Search

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, chronic multisystemic disease which, depending on its severity, can lead to considerable physical and cognitive impairment, loss of ability to work and the need for nursing care including artificial nutrition and, in very severe cases, even death.The aim of this D-A-CH (Germany, Austria, Switzerland) consensus statement is 1) to summarize the current state of knowledge on ME/CFS, 2) to highlight the Canadian Consensus Criteria (CCC) as clinical criteria for diagnostics with a focus on the leading symptom post-exertional malaise (PEM) and 3) to provide an overview of current options and possible future developments, particularly with regard to diagnostics and therapy. The D-A-CH consensus statement is intended to support physicians, therapists and valuer in diagnosing patients with suspected ME/CFS by means of adequate anamnesis and clinical-physical examinations as well as the recommended clinical CCC, using the questionnaires and other examination methods presented. The overview of the two pillars of therapy for ME/CFS, pacing and symptom-relieving therapy options, is intended not only to provide orientation for physicians and therapists, but also to support decision-makers from healthcare policy and insurance companies in determining which therapy options should already be reimbursable by them at this point in time for the indication ME/CFS., (© 2024. The Author(s).)

Objective: In this study we explored the subjective experiences and needs of people with severe mental illness regarding dietary and weight-related support within routine care., Methods: For this purpose, a total of 16 interviews with adults living with mental illness were conducted in Ulm (Germany) and Graz (Austria) using a semi-structured topic guide and were analysed in a qualitative approach., Results: Several participants criticized the limited support by professionals regarding diet- and weight-related problems and wished for greater awareness of these issues in mental health care., Conclusion:   The implementation of health-promoting services in mental health care is important to ensure needs-oriented care from the patients' point of view. Interdisciplinary care concepts could be used to share responsibilities among several professional groups., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Cannabis is the illegal drug most frequently used by Minors in Austria. Due to the gradual decriminalization and legalization that has taken place in many European countries in recent years, the ÖGKJP would like to take a balanced and scientifically based stand on the complex issue of cannabis use and abuse among young people., Methods: The authors searched the medline for current studies using searches tailored to each specific subtopic. Furthermore, recognized compendiums were quoted., Results: While occasional recreational use of cannabis in adults with completed brain maturation and no risk profile for mental disorders is likely to be relatively harmless, early initiation of use with regular use and the increasingly available, highly potent cannabis varieties can lead to explicit and sometimes irreversible neurocognitive brain dysfunction., Conclusion: Legalisation of cannabis consumption for minors needs to be objected to due to the risks of the expected damage in the area of brain development. At the same time, however, it is important to establish sensible legal regulations in order to be able to adequately counteract the fact that over 30% of all European young people occasionally consume cannabis. We are also clearly recommending to not criminalize cannabis users and provide necessary support to vulnerable and addicted cannabis users., (© 2022. The Author(s).)

Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In Austria there is a lack of registered experts in the field of forensic child and adolescent psychiatry. Their tasks include the assessment of young people in various legal issues, but there is also a lack of child and adolescent psychiatrists for treatment and care for mentally ill adolescents in prison. This lack means that child psychiatric questions are often answered by psychologists or adult psychiatrists.In the group of incarcerated young people, there is an increased proportion of mental illnesses. However, it is also known that young people with-primarily externalizing-mental illnesses also show a significantly increased risk of becoming delinquent. Specialized youth psychiatric treatment can also have a (relapse) preventive effect.To ascertain the exact requirement in Austria, the figures are lacking. These numbers should be collected urgently.Furthermore, a structured training for forensic child and adolescent psychiatrists should be expanded and a platform for exchange and supervision of child psychiatrists working in forensic topics would be desirable. If it is possible to cover the need in this area, the goal that children and adolescents are only examined by specially trained child and adolescent psychiatrists, can be achieved., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well-structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants., (© 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here., (© 2022. The Author(s).)

Introduction: The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic., Method: At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey., Results: Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups., Conclusion: This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments., Competing Interests: Alle Autorinnen/Autoren dieser Studie erklären keinen Interessenkonflikt., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The Lower Austrian Wachau region was an early COVID-19 hotspot of infection. As previously reported, in June 2020, after the first peak of infections, we determined that 8.5% and 9.0% of the participants in Weißenkirchen and surrounding communities in the Wachau region were positive for immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies against the receptor-binding domain of the spike protein of SARS-CoV-2, respectively. Here, we present novel data obtained eight months later (February 2021) from Weißenkirchen, after the second peak of infection, with 25.0% (138/552) and 23.6% (130/552) of participants that are positive for IgG and IgA, respectively. In participants with previous IgG/IgA positivity (June 2020), we observed a 24% reduction in IgG levels, whereas the IgA levels remained stable in February 2021. This subgroup was further analyzed for SARS-CoV-2 induced T cell activities. Although 76% (34/45) and 76% (34/45) of IgG positive and IgA positive participants, respectively, showed specific T cell activities (upon exposure to SARS-CoV-2 spike protein-derived peptides), those were not significantly correlated with the levels of IgG or IgA. Thus, the analyses of antibodies cannot surrogate the measurement of T cell activities. For a comprehensive view on SARS-CoV-2-triggered immune responses, the measurement of different classes of antibodies should be complemented with the determination of T cell activities., Competing Interests: The authors declare no conflicts of interest.

