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Drei Fallbeispiele von schizophren erkrankten Patienten wurden einer Stichprobe von 520 Personen aus allen Teilen Deutschlands vorgelegt (25,1% psychiatrisch tatige Arzte, 3,7% Psychologen, 8,1% Sozialarbeiter, 14,6% Krankenpflegepersonal, 48,6% andere). Jeweils wurden Entscheidungen zu Zwangseinweisung und neuroleptischer Zwangsbehandlung erfragt. Fall 1: junger Mann, erste Episode, wahnhaft, extremer sozialer Ruckzug; Fall 2: Frau mit hebephrenem Verlaufstyp, schlagt die mit ihr zusammenlebende Mutter; Fall 3: verwahrlosender Patient mit wiederholtem Rezidiv, wahnhaft, sozial zuruckgezogen. In allen Fallen entschieden sich Psychiater ahnlich wie andere Berufsgruppen und Laien, wahrend Sozialarbeiter haufiger gegen Zwangsbehandlungen votierten. Multivariate Analysen zeigten, dass auser der Berufsgruppe hauptsachlich hoheres Lebensalter diejenige Variable war, die mit einem Votum fur Zwangsbehandlungen assoziiert war. Eigene Erfahrungen mit psychisch Kranken waren keine oder nur schwache Pradiktoren.

Entgegen zahlreicher Widerstande haben wir 2005 in der Asklepios Klinik Nord Ochsenzoll in Hamburg eine „Behandlungseinheit fur Frauen“ (BeF), die nicht nur ausschlieslich Frauen behandelt, sondern auch aus einem ausschlieslich weiblichen Therapeutenteam mit Arztinnen, Psychologinnen, Ergound Tanztherapeutinnen besteht, eroffnet. Behandelt werden schwerpunktmasig Patientinnen mit Traumafolgestorungen (z.B. PTBS, dissoziative Storungen) sowie Frauen mit allgemeinpsychiatrischen Diagnosen, die den Wunsch haben, auf einer Frauenstation behandelt zu werden. Sehr haufig horten wir das Argument, dass reine Frauenstationen antiquiert waren, und letztlich nur einen Ruckschritt in das „tiefe Mittelalter“ der Psychiatriegeschichte sind. In der Tat herrschte in der psychiatrischen Versorgung bis zur Mitte des 20. Jahrhunderts eine Geschlechtertrennung, welche mannliche und weibliche Patienten weitgehend voneinander isolierte. Im Zuge der Humanisierung und Normalisierung der Psychiatrie, die sich in erster Linie gegen die restriktiven, deprivierenden und hospitalisierenden Krankenhauszustande wandte, setzte sich erst in den 50er-Jahren des 20. Jahrhunderts eine Mischung der Geschlechter auf den psychiatrischen Stationen durch, die durch die Psychiatrieenquete 1975 noch einmal ausdrucklich empfohlen wurde. Man erhoffte sich von der Geschlechtermischung in erster Linie eine weitgehende Normalisierung der therapeutischen Gemeinschaft der Patienten analog der Welt auserhalb der Klinik. Der meistgeauserte Kritikpunkt gegenuber unserer Behandlungseinheit fur Frauen war, dass eine Trennung von Frauen und Mannern eine kunstliche Spaltung der Welt suggeriere. Dadurch wurden Frauen mangels Kontakt oder Auseinandersetzung mit Mannern die Halfte der Realitat ausblenden und sich kokonartig in eine irreale Schonwelt zuruckziehen, die spatestens bei der unvermeidlichen Ruckkehr in die Realitat wie eine Seifenblase zerplatze. Als weiteres Argument gegen eine Geschlechtertrennung wurde die moglicherweise verdeckte Implikation von Schuldzuweisungen an das mannliche Geschlecht angefuhrt: Gerade bei einer Frauenstation mit dem Schwerpunkt der Traumatherapie lage die Gefahr darin, Frauen einseitig als Opfer und Manner als Tater zu stigmatisieren und damit demMann per se offen oder verdeckt die Taterrolle zuzuschreiben. Die Verfestigung eines einseitigen und problematischen Mannerbildes ware dann die Folge. In Anbetracht des heutigen Wissensstandes greift jedoch die Frage, ob eine Frauenstation per se sinnvoll ist oder nicht, zu kurz. Eine differenziertere Frage ware, unter welchen Bedingungen eine Behandlungseinheit fur Frauen fur welche Patientinnen sinnvoll ist. In der gegenwartigen Gesundheitsforschung ist eine geschlechtsdifferente Betrachtung von Erkrankungen ein zunehmend aktueller werdendes Thema. Frauenspezifische Fragestellungen werden nicht mehr nur im angloamerikanischen Raum, sondern zunehmend auch in Deutschland rezipiert und finden Eingang in gesundheitspolitische Konzepte [1–3]. Dennoch liegt die konkrete Versorgungsrealitat psychiatrischer Patienten und Patientinnen weit hinter den aktuellen Forschungserkenntnissen uber Geschlechterdifferenzen zuruck, sodass geschlechtersensible Therapieangebote in der Psychiatrie bislang noch eine Raritat sind. Besonders erstaunlich ist, dass es ausgerechnet fur traumatisierte Patienten und Patientinnen kaum geschlechtsspezifische Angebote in der Psychiatrie gibt. Unterliegen doch gerade Gewalterfahrungen einer geschlechtsspezifischen Haufung und Uberformung [4,5]. Vor allem unter psychiatrischen und psychosomatischen Patienten und Patientinnen in stationaren Institutionen liegen allein die Pravalenzdaten von sexuellem MissPro

