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Background Assessment of age-associated disorders has become increasingly important. Methods In a clinical setting, people with intellectual disability with and without dementia were assessed retrospectively using the Neuropsychological Test Battery (NTB) and the Dementia Questionnaire for People with Learning Disabilities (DLD) at two different times to analyse neuropsychological changes and diagnostic validity. One group (n = 44) was assessed with both instruments, while the DLD was applied in 71 patients. Results In the NTB (n = 44), only patients with dementia (n = 26) showed a decline in the NTB total score and three subscales. Receiver operating characteristic analysis revealed a diagnostic sensitivity of .67, a specificity of .81, and an area under the curve (AUC) of .767. In the DLD group (n = 71), only those with dementia displayed a decrease in the cognitive and social scale; diagnostic sensitivity and specificity values were low (.61/.63) and the AUC was .704. Conclusions Neuropsychological assessment was sensitive to detect cognitive changes over time. Sensitivity values of both instruments suggest a reassessment at a later time point.

Die Studie uberpruft Praktikabilitat einer modifizierten Version des AMDP-Interviewleitfadens (AMDP-ILF) in der Anwendung bei Menschen mit geistiger Behinderung (MmgB). Bei 19 Patienten wurden die Symptome fur Selbst- und Selbst-/Fremdbeurteilung gemas des AMDP-ILF in der Original-, in der modifizierten Version und in freier Frageform auf Verstandlichkeit bei Menschen mit geistiger Behinderung uberpruft. Mit dem Original-AMDP-ILF konnten 50% der MmgB eine verwertbare Antwort zu den Fragen der jeweiligen Items geben, weitere 85–90% konnten zusatzlich mit der Version in leichter Sprache erreicht werden. Die Studie zeigte deutliche Hinweise, dass der modifizierte AMDP-ILF ein geeignetes Instrument zur psychopathologischen Befundung bei MmgB ist. This study evaluates the usefulness of a modified version of “AMDP Interview Guidance”, the established German instrument in simple language for psychopathological examination. A total of 19 patients with intellectual disabilities underwent psychopathological examination with the help of the original version of the AMDP interview guidance, a modified version and a free, non-standardised and the three versions were assessed. With the original version of the AMDP interview guidance, 50% of the patients with intellectual disabilities were able to answer in a proper way and delivered an appropriate result for the psychopathological assessment. Of the remaining patients 85–90% could handle the questions of the modified version with success. The modified version of the AMDP interview guidance in simple language seems to contribute to a better psychopathological examination compared with the original version. Further studies with a statistically appropriate number of patients need to be carried out in the future.

Objective: Meta-analyses show that Acceptance and Commitment Therapy (ACT) is an efficacious treatment for a wide range of mental health problems. However, few studies have examined the effectivene...

Culture and socialization influence how individuals perceive and express emotional distress. Research therefore, must consider the context to capture individual experiences. However, the majority of studies on factors associated with emotional distress among migrants use quantitative approaches, limiting an in-depth understanding. This study investigates emic themes of emotional distress among Vietnamese migrants by integrating anthropological and psychiatric approaches. The mixed methods study first quantified differences in reported themes of distress between Vietnamese ( n = 104) and German ( n = 104) patients, who utilized two psychiatric outpatient clinics in Berlin, Germany. Based on these differences, ethnographic interviews were conducted with 20 Vietnamese patients. In the quantitative part, differences in frequency of reported distress between Vietnamese and German patients indicate cultural and migration-related issues among Vietnamese migrants, such as the upbringing of children in a transcultural context. In the qualitative part, interviews with Vietnamese patients elicited contextualizing information and additional themes of distress. Besides commonly expressed socioeconomic themes, such as work and finances, we identified affectively charged themes concerning roles toward partnership and children. A central emic theme is expressed as “moments of speechlessness,” which go beyond a lack of language proficiency and challenge patients in different spheres of life. Migration entails complex affective dynamics, determined by a specific migratory and post-migratory context. Within this context, norms and values determine which themes of distress patients articulate openly. Therefore, an interdisciplinary, mixed-methods approach can yield a contextualized understanding of emotional distress and the complex nature of migration.

Zusammenfassung Anamnese und klinischer Befund Eine Patientin mit T1DM, Panikstörung und Hypoglykämieangst (Diabetesdauer 4 Jahre, BMI 25,6) wurde in der Tagesklinik Psychosomatik mit einem multimodalen Behandlungsansatz behandelt. Sie berichtet von ausgeprägter Angst vor Hypoglykämie und von wiederholten Hypoglykämien. Aus Angst vor Hypoglykämien veränderte die Patientin ihr Diabetes-Selbstmanagