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Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the con, Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries. Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients' sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries' effect. The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20-F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries' effect, the risk of being coerced was higher in Poland. Patients' sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model. The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries' effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards., Funding Agency:European Commission QLG4-CT-2002-01036

Background: Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied. Methods: 291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed. Results: When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men. Conclusions: Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be bec, Funding Agencies:European Commission (Quality of life and Management of Living Resources Programme) QLG4-CT-2002-01036Czech Ministry of Education MSM002160849; PRVOUK-P26/LF1/4; PRVOUK-P03/LF1/9

Thesen 1. Die vorliegende Arbeit beschäftigt sich mit der Enthospitalisierung geistig behinderter Langzeitpatienten aus dem Sächsischen Krankenhaus für Psychiatrie und Neurologie Altscherbitz. Inhaltliche Schwerpunkte der Untersuchung sind die Lebensqualität, die soziale Integration und die Rehospitalisierungen nach der Entlassung. 2. Es wurden 65 ehemalige Patienten auf der Grundlage der Krankenakte zum Enthospitalisierungszeitpunkt (zwischen 1991 und 1999) und anhand eines persönlichen Interviews und einer Aktenanalyse zum Erhebungszeitpunkt (2003) untersucht. Zur Kerndatenerfassung wurde ein standardisierter zweiteiliger Erhebungsbogen erarbeitet. Dabei wurden neben soziodemografischen und krankheitsbezogenen Daten das Geschlecht, das Alter und die Hospitalisierungsdauer einbezogen. Darüber hinaus kam das Berliner Lebensqualitätsprofil, ein daraus abgeleiteter Score für soziale Integration, die Nurses Observation Scale for Inpatients (NOSIE) und der Fragebogen zur Erfassung des individuellen Hilfebedarfs im Bereich Wohnen (HMBW) zur Anwendung. 3. Obwohl sie einen großen Anteil der Populationen von Langzeitpatienten ausmachten, fanden die geistig Behinderten in der psychiatrischen Forschung bisher nur wenig Beachtung. Es wurden deshalb auch Erkenntnisse aus anderen Fachgebieten, wie der Geistigbehindertenpädagogik, berücksichtigt. 4. Die hier untersuchten ehemaligen Patienten unterscheiden sich bezüglich soziodemografischer, biografischer und medizinischer Daten von der sonst in psychiatrischen Enthospitalisierungsstudien erfassten Klientel mit überwiegend schizophrenen Erkrankungen. Die geistig Behinderten wurden sehr früh, 72% vor dem 20. Lebensjahr, hospitalisiert. Die durchschnittliche Verweildauer betrug 28 Jahre (Range sechs bis 67 Jahre). Über die Hälfte der Patienten verblieben beim ersten stationären Aufenthalt dauerhaft in der Klinik. 19 Patienten hatten eine leichte, 46 eine mittelgradige geistige Behinderung. In 19 Fällen bestand eine neurologisch-psyc

This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n = 1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery. (C) 2011 Elsevier B.V. All rights reserved.

Aim: This research aimed to assess the contribution of the five core areas of the transactional stress model to the relatives' psychological distress (PD) when informally taking care of patients with functional psychoses treated in community mental health care. Subjects and methods: Cross-sectional data from 163 relatives were collected in interviews, while data on 158 patients were collected by analyzing clinical charts. The following areas were assessed: socio-demographic and illness-related features of the patients, socio-demographic features of the relatives (environmental variables); sense of coherence, mastery, causal attributions and opinions of relatives about mental disorders (person variables); interpersonal problems with the patients as well as the assessment of their symptoms by the relatives themselves (primary appraisal); support received, critical life events and burden of relatives caused by their own illnesses (secondary appraisal); control behavior and efforts of relatives to engage the patients in activities (coping). PD was assessed with the 12-item version of the General Health Questionnaire. Bi-variate correlation analysis and a multiple linear regression model were the main test statistical approaches. Results: Correlation analysis showed that differences between diagnostic groups referred to primary and secondary appraisal processes, in particular. Results of the statistical model provided evidence for the importance of primary appraisal and person variables for influencing PD, and for the lack of importance of coping and environmental variables. Conclusion: The study enhanced the validity of the transactional stress model to demonstrate the influence of salutogenetic concepts such as sense of coherence.

Objective: Involuntary treatment in mental health care is a sensitive but rarely studied issue. This study was part of the European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice (EUNOMIA) project. It assessed and compared the use of coercive measures in psychiatric inpatient facilities in ten European countries. Methods: The sample included 2,030 involuntarily admitted patients. Data were obtained on coercive measures (physical restraint, seclusion, and forced medication). Results: In total, 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. The most frequent reason for prescribing coercive measures was patient aggression against others. In eight of the countries, the most frequent measure used was forced medication, and in two of the countries mechanical restraint was the most frequent measure used. Seclusion was rarely administered and was reported in only six countries. A diagnosis of schizophrenia and more severe symptoms were associated with a higher probability of receiving coercive measures. Conclusions: Coercive measures were used in a substantial group of involuntarily admitted patients across Europe. Their use appeared to depend on diagnosis and the severity of illness, but use was also heavily influenced by the individual country. Variation across countries may reflect differences in societal attitudes and clinical traditions. (Psychiatric Services 61: 1012-1017, 2010)