Objective: Four available instruments for the measurement of violence were compared. The association between psychopathological status at admission and violence during in-patient treatment was examined. Method: In 199 consecutively admitted patients (143 with schizophrenia or schizoaffective disorder, 56 with non-psychotic disorders), the PANSS was recorded at the time of admission. Violent behaviour against self and others was assessed for the total period of in-patient treatment using the scales MOAS, SDAS, SOAS and VS. Results: The sumscores of the scales correlated highly (r between 0.78 and 0.91), but the scales differed in sensibility and inter-rater reliability. There was a strong association between thought disorders and violent behaviour during in-patient treatment in psychotic patients (beta=0.34; P

Aggressive behavior directed against self and others was examined in a sample of patients with schizophrenia during their first hospitalization and during any subsequent hospitalizations over the next two years.The charts of 138 patients (77 men and 61 women) with a first episode of schizophrenia or schizoaffective disorder admitted to a psychiatric hospital in Weissenau, Germany, were reviewed to obtain information about four types of aggressive behavior (verbal aggression and aggression against objects, self, and others). Similar chart reviews were conducted for 83 patients (47 men and 36 women) who were rehospitalized during the next two years. The severity of the four types of behavior was rated using the Modified Overt Aggression Scale. Stepwise multiple regression was used to identify predictors of the number and duration of rehospitalizations.Seventy-five percent of the men and 53 percent of the women in the sample exhibited some type of aggressive behavior during the first or subsequent admissions. Seventeen percent of men and 26 percent of women attempted suicide. Among the predictors of rehospitalization that were examined, which did not include medication compliance, only aggressive behavior against self and against others were significant predictors during the two years after first admission. Predictors of aggressive behavior against others were male sex, number of hospitalizations, and alcohol abuse (among men only). Self-directed aggressive behavior was correlated with days of hospitalization but not with number of rehospitalizations.Aggressive behavior against self and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.

