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Importance: Home treatment (HT) has been associated with fewer inpatient treatment (IT) readmission days but lacks evidence on reducing combined psychiatric hospital service use (IT, HT, day clinic)., Objective: To assess the association of intensive home treatment (IHT) compared with IT regarding readmission rate, social outcomes, and clinical outcomes., Design, Setting, and Participants: This quasi-experimental, nonrandomized trial was conducted from 2020 to 2022 in 10 psychiatric hospitals in Germany. Propensity score (PS) matching was used to compare both treatment models at the 12-month follow-up using standardized instruments and routine hospital data. All patients were screened until the target sample size was reached, based on these criteria: stable residence with privacy for sessions, no child welfare risk, primary diagnosis within International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F0X to F6X, residence in the catchment area, no commitment order, no acute suicidality or severe aggression requiring hospitalization, capacity to consent, not participating in other interventional studies, sufficient German language skills, no substantial cognitive deficits or intellectual impairment, and no more than 7 days in IHT or IT before recruitment. Statistical analysis was performed from February to November 2023., Intervention: IHT provided daily acute psychiatric treatment at home, while IT was psychiatric inpatient treatment as usual. The mean treatment duration of the index treatment was 37.2 days for IHT and 28.2 days for IT., Main Outcomes and Measures: The inpatient readmission rate was the primary outcome. Secondary outcomes were combined readmission rate, total inpatient days, job integration, quality of life, psychosocial functioning, symptom severity, and recovery., Results: Of 1396 individuals, 200 patients receiving IHT and 200 patients receiving IT were included (264 female [65%]; mean [SD] age, 45.45 [15.83] years [range, 18-88 years]). Baseline sociodemographic and psychometric characteristics did not differ significantly between the groups. At 12-month follow-up, patients in the IHT group had lower inpatient readmission rate (IHT vs IT: 31.12% vs 49.74% IT; mean difference, 18% [95% CI, 9%-28%; P < .001), combined readmission rate (mean difference, 13% [95% CI, 4%-24%; P < .001), and fewer inpatient days (mean difference, 6.82 days; P < .001) than the IT group., Conclusions and Relevance: This nonrandomized clinical trial found that patients receiving IHT had a lower likelihood of utilizing hospital-based psychiatric services and spent fewer inpatient days, suggesting that IHT is a viable alternative to IT., Trial Registration: ClinicalTrials.gov Identifier: NCT04745507.

This retrospective follow-up study over one year (after discharge from the index treatment), compares the effects of inpatient-equivalent home treatment (IEHT) and regular psychiatric treatment using subjective and objective quality indicators. Using a 1:1 matching of cohorts (diagnosis, age, gender, number of previous treatments and severity of illness), 732 IEHT patients were assigned to a comparison group. Outcome data was taken from the routine data of the clinic database and the in-house basic documentation. In the subjective quality measure, patients and practitioners in regular psychiatric treatment reported a significantly higher improvement in condition. In terms of the objective quality measure, the number of further inpatient treatment days in the observation period, the two groups did not differ significantly, which can be interpreted as encouragement for the use of this new, increasingly established form of treatment., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: Inpatient-Equivalent Home Treatment (IEHT) for mental health is new in Germany and therefore requires quality development. A best practice model (BPM) for IEHT is being developed from a service user perspective., Methods: 1. Collection and organization of evidence (literature review; n=55 interviews with service users), 2. qualitative analysis and formulation of criteria; 3. consensus and grouping of criteria (Delphi process)., Results: 58 Best practice criteria were developed in 8 groups: 1. Information, access and crisis management; 2. Treatment framework, end of treatment and continuity; 3. Scheduling, organization of contacts and flexibility; 4. Practical support and activation; 5. Treatment and therapy services; 6. Treatment team and staff; 7. Relatives, caregivers and community; and 8. Privacy and behavior in the home environment., Conclusion: The BPM provides initial guidance for a user-centered assessment of the implementation of IEHT., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

This part of the AKtiV Study focuses on treatment satisfaction of patients and their relatives within Inpatient Equivalent Home Treatment (IEHT) and regular treatment. Stress of relatives and job satisfaction and workload of employees in IEHT is also considered. Relevant Parameters were collected via established as well as newly adapted questionnaires at the end of treatment. Patients and relatives in IEHT are significantly more satisfied. The stress experienced by relatives is reduced in both forms of treatment. Employees in IEHT are generally very satisfied, although there is no correlation with the satisfaction of relatives and patients. Known limitations of satisfaction surveys must be taken into account. In general these results encourage the expansion and continuous development of this new form of treatment in Germany., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht.

Aim: The quasi-experimental AKtiV study investigates the effects inpatient-equivalent home treatment (IEHT). This paper describes the study population based on demographic and clinical parameters at baseline and compares the index treatment., Methods: Over a period of 12 months 200 IEHT users were included in the intervention group (IG) and 200 inpatients were included in the control group (CG). The comparability of the two groups was ensured by propensity score matching (PSM)., Results: In addition to the PSM variables, IG and CG did not differ significantly from each other variables at study inclusion. The duration of the index treatment was significantly longer in the IG (M=37.2 days) compared to the CG (M=27.9 days; p<0.001)., Conclusion: The similarity of the two groups enables comparisons over 12 months, investigating IEHT effects on long-term outcomes., Competing Interests: Die Autor*innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates., Methods: A total of 200 service users receiving IEHT were compared with 200 matched statistical "twins" in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9)., Results: Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients., Conclusions: Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Investigations reporting positive effects of extracorporeal shockwave therapy (ESWT) on nerve regeneration are limited to the rat sciatic nerve model. The effects of ESWT on muscle-in-vein conduits (MVCs) have also not been investigated yet. This study aimed to evaluate the effects of ESWT after repair of the rat median nerve with either autografts (ANGs) or MVCs. In male Lewis rats, a 7 mm segment of the right median nerve was reconstructed either with an ANG or an MVC. For each reconstructive technique, one group of animals received one application of ESWT while the other rats served as controls. The animals were observed for 12 weeks, and nerve regeneration was assessed using computerized gait analysis, the grasping test, electrophysiological evaluations and histological quantification of axons, blood vessels and lymphatic vasculature. Here, we provide for the first time a comprehensive analysis of ESWT effects on nerve regeneration in a rat model of median nerve injury. Furthermore, this study is among the first reporting the quantification of lymphatic vessels following peripheral nerve injury and reconstruction in vivo. While we found no significant direct positive effects of ESWT on peripheral nerve regeneration, results following nerve repair with MVCs were significantly inferior to those after ANG repair.

To get information about different ways inpatient equivalent treatment (IET) is implemented and organized eight specialized psychiatric hospitals and departments in Germany were asked to report on implementation details. OUTCOME: Organization and treatment processes depend on local conditions and existing structures. Legal barriers complicate the implementation process, however patients as well as team members report very positive experiences.Current data only give first hints but aren't sufficient to draw viable conclusions. Consequential issues will be picked up within the AKtiV-Study of the Innovationsfonds., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

