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ZusammenfassungAktive Sterbehilfe ist aktuell in Österreich noch gesetzlich verboten. Aufgrund einer Entscheidung des Verfassungsgerichtshofs wäre assistierter Suizid ab dem Jahr 2022 gänzlich legal. Eine gesetzliche Regelung, die Grenzen zwischen legalen Formen einer Assistenz sowie deren Voraussetzungen und weiterhin unerlaubten Assistenzleistungen zieht, ist derzeit noch nicht in Sicht. Ein Suizid, der auf Verlangen des Suizidenten von fremder Hand herbeigeführt wird, bleibt jedenfalls weiterhin strafbar; dies auch dann, wenn der Suizident physisch nicht mehr in der Lage ist, bei seiner Tötung mitzuwirken. In mehreren europäischen Ländern wurde aktive Sterbehilfe bereits legalisiert und in manchen Ländern, wie zum Beispiel der Schweiz, kann assistierter Suizid auch ohne lebenszeitlimitierende Grunderkrankung, bei unerträglichem Leid und insuffizient vorhandenen weitere Behandlungsmöglichkeiten in Anspruch genommen werden. In diesem Fallbericht wird die Kasuistik einer Patientin geschildert welche, als Grunderkrankung an einer Persönlichkeitsstörung leidend, einen assistierten Suizid in der Schweiz geplant hatte. Es werden die ethischen und juristischen Hintergründe dieses Fallberichts diskutiert.Das zur Verfügung stellen assistierter Suizidmöglichkeiten birgt die große Gefahr, dass Menschen mit psychischer Erkrankung, insbesondere bei schweren depressiven Episoden, Behandlungsangebote ablehnen und anstelle Suizid durch einen professionellen Sterbehilfeanbieter wählen könnten. Insbesondere gewarnt werden muss vor der Tatsache, dass Menschen in aktuell schwer depressivem Zustandsbild aufgrund dessen zumeist unter eingeschränkter Entscheidungsfähigkeit leiden und nur bedingt über die Möglichkeit der freien Willensentscheidung verfügen.

Objective Major depressive disorder (MDD) and anxiety disorders are both common and especially challenging during pregnancy. Considering possible risks of intrauterine drug exposure of the child, the role of psychopharmacological treatment is ambiguous and various negative obstetric outcomes were inconsistently associated with medication. Consequently, a critical examination of peri- and postnatal phenomena associated with intrauterine exposure to antidepressants based on serotonin-reuptake inhibition (SRI) and subsumed under the term "poor neonatal adaptation syndrome" (PNAS) is urgently called for. Methods A comprehensive literature search was conducted, revealing a total number of 33 relevant studies and 69 individual outcomes among 3025 screened studies. Seventeen outcomes allowed meta-analytic evaluation (random effects model). Measures for heterogeneity (I2 ) and contour-enhanced funnel plots were generated. Results Single studies showed increased risks for deficits in neurological functioning and autonomous adaptation in SRI exposed infants. Meta-analytical evaluation showed increased symptom occurrence or severity in exposed neonates for low APGAR scores, birth weight, size for gestational age, preterm delivery, neuromuscular and autonomous regulation, and higher rates of admission to specialized care. Mostly, increased risk after SRI exposure was supported by comparison to unexposed infants born to mothers diagnosed with depression. Conclusion Whereas statistically significant evidence for various effects of intrauterine exposure to SRI was found, the clinical relevance remains unresolved due to inherently low data quality in this research domain and insufficiently defined samples and outcomes. More systematic research under ethical considerations is required to improve multiprofessional counselling in the many women dealing with MDD during pregnancy and the peripartum.

Zusammenfassung Ziel Identifikation von intrinsischen Motivatoren, die bei der Berufswahl Psychiatrie eine Rolle spielen. Methodik 14 leitfadengestützte Tiefeninterviews wurden mithilfe von Codierungsrahmen systematisch ausgewertet. Ergebnisse Positive Aspekte waren der zwischenmenschliche Fokus und der ganzheitliche Ansatz. Negative Dimensionen waren das schlechte Image unter Kolleg*innen, Vorurteile und Stigma. Die Entstigmatisierung der Psychiatrie und die Gleichstellung psychiatrischer mit somatischen Aspekten in Fallberichten wurden als Möglichkeiten vorgeschlagen, das Interesse am Fach Psychiatrie zu erhöhen. Schlussfolgerung Um die Beliebtheit der Psychiatrie bei Mediziner*innen zu steigern, bedarf es Maßnahmen zur Bekämpfung von mit Psychiatrie verbundenem Stigma im Gesundheitswesen. Im Rahmen der medizinischen Lehre müssen psychiatrische Störungen, welche durch ihre hohe Prävalenz alle medizinischen Disziplinen betreffen, entsprechende Gewichtung erhalten.