In the Table 3 of the original publication, the value ‘‘32’’ in 5th column has been misplaced. It should belong to the third row instead of the fourth row. Language: en

Recent studies confirm a significantly (several times, in fact) increased risk for schizophrenics to commit severely violent acts compared to the general population. Violent acts of minor degree and threats not followed by forensic detention are even much more common. Data on prevalence depend on study conditions, sample selection, and outcome definitions of violence. In psychiatric hospitals, too, violent and threatening behaviour seems to occur most frequently in schizophrenic patients. However, in this respect findings are inconsistent and display considerable variations across different countries and times (with increasing rates reported within the last decade). Additional risk indicators beside the diagnosis of schizophrenia are male gender, comorbidity with personality disorders, substance abuse, lack of adequate treatment and increasing social disintegration due to an unfavourable course of the illness. The violence risk does not seem to decrease with increasing age in contrast to the general population. Beyond these sociodemographic data and variables related to treatment and course of illness, psychopathological causes of violence are less evident. Even imperative hallucinations are not clearly associated with violence: systematic delusions are associated with severe violent acts, but not with the much more frequent violent acts of minor degree. Most probably, the total of psychopathological symptomatology is associated with the proneness to aggressive behaviour. Neuropsychological and biological findings are also inconsistent. Language: de

BACKGROUND Carrying out dialysis against a patient's will poses specific legal and ethical problems. Decisions have to be made under time pressure, there is often an immediate threat to life, the intervention is rather difficult to carry out against a patient's will, and the same dilemma repeats itself continuously within some days. METHOD We report on a 45-year-old man with moderate dementia due to hypertensive encephalopathy who was involuntarily admitted to a psychiatric hospital by a court order because of his refusal of dialysis. RESULTS Dialysis could be carried out with moderate coercion in a general hospital and was subsequently accepted by the patient after two treatments. The protest of the psychiatric hospital against the obligation to provide dialysis by coercion was accepted by the superior court some weeks after discharge of the patient, because dialysis is not provided in the psychiatric hospital. DISCUSSION Though a good outcome could be achieved in this particular case, many questions remain unclear concerning the feasibility of dialysis under coercion in cases of patients with impaired capacity to give informed consent, and the legal responsibility for the realization of court orders.

Patients who participated in a randomized controlled trial comparing subjective distress and traumatic impact after seclusion or mechanical restraint were interviewed about the coercive measure about one year later.Between May and December 2006, patients were interviewed about one year after experiencing seclusion or mechanical restraint as an inpatient. Items from the Coercion Experience Scale (CES) were used in the original and the follow-up studies to assess distress on a 5-point scale, with higher scores indicating greater distress. Patients were also asked about subjective feelings about the coercive measure and completed the Impact of Event Scale-Revised (IES-R) to assess symptoms of posttraumatic stress disorder (PTSD).Sixty (59%) of the 102 patients in the original sample were included for follow-up. Although the original study found no differences between patients who experienced seclusion or mechanical restraint, the follow-up study found significantly higher mean scores for CES items among patients who had experienced mechanical restraint (2.5 and 3.7, respectively, p.001). IES-R scores did not differ significantly. IES-R scores for two patients who experienced mechanical restraint and one who experienced seclusion indicated probable PTSD. Patients reported experiencing a wide range of negative feelings during the measure, most frequently helplessness, tension, fear, and rage. However, 58% reported some positive effects. Contact with staff was most helpful in alleviating distress during the coercive measure.Contrary to the original study, the follow-up study suggested that seclusion might be a less restrictive alternative for most patients. The incidence of PTSD seemed lower than expected.

Cross-sectoral integrated health-care and the regional psychiatry budget are two models of cross-sectoral health care (comprising in-patient and out-patient care) in Germany. Both models of financing were created in order to overcome the so-called fragmentation in German health care. The regional psychiatry budget is a specific solution for psychiatric services whereas integrated health care models can be developed for all areas of health care. The purpose of this overview is to elucidate both the current state of implementation of these models and the results of evaluation research.Systematic literature review, additional manual search.28 journal articles and 38 websites referring to 21 projects were identified. The projects are highly heterogenuous in terms of size, included populations and services, aims, and steering-function (concerning the different pathways of care).The projects yield innovative models of mental health care capable of competing with the co-existing traditional financing systems of in-patient and out-patient services. The future of mental health care organisation in Germany is currently open and under political discussion.