First descriptive statistics on satisfaction with Inpatient equivalent treatment (IET), gathered on self report, of 100 patients are presented. Data has been collected at two psychiatric hospitals in Südwürttemberg.In general results suggested high satisfaction. Approval rate on making use of this innovative treatment again, was 88 % (SD = 26.1). Differences between the distribution of satisfaction values, differentiated by clinic location or psychiatric main diagnosis, have been shown.Results indicate high acceptance by the persons concerned. After the establishment of IET within the past 3 years, these results are building a methodological basis and origin for a wide-ranging evaluation of satisfaction with this sort of crisis resolution within the "AKtiV-Studie" of the Innovationsfonds 2020-2023., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Computerized gait analysis is a common evaluation method in rat models of hind limb nerve injuries, but its use remains unpublished in models of segmental nerve injury of the forelimb. It was the aim of this work to investigate if computerized gait analysis is a feasible evaluation method in a rat model of segmental median nerve injury and autograft repair. Ten male Lewis rats underwent 7-mm resection of the right median nerve with immediate autograft repair. The left median nerve was resected without repair and served as an internal control. Animals were assessed for 12 weeks after surgery via CatWalk (CW) gait analysis every 2 weeks. Evaluation of motor recovery by means of the grasping test was performed weekly while electrophysiological measurements were performed at the end of the observation period. CW data were correlated with grasping strength at each post-operative time point. CW data were also correlated with electrophysiology using linear regression analysis. Principal component analysis was performed to identify clusters of outcome metrics. Recovery of motor function was observable 4 weeks after surgery, but grasping strength was significantly reduced ( p < 0.01) compared to baseline values until post-operative week 6. In terms of sensory recovery, the pain-related parameter Duty Cycle showed significant ( p < 0.05) recovery starting from post-operative week 8. The Print Area of the right paw was significantly ( p < 0.05) increased compared to the left side starting from post-operative week 10. Various parameters of gait correlated significantly ( p < 0.05) with mean and maximum grasping strength. However, only Stand Index showed a significant correlation with compound muscle action potential (CMAP) amplitude ( p < 0.05). With this work, we prove that computerized gait analysis is a valid and feasible method to evaluate functional recovery after autograft repair of the rat median nerve. We were able to identify parameters such as Print Area, Duty Cycle, and Stand Index, which allow assessment of nerve regeneration. The course of these parameters following nerve resection without repair was also assessed. Additionally, external paw rotation was identified as a valid parameter to evaluate motor reinnervation. In summary, computerized gait analysis is a valuable additional tool to study nerve regeneration in rats with median nerve injury., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Heinzel, Oberhauser, Keibl, Swiadek, Längle, Frick, Kolbenschlag, Prahm, Grillari and Hercher.)

Injuries of the peripheral nervous system are common among the population affecting around 3% of all trauma patients. This high clinical need in the field of peripheral nerve injury and regeneration has been steadily driving experimental and epidemiological research. Thereby, it is crucial to determine the exact degree of recovery of end-organ function. Regeneration after nerve injuries is assessed by a wide variety of techniques and pre-clinical model systems, where rodent models are among the most widely used. However, results from rodents are difficult to translate to human patients in general, and reproducible and comparable assessment of functional recovery is of highest importance. Computerized gait analysis allows comprehensive acquisition of locomotor function. As the animals cross the recording device voluntarily, functional recovery is assessable with a minimum degree of human interference on their behavior. This article aims to give a detailed overview on the existing literature on CatWalk gait analysis in rodent models of peripheral nerve injuries of upper and lower extremities, e.g. axonotmesis, neurotmesis or fibrosis, with special emphasis on differences between models. Researchers interested in assessment of locomotor function in such models will especially benefit from this work as it will provide them with an overview of the various experimental setups and expected outcomes. This work also addresses potential pitfalls and hurdles in order to promote well designed, comparable studies allowing for accelerated development of therapeutic strategies in peripheral repair and regeneration., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective of the Study: General practitioners are mainly responsible for primary health care. Patients with mental disorders, in particular patients with complex or multiple needs, use these services infrequently in case of somatic complaints. Psychiatric outpatient clinics have to deal with these patients and have perhaps an additional role in diagnosing and treating somatic co-morbidities. This should be evaluated., Methods: Physicians in outpatient clinics of the Centre of Psychiatry Suedwuerttemberg were asked about their attitude towards somatic co-morbidities, somatic co-treatment and prescribing somatic drugs. In addition, data of the outpatient clinic documentation were evaluated with respect to the treatment by general practitioners and somatic diagnosis., Results: 72% of all patients said that they have a general practitioner. Physicians in outpatient clinics said that they had a high responsibility for somatic co-treatment especially for those patients who did not have a general practitioner. The frequency and type of a somatic co-morbidity was different in patients from general psychiatric, geriatric psychiatry and addiction outpatient clinics., Conclusions: Our results demonstrate that psychiatric outpatient clinics play a crucial role in diagnosing and treating somatic disorders. Their extent depends on the type of the psychiatric and the somatic disorder but also on the financing of the outpatient clinic., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The objective of this paper is to describe the agreement from the perspective of the authors who, as experts for the Deutsche Krankenhausgesellschaft (DKG - German Hospital Federation), have accompanied the PsIA negotiations since 2013. It traces the development of the PsIA negotiations leading to the "Änderungsvereinbarungen zur Vereinbarung zu den Psychiatrischen Institutsambulanzen gemäß § 118 Abs. 2 SGB V" (amendment agreements to the Agreement concerning the Psychiatric Outpatient Departments according to § 118 Abs. 2 SGB V - German Social Security Statute Book) of October 2019 with its striking difficulties in view of partly diametrally opposed interests of the negotiating partners.