In den letzten Jahrzehnten hat sich die Versorgung psychisch Kranker in einem Ausmas verandert wie in keinem anderen Fachgebiet. Die Zahl psychiatrischer Betten wurde im Vergleich zu den 70-er Jahren des letzten Jahrhunderts in Osterreich auf weniger als ein Drittel reduziert. Parallel dazu stieg aber die Zahl der Betten zur Behandlung psychisch Kranker in anderen Bereichen, beispielsweise in der forensischen Psychiatrie, deutlich an. Die Verlagerung von Betten aus den psychiatrischen Krankenhausern in Allgemeinkrankenhauser fand in vielen europaischen Landern statt. Angesichts der Tatsache, dass die meisten psychisch Kranken auch unter korperlichen Krankheiten leiden und die somatische Komorbiditat den wichtigsten Grund fur die verkurzte Lebenserwartung psychisch Kranker darstellt, ist dies eine auserst positive Entwicklung. Das „Assertive Community Treatment“, eine intensive nachgehende ambulante Versorgung unter Einbeziehung von Psychiatern, ist gerade fur schwer und chronisch psychisch Kranke von Vorteil.

Negativsymptome sind ein Kernmerkmal der Schizophrenie. Ihre Erfassung und Therapie sind komplex. Patienten mit kognitiver Dysfunktion und psychomotorischer Verlangsamung erfullen nicht immer die Kriterien einer Schizophrenie nach DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Bei der Diagnose einer Schizophrenie mit negativen Symptomen sollte immer auch differenzialdiagnostisch die Diagnose einer chronischen affektiven Storung in Erwagung gezogen werden.

Objective: Attention-deficit hyperactivity disorder (ADHD) often coincides with substance abuse and delinquency. A sample of opioid-maintained inmates was assessed for symptoms of ADHD, substance abuse history, types of offense, psychiatric comorbidities, and psychopharmacological treatment using a standardized battery of instruments. Method: Adult inmates (n = 133, mean age 35.7 years, 21.8% female) in opioid-maintenance therapy (OMT) were administered the Adult ADHD self-report scale, Wender Utah Rating Scale, Mini International Neuropsychiatric Interview, ­European Addiction Severity Index. Results: Fifty percent screened positive for childhood and 17% for adult ADHD, four (3.1%) received ADHD medication. Inmates with ADHD symptom status were significantly younger at first substance abuse, reported more drug overdoses, longer duration of cocaine and prescribed medication abuse and more in- and outpatient treatments (all p < 0.05). For all inmates in OMT a high rate of psychiatric comorbidities was observed (78.9%). Conclusion: There is a need for assessment of ADHD and other psychiatric comorbidities in OMT prisoners. Evidence-based treatment should be routinely provided.

Anliegen: Es wurde untersucht, ob das Ausmas der Depressivitat der Vater und der Mutter von der Krankheitssymptomatik von Schizophreniekranken beeinflusst wird. Methode: 101 Mutter und Vater derselben Patienten fullten das „Beck Depression Inventory“ (BDI) aus. Die Kranken wurden mittels „Positive and Negative Syndrome Scale“ untersucht. Ergebnisse: Es fand sich ein positiver Zusammenhang zwischen der Negativsymptomatik und der Depressivitat beider Elternteile sowie zwischen der Positivsymptomatik und der Depressivitat der Vater. Schlussfolgerungen: Die Depressivitat der Eltern ist mit Symptombereichen der Schizophrenie assoziiert.

