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Background There is limited knowledge of whether cognitive-behavioral therapy (CBT) or second-generation antipsychotics (SGAs) should be recommended as the first-line treatment in individuals at clinical high risk for psychosis (CHRp). Hypothesis To examine whether individual treatment arms are superior to placebo and whether CBT is non-inferior to SGAs in preventing psychosis over 12 months of treatment. Study Design PREVENT was a blinded, 3-armed, randomized controlled trial comparing CBT to clinical management plus aripiprazole (CM + ARI) or plus placebo (CM + PLC) at 11 CHRp services. The primary outcome was transition to psychosis at 12 months. Analyses were by intention-to-treat. Study Results Two hundred eighty CHRp individuals were randomized: 129 in CBT, 96 in CM + ARI, and 55 in CM + PLC. In week 52, 21 patients in CBT, 19 in CM + ARI, and 7 in CM + PLC had transitioned to psychosis, with no significant differences between treatment arms (P  = .342). Psychopathology and psychosocial functioning levels improved in all treatment arms, with no significant differences. Conclusions The analysis of the primary outcome transition to psychosis at 12 months and secondary outcomes symptoms and functioning did not demonstrate significant advantages of the active treatments over placebo. The conclusion is that within this trial, neither low-dose aripiprazole nor CBT offered additional benefits over clinical management and placebo. [ABSTRACT FROM AUTHOR]

Filicides lead to questions about motives and missed opportunities for prevention. The development of preventive strategies is difficult due to heterogeneous perpetrator-victim dynamics. Eighteen child killings by parents over a period of 10 consecutive years in the catchment area of Dusseldorf's Institute of Legal Medicine were identified, and the autopsy reports and prosecution files were analysed. With regard to motives and psychodynamics, a heterogeneous group of perpetrators were identified; the perpetrators were responsible for 8 accidental filicides, 3 killings of unwanted children, 1 killing during perpetrator psychosis, 1 spousal revenge killing and 5 homicide-suicides. Except for the homicide-suicides, overburdening seemed to be the main risk factor for the killings. Preventive measures are difficult to establish. They should focus on awareness campaigns and increasing or establishing multi-professional support for affected families. [ABSTRACT FROM AUTHOR]

Aim: Psychological interventions, such as cognitive behavioural therapy (CBT) and supportive counselling (SC), are used to treat people with schizophrenia and people at clinical high risk (CHR) of psychosis. However, little information is available on predictors of treatment response. This study aims to identify such predictors of psychological interventions in CHR. Methods: A total of 128 help‐seeking CHR outpatients were randomized into two groups—integrated psychological intervention (IPI), including CBT, and SC—for 12 months. Multiple regression analysis was used to identify demographic, symptomatic and functional variables that predict improvement in positive (PANSS Positive), negative (PANSS Negative) and basic symptoms (Basic symptom total score) and improvement in functioning (GAF) at 1‐year follow up. Results: In the merged group (IPI + SC), people who lived independently, were younger and presented with higher baseline functioning showed more improvement in symptomatic outcomes at follow up. Negative symptoms at baseline predicted less improvement in positive and basic symptoms. Being married or cohabiting and living in the primary family were found to correlate with good functioning at 1‐year follow up. Conclusions: Younger CHR individuals and those who are functioning well may particularly benefit from early intervention. Treatment might need to be modified for low‐functioning CHR and those who already display higher scores of negative symptoms. Registration number: NCT00204087 [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation. Methods: A risk‐based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first‐episode psychosis and those with full‐blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211). The CHR sample was subdivided according to a prognostic index yielding 4 CHR sub‐classes with increasing risk for transition to psychosis. Results: Negative beliefs about the self were associated with paranoid ideation in CHR and a lower risk state. In the highest risk state and full‐blown psychosis, there is an association with negative beliefs about others. Conclusion: These findings are in line with theories suggesting a switch from a predominantly activated negative self‐schema to a malevolent others‐schema in association with paranoid ideation along the risk‐continuum. However, due to methodological limitations these results should be replicated by future studies. [ABSTRACT FROM AUTHOR]

Aim Schizophrenia is a heterogeneous disorder that presents differently in men and women: men show a higher propensity to negative symptoms, lower social functioning, earlier age at onset and co-morbid substance abuse, whereas women display more affective symptoms. It is unknown whether these differences extend to subjects at high risk ( HR) of psychosis. Thus, the aim of the present study was to address this question. Methods Clinical symptoms and functioning were assessed using structured interviews in 239 HR subjects (female, n = 80). The definition of being at HR was based on the criteria used in the European Prediction of Psychosis Study ( EPOS). Results Men displayed more pronounced negative symptoms, higher rates of past substance abuse disorders and higher deficits in social functioning. No gender difference was found for depression, which affected almost 50% of the cohort, or age at onset for the fulfilment of HR criteria. Conclusion The higher impairment in specific symptoms observed in male schizophrenia patients was also present in subjects at HR for psychosis. Further studies are required to determine whether these symptoms are gender-specific predictors of transition to psychosis and whether they warrant gender-specific interventions. The high propensity to depression in the present cohort, which was particularly pronounced in the male cohort compared with the general population, in conjunction with the observed increase in negative symptoms and functional impairment, should alert clinicians to the necessity for the identification and treatment of HR subjects, irrespective of the degree to which these features are associated with transition risk. [ABSTRACT FROM AUTHOR]