Hintergrund Das Ziel der vorliegenden Untersuchung war die Anwendung des neu konstruierten Fragebogens zur Erfassung der subjektiven Wahrnehmung und Bewertung der Aufnahme in eine psychiatrische Klinik (FEA-P). Insbesondere sollte der Zusammenhang mit Patienten- und Klinikmerkmalen sowie situativen Faktoren analysiert werden. Patienten und Methoden Für die Analyse wurden die Daten von 708 Patienten sowie Fragebögen der 6 beteiligten Kliniken und Stationsfragebögen ausgewertet. Neben einem Klinikvergleich der Basisdaten wurden univariate und multivariate Zusammenhangsanalysen zwischen dem Gesamtscore des FEA-P und den personengebunden und institutionellen unabhängigen Variablen berechnet (ein- und mehrfaktorielle Varianzanalysen, Korrelationsanalysen und deren Effektstärken). Ergebnisse Die Analysen ergaben signifikante univariate Zusammenhänge mit kleinen bis mittleren Effektstärken zwischen dem FEA-P-Gesamtscore und einer Reihe unabhängiger demographischer, klinischer und institutioneller Merkmale sowie für einige nicht unabhängige situative Faktoren. In der multivariaten Analyse galt dies bei den Patientenmerkmalen nur noch für Geschlecht, Alter, Diagnose, den eigenen Entschluss zu einer stationären Aufnahme sowie die Frage danach, ob die Aufnahme mit dem vorbehandelnden Arzt geplant war. Auf der Klinikseite waren offene vs. geschlossene Stationstüren, der störungsspezifische Stationsauftrag und die Anzahl der untergebrachten Mitpatienten mit dem Erleben der Aufnahme durch die Patienten signifikant assoziiert. Schlussfolgerungen Der FEA-P scheint grundsätzlich als Instrument der Qualitätssicherung geeignet. Institutionelle sowie situative Faktoren konnten identifiziert werden, die mit dem Erleben der stationären Aufnahme in Zusammenhang stehen und von denen einige prinzipiell veränderbar sind.

Cardiovascular risk factors, electrocardiographic findings and preexisting diseases of the cardiovascular system were recorded in 90 schizophrenic patients (mean age 62.6 yrs., mean duration of hospitalisation 28.6 yrs.). The obtained data were compared with a group of depressive inpatients matched for age and sex and with corresponding data of the german population. Although among the schizophrenic patients heavy cigarette-smoking was significantly more frequent, hints for a myocardial infarction in history were found in only 3 of these patients and, in contrast, in 7 depressive patients. Systolic and diastolic blood pressure did not differ among depressive and schizophrenic subjects with mean levels in both groups being lower than in the corresponding age of the general population. Total cholesterol levels were lowest in the schizophrenics; in the depressive patients, however, lower than in the general population. There was a continual increase of cholesterol with progressive age in depressive subjects and in the general population. An adverse tendency was found in the long-term-hospitalized schizophrenics of both genders. In male schizophrenics a significant negative correlation between the duration of hospitalisation and both serum cholesterol and diastolic blood pressure could be observed. This may explain cardiovascular mortality rates in these patients which are not elevated in spite of heavy smoking and lack of movement.