During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However, not all interventions are evidence based. Patients with cannabis and cocaine/amphetamine use disorders and special patient populations especially lack evidence-based treatment recommendations. Many patients undergo treatment that has not been scientifically evaluated for quality and efficacy. Moreover, there are large disparities regarding availability and treatment access across Europe, with the new member states of the European Union (EU) reporting long waiting lists and low treatment coverage. Even in Austria, which ranks among the countries with relatively high treatment coverage and good diversification of treatment in opioid maintenance therapy due to the availability of methadone, buprenorphine, and slow-release oral morphine (SROM), a considerable population of untreated or inadequately treated patients exists. Treatment for substance use disorders in Europe still has scope for improvement in terms of treatment availability and access, which is ideally provided by further development and implementation of evidence-based interventions.

Anliegen: Der Bedarf der Angehorigen von Schizophreniekranken, die erstmals mit einer psychiatrischen Einrichtung in Kontakt kamen, sollte analysiert werden. Methode: 93 Angehorige Schizophreniekranker wurden mittels „Carers’ Needs Assessment for Schizophrenia“ (CNA-S) untersucht. Ergebnisse: Die haufigsten Probleme der Angehorigen von Kranken beim Erstkontakt waren zu wenig Information uber die Krankheit und Sorgen bezuglich der Krankheit. Individuelle Psychoedukation wurde im Falle eines Erstkontakts signifikant gehauft benotigt. Schlussfolgerungen: Beim ersten Kontakt werden einige Interventionen haufiger als im spateren Krankheitsverlauf benotigt.

Untersuchung zur Wirksamkeit, Akzeptanz, Vertraglichkeit und Verbleiberate der Buprenorphin/Naloxon-Behandlung bei opioidabhangigen Patienten in einem ambulanten Setting. Die Untersuchung wurde in einem open-label, prospektiven, multizentrischen Design (25 Zentren) mit 307 Patienten uber einen Untersuchungszeitraum von 12 Monaten durchgefuhrt. Dropouts wurden auf Pradiktoren fur den Behandlungsabbruch analysiert. Die Retentionsrate betrug nach 12 Monaten 45,6%, wobei die hochste Retentionsrate Patienten mit Buprenorphinvorbehandlung aufwiesen. Die Dropout-Analyse erbrachte 3 signifikante Pradiktoren fur einen vorzeitigen Studienabbruch: Eine kurzere Dauer der Heroinabhangigkeit (p=0,038), ein geringeres Alter beim Erstkontakt mit Heroin (p=0,028) sowie eine hohere Einstellungsdosierung (p=0,017). Etwa zwei Drittel der Befragten zeigten sich mit der Behandlung sehr zufrieden bzw. zufrieden, wobei die Selbsteinschatzung mit der Fremdeinschatzung der Mediziner nicht deckungsgleich war. Die Untersuchung zeigt, dass noch ein erheblicher Schulungsbedarf zur Buprenorphin/Naloxon-Medikation besteht, insgesamt das Ergebnis bezuglich Retentionsrate und Zufriedenheit mit Ergebnissen chronischer Erkrankungen im Einklang steht.

Anliegen: Die Diagnose Schizophrenie ist in besonderem Ausmas mit Stigma verbunden. Vor allem internalisiertes Stigma, die Ubernahme von negativen Vorstellungen ins Selbstbild, stellt eine wesentliche Barriere im Recovery-Prozess dar. Mit der von Jennifer Boyd Ritsher und KollegInnen entwickelten Internalized Stigma of Mental Illness-Skala (ISMI) lasst sich internalisiertes Stigma valide erfassen. Ziel der Studie war es, die psychometrischen Eigenschaften der deutschen Version der ISMI bei Personen mit einer Psychose aus dem schizophrenen Formenkreis zu prufen. Methode: Die ISMI wurde ins Deutsche ubersetzt und Reliabilitat und Validitat sowie Pradiktoren fur internalisiertes Stigma wurden gepruft. Dazu fullten 157 Personen die ISMI selbststandig aus. Weiterhin wurden soziodemografische und klinische Daten sowie zur Uberprufung der Konstruktvaliditat Daten zu Devaluation-Discrimination, Depression, Selbstwert, Empowerment, Kontrolluberzeugungen und Lebensqualitat erfasst. Ergebnisse: Die deutsche Version der ISMI zeigte bei Personen mit einer Psychose aus dem schizophrenen Formenkreis gute psychometrische Eigenschaften mit einer hohen internen Konsistenz, guten Test-Retest-Reliabilitat und guten Konstruktvaliditat. Insgesamt zeigte etwa ein Drittel eine hohe Auspragung an internalisiertem Stigma. Als Pradiktoren fur ein hoheres Ausmas an internalisiertem Stigma fanden sich ein Mangel an sozialen Kontakten, eine Schulbildung unterhalb des Abiturniveaus und eine stationare bzw. tagesklinische Behandlung (versus ambulante Behandlung). Schlussfolgerungen: Die Ergebnisse sprechen fur eine Vergleichbarkeit der deutschen Version der ISMI mit der Originalversion und verweisen darauf, dass mit der deutschen Version der ISMI internalisiertes Stigma bei Personen mit einer Psychose aus dem schizophrenen Formenkreis valide und reliabel erfasst werden kann. Dies ermoglicht, die Reduktion von internalisiertem Stigma als Behandlungsziel zu definieren und zu uberprufen.