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

Atypical neuroleptics have improved drug treatment in schizophrenia. However, their use varies greatly between countries and continents. Recent meta-analyses have deemphasized the range and magnitude of their superiority compared to typical neuroleptics. Aims of the present study were to contribute effectiveness data to this discussion. In 725 inpatients with ICD-10 diagnoses F20, 22-25 from four German psychiatric inpatient units acute neuroleptic treatment and outcome were analyzed under naturalistic conditions. Treatment strategies were stratified post hoc to answer the question, which proportion--and which kind--of patients are primarily given atypicals or typicals, for how long, at which rate and when the atypical/typical drugs are switched to typical/atypical drugs, and what the respective outcomes are. As the results demonstrate, atypicals were administered one time during inpatient treatment in nearly 48% of the patients, however as first choice drugs in only 15% of this population. Treatment change occurred in 28% after 5-6 weeks irrespective of the first drug choice. Outcome differences were, if at all, only modest and not systematically biased towards a single strategy. In conclusion, frequency of inpatient treatment with atypical neuroleptics corresponds to pharmaco-epidemiological data in Europe, but is still lower than in the US. Contrary to contemporary guideline recommendations atypical neuroleptics under routine inpatient treatment conditions we scarcely administered as first choice treatment, and acute clinical outcome is comparable to that under treatment with typical neuroleptics. Reasons and implications of these findings considering the methodological limitations are discussed. [ABSTRACT FROM AUTHOR]

Purpose of Review: The German mental healthcare system is currently undergoing discussions regarding the assessment of mental healthcare quality and the identification of potentials for optimizing mental healthcare. Quality assurance projects play an important role in the optimization of the care for the mentally ill in Germany. This review describes the most recent results of quality assurance programs from Germany as identified by a systematic literature search covering the time span 1 January 2008 until 1 June 2009., Recent Findings: The German mental healthcare system is characterized by a high degree of structural quality. Quality assurance research in German mental healthcare is multifaceted and several projects are underway to determine the cost-effectiveness of procedures in mental healthcare and the development of quality indicators., Summary: In Germany, mental healthcare research is a rapidly developing field. Potentials for improvements can be identified in the assessment of process and outcome quality, the regional distribution, and the coordination among service providers. More studies are needed to identify the best methods to assess quality in mental healthcare with a view to improve process and outcome quality.

The German Research Network On Schizophrenia (GRNS) is a nationwide network currently comprising 16 psychiatric university departments and 14 state and district hospitals, as well as six local networks of psychiatric practices and general practitioners collaborating on about 25 interrelated, multicenter projects on schizophrenia research. The GRNS aims to intensify collaboration and knowledge exchange between leading research institutions and qualified routine care facilities, both within (horizontal network) and between (vertical network) the two levels of research and care, in order to create the scientific preconditions for optimization of the management of schizophrenia. The concept and the first results of studies aiming at the investigation of (i) strategies for early detection and early intervention in the prodromal stage of psychosis; (ii) treatment in first-episode schizophrenia; (iii) quality management; and (iv) destigmatization, are described as examples of this effort.

Background: Within a pharmacoepidemiologic study, characteristics of patients with schizophrenia switched from first- to second-generation antipsychotics (FGAs and SGAs, respectively) or to antipsychotic polypharmacy were compared with those of patients maintained on treatment with FGAs. The primary aim was to assess factors associated with antipsychotic switching and to compare disease course with regard to mental state and social functioning., Method: Adult inpatients with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder were assessed in 7 psychiatric hospitals. Data were collected between 2001 and 2002. For those patients (N = 847) with an antipsychotic prescription at discharge, t tests and covariance and logistic regression analyses were used to evaluate the relationship between demographic and clinical characteristics and antipsychotic switching., Results: Patients switched from FGAs to SGAs had fewer previous psychiatric admissions, a shorter illness duration, fewer substance disorders, and a higher probability of working in a competitive setting but more pronounced symptoms than those maintained on treatment with FGAs. Mental state and social functioning after case-mix adjustment were more favorable in the group switched to SGA monotherapy but not in those patients administered FGAs and SGAs concurrently at discharge. Logistic regression controlling for demographic and clinical variables revealed that a short disease duration (p <.05), fewer previous psychiatric hospitalizations (p <.01), voluntary admission (p <.05), and pronounced thought disorder (p <.05) were significantly associated with switching from FGAs to SGAs. Hospital differences were also observed., Conclusion: Remaining on FGAs or switching to SGAs in schizophrenia care depends strongly on institutional practices in addition to the previous disease course and health care utilization.