Background: Crimes against humanity took place in many institutions as well as psychiatric departments during the Nazi dictatorship., Objectives: The aim of this review paper is to present a special kind of dealing with crimes in psychiatric institutions on a local and regional level., Methods: Analogous to the psychiatric-psychotherapeutic approach with traumatized individuals, the procedure "secure-describe and work through-reconnect" is suggested for the collective within the frame of remembrance work and commemorative culture., Results: As an example of a collective memorial process, the handling of the topic of the crime of Nazi euthanasia in Carinthia/Austria is presented., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Background: Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited., Objective: Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence., Material and Methods: A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database., Results: A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations., Conclusion: The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Mathilde Ludendorff (nee Spiess, widowed von Kemnitz, divorced Kleine) was one of the first women who studied medicine in Imperial Germany. She wrote a feminist doctoral thesis, refuted Sigmund Freud's psychoanalysis early in her career, detected the fraud of Albert von Schrenck-Notzing's spiritualist research, became a specialist for nervous and mental diseases after only 17 months of training with Emil Kraepelin, as his-according to her own words-best pupil, treated General Ludendorff's first wife and soon became his second, developed a Germanic philosophy too radical for Adolf Hitler's taste, was considered as a primary culprit after a first denazification trial in 1949 and contested the expert opinion of her colleague Professor Georg Stertz about her own mental state. Her books are still in print and her Alliance for God Cognizance (Ludendorff) still exists and is monitored by the National Intelligence Agency., (© 2021. Der/die Autor(en).)

Background: Smell dysfunction has been recognized as an early symptom of SARS-CoV-2 infection, often occurring before the onset of core symptoms of the respiratory tract, fever or muscle pain. In most cases, olfactory dysfunction is accompanied by reduced sense of taste, is partial (microsmia) and seems to normalize after several weeks, however, especially in cases of virus-induced complete smell loss (anosmia), there are indications of persisting deficits even 2 months after recovery from the acute disease, pointing towards the possibility of chronic or even permanent smell reduction for a significant part of the patient population. To date, we have no knowledge on the specificity of anosmia towards specific odorants or chemicals and about the longer-term timeline of its persistence or reversal., Methods: In this longitudinal study, 70 participants from a community in Lower Austria that had been tested positive for either IgG or IgM SARS-CoV-2 titers in June 2020 and a healthy control cohort (N = 348) underwent smell testing with a 12-item Cross-Cultural Smell Identification Test (CC-SIT), based upon items from the University of Pennsylvania Smell Identification Test (UPSIT). The test was performed in October 2020, i.e. 4 months after initial diagnosis via antibody testing. Results were analyzed using statistical tests for contingency for each smell individually in order to detect whether reacquisition of smell is dependent on specific odorant types., Results: For all odorants tested, except the odor "smoke", even 4 months or more after acute SARS-CoV-2 infection, participants with a positive antibody titer had a reduced sense of smell when compared to the control group. On average, while the control cohort detected a set of 12 different smells with 88.0% accuracy, the antibody-positive group detected 80.0% of tested odorants. A reduction of accuracy of detection by 9.1% in the antibody-positive cohort was detected. Recovery of the ability to smell was particularly delayed for three odorants: strawberry (encoded by the aldehyde ethylmethylphenylglycidate), lemon (encoded by citronellal, a monoterpenoid aldehyde), and soap (alkali metal salts of the fatty acids plus odorous additives) exhibit a sensitivity of detection of an infection with SARS-CoV-2 of 31.0%, 41.0% and 40.0%, respectively., Conclusion: Four months or more after acute infection, smell performance of SARS-CoV-2 positive patients with mild or no symptoms is not fully recovered, whereby the ability to detect certain odors (strawberry, lemon and soap) is particularly affected, suggesting the possibility that these sensitivity to these smells may not only be lagging behind but may be more permanently affected., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Older adults are particularly affected by the current COVID-19 (SARS-CoV-2) pandemic. The risk of dying from COVID-19 increases with age and is often associated with pre-existing health conditions. Globally, more than 50 million-in Austria currently approximately 140,000 people-suffer from dementia. The co-occurrence of dementia as a "pandemic of old age" together with the COVID-19 pandemic has a double impact on persons living with dementia and their caregivers. The COVID-19 pandemic poses major challenges for individuals with dementia and their caregivers: (1) People with dementia have limited access to information on COVID-19, may have difficulties with protective measures such as wearing masks and in remembering safety regulations. (2) People with dementia live alone or with their family, or are institutionalized. To reduce the chance of infection among older people in nursing homes, Austrian local authorities have banned visitors to nursing homes and long-term care facilities and implemented strict social-distancing measures. As a result, older people lost face-to-face contact with their family members, became isolated and social activities stopped. Consequently, anxiety, stress and serious concerns about infections among staff in nursing homes increased and they developed signs of exhaustion and burnout during the full lockdown of the facilities. Thus, due to the emerging COVID-19 crisis, the Austrian Alzheimer Association (Österreichische Alzheimer Gesellschaft, ÖAG) and international societies developed recommendations to support people living with dementia and their caregivers on various issues of physical and mental health.