Objectives Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials. Methods Two double-blind, double-dummy, randomized controlled trials (Pilot study, European sample† of MOTHER-trial) comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted. In both studies, participants received voucher-based incentives for attendance and completion of study assessments. In the MOTHER trial, participants additionally received escalating voucher incentives for drug-free urine samples. Neonatal abstinence syndrome was treated with oral morphine solution based on standardized modified Finnegan scores. Results After a mean treatment period of 13.79 weeks in the Pilot study (PS, n = 18) and 20.78 weeks in the MOTHER-trial (MT, n = 41), respectively (p

Background: Prior studies have reported on the pregnancies and outcomes of in vitro fertilization (IVF) in special subpopulations; however, there is a lack of studies on opioid-exposed IVF-conceived neonates. Case Presentation: A young adult IVF-pregnant woman was maintained on buprenorphine throughout pregnancy and received follow-up from the addiction clinic from estimated gestational week 32. She delivered healthy dichorionic twins via cesarean section at 38 weeks gestational age (buprenorphine dose at time of delivery: 16 mg). All maternal supervised urinalysis taken as of gestational week 32 were negative for concomitant substances (prior to treatment initiation at the addiction clinic, only self-reports of abstinence from concomitant substances were available). Both healthy children (male birth weight: 3140 g, female birth weight: 2650 g) developed an unusual course of neonatal abstinence syndrome (NAS) requiring extensive treatment (total morphine dose male: 22 mg, and female: 26.75 mg; length of treatment: 33 and 34 days, respectively; duration of hospitalization: 40 days). Discussion: The highly severe and long-lasting NAS in both neonates represents a very unusual course following an uneventful pregnancy, and influencing iatrogenic factors cannot be ruled out. Given the multiple variables influencing infant outcomes, this highlights the importance of high-quality, evidence-based standard operating procedures, which (1) are initiated as early as possible during pregnancy to minimize risk factors for adverse infant outcomes, such as concomitant substance use during pregnancy; (2) support the substance-dependent woman throughout the postpartum period, especially in cases of multiple and/or IVF-conceived pregnancies, where additional challenges may arise; and (3) consider the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Anliegen: Es sollte versucht werden, Pradiktoren fur die Belastungen von Angehorigen Schizophreniekranker zu identifizieren. Methode: 135 Angehorige Schizophreniekranker wurden mittels „Carers’ Needs Assessment for Schizophrenia“ (CNA-S) und dem „Involvement Evaluation Questionnaire“ (IEQ) untersucht. Ergebnisse: Jene Angehorigen, die Hilfen benotigten, jedoch nicht ausreichend oder gar nicht erhielten, berichteten uber erhohte Sorgen und vermehrte Spannungen mit den Kranken. Schlussfolgerungen: Defizite im Versorgungsangebot haben eine negative Wirkung auf Angehorige.

Research has shown that substance use, abuse and addiction are not limited to a specific age group. Problems related to substance addiction are an important cause of morbidity in the population aged 65 years and above, especially the abuse of prescription drugs and legal substances. A lack of evidence-based studies and tailored treatment options for the aging population is evident. Appropriate and effective health care is an important goal to improve the health-related quality of life of elderly people. Research in the increasingly aging population needs to include an age- and gender-sensitive approach.