OBJECTIVE: A project of quality management funded by the German Ministry of Health is presented which aims at recording and reducing of coercive measures (seclusion, restraint, forced medication). METHOD: Since 1997, a study group for prevention of violence and coercion consisting of physicians, nurses and other psychiatric professionals from 18 psychiatric hospitals is working in Baden-Wuerttemberg and Bayern. A common documentation of coercive measures has been introduced, variables of interest such as percentage of patients exposed to coercive measures in each principal diagnostic group of the ICD-10 have been defined for purposes of benchmarking. Aims of the project are 1) a complete documentation of all coercive measures in 12 psychiatric hospitals in a 12-month period and a benchmarking, taking into account structural characteristics of the hospitals and the respective catchment area, 2) providing a manual for a one-day de-escalation training for all professional groups working with psychiatric patients. PRELIMINARY RESULTS: A pilot study demonstrated that about 9 % of all admitted patients have been exposed to coercive measures in a subset of the participating hospitals. The variance between the hospitals was rather high. Language: de

The folic acid (FOA) level was determined in serum and erythrocytes in 100 epileptic patients and 100 control patients using a luminescence assay. A lowered FOA concentration in serum, erythrocytes, or both was observed in 15% of the epileptic patients and in 2% of the control group. In the epileptic patients, the FOA in the serum and in the erythrocytes was significantly lower than that in the control group. Patients receiving carbamazepine monotherapy had a significantly lower FOA level in the erythrocytes than did patients receiving phenytoin monotherapy. The FOA level showed a negative correlation to the duration of epilepsy. None of the patients with lowered FOA had a normal mental status. The course of the supplementation treatment with 5 mg folinic acid (or FOA) of four patients with FOA deficiency could be monitored psychopathometrically. All four patients showed an improvement in their well-being and the majority of measured variables of the cognitive performance.

The Centre of Psychiatry Suedwuerttemberg routinely records data on service use of in-patient units, day hospitals and out-patient services on a daily basis as well as data on the respective patients according to the German Basic Documentation (BADO). Other psychiatric services in the catchment area of the districts Ravensburg and Bodenseekreis such as services of sheltered living, residential homes and vocational services collect identical data per day of use. Aim of the study is to compare routinely recorded data of mental health service use and direct cost of service use with sample data. We compared analyses of mental health service use and direct cost of service use with routinely recorded data with analyses using sample data.Concerning the year 2008, we joined these different data sets, processing them in order to obtain pseudonymity and fulfil data protection requirements. This joint data set maps the total expenditures for psychiatric care utilisation in this region.Using a data set of this kind, analyses of health economy are possible which are comparable or even superior to those from sample data.Routinely recorded data are a cost-saving alternative to sample data.

The authors deserve thanks for their clear explanation from a forensic medical perspective. The article refers primarily to patients in homes for elderly people and nursing homes. With regard to the authors’ observations relating to psychiatry, however, I wish to raise several objections. It is not the case that restraints in psychiatry are used primarily to prevent patients from self harm and attempted suicide. The articles cited by the authors in support of their statement—including one of mine—do not show this. Restraints to prevent self harm and suicide are regarded as inappropriate in the psychiatric setting, with the exception of extreme cases. Such problems need to be approached by means of qualified, intensive, interpersonal therapy. In the psychiatric setting, those most affected by restraining measures are patients with dementia—for the same reasons that are mentioned in the article itself, mostly to prevent (primarily nocturnal) falls with severe injuries. In other diagnostic groups, the most common reasons are threatening and manifestly aggressive behaviors, such as has been described in the article by Kallert et al (2007), which the authors cite. With regard to the legal regulations mentioned in the article, clarification is required: freedom restraining measures (FRM) because of aggressive behavior are permitted only in the acute emergency setting (according to paragraphs 34/35 of the German Penal Code, justifiable emergency) or, under German public law, in the context of admission to psychiatric hospitals according to state law. According to the guardianship law, which applies exclusively in nursing homes and non-psychiatric hospitals, freedom restraining measures are allowed only for the benefit of the affected patient, but not to avert danger to third parties.