Background: Alcohol dependence is one of the most serious diseases of addiction in Germany. The new S3-guideline "Screening, Diagnostics and Treatment of Alcohol-Related Disorders" has been presented in 2015 and summarizes the present state of knowledge pertaining to the diagnosis and treatment of alcohol abuse and alcohol dependence., Methods: This guideline was developed over four years within the framework of the Association of the Scientific Medical Societies in Germany (AWMF). The German Association for Psychiatry, Psychotherapy and Psychosomatics ( DGPPN ) and the German Society for Research and Therapy in Addiction (DG-Sucht) took the lead in the organization. More than 50 professional societies and associations and health organizations as well as more than 60 acknowledged experts were involved, including networks of self-help groups and relatives. The working group on "health care organization", whose results are presented here, was one out of thirteen working groups, focusing on the task how to implement the guideline under the basic conditions of the German health care system with its sectors and interfaces., Results: For the chapter on "health care organization" 27 recommendations have been consented. Many of these have been prepared by the respective working groups. These recommendations cover areas such as screening, diagnostics and short interventions, detoxification and withdrawal as well as pharmacotherapy, physical complications and psychic comorbidity, medical rehabilitation and other forms of post-acute treatment, primary care by general practitioners, as well as specific target groups such as children and adolescents, (pregnant) women and the elderly, and, in addition, self-help approaches., Conclusion: For needs-based diagnostics and treatment of alcohol-related disorders, guideline-based recommendations for health care organization offer a framework for the cooperation and coordination of all health sectors and occupational groups, especially with respect to their interfaces. This includes the cooperation between the medical and the psychosocial system and stretches from harm reduction to social inclusion of people concerned. Particularly the field of rehabilitation with its explicit aims for participation relies heavily on such a cooperation., Competing Interests: Frau PD Dr. Eva Hoch erhielt Vortragshonorare von den Firmen Desitin und Janssen. Die anderen Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In Germany, mandatory standards in staff job characteristics concerning inpatient (clinic and day clinic) treatment in psychiatry and psychotherapy were established for the very first time in the year 1990. Those job characteristics, concerning the several groups of professionals in German psychiatric-psychotherapeutic hospitals and departments underwent significant changes causing issues of law, professional and socio-cultural development since then. Besides general structurally changes, the present article focuses more particularly on the field of inpatient psychiatric intensive care therapy., Competing Interests: Interessenkonflikt: Herr Prof. Längle gibt an, dass kein Interessenkonflikt besteht.Herr Prof. Löhr hat Vortragshonorare und in diesem Zusammenhang entstandene Reisekosten von der Firma Jansen Cilag erhalten, Vortragshonorare und in diesem Zusammenhang entstandene Reisekosten unterschiedlicher Kliniken und Bildungseinrichtungen, Mitarbeit bei der Plattform Entgelt der DGPPN., (© Georg Thieme Verlag KG Stuttgart · New York.)