Background Chronic medical conditions such as opioid dependence require evidence-based treatment recommendations. However, pregnant women are underrepresented in clinical trials. We describe the first within-subject comparison of maternal and neonatal outcomes for methadone vs. buprenorphine exposed pregnancies. Though methadone is the established treatment of pregnant opioid dependent women, recent investigations have shown a trend for a milder neonatal abstinence syndrome (NAS) under buprenorphine. However, it is not only the choice of maintenance medication that determines the occurrence of NAS, other factors such as maternal metabolism, illicit substance abuse and nicotine consumption also influence its severity and duration and represent confounding factors in the assessment of randomized clinical trials.

Gender, a biological determinant of mental health and illness, plays a critical role in determining patients’ susceptibility, exposure to mental health risks, and related outcomes. Regarding sex differences in the epidemiology of opioid dependence, one third of the patients are women of childbearing age. Women have an earlier age of initiation of substance use and a more rapid progression to drug involvement and dependence than men. Generally few studies exist which focus on the special needs of women in opioid maintenance therapy. The aim of this paper is to provide an overview of treatment options for opioid-dependent women, with a special focus on buprenorphine, and to look at recent findings related to other factors that should be taken into consideration in optimizing the treatment of opioid-dependent women. Issues addressed include the role of gender in the choice of medication assisted treatment, sex differences in pharmacodynamics and pharmacokinetics of buprenorphine drug interactions, cardiac interactions, induction of buprenorphine in pregnant patients, the neonatal abstinence syndrome and breastfeeding. This paper aims to heighten the awareness for the need to take gender into consideration when making treatment decisions in an effort to optimize services and enhance the quality of life of women suffering from substance abuse.

Hintergrund: Opioidabhängigkeit während der Schwangerschaft stellt ein signifikantes und wachsendes Problem im Gesundheitswesen dar. Die Suchterkrankung wird mit gesundheitlichen Risiken für Mutter und Kind assoziiert, vor allem aufgrund von im Rahmen dieser Erkrankung auftretenden Risikoverhaltensweisen. Methodik: Es wurde aktuelle Literatur zum Thema Opioid-Erhaltungstherapie (OET) während der Schwangerschaft in Zusammenhang mit neonatalen Outcome-Parametern über die Datenbank «pubmed.gov» recherchiert. Ergebnisse: OET mit Methadon (MMT) stellt die «state-of-the-art» Behandlung bei Opioidabhängigkeit während der Schwangerschaft dar, wird jedoch mit einer Prävalenz des Neonatalen Abstinenz Syndroms (NAS) von 60–80 % assoziiert. Als vielversprechende Alternative erscheint Buprenorphin, einzelne Studien weisen auf eine geringere Prävalenz von NAS bei OET mit Buprenorphin. Schlussfolgerungen: Bisherige, hauptsächlich retrospektiv durchgeführte Studien zu Buprenorphin und Methadon lassen aufgrund von methodischen Mängeln nur bedingt Rückschlüsse auf Vor- und Nachteile bezüglich NAS zu. Die «MOTHER» Studie soll hier als Modell für evidenzbasierte klinische Studien fungieren.

In dem vorliegenden Einzelfallbericht wird eine internetbasierte Methode des Monitorings psychotherapeutischer Veranderungsprozesse, das Synergetic Navigation System (SNS), an einem 23-jahrigen mannlichen Patienten mit der Diagnose einer Zwangsstorung untersucht, der im Rahmen einer siebenwochigen stationaren Verhaltenstherapie taglich einen 46-Items umfassenden Fragebogen mittels SNS ausgefullt hat. Es kann aufgezeigt werden, dass durch die SNS-Zeitreihenanalyse der gesamte Therapieverlauf online gut abgebildet werden kann und Phasen erfasst werden konnen (Phasen kritischer Instabilitat), welche die Voraussetzung fur eine langfristige Symptomverbesserung sind.

Background: An individual’s capacity to counteract the stigma of mental illness, stigma resistance (SR), is considered as playing a crucial role in fighting stigma. However, little is known about SR and its correlates in patients with schizophrenia or schizoaffective disorder. Aim: Exploring SR in patients with schizophrenia or schizoaffective disorder. Method: One hundred fifty-seven participants completed the ‘‘Internalized Stigma of Mental Illness’’ (ISMI) Scale including its subscale on SR. Measures of perceived devaluation and discrimination, depression, selfesteem, empowerment, quality of life, and demographic and clinical variables were obtained. Results: Two-thirds of all patients showed high SR. SR correlated positively with self-esteem, empowerment, and quality of life and negatively with stigma measures and depression. A social network with a sufficient number of friends, being single or married, in contrast to being separated, as well as receiving outpatient treatment, was associated with higher SR. Conclusions: SR is a new and promising concept. The development of stigma-resisting beliefs might help individuals in their hope of finding a fulfilling life and in their recovery from mental illness.