The aim of the study was to assess rates of severe parkinsonism related to different antipsychotic drugs (APDs) using data from an observational pharmacovigilance programme in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP). Data on APD utilization and reports of severe APD-induced parkinsonism were collected in 99 psychiatric hospitals in Austria, Germany and Switzerland during the period 2001-2016. Of 340,099 patients under surveillance, 245,958 patients were treated with APDs for the main indications of schizophrenic disorders, depression, mania and organic mental disorders. A total of 200 events of severe APD-induced parkinsonism were identified (0.08%). First-generation low-potency APDs were significantly less often implicated (0.02%) than second-generation APDs (0.07%) and first-generation high-potency APDs (0.16%). Among the second-generation APDs, amisulpride and risperidone ranked highest. The phenothiazines were associated with significantly lower rates of severe parkinsonism (0.02%) than those of the butyrophenones (0.11%) and thioxanthenes (0.12%). In 71 cases (35.5%), more than 1 drug was considered responsible for the induction of severe parkinsonism. In 44 patients (22.0%), the symptoms were extremely severe, leading to complete immobility and/or massive complications such as pneumonia and severe injuries due to falls. Higher age (> 60 years) was associated with significantly higher rates of severe parkinsonism, as were the diagnoses of schizophrenic disorder or mania. The large number of patients included in the present survey allows for the comparison of severe parkinsonism rates related to different APD classes and single APDs. The first-generation low-potency APDs had significantly reduced risk of severe parkinsonism compared not only to high potency but also to second-generation APDs.

Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000-2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis "adjustment disorder" is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.

Backround: Emotionally unstable personality disorder (EUPD) has a high prevalence worldwide and especially in in-patient psychiatric settings, varying in age and gender. Due to the complex clinical picture, repeated admissions and high costs, health systems are facing great challenges., Methods: For the calculations Statistik Austria data of inpatient stays of patients with mental and behavioral disorders with special regard to EUPD as main discharge diagnosis in Austria in the period 2001-2016 were used. Included were patients with age over 14 years, admission to a psychiatric clinic in acute care and maximum length of stay of 365 days. Age, gender and length of stay were analyzed with SPSS®, evaluated in descriptive form and related to each other., Results: The prevalence of EUPD within all mental and behavioral disorders was 4.0%. Of all personality and behavioral disorders, as well as specific personality disorders, EUPD had the highest prevalence (65.3% and 79.3%). About four times more women (79.8%) than men (20.2%) received inpatient treatment. Most patients (23.1%) were admitted at the age of 20-24 years. From 40 years of age the number of admissions clearly decreased. The largest percentage of men was found to be in the age group over 45 years (27.0%) and 183-365 inpatient days (27.0%), those of women aged 15-19 (83.4%) and 0 and 14-182 inpatient days (81.4% each). The average length of stay was 13 days for women and 12 days for men. 11.3% of patients left the clinic on the day of admission, 61.2% were treated for 1-13 days, 27.2% for 14-182 days, and 0.2% for 183-365 days.

Mental disorders are common and have severe consequences for the patients, their relatives, and society. Mental health care planning requires precise knowledge of the prevalence of psychiatric disorders and details regarding the provided treatment. Because administrative data lack information on persons not in contact with health services, we need epidemiologic studies delivering nationwide information on the prevalence of psychiatric disorders. This requirement induces the need for adequate sampling procedures to collect reliable data, allowing for accurate estimations of mental health care needs, over- and underprovision. This is the purpose of the Austrian Psychiatric Prevalence Survey (APPS).The present technical report describes the exact procedure how a nationwide sample has been drawn, adopting a stratified cluster sampling scheme. Because such a complex sampling procedure requires an adequate weighting to obtain unbiased population estimates, this report also contains the exact steps to calculate the corresponding weights. This way, the report not only fosters the full disclosure of the sampling strategy of the APPS, it may also serve as a best practice example for similar endeavours.

Objective: The "Geriatric Depression Scale" consisting of 15 items (GDS-15) is a well-known screening tool for depression among the elderly. Until now the criterion validity of the German language GDS-15 was not investigated in a sample of the adult general population., Methods: 504 persons of the Austrian general population completed the GDS-15. Using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) ICD-10 diagnoses were established. Receiver Operating Characteristics (ROC) analysis was conducted. Possible gender and age differences were explored., Results: The overall discrimination of the GDS-15 was sufficient (ROC-AUC 0,851). The cut-off value developed on the basis of our sample was 2/3 with a sensitivity of 71.8 % und a specificity of 82.8 %. We could not find significant gender or age group differences., Conclusion: This is the first study investigating the criterion validity of the German language GDS-15 in the adult general population. The sensitivity and specificity are sufficient and comparable with the findings among other screening tools., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Attachment is a psychological parameter across cultures and is influenced by childhood experiences. Though the construct of attachment tends to certain stability, different influences, like culture, can change the quality of attachment during lifetime. As can be seen from the example of depression in adulthood the clinical symptoms of this disorder may be different due to the cultural background., Methods: The present study focuses on inter- and intracultural differences concerning the attachment qualities of Turkish people in the homeland, Turkish migrants in Austria and Austrians (N = 297) by using the self-assessment questionnaire RSQ. Each ethnic group consisted of a healthy control group (N = 153) as well as a patient group currently suffering from a depressive episode (N = 144) and were getting an in or outpatient treatment., Objective: The hypothesis tested was whether culture moderates a correlation between depressive disorders and attachment abilities., Results: There were significant differences in attachment ability between cultures whereby controls presented significantly more secure attachment ability in all parameters compared to patients. While the Austrian control group showed the most secure attachment orientation, the Austrian patients had the highest level of insecurity, followed by the migrant group. However, the comparison of healthy and depressive Turks revealed no significant differences., Conclusion: Thus, culture shows significant effects concerning depressive disorders and attachment dimensions.