Backround: In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany., Objectives: The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups., Method: In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals., Results: Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses., Conclusion: Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment.

Background: Waiting periods for inpatient or outpatient psychotherapeutic treatment are generally considerable. For patients treated in a psychiatric day-clinic or hospital, implementation of a recommended subsequent psychotherapeutic treatment might be difficult., Objectives: In part II of the psychotherapy after hospital or day clinic (PAKT) study, we examined how the recommendation for psychotherapy can be implemented after psychiatric treatment., Materials and Methods: Three months after discharge from one of four psychiatric hospitals in southern Germany, we interviewed 306 patients who received a recommendation for psychotherapeutic treatment after their hospital stays if the recommendation was implemented successfully., Results: Only about 12 % of the patients in the follow-up group were unable to implement the general recommendation for psychotherapy after psychiatric stay despite motivation for psychotherapeutic treatment. In the case of recommendation for outpatient psychotherapy, 20 % were unsuccessful. Predictors for successful implementation were education and employment, whereas variables like age, gender, diagnosis, or severity of disorder did not play a significant role., Conclusions: The relatively small percentage of unimplemented psychotherapeutic treatment is surprising at a first glance. However, the proportion recommended for psychotherapy after psychiatric stay was less than 10 %, as shown in the first part of the study (see PAKT Study Part I, doi:s00115-016-0107-z).

Objective: The article describes care in a psychiatric clinic between 1946 and 1975. This happens against the background of the current psychiatry-historical literature in which this phase of psychiatric care is described often summarily with the destructive words of the report of the 'Psychiatrie-Enquête' of 1975. Improvements achieved in this time were hardly examined up to now though they contributed substantially to the later effects of the 'Psychiatrie-Enquête'., Methods: The medical annual reports of the psychiatric clinic of Zwiefalten, today ZfP Südwürttemberg, refering to the mentioned period were sighted and evaluated concerning their contents., Results: In the called period evident organizational and structural defects are deplored in the annual reports. Nevertheless, from the late 1940 s on, modern care elements appear, as for example the broadening of the range of the therapeutic offers, multiprofessional treatment, diagnosis-specific concepts for the wards, opening of stations and extensive outpatient care., Conclusion: It is shown that already before the appearance of the final report of the Enquête commission clear progress concerning psychiatric care was achieved., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim of the study was to examine the differences between former involuntary and voluntary patients with a schizophrenic disorder with regard to time to and frequency of rehospitalization., Methods: In this prospective observational study, 374 patients with a diagnosis of schizophrenia or schizoaffective disorder were included. At the time of inclusion, 290 (77.5 %) were hospitalized voluntarily and 84 (22.5 %) involuntarily. Follow-up assessments were conducted half-yearly over a 2-year period with measures of PANSS, GAF, sociodemographic data and cognitive functioning. These data served as covariates for adjustment in statistical models that included a Cox regression model, a random-effect logit model and a random-effect tobit model., Results: After adjustment for other relevant covariates, the Cox regression showed that involuntary treatment is a significant risk factor of subsequent rehospitalization (HR = 1.53; CI = 1.06, 2.19; p = 0.02). The involuntary group had higher half-year incidence rates of rehospitalization, and in case of rehospitalization the duration of hospital stay was longer., Conclusions: Involuntary hospitalization seems to be associated with a higher risk of rehospitalization and longer subsequent hospital stays in patients with schizophrenia and schizoaffective disorders. Further studies are needed to examine in detail the processes and interventions that are suitable for interrupting circles of repeated hospitalizations, especially in former involuntary patients.