ObjectiveIn this study we aimed to evaluate long-term effects of a community-based, quality of life oriented psychoeducational intervention for schizophrenia with and without booster sessions.MethodOne hundred and three outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a 9-week psychoeducational programme. At the end of the programme groups were block-randomised to either an extension programme comprising monthly booster sessions for a further nine months (booster condition) or routine clinical care with no further group meetings (non-booster condition). Outcome measures were applied before and after the seminar and at 6 and 12 months.ResultsPositive effects were observed after the short-term 9-week programme with regard to symptoms, knowledge about the illness, illness concept, control convictions and quality of life. These effects were retained over the 12-month period in both conditions. The only relevant difference between the booster and the non-booster conditions concerned external control convictions.ConclusionOverall this 9-week programme has shown encouraging effects still present at 12 months after baseline independent of booster or non-booster conditions. Further studies are needed to explore whether a subgroup of patients, those with impaired neurocognitive and social functioning, can benefit significantly from booster sessions.

Aims: The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods: Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results: The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

Objective: To identify factors that influence attitudes towards psychopharmacological treatment in patients suffering from schizophrenia and schizoaffective psychoses. Methods: Ninety-two participants in an outpatient psychoeducational program, classed as "pharmacophobic" or "pharmacophilic" according to the Drug Attitude Inventory scale, were compared with regard to sociodemographic variables, clinical characteristics, subjective deficit syndrome, illness concepts, knowledge, locus of control, and quality of life. Results: The 59 pharmacophilic and the 33 pharmacophobic patients did not differ significantly with regard to most sociodemographic variables, symptoms, or classic personality traits such as locus of control, self-concept, and quality of life. The only differences concerned hospitalization history (P < 0.05) and statements on the actual, subjective experience of desired and undesired effects of medication (P < 0.01). Conclusions: The impact of subjective experiences with drug treatment on attitudes towards medication and compliance needs to be a main focus of interventions targeting attitudes towards pharmacological treatment.

The chaotic lives of women who are drug dependent and their frequent lack of consistent prenatal care put them at risk for many medical problems during pregnancy. Illicit drug use during pregnancy also places women at increased risk for obstetrical complications. The complexity of medical problems in the pregnant drug abuser is complicated by the attendant psychosocial problems and psychiatric comorbidities seen in this population. Psychiatric diagnoses, treatment, and patient compliance are often hindered when the main focus of attention is on drug-related problems. The stigma associated with maternal drug use and difficult life circumstances are additional burdens to successful treatment entry and adherence for women. The basis for stabilizing most opioid-dependent pregnant women is agonist maintenance therapy in the context of comprehensive services, and the treatment of psychiatric comorbidities is a key component in optimizing pregnancy and child outcomes.

This study investigates neuronal activation patterns during the psychotherapeutic process, assuming that change dynamics undergo critical instabilities and discontinuous transitions. An internet-based system was used to collect daily self-assessments during inpatient therapies. A dynamic complexity measure was applied to the resulting time series. Critical phases of the change process were indicated by the maxima of the varying complexity. Repeated functional magnetic resonance imaging (fMRI) measurements were conducted over the course of the therapy. The study was realized with 9 patients suffering from obsessive-compulsive disorder (subtype: washing/contamination fear) and 9 matched healthy controls. For symptom-provocative stimulation individualized pictures from patients’ personal environments were used. The neuronal responses to these disease-specific pictures were compared to the responses during standardized disgust-provoking and neutral pictures. Considerably larger neuronal changes in therapy-relevant brain areas (cingulate cortex/supplementary motor cortex, bilateral dorsolateral prefrontal cortex, bilateral insula, bilateral parietal cortex, cuneus) were observed during critical phases (order transitions), as compared to non-critical phases, and also compared to healthy controls. The data indicate that non-stationary changes play a crucial role in the psychotherapeutic process supporting self-organization and complexity models of therapeutic change.