Objective: The "Center of Epidemiologic Studies - Depression scale" (CES-D) is a well-known screening tool for depression. Until now the criterion validity of the German version of the CES-D was not investigated in a sample of the adult general population., Methods: 508 study participants of the Austrian general population completed the CES-D. ICD-10 diagnoses were established by using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Receiver Operating Characteristics (ROC) analysis was conducted. Possible gender differences were explored., Results: Overall discriminating performance of the CES-D was sufficient (ROC-AUC 0,836). Using the traditional cut-off values of 15/16 and 21/22 respectively the sensitivity was 43.2 % and 32.4 %, respectively. The cut-off value developed on the basis of our sample was 9/10 with a sensitivity of 81.1 % und a specificity of 74.3 %. There were no significant gender differences., Conclusion: This is the first study investigating the criterion validity of the German version of the CES-D in the general population. The optimal cut-off values yielded sufficient sensitivity and specificity, comparable to the values of other screening tools., Competing Interests: Der Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The number of people with diseases of the schizophrenia spectrum in old age will increase significantly in the coming years. In the literature the topics of schizophrenia and delusional disorders in older and old people are inadequately represented., Aim: This article gives an overview of the most important diagnostic and differential diagnostic characteristics. Another important aspect is the pharmacological and non-pharmacological treatment options in old age., Material and Methods: The S3 guidelines of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) from 2006, the guidelines of the World Federation of Societies of Biological Psychiatry (WFSBP) from 2012, 2013, 2015 and the consensus statement of the Austrian Association for Neuro-Psychopharmacology and Biological Psychiatry (ÖGPB) from 2016 formed the basic literature for this review. In addition, a targeted search in the databases PubMed, PubPsych and Cochrane Library as well as in German Journals, such as DerNervenarzt, Neuropsychiatrie, Psychiatrische Praxis and Zeitschrift für Gerontologie und Geriatrie concerning the keywords schizophrenia, delusional disorder, diagnostics, therapy and older people was carried out., Results: Besides aspects on epidemiology, clinical manifestation, diagnostics, differential diagnostics and course of the illness, pharmacological and non-pharmacological treatment options are presented., Conclusion/discussion: In clinical practice a clear diagnostic assignment is often a challenge in older and very old people with psychotic symptoms, The necessary pharmacological treatment is available but is limited by tolerability, comorbidities and polypharmacy. Non-pharmacological treatment options have hardly been investigated.

Objective: Many psychiatric hospitals in Austria have an open door policy. We aimed to compare staffing levels, use of coercive measures, and beds per inhabitants between an Austrian and a German psychiatric hospital with partly locked doors., Methods: Analysis of frequency of seclusion and restraint, aggressive incidents, police searches, availability of beds, and staffing levels in standardized counts., Results: German wards were open 65 % of daytime, Austrian wards 100 %. In the German region, considerable part of hospital beds were located in day clinics and psychosomatic clinics. The percentage of all admissions subjected to coercion was considerably lower in Germany, but this did not apply to involuntary admissions. Police searches were comparable in frequency. Staffing levels of physicians and psychologists were similar, in Austria considerably more nurses were available., Conclusion: The results do not provide evidence that the open door policy in Austrian psychiatry is realized by use of other coercive measures. Possibly more nursing staff is important to open doors., Competing Interests: Tilman Steinert gibt an, dass kein Interessenkonflikt besteht.Joachim Scharfetter erhielt Travel Grants von Amomed, Lundbeck und Janssen sowie Vortragshonorare von AOP-Orphan und GL-Pharma., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Suicides are generally the consequence of overchallenged coping strategies of individual for psychological, social or internal and external biological strain factors. Timing of the suicide, too, may be influenced by external factors. Studies so far have yielded in part inconsistent results concerning the association of suicides with particular days or periods of the year. Even less is known regarding a potential effect of the time of birth on suicide risk., Methods: The Tyrol Suicide Register (TSR) provides data on suicides occurring in the Austrian State of Tyrol including birthday of the suicide victim and day of the suicide. In the present study the frequency of suicides was analyzed with regard to birthday, day of the week, major holidays and season over a period of 17 years. Further, a potential association with month of birth and zodiac signs was studied., Results: We found a significant variation in suicide frequency concerning day of the week with a peak on Mondays and Tuesdays and seasonality with increased numbers in spring and summer months., Conclusions: The increase of suicide numbers at the beginning of the week may be explained by the "broken-promise effect" which has been described as the consequence of frustrated expectations concerning the weekend. Possible explanations for the suicide peaks in spring and summer may be biological, specifically serotonergic alterations as well as the experience of depressed patients perceiving the social and emotional contrast to people who are able to enjoy these periods of pleasure and outdoor activities.

