective suggestions concentrating especially on the patients' main point of emphasis, i.e. vocational rehabilitation.

One step in a public health research project focuses on the analysis of the individual (expert-based) normative needs for mental health care of chronic schizophrenic patients (n = 115) in the Dresden Region during the first year post hospital release and the extent to which this can be met by the current established level of complementary care. It is an exemplary contribution to the evaluation of community psychiatry as restructured in the Free State of Saxony following German reunification. The results of the study can be condensed to the following interpreting essential statements. Schizophrenics' normative needs for care are not a statistical issue. The single case analysis corroborates a high rate of relevant fluctuations, above all within the clinical sector (e.g. concerning "dyskinesias and other side effects"), that pose a particular challenge to the flexibility of a system of community psychiatry. This includes that the consequence for the practice of care implies then that when diagnosing course, attention must be paid to shifts in the content of the needs for mental health care (e.g. increasing importance of factors, which contain impairments of basic social competences) in order to orient to them any health care measures already initiated.--With the aid of the used research instrument (Needs for Care Assessment) deficits in meeting the needs for care can be identified. In the Dresden Region considerable deficits persist apparently in the subsections recreational activities and occupational and communication skills, which can be ascribed to the lack of appropriate institutions of care in the area.--The normative needs for care of schizophrenic patients cannot be determined simply on the basis of a few, quickly identifiable markers. Rather it demands individualized analysis incorporating variables pertaining to psychopathology, subjective coping, social competence and the course of the disorder. The development of the needs for care over the period of one year can apparently be predicted by trends in the social sector that are already visible within the first months. With regard to aspects of care planning this finding illustrates the limited ability of cross-section surveys to make definitive statements, as well as the predominance of social disabilities over the entire spectrum of the normative needs for psychiatric care.

An initial cohort of 115 patients with chronic schizophrenia was studied during the period of care provided by community psychiatry programmes in the Dresden region one month and 12 months post hospital release using, among other instruments, the Berliner Bedürfnisinventar (Berlin Inventory of Care Needs). Thus a subjective need structure was identified over a one-year period, which is related primarily to autonomic basic social competence, a qualitatively sophisticated level of competence with regard to bonding and relationships, as well as (at least threatening) elements of social disintegration. Features characteristic of the course of disease (e.g. length of illness, changes in the psychopathological symptoms) and a factor of self-perceived disorder-related personal changes are the decisive predictors of how the extent of care needed will develop during the study period. Conclusions result from perceived deficits of care (e.g. with regard to employment/occupation). They pertain to a further content and institutionalized establishment of care-providing elements, which are not yet (currently) offered in a system of care that is being restructured along the lines of community psychiatry following German reunification. These conclusions fortify results of an analysis of normative needs for care and the current structure of community-based psychiatric care in the Dresden region.

The necessity for a standardized documentation system for the complementary sector of psychiatric care is pointed out, and the goals and requirements to be met are debated. The test-version of such a documentation system (abbrev. BADO-K) is shown. It consists of modules for the assessment of client-centered data, and for the documentation of the treatment process in various facilities. Furthermore, a module of questionnaires and instruments for assessing outcome variables (e.g. quality of life) is integrated. The principles for using the paper-pencil-version and the EDP-version are outlined and discussed with regard to the legal regulations concerning the protection of personal data. Finally, possibilities and limitations of the presented documentation system are discussed. It is argued that the BADO-K is an useful instrument for evaluating the process and outcome of community psychiatric care.

An instrument documenting the care process in in-patient psychiatric services within the German mental health care system has been developed (BADO). This paper reports on the development of a documentation system for all non-hospital based mental health services (day centres, community mental health centres, supported accommodation, work rehabilitation services for general adult psychiatric patients and people with substance misuse). The development process and the instrument (PC and paper and pencil version) are described. The documentation system (BADO-K) could be an important prerequisite for quality assurance in non-hospital based mental health care, and its structure ensures compatibility with the corresponding hospital-based documentation system.

Purpose: Evaluating the establishment of social psychiatry services (SPS) in Saxony was part of a public health research project., Method: One of the variables in a specifically designed assessment instrument--used in 8 SPS during the period 08/95-01/97--was the retrospective statement concerning changes in the client's vocational situation caused by the social upheavals in 1989., Results: 40.6% (n = 335) answered in the affirmative. Men are significantly overrepresented in the group with vocational changes; compared to the population without vocational changes the proportion of currently unemployed persons (56%) is five times higher; only 16% are still employed. Neurotic/personality disorders as well as brief mental disturbances and dependency disorders are more frequent than in the whole SPS-clientele.--The most important constellation (19%) identified by a configuration-frequency analysis is that of patients with prolonged psychotic disorders (started < 1990, not associated with dependency disorder) who were employed at sheltered workplaces during the GDR-period despite of their mental disorder., Conclusion: Following the political German reunification possibilities of vocational rehabilitation have deteriorated and up to now the number of newly established alternatives in regional mental health services is insufficient.