Objective To examine smoking behaviour and motivation to reach abstinence among staff and patients of a psychiatric hospital.Methods In two due day surveys all in-patients and staff of the Centre for Psychiatry Weissenau were interviewed by a questionnaire.Results The response rate was 78.5 %. 442 (48 %) out of 933 subjects (523 patients, 410 staff) were smokers. Patients were smoking more frequently than staff (58 % vs. 34 %) and were more severely nicotine-dependent. Significant gender differences were observed with regard to prevalence and nicotin dependence. 57 % said they wanted to stop smoking and 34 % would appreciate therapeutic offers. There were no significant differences between patients and staff.Conclusions Psychiatric patients are as motivated as staff for offers about smoking cessation. There is a need for therapeutic offers.

Mechanical restraint and seclusion are not therapeutic interventions but procedures to safeguard patients or staff representing a failure of therapeutic approaches. Quality management including benchmarkings yields considerable variations between different hospitals. However, an enduring and significant decrease in the frequency and duration of such coercive measures so far has not been achieved by means of quality management. A new set of approaches is therefore required.Amending the British practice of "physical restraint" for German conditions, a technique of holding the patient was developed accompanied by manualised interventions of verbal de-escalation. In contrast to mechanical restraint, the technique represents a therapeutic intervention and is usually of short duration. An implementation is planned in a group of hospitals collaborating in the prevention of violence and coercion in psychiatry.This new technique appears a promising approach to fundamentally change the practice of mechanical restraint in Germany. Evidence of the effect of this technique on frequency and duration of mechanical restraints needs to be gathered.

Coercive measures that restrict personal freedom have been in the focus of critical public interest since the beginning of modern psychiatry. Psychiatric hospitals have the two-fold mission to prevent danger to self or danger to others on the one side and on the other to keep optional coercive measures as little restrictive and as short as possible. Critical and regardful handling of coercive measures has both qualitative and quantitative aspects. For quantitative comparisons, we introduced benchmarking in psychiatric hospitals in Baden-Wuerttemberg, which in the meantime have been joined by hospitals in other German federal states, Switzerland, and Luxemburg. The most important quality indicators include the percentage of admissions exposed to coercive measures and the mean duration of a coercive measure. For the purpose of benchmarking, the results of four quality indicators are presented, separated for each ICD-10 principal diagnostic group, both cross-sectionally and longitudinally. The project has been continuously pursued since 2004. Participating hospitals were allowed to develop their own projects to reduce coercive measures according to the benchmarking results.

To assess the quality of data recorded using a modified version of the German Psychiatric Basic Documentation (BADO) and to use this assessment as the basis for the development of a short version of the BADO.BADO codings of a random sample of 200 admitted cases in 2007 were compared to information retrieved from computer-based records for the same patients.In general, the quality of data recorded using the BADO was good, particularly in terms of the accuracy and the completeness of the data. However, a comparative analysis of the data suggests that ambiguities in the coding of particular BADO items might reduce their sensitivity and precision.Data recorded using the BADO is fit for the purposes of quality management and, with some limitations, for research applications. The short version of the BADO developed using the results of the evaluation, significantly enhances its user-friendliness and increases the reliability of the coded data.