Objective: Studies investigating the frequency of psychoeducation in depression for patients and their family members in hospital settings and assessing how psychoeducation is offered are lacking., Methods: Two postal surveys were done five years apart addressing these questions to the heads of all psychiatric hospitals in Germany, Austria and Switzerland., Results: 67 % of the participating hospitals offered psychoeducation in depression. 60 % of the patients treated in the hospitals participated in psychoeducation groups, whereas only 13 % of the family members did. In the mean, a single psychoeducational session lasted for 61 minutes (SD = 14), took place 1.4-times per week (SD = 0.5) and there were 7.4 sessions (SD = 2.8). 56 % of the moderators of the psychoeducational groups used a published manual for conducting the groups., Conclusion: The frequency of offering psychoeducation in depression for patients is almost comparable to that in schizophrenia. However, there is still room for improvement, especially when it comes to family psychoeducation in depression where all efforts need to be done to increase the number of groups offered in order to inform more families and help them coping with depression., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: To record and measure the nature and severity of stigma and discrimination experienced by people during a first episode of schizophrenia and those with a first episode of major depressive disorder., Methods: The Discrimination and Stigma Scale (DISC-12) was used in a cross-sectional survey to elicit service user reports of anticipated and experienced discrimination by 150 people with a diagnosis of first-episode schizophrenia and 176 with a diagnosis of first-episode major depressive disorder in seven countries (Austria, Croatia, Czech Republic, Poland, Romania, Sweden and Turkey)., Results: Participants with a diagnosis of major depressive disorder reported discrimination in a greater number of life areas than those with schizophrenia, as rated by the total DISC-12 score (p = .03). With regard to specific life areas, participants with depression reported more discrimination in regard to neighbours, dating, education, marriage, religious activities, physical health and acting as a parent than participants with schizophrenia. Participants with schizophrenia reported more discrimination with regard to the police compared to participants with depression., Conclusion: Stigma and discrimination because of mental illness change in the course of the mental diseases. Future research may take a longitudinal perspective to better understand the beginnings of stigmatisation and its trajectory through the life course and to identify critical periods at which anti-stigma interventions can most effectively be applied., (© The Author(s) 2014.)

Objective: Most studies about the burden of schizophrenia carers included only one care-giving relative, usually the patients' mothers. The present study intended to analyse differences of the level of burden between mothers and fathers of the same patients., Methods: 101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. They were assessed by means of the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia"., Results: Mothers showed significantly higher scores than fathers regarding the subscores "Tensions" and "Urging". Multiple linear regression analyses showed positive associations between the frequency of mothers' as well as fathers' unmet needs and dimensions of caregiver involvement., Conclusion: Unmet needs among mothers and fathers have negative effects on their burden. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: This article investigates suicide rates from 2000 to 2010 in Austria, a country with now average rates that had started to decline in the mid-80s., Results: Rates declined in the observed period, to an average of 26.1 per 100,000 persons for men, 8.2 for women, and 16.9 in the general population. The decrease was found in all age-groups, but more marked in women, with a reduction by 26.3 % compared with the previous decade than in men (20.0 % reduction). Hanging still is the most common method, 49.1 % for men and 35.0 % for women, although also on the decline. Furthermore, person years of lost life were calculated, also reflecting a decrease from 40,702 years in 2000 to 29,883 in 2010. Altogether, 372,551 years of life were lost by suicide in Austria in the period 2000-2010, 277,998 years among men and 94,553 years among women., Conclusions: Concerning the still observed increase in old age-groups and the huge amount of lost life years, it is argued that implementation of the National Suicide Prevention Programme for Austria is strongly needed.

In German speaking countries, during the last decades, we can see a growing, though albeit small, integration of psychiatry and psychosomatics into (somatic) medicine. This article outlines the importance of the growing number of elderly patients in medical care as a vantage point for c-l-psychiatrists to play a pro-active role in implementing adequate structures and processes for diagnostics and treatment of this patient group. It is argued that delirium (in dementia) can and should be regarded as a paradigm for a biopsychosocial disorder sui generis. In addition, aspects of the cl-psychiatrists role at two important interfaces of somatic and psychological medicine, i.e. primary care and emergency rooms, are highlighted. Finally, some information about the development of the professionalization of cl-psychiatry in Europe is given.

Objective: This article describes the current state of research concerning the fate of mentally ill people in the psychiatric hospital of Klagenfurt am Wörthersee during the era of National Socialism (NS). Sterilization based on the "Erbgesundheitsgesetz" (genetic health law) deportation to the Castle of Hartheim near Linz, transport to Klagenfurt and killing in the departments of the hospital are documented. This knowledge is to be given to the relatives., Method: Encouraged by diverse public work activities relatives of victims of NS euthanasia sought contact with the department to discover the fate of relatives. Touching meetings with the relatives took place., Results: Since January 2011 the contacting relatives, their motives and the meetings have been protocolled and in this study an attempt is made to give an initial characterization of these people., Conclusion: This approach of a reconstructive biographical work together with relatives of the victims is presented as a proactive duty of psychiatric institutions.