Background: There is considerable variance in involuntary psychiatric hospital admission rates both in Europe and Germany. In a prospective comparison between five hospitals in three German federal states we assessed and analyzed involuntary psychiatric hospital admissions, including the patient's perspective., Material and Method: All involuntarily admitted patients were assessed by an independent researcher. Clinical data, patient and psychiatrist views were documented with different instruments including the McArthur admission experience survey., Results: In this study 104 out of 244 involuntarily admitted patients gave informed consent. We found considerable differences between study centres concerning involuntary admission quotas (3.2-25.8% of all hospital admissions) and involuntary admission rates (16.6-97.6 per year per 100,000 inhabitants). Hospitals in the state of Baden-Württemberg had the lowest involuntary admission rates while they were highest in Bavaria. In Baden-Württemberg involuntarily admitted patients were more likely to suffer from chronic schizophrenia, they were more severely ill and experienced the involuntary hospital admission as more strenuous. There were no differences between centres concerning frequency of dangerous behavior or self-harm., Conclusion: We found a high variance across regions concerning the reasons for, frequencies and legal basis of involuntary hospital admissions. Regional differences of legal frameworks and service organization can explain this only to a limited amount. Transparency, legal certainty and reflection of stakeholder roles are a future necessity. Furthermore, there is a need for stringent compliance with legal regulations and coherent documentation.

Course trajectory analyses have been performed primarily for treatment response in acute episodes of schizophrenic disorders. As yet, corresponding data for the long-term course are lacking. Within a multicenter prospective observational study, 268 patients with schizophrenia were assessed at discharge from hospital and followed up after 6, 12, 18, and 24 months. A latent class growth analysis was performed on the scores from the Positive and Negative Syndrome Scale (PANSS). A two-class conditional latent class model showed the best data fit (Entropy: 0.924). The model divided the sample into a group with amelioration in all PANSS subscales (60%) and a group with stable positive/negative and deteriorating general psychopathology symptoms (40%). Global functioning (GAF score), gender, age, living situation and involuntary admission predicted course trajectory class membership. The model was predictive of significant differences between the two groups in health care service costs and quality of life. The results underline the heterogeneous course of the illness, which ranged from amelioration to deterioration over a 2-year period. Statistical models such as trajectory analysis could help to identify more homogenous subtypes in schizophrenia., (© 2013 Published by Elsevier Ireland Ltd.)

Purpose: The purpose of the study was to examine the long-term influence of involuntary hospitalization on medication adherence, engagement in out-patient treatment and perceived coercion to treatment participation., Methods: In a naturalistic observational multi-centre study, 290 voluntarily and 84 involuntarily hospitalized patients with schizophrenia or schizoaffective disorder had been followed up over a period of 2 years with half-yearly assessments. Assessments included self-rated medication adherence, externally judged medication adherence by blood levels, engagement in treatment and perceived coercion. The statistical analyses were based on multilevel hierarchical modelling of longitudinal data. Level and development of the outcome was controlled for involuntariness, for sociodemographic characteristics and clinical history., Results: Involuntariness of the index-hospitalization did not have an effect on the development of treatment engagement or medication adherence judged by blood levels in the course of the follow-up period when the models were controlled for sociodemographic variables and clinical history. It was associated, though, with a continuously lower self-rated medication adherence. Moreover, former involuntarily hospitalized patients more often felt coerced in several treatment aspects at the follow-up assessments. Yet, there was no difference between the voluntary and involuntary group with regard to the development of the levels of adherence or coercion experiences over time., Conclusions: Involuntary hospitalization does not seem to impair future treatment engagement in patients with schizophrenia, but formerly involuntarily hospitalized patients continue to be more sensitive to subjective or real coercion in their treatment and more vulnerable to medication non-adherence. Hereby, their risk of future involuntary hospitalization might be increased.