Background Prior studies have shown an increased vulnerability among males to adverse outcomes during the postnatal period. Most children exposed to opioids and other medications in utero develop neonatal abstinence syndrome (NAS), yet individual predisposition for NAS is poorly understood. Objective This investigation examined the role of neonatal sex in the postnatal period for neonates exposed to standardized opioid maintenance treatment in utero with a focus on NAS regarding severity, medication requirements, and duration. Methods This was a secondary analysis of data collected in a prospective randomized, double-blind, double-dummy, multicenter trial (MOTHER study) that examined the comparative safety and efficacy of methadone and buprenorphine during pregnancy. A total of 131 neonates born to opioid-dependent women randomized at 6 US sites (n = 74) and 1 European site (n = 37) were analyzed. Sex-based differences in birth weight, length, head circumference, NAS duration, NAS severity, and treatment parameters of full-term neonates were assessed. Results Males had a significantly higher birth weight ( P = 0.027) and head circumference ( P = 0.017) compared with females, with no significant sex difference in rates of preterm delivery. No significant sex-related differences were found for NAS development, severity, or duration, or medication administered, and there were no significant differences in concomitant drug consumption during pregnancy ( P = 0.959). Conclusions This unique prospective study shows similar postnatal vulnerability for both sexes, suggesting that factors other than sex are the major determinants of clinically significant NAS. ClinicalTrials.gov identifier: NCT 00271219 .

Pregnancy in opioid-dependent women is a major public health issue. Women who are afflicted by opioid addiction are a highly vulnerable group of patients frequently becoming pregnant unplanned and at risk of adverse pregnancy outcomes and peri-natal complications. Opioid agonist maintenance treatment is the best option for the majority of women. Ideally, early and closely monitored treatment in an interdisciplinary team approach including social workers, nurses, psychologists, psychiatrists, gynecologists, anesthesiologists, and pediatricians should be provided. The treatment of comorbid psychiatric conditions, the resolution of financial, legal, and housing issues, and the psychosocial support provided have a significant effect on optimizing pregnancy outcomes. This paper aims to update health professionals in the field of gynecology and obstetrics on the latest optimal treatment approaches for mothers suffering from opioid dependence and their neonates.

Background: Multi-center trials enable the recruitment of larger study samples, although results might be influenced by site-specific factors. Methods: Site differences of a multi-center prospective double-blind, double-dummy randomized controlled trial (7 centers: Central Europe (Vienna)/USA (3 urban/3 rural centers)) comparing safety and efficacy of methadone and buprenorphine in pregnant opioid-dependent women and their neonates. Results: Urban US women had the highest rate of concomitant opioid (p = 0.050) and cocaine consumption (p = 0.003), the highest dropout rate (p = 0.001), and received the lowest voucher sums (p = 0.001). Viennese neonates had significantly higher Apgar scores 1 min (p = 0.001) and 5 min after birth (p < 0.001) and were more often born by cesarean section (p = 0.024). Rural US newborns had a significantly shorter neonatal abstinence syndrome treatment duration compared to Viennese and urban US sites (p = 0.006), in addition to other site-specific differences, suggesting a more severely affected group of women in the urban US sites. Conclusion: This clinical trial represents a role model for pharmacological treatment in this unique sample of pregnant women and demonstrates the clinical importance of considering site-specific factors in research and clinical practice.

Background The Internet is an important source of health information for people with psychiatric conditions. Little is known about the way patients with schizophrenia use the Internet when it comes to issues related to their illness. Data on their specific needs, difficulties, and the consequences related to Internet use are lacking. Objective Our objective was to investigate the nature and subjective consequences of health-related Internet use among patients with schizophrenia. Methods In all, 26 individual semistructured interviews were conducted and analyzed qualitatively in groups of 4 until theoretical saturation was achieved. Results Study results suggest that the Internet is an influential source of illness-related information for patients with schizophrenia. Many aspects of their behavior around the Internet resemble those of individuals not afflicted by mental illness. Importantly, problems specific to patients with schizophrenia were stimulus overflow, an inability to deal with the abundance of information, difficulties with concentration, lack of energy, paranoid ideas, symptom provocation, and the need to distance themselves from illness-related topics as part of the recovery process. Internet information was subjectively perceived as having the potential to significantly change patients’ attitudes toward medication and their relationships with doctors. Conclusions These findings provide insight into how individuals with schizophrenia handle illness-related Internet information. The data could contribute to the continuous development of Internet-based interventions and offer novel approaches to optimizing traditional treatment options.