Purpose: This study intended to analyze the prevalence of physical diagnoses at psychiatric inpatient hospital wards., Methods: For this purpose we used partially aggregated administrative data from routine diagnostic documentation of Austrian hospitals. All psychiatric and physical main and secondary diagnoses according to ICD-10 of all psychiatric inpatient units in Austria of the years 2007 were used., Results: Of 79,027 psychiatric hospital admissions 75,224 received a psychiatric and 3803 a somatic main diagnosis at discharge. Diseases of the vascular system (20 %) were the most frequent somatic diagnoses, followed by endocrine and metabolic diseases (16.4 %) and neurological diseases (14.4 %). Among patients suffering from schizophrenia, the most frequent physical diagnoses were endocrine and metabolic diseases. Among those with affective disorders, vascular diseases as well as endocrine and metabolic diseases were found most often., Conclusions: Physical diagnoses are very common among psychiatric inpatients. Mass screening and specialized prevention programs should be evaluated regarding their effectiveness for this population.

Background: Continuation and maintenance electroconvulsive therapy (c/m ECT) is a long-term treatment option in severely and chronically ill patients with mood disorders, who are unresponsive or intolerant to medication. Due to the current lack of empirical studies, c/m ECT is still a clinical tool with little evidence., Methods: We conducted a retrospective analysis of patients' charts who received c/m ECT over a 10-year period. Outcome was measured by comparing the number of pre-c/m ECT and post-c/m ECT hospitalizations, as well as inpatient days per year and mean duration of hospital stays., Results: In 19 patients (63% female; mean age 53.5 ± 12.0 years) with either bipolar (42%) or unipolar (58%) mood disorder, with the majority of patients suffering from a depressive episode at hospital admission (95%), c/m ECT was initiated after a successful series of ECT. In a 5-year interval before and after starting c/m ECT the number of hospitalizations per year (0.87 vs. 0.28, p < 0.001), inpatient days per year (30.8 vs. 4.5 days, p < 0.001), as well as the mean duration of hospital days (30.5 vs. 16.7 days, p = 0.02) decreased significantly., Conclusion: Our data support previous results showing that c/m ECT is an efficacious option in treating and favourably altering the course of therapy-resistant affective disorders. Further research using a controlled study design and larger sample sizes are needed to convincingly define indication and performance of c/m ECT.

Purpose: The purpose of this study is to compare the prevalence of depression among different types of hospital departments. Furthermore, it compares different methods for assessment of its recognition by non-psychiatric physicians., Methods: 993 inpatients of internal, surgical, gynecological and physical rehabilitation wards of community hospitals were interviewed by research psychiatrists using the Clinical Interview Schedule. Ward physicians were asked to fill in a short questionnaire in order to assess whether they could correctly identify patients with mental illnesses. In addition, routine discharge diagnoses were assessed., Results: Of the total sample, 13.3 % suffered from depression. Depression was most frequent on physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. On gynecological wards, prevalence of depression was lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, which equals less than half of those identified by questionnaire., Results: Of the total sample, 13.3 % of patients suffered from depression. Depression was most frequent in physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. In gynecological wards, the prevalence of depression was the lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, less than half of those identified by the questionnaire., Conclusions: Depression is very common among inpatients of physical hospital departments. Unfortunately, depression is frequently overlooked in everyday clinical work. Routine discharge diagnoses give only very limited information about how often ward physicians recognize mental disorders. Furthermore, hospital discharge diagnoses should not be used for planning mental health services.

Background: In view of the high prevalence of dependent smokers in psychiatric inpatient facilities advice for smoking cessation seems crucial. Due to the relatively short duration of stay in acute psychiatric wards (in our facility < 2 weeks) there is a need for therapeutic concepts that link to outpatient settings. The transtheoretical model by "Prochaska and DiClemente" (TTM) seems suitable to create an appropriate therapeutic concept., Methods: At the department of adult psychiatry located at Tulln university hospital, Austria, psychoeducational groups for smoking cessation were conducted. Apart from the degree of dependence using Fagerström test for nicotine-dependence (FTND), 100 mm visual analogue scales (VAS) were utilized to evaluate the patients' motivation for quitting smoking (100 VAS: maximimum motivation), the presenting physician (100 VAS: best performance), the content (100 VAS: best content) and the comprehensibility (100 VAS: optimum understanding)., Results: Out of 37 participants, the majority (89.2 %), showed a moderate to very strong nicotine dependence. The median motivation for smoking cessation was 56 VAS, the median change in motivation 67 VAS, the content 96 VAS, comprehensibility 94 VAS and presenter was rated with 95 VAS., Conclusions: In general, patients showed high levels of nicotine dependence. The psychoeducational group was predominantly evaluated in a positive way. Individual change in motivation to quit smoking might correspond to a stage in the TTM making a collaboration with outpatient facilities inevitable.

Background: The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution., Methods: A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013., Results: There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved., Conclusion: A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

Objective: Several prior studies have investigated whether patients with "non-cognitive" mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences., Methods: Using the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders., Results: In multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS., Conclusions: It seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.