The purpose of this study was to examine patients' response profiles to the Medication Adherence Rating Scale (MARS) and to evaluate the potential of response styles as predictors of the future course of psychotic disorders in terms of rehospitalisation and maintenance of medication. A total of 371 psychiatric in-patients with schizophrenia or schizoaffective disorder who were taking part in a naturalistic long-term study completed a German version of the MARS. A Latent Class Analysis (LCA) was performed. Five latent classes of response styles could be identified: "moderately adherent", "critical discontinuers", "good compliers", "careless and forgetful", and "compliant sceptics". Class membership was found to be related to the severity of symptoms, level of functioning, insight into illness, insight into necessity of treatment, treatment satisfaction and medication side effects. At a six-month follow-up appointment, significant differences between the classes persisted. Participants showing a "good compliers" response pattern had a significantly better prognosis in terms of rehospitalisation rate and maintenance of the original medication than "critical discontinuers". Evaluation of the MARS by studying response profiles provides informative results that reach beyond the results obtained by an evaluation by scores. Patients can be classified into adherence groups that are of predictive value for long-term patient outcome., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective of this observational trial is to examine the effects of quetiapine in comparison with olanzapine and risperidone on clinical outcomes and quality of life in patients with schizophrenia and schizoaffective disorder in routine care. 374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine, or risperidone at discharge from inpatient treatment were included. Clinical and psychosocial outcomes were assessed before discharge and at 6, 12, 18, and 24 months. Statistical analyses were conducted by mixed-effects regression models for longitudinal data. The propensity score method was used to control for selection bias. Patients discharged on olanzapine had significantly lower hospital readmissions than those receiving quetiapine or risperidone. The average chlorpromazine equivalent dose of quetiapine was higher than in patients treated with olanzapine or risperidone. No further significant differences between treatment groups were found. Quetiapine and risperidone are less effective in preventing the need for psychiatric inpatient care than olanzapine, and higher chlorpromazine equivalent doses of quetiapine are needed to obtain clinical effects similar to those of olanzapine and risperidone.

Objective: To examine the Patient Global Impression Scale of Improvement (PGI) as a quality indicator in routine psychiatric in-patient treatment and to determine its concordance with doctors' assessments., Methods: Patients treated in 2007 in 5 hospitals and 4 day-clinics were included. A set of patient and treatment characteristics (German BADO) and CGI scales were recorded in all patients. Patients were required to give a PGI rating at discharge., Results: PGI ratings could be obtained in 70.3 of the patients (N = 3957). PGI and doctors' CGI-I ratings were in agreement with no more than one degree of difference on the 7-point scale of the PGI in 89.8 %. Characteristics of those patients who significantly deviated from the doctors' assessments were determined., Conclusions: The PGI scale is appropriate as a quality indicator for routine clinical treatment which can rather easily be obtained., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To clarify to what extent subjectively-stated effects and side-effects differ between conventional and atypical neuroleptic agents and to what degree they depend on the method of questioning., Methods: Effects and side effects of antipsychotic medication in 136 schizophrenia patients were studied through naturalistic observation over a period of 12 months (3 measurement time points) and information sought in 2 different ways: firstly, patients gave spontaneous information on the effects/side effects; they were then asked in detail on the basis of a checklist., Results: Patients gave far less information spontaneously than when asked questions. There were no differences between typical and atypical antipsychotic agents in terms of effects or side effects. Patients, who could give spontaneous information on side effects, but not on positive effects of their neuroleptic agents, discontinued their medication more frequently in the further course., Conclusions: Information given by patients represents and important and usable source of information, but it can be influenced by the nature of questioning. A fundamental recommendation of the prescription of typical or atypical antipsychotic agents is not possible on the basis of the data.

Objective: Unemployment rates are high in people with schizophrenia, so that considerable importance is attached to measures to improve their ability to work and their vocational integration., Methods: In a study of the German Research Network on Schizophrenia the long-term effects of four-week vocational and ergotherapeutic measures on in-patients were investigated. The target criteria were the vocational integration, level of general functioning (Global Assessment of Functioning Scale) and psychopathology (Positive and Negative Syndrome Scale). 227 patients were randomized and assigned either to a work-oriented vocational therapy group, or to a creativity-oriented ergotherapy group; 163 patients completed the study. Data was available for 89 patients at the last catamnesis point after two years., Results: No differences were seen between the effects of the two forms of therapy on the development of vocational integration or on general functioning level and psychopathology after two years. The number of patients in regular work declined over this period., Conclusions: It is assumed from this that short-lasting vocational and ergotherapeutic measures do not have any long-term influence on the vocational integration of patients with schizophrenia.