In the wake of the disintegration of the policlinical system which had prevailed in the former German Democratic Republic, far-reaching restructuring has become necessary in the "new" German laender in the field of complementary psychiatric care. Establishment throughout the state of Saxony of a uniform outreach-based ambulatory service ranks as a first component towards building regionalized community psychiatric networks. In light of some twenty years of experience in the old laender, this function is considered a task of the Social Psychiatric Services ("Sozialpsychiatrische Dienste", SPDIs). The present study had been directed at a state-wide investigation of the expectations community-practice psychiatrists (n = 165), physicians in psychiatric clinics (n = 95) and staff working in SPDIs (n = 138) in Saxony hold regarding service programmes and operating methods of these newly established service delivery structures. Given the high return rates in this anonymous postal questionnaire study, the findings presented are considered near-representative. A concurrent finding for all of the groups interviewed, expectations concerning the client population to be serviced by the SPDIs focus on the group of persons with chronic mental illness. Also, the expectations expressed concerning major care/therapeutic services to be rendered by the SPDIs concur in their emphasis on a core area of immediately client-oriented SPDI activities. Between the two medical groups, a major difference found is that community-practice psychiatrists more frequently expect high SPDI commitment regarding sociotherapeutic programmes at an institutional level, whereas clinical physicians expect them to focus on taking over medical therapies in the narrower sense. The expectations SPDI staff hold relative to the therapeutic services to be rendered by themselves go beyond the scope of what has so far been implemented in their current activity, and qualitative content analyses are presented in the article for each of the areas concerned. Along with better staffing levels, removal of in-service organizational and further education deficits are identified by SPDI staff as the two main requirements for stabilizing their operations. In order to counter undue burdening of the SPDI with service expectations and to enable a more clear-cut positioning of its programme structures within a complex psychosocial service delivery system, it is necessary--at least in the state of Saxony--that further needs-oriented establishment and/or extension of community-based psychiatric services and agencies take place.

In accordance with the intentions of the Saxonian planning for restructuring mental health services the establishment of social psychiatry services (SPS) was evaluated. The results presented here originate from one part of a public health research project. In 8 selected SPS a client-centred documentation of care episodes (n = 825) was conducted during the period 8/1995-1/1997 using a specifically designed instrument. In the whole group (54% women; mean age women (49.6 years) > men (43.2 years); 39% schizophrenic, 13% affective disorders, 21% alcoholism) significant differences in the distribution of diagnoses could be found on comparing urban and rural regions: 50% schizophrenic disorders (urban) vs. 20% (rural); 34.5% dependency disorders (rural) vs. 12% (urban). Concerning the chronicity of mental disorders (whole group: first contact with psychiatric institution for 30% of the clientele < 1985; 67% formerly hospitalised) there are considerable variations between SPS in urban and rural areas. Cooperative contacts with other complementary psychiatric institutions as well as the spectrum of items of care also differ significantly between the investigated SPS. Related to the diagnoses some impressive concentrations of care/therapeutical activities could be identified: e.g. home visits (37.2% of the activities) are very important especially for schizophrenic patients, consultations focusing on practical issues (35%) are of eminent significance for dependency disorders. The results lead to the conclusion that the Saxonian SPS already realise an extensive and time-consuming spectrum of social psychiatric activities. However, strengthening these institutions on a professional and personal level as well as the further establishment of psychiatric facilities close to the community seem necessary to achieve concentration on main diagnostic groups, establishment of more homogeneous care strategies, and implementation of coordinative SPS-activities.

After the "Polyclinic system" that had predominated in the GDR had been dismantled, a far-reaching restructuring of the complementary psychiatric care sector became necessary. In the State of Saxony, comprehensive establishment of a homogeneous home-visit outpatient service is the first building block in an interlinked system of regionalized community psychiatry. Based on about 20 years of experience in the Federal States of the FRG, this function is fulfilled by social psychiatry services (SPS). The present study investigates the expectations of free-practising psychiatrists (n = 165), doctors in psychiatric hospitals (n = 95) and staff of social psychiatry services (n = 138) throughout the State of Saxony in respect of available care and the way these new care structures work. The results are approximately representative owing to the high rate of responses in an anonymous postal survey of three specified groups (48.5%, 67.4%, 84.0%). All the groups surveyed expected that the clientel to be looked after by SPS will chiefly consist of the group of chronically mentally ill persons. Moreover, the consistently expressed expectations as to the central care/therapy to be provided by SPS can be summarised as the core of directly client-oriented SPS work. This consists of the elements "welfare work", "individual and institutionalised social therapy", and "help in administrative measures". The main differences between the two groups of doctors is that free-practising psychiatrists more often expect a large SPS involvement with regard to social therapy provided at an institutional level, whereas hospital doctors expect this with regard to medical therapies in the strict sense. Hospital doctors have greater expectations that SPS will also fulfil further functions: work with relatives, public relations, establishment of a crisis service and running self-help groups. The expectations of SPS staff with regard to the therapy they should provide themselves exceed what has already been currently achieved in all sectors. A detailed analysis of contents is also presented in this article. Besides improved staffing, SPS employees state that eliminating internal organisational and postgraduate training deficits are two major requirements for stabilization of their work. Appraisals of the quality of care for the chronically mentally ill in the outpatient complementary sector requested by hospital doctors and SPS staff in comparison with former provision structures in the GDR, show deterioration in the economic security of patients as well as of possibilities available in occupational rehabilitation. On the other hand, there are some improvements in the training of specialist staff whereas protection of the personality rights of patients as well as care measures are now free from ideological bias. These are crucial prerequisites for an update individualised, need-orientated therapeutic procedure. To counteract overburdening of the SPS with expectations of care and to enable a more unequivocal positioning of its structure in a complex system of psychosocial care, further need-orientated development and establishment of psychiatric facilities close to the community concerned, are urgently required, a least as far as the State of Saxony is concerned.