Objective: The purpose of the present study was to investigate the problems and needs for interventions among caregivers of patients with schizophrenia who were the first time in contact with psychiatric services., Methods: 93 family caregivers of schizophrenia patients during the first contact with services were investigated by means of the the "Carer's Needs Assessment for Schizophrenia" (CNA-S)., Results: The most frequent problems of caregivers of first contact patients with schizophrenia were insufficient information on mental illness and concerns about the patient's future. Individual psychoeducation was needed significantly more often among caregivers of first contact patients than among those having been previously in contact with psychiatric services., Conclusion: Those being the first time in contact with psychiatric services need some specific interventions significantly more often than later., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Between 1891 and 1893 the famous Austrian and German neuropsychiatrists Julius Wagner-Jauregg and Paul Julius Möbius disputed in leading German and Austrian medical journals about mental and physiological changes and symptoms in people who after strangulation could be revived in time to survive. Their dispute even touched personal issues., Methods: For the study, the original sources were studied and contrasted with relevant secondary sources., Results: The dispute was mainly about two opposing concepts: On the one hand, Wagner-Jauregg supported an organic, neurological concept; on the other hand a psychoreactive-symptoms concept represented by Möbius and elaborated by him first in his concept of hysteria., Discussion: The study elaborates these factual differences in completely different approaches to psychiatry and - at least in the case of Möbius - how a medical theory was embedded into a pre-existing philosophical system., Consequences: The dispute studied discusses a philosophical problem which has remained incompletely understood until the present day - the relationship of body and mind. Hence the study on this dispute is more than just an interesting aspect in the history of sciences, but rather the illustration of a meeting of two opponents in a still relevant discussion., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Psychoeducation has been shown to reduce relapse rates in several psychiatric disorders. Studies investigating for which psychiatric diagnoses psychoeducation is offered and assessing its perceived relevance compared to other interventions are lacking., Methods: A two-part questionnaire addressing these questions was sent to the heads of all psychiatric hospitals in Germany, Austria and Switzerland. Results were compared with those from a similar survey 5 years earlier., Results: 289 of 500 (58%) institutions responded. Significantly (p = 0,02) more institutions (93%) offer any type of psychoeducation as compared to 5 years before (86%). Psychoeducation is mainly offered for schizophrenia (86%) and depression (67%) and less frequently for anxiety disorders (18%) and substance abuse (17%). For the following specific diagnoses it is offered by less than 10% of the institutions: Personality disorder, bipolar disorder, posttraumatic stress disorder, dementia, obsessive compulsive disorder, sleeping disorders, eating disorders, schizophrenia plus substance abuse, pain, attention deficit hyperactivity disorder and early psychosis. 25% offer diagnosis-unspecific psychoeducation. 'Pharmacotherapy' (99%), 'basic occupational therapy' (95%) and 'psychoeducation for patients' (93%) were the therapies being most often, 'light therapy' (24%) and 'sleep deprivation' (16%) the therapies being least often perceived as relevant by the respondents when asked about the value of different interventions offered in their hospitals. Art therapy (61%) and psychoanalytically oriented psychotherapy (59%), two therapies with a smaller evidence base than light therapy or sleep deprivation, were perceived as relevant by more than the half of the respondents., Conclusion: Psychoeducation for patients is considered relevant and offered frequently in German-speaking countries, however, mostly only for schizophrenia and depression. The ranking of the perceived relevance of different treatment options suggests that the evidence base is not considered crucial for determining their relevance.

Objective: To investigate the associations and connotations of the general public to psychoanalysis., Methods: A representative telephone survey was conducted in the city of Vienna. 1,205 people over 16 years of age were interviewed. As part of a fully structured interview associations to psychoanalysis were investigated by an open question. Results were subsequently further analyzed by means of content analysis., Results: Psychoanalysis is widely known in the general public. But associations are rather limited. Besides the name of Sigmund Freud, people do not have many associations to psychoanalysis. The picture of psychoanalysis is rather orientated towards the past., Conclusions: Despite its high profile, a rather undifferentiated and one-dimensional image of psychoanalysis is prevalent among the general public., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Schizophrenia is particularly associated with stigma. Especially internalized stigma, the inner subjective experience of stigma and its psychological effects resulting from applying negative stereotypes and stigmatising attitudes to oneself, is a barrier to recovery. The Internalized Stigma of Mental Illness-scale (ISMI) developed by Jennifer Boyd Ritsher and colleagues is a valid instrument for self-rated assessment of the subjective experience of stigma. The aim of the study was to examine the psychometric properties of the German Version of the ISMI among people with schizophrenia spectrum disorder., Methods: The ISMI was translated into German. Reliability and validity of the instrument were tested and predictors of internalized stigma were explored. Data of 157 people were collected on the ISMI and demographic and clinical variables. Construct validity was tested by comparing results with already established constructs such as perceived devaluation and discrimination, depression, self-esteem, empowerment, control convictions and quality of life., Results: The German Version of the ISMI showed good psychometric properties with high internal consistency, good test-retest reliability and good construct validity among people with schizophrenia spectrum disorder. About one third had a mean above the midpoint of the scale indicating a high level of internalized stigma. Internalized stigma was predicted by insufficient social network, level of education less than high school and inpatient or day clinic treatment compared to outpatient treatment., Conclusion: Results suggest that the German version of the ISMI is comparable to its original version. With the German version of the ISMI internalized stigma can be measured reliably and validly among people with schizophrenia spectrum disorder. Future studies may use the ISMI to record changes in internalized stigma pertinent to the achievement of therapeutic goals., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hormonal fluctuations during the perimenopausal transition lead to physical discomfort but are also frequently accompanied by mood swings, depressive symptoms, anxiety and sleeping disorders. The important role of the neurotransmitter serotonin in the pathogenesis of anxiety disorders and major depression is unquestioned, but only little is known about the influence of sex hormones on the serotonergic system. This review provides an overview of potential risk factors for the occurrence of affective disorders in the menopausal transition and discusses possible therapeutic options. Current research findings from longitudinal studies testing the efficacy of hormone replacement therapy and antidepressants with effects on the serotonergic neurotransmission on physical and mental discomforts during menopause are presented. Furthermore, studies using positron emission tomography and genetic methods that explore the effects of sex steroids on different components of the serotonergic system are shown. The interactions between estrogen, progesterone and the serotonergic system are described, and possible neurobiological and endocrinological mechanisms underlying depressive symptoms in the perimenopause are elucidated.