Objective: Little is known about the effectiveness and the cost of care for patients treated in vocational rehabilitation programs,although vocational therapy is an essential part of inpatient treatment and community care of patients with schizophrenia., Methods: As a part of a randomised controlled trial in 5 centres, the long-term direct cost of care for patients with schizophrenia,being treated with different vocational rehabilitation programs during an index-stay in a psychiatric hospital were assessed. results were compared to controls who received non-specific ergo-therapeutic treatment instead., Results: Cost differences between study patients and controls were small and not statistically significant. However, cross-centre costs differed considerably., Conclusion: In spite of standardized inclusion criteria and a randomised assignment of study patients, a selection bias, triggered by the differing vocational rehabilitation programs is assumed as a source of cross-centre cost-variation which might be supported by differing service offers in the study regions.

Objective: Topic of this article is an investigation on the patients' perspective of involuntary treatment in psychiatry. The results of two studies are presented., Methods: The first study surveyed 40 patients involuntarily admitted to the Department of Psychiatry and Psychotherapy of the University Hospital of Tübingen, Germany, according to the commitment law. The interviews were carried out within the first days of admission. The second study carried out a retrospective follow-up of 47 court-committed patients; the mean period between commitment and follow-up was 29 months., Results: The majority of patients evaluated the involuntary treatment as not justified--both in direct context and in a long distance to it. A substantial part of the sample, however, showed insight into illness and treatment at the time of follow-up. Extreme positions were preferred; an ambivalent attitude was rare., Conclusions: It is necessary to pay attention to the events around the involuntary treatment individually and to offer systematic aftercare.

Objectives: In a previous study the effectiveness of vocational therapy was evaluated using the Osnabrück Profile of Working Abilities (O-AFP). No or only minor effects were detected. The goal of this reanalysis is to identify distinct responder groups., Methods: Hierarchical cluster analysis of O-AFP-scores before and after treatment, anovas, t-statistics as well as regression and discriminant analyses were applied to specify the clusters., Results: For each of the O-AFP-scales (Learning Ability, Social Communication Ability, Adaptation) three subgroups different in level and slope of abilities could be identified. Improvements with medium to high effect sizes were detected for Social Communication Ability (34 %) and Learning Ability (14 % of the patients), deterioration was found in 30 % of the patients for Adaptation. Subgroups could be described with the help of symptomatology. Further variables and subgroup membership could be predicted above chance by discriminant and regression analysis., Conclusion: Targeted and more appropriate design of vocational therapy seems necessary.

Objective: The aim of the present study was to clarify whether the mediation of homeless persons identified as mentally ill into the sociopsychiatric or the help-seeking system can be facilitated by a short-term intervention., Method: Probands with at least one psychiatric diagnosis according to ICD-10 (73 % of the sample) were randomized to the intervention group (manualized procedure with five brief contacts) or to the control group (no intervention). The course of the contacts and the further help-seeking behavior after 4 and 8 months were registered., Results: The very sporadic participation of the patients in the therapeutic discussion permitted a manualized procedure in individual cases only. The establishment of contact was very successful, but the problem-centered procedure only within limits. The intergroup comparison revealed no fundamental differences in the utilization of offers of support during the course of the study. Overall, however, the number of users tended to increase, with an increased contact frequency being recorded especially among those participating in therapeutic discussions., Conclusions: Only a relatively small proportion of the clientele can be reached through short-term behavior therapy. Fundamentally a low-profile, primarily outreach-based offer founded on longer-term contact appears to be more promising.