Patienten aus Kliniken fur Psychiatrie und Psychotherapie in Deutschland werden vermutlich haufig mit der Empfehlung einer ambulanten oder stationaren psychotherapeutischen Weiterbehandlung entlassen. Genauere Daten dazu liegen bisher jedoch nicht vor. Viele Autoren ausern die Befurchtung, dass Patienten mit schwereren Krankheitsauspragungen, worum es sich bei vorangehendem Aufenthalt in einer psychiatrischen Klinik in der Regel handeln durfte, eine Benachteiligung in der ambulanten psychotherapeutischen Versorgung erfahren [1; 2]. Regionale Versorgungsunterschiede konnten dabei eine Rolle spielen. Diesen Fragestellungen wurde in einer multizentrischen Studie nachgegangen. Die Studie wurde von Mai bis Dezember 2009 in vier Kliniken fur Psychiatrie und Psychotherapie mit Versorgungsauftrag durchgefuhrt. Insgesamt wurden 343 Personen mit einer Empfehlung fur stationare oder ambulante Psychotherapie im Anschluss an ihre stationare psychiatrische Behandlung kurz vor ihrer Entlassung um ihre Teilnahme an der Studie gebeten und ein erstes Interview durchgefuhrt. Um die Realisierung einer stationar gegebenen Psychotherapieempfehlung ermitteln zu konnen, wurden nach 3 Monaten Telefoninterviews zur Umsetzung der Psychotherapieempfehlung gefuhrt. Insgesamt konnten in den vier Zentren 306 (89,2%) Teilnehmer erneut befragt werden. Das Studiendesign wird prasentiert und erste Ergebnisse werden vorgestellt. Gefordert durch das Forschungsnetz psychische Gesundheit (FpG7) Literatur: 1 Melchinger H, Rossler W, Machleidt W. Ausgaben in der psychiatrischen Versorgung – Ist die Verteilung der Ressourcen am Bedarf orientiert? Der Nervenarzt 2006; 77:73-80. 2 Roth-Sackenheim C. Qualifizierte ambulante Versorgung psychisch Erkrankter durch fehlgeleitete Ressourcenverteilung nur noch Utopie. Nervenarzt 2003; 74:1057-1065.

To examine whether the utilisation of preventive medical checkups and contacts to doctors differs between people with schizophrenia and a comparison group of comparable social status in Germany.120 patients, each 40 from a hospital, an out-patient clinic and a residential home, were interviewed as well as 118 attendants of a social welfare office as a comparison group.Cancer screenings were realised less frequently than in the general population both among the patients and the controls. Contacts with doctors of somatic disciplines were more frequent among patients than among controls and the general population.The health behaviour of patients with schizophrenia was not significantly different from a comparison group with similar social status.

ResumenLos estudios epidemiológicos, animales y clínicos produjeron resultados contrapuestos con respecto a una supuesta asociación entre el aumento del riesgo de suicidio y violencia y los niveles bajos de colesterol en suero. Hasta ahora, no se ha dispuesto de datos para los pacientes con esquizofrenia, un trastorno con un conocido aumento del riesgo de violencia. Se investigaron las correlaciones de los niveles de colesterol en suero en la admisión y medidas de violencia en 103 pacientes admitidos consecutivamente (44 varones, 59 mujeres) de una unidad de admisión psiquiátrica general. A setenta sujetos se les diagnosticó que sufrían esquizofrenia o trastorno esquizoafectivo (F20, F25 de la CIE-10), y a 33 se les diagnosticó que sufrían trastornos no psicóticos (sobre todo, trastornos de la personalidad). El nivel total de violencia mostrada durante el periodo de tratamiento hospitalario se midió en cada paciente por la Escala de Agresión Abierta Modificada (MOAS), la Escala de Disfunción Social y Agresión (SDAS), la Escala de Observación de la Agresión para el Personal (SOAS) y la Escala de Violencia (VS). Las correlaciones de todas las medidas de violencia fueron altas (de 0,75 a 0,90), pero no se encontró correlación con los niveles de colesterol para los sujetos psicóticos ni para los no psicóticos, ni para los hombres ni para las mujeres. La hipótesis de asociaciones entre la violencia y los niveles de colesterol no está apoyada por los datos.

Assessment of patients' subjective experiences of an admission to a psychiatric hospital.Subjective experiences of psychiatric admissions were recorded with a semi-structured interview in 72 fairly representative in-patients. Patients' satisfaction with treatment was recorded with the ZUF-8 questionnaire. Additionally, 52 in-patients on nine wards were interviewed in focus groups.From the patients' point of view, the most important aspects of the admission were staff, ward atmosphere and fellow patients. Violence and coercion played only a minor role. In the face-to-face interviews, assessments were generally positive, while in focus groups negative experiences and criticism were also reported.Future surveys should be conducted anonymously to minimize social desirability bias. Focus groups yield an important extension of individual interviews.

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.