As a medical topic psychosomatic medicine is able to look back on an almost 100-year-old tradition. Nevertheless, questions about its definition, area of application and by whom it should be practiced remains unsolved. This causes considerable tension with the field of psychiatry which has always seen psychosomatic medicine as a subspecialty of its own discipline. In the article, the development and current position of psychosomatic medicine in German speaking countries other than Germany (Austria, Switzerland and South Tyrol) is presented. While psychosomatic care is currently planned and also partially already executed in Austria, psychosomatic medicine in Switzerland is located with general practitioners on the one hand and consultation-liaison psychiatry on the other. After the radical psychiatric reform of the late 1970s in South Tyrol psychosomatic medicine proved to be a means to remove taboos regarding psychiatric institutions and the mentally ill.

Objective: Relatives of persons with schizophrenia have an essential role in informal caregiving. This may result in a high level of burden. Aim of the study was to investigate, if the frequency of unmet needs among relatives caring for schizophrenia patients increases the risk for burden among these relatives., Methods: 135 relatives of patients with schizophrenia or schizoaffective disorder were investigated by means of the "Involvement Evaluation Questionnaire" (IEQ) and the "Carer's Needs Assessment for Schizophrenia" (CNA-S)., Results: Multiple linear regression analyses showed positive associations between the frequency of caregivers' unmet needs and the IEQ-subscores "tension" and "worrying". Further, the IEQ-subscore "worrying" was significantly lower among caregivers of outpatients than among caregivers of inpatients or day hospital patients. The IEQ-subscore "urging" was significantly associated with patient's negative symptoms., Conclusion: Unmet needs among caring relatives have negative effects on their burden. Further, the patients' type of treatment setting (inpatient, outpatient, day hospital) seems to predict caregivers' burden., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: A sample of patients with a puerperal psychosis of an early manifestation is investigated in respect of special risks of suicide and infanticide., Methods: During a 20-year period 96 patients who had been fallen ill with a puerperal psychosis within four weeks after delivery were admitted to a psychiatric university hospital. Patients with an acute exacerbation of a known schizophrenic disorder were excluded. In a subgroup of 37 patients states of a previous (affective, bipolar affective) psychotic illness were recorded already before the puerperal index episode, in a subgroup of 59 patients puerperal psychosis was the first manifestation of a psychotic illness. Suicide- and infanticide-relevant psychopathological symptoms were analysed (suicidal ideas/behaviour before/during inpatient treatment, general disorganized aggression, psychotic anxieties related to baby, infanticidal obsessions, aggressive ideas/behaviour towards baby, neglect, infanticidal impulses)., Results: Puerperal psychoses were distributed to the diagnostic categories of psychotic depressive disorder, bipolar affective disorder, and schizoaffective disorder. Six patients died due to suicide, tragically already some few days till weeks after discharge from psychiatric hospital, despite a pronounced or even complete remission of puerperal psychotic symptoms at the time of discharge. Three patients committed an extended suicide attempt that resulted in two infanticides. All isolated and extended suicides were committed in a state of depressive mood and presumably synthymic delusion., Conclusions: Suicidal ideas and behaviour play a major role in patients with puerperal psychosis before and during inpatient treatment. An increased risk for mothers and babies may persist, however, even after a seemingly good symptomatic remission. Besides the clinical challenge of general prevention of puerperal psychosis the request of adequate models of inpatient treatment, carefully prepared discharge, close afterdischarge follow up, and continuous outpatient care have to be stressed.

Suicide Prevention Austria (SUPRA) is a package of measures which should help the Austrian ministry of health to realize an evidence based suicide prevention program. That such a program is indispensible can be seen on the fact that suicide is on the second position as cause of death in male Austrians up to the age of forty. The concept itself summarizes successful national programs which fit to the Austrian situation. In the meantime the Austrian ministry of health established an office for coordination of the SUPRA program and a commission of experts which is responsible for the first activities of the national Austrian suicide prevention program.