Objective:The quality of life (QOL) of patients with schizophrenia has been found to be positively correlated with the social network and empowerment, and negatively correlated with stigma and depression. However, little is known about the way these variables impact on the QOL. The study aims to test the hypothesis that the social network, stigma and empowerment directly and indirectly by contributing to depression influence the QOL in patients with schizophrenia and schizoaffective disorders.Method:Data were collected on demographic and clinical variables, internalized stigma, perceived devaluation and discrimination, empowerment, control convictions, depression and QOL. Structural equation modelling (SEM) was applied to examine the impact of the above-mentioned constructs on QOL.Results:The influences of the social network, stigma, empowerment and depression on QOL were supported by the SEM. A poor social network contributed to a lack of empowerment and stigma, which resulted in depression and, in turn, in poor QOL. Interestingly, however, the social network and stigma did not show a direct effect on QOL.Conclusions:Following a recovery approach in mental health services by focusing on the improvement of the social network, stigma reduction and especially on the development of personal strength has the potential to reduce depression in patients with psychosis and improving their QOL.

Background: Little comparable information is available regarding clinical characteristics of opioid-dependent women from different countries. In the present study, women from the USA, Canada and a Central European country, Austria, screened for participation in the Maternal Opioid Treatment Human Experimental Research study, were compared with respect to their demographic and addiction histories. Methods: Pregnant women (n = 1,074) were screened for study participation using uniformed clinical criteria and instruments. The screening results were compared with regard to exclusion, demographics, drug use, and psychosocial and treatment histories. Results: Compared to the screened US and Canadian women, Austrian women were more likely to be younger (p < 0.001), white (p < 0.001), had significantly lower levels of educational attainment (p < 0.001), were less likely to use opioids daily (p < 0.001) and more likely to have been prescribed buprenorphine (p < 0.001). Compared to both rural and urban US groups, the Austrian group was less likely to have legal issues (p < 0.001) and was younger when first prescribed agonist medication (p < 0.001). Conclusion: The differences between North American and European groups may offer unique insights concerning treatment and pregnancy outcomes for opioid-dependent pregnant women.

Objective Our aim was to identify areas of improvement for current Opioid Maintenance Treatment (OMT) approaches, by analysing European Quality Audit of Opioid Treatment (EQUATOR) data from 8 European countries (Austria, Denmark, France, Germany, Norway, Portugal, Sweden, UK). Method A standardised face-to-face survey was administered to OMT patients (OMT-P) and active opioid user (AOU). Reasons for entering and staying out of OMT, rules pertaining to OMT, and factors facilitating OMT retention were compared between countries, and between OMT-P and AOU groups. Both groups were divided into those who never had OMT before [un-experienced OMT-P (n=573) and AOU (n=360)] and those who had been maintained at least once [experienced OMT-P (n=746) and AOU (n=377)]. Results Motives for starting OMT vary distinctly between countries (p≤0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT . Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p≤0.05). Conclusion The major strength of this investigation was the homogenous methodology applied in all countries, which enabled new insights in variations between treatment systems and their impact on patient outcome. Treatment systems need to aim an optimal balance between flexibility and structure. Standardised approaches that still permit tailoring treatment to individual patient needs are crucial to yield maximum benefit for patients, and reduce the considerable societal economic burden of addiction.

The author calls for the consideration the group of opioid-dependent women is a particularly vulnerable target population and that a cash incentive for sterilization to a substance-dependent woman should not be done in such a manner as it would be to other psychiatric patients. The author discusses the legislation of sterilization in Europe providing a historical overview using the case examples and their negative outcomes in Nazi Germany the Lutheran Church in Sweden and the Roma women in the Czech Republic. However the author recommends Austria to serve as an example of how an appropriate regulation is structured as it involves informed consent and special safeguards in order to protect mentally disabled people. Additional considerations include the stability of a mental condition during the contraceptive decision-making process a comprehensive care setting with a multi-profession team approach and the high rate of psychiatric co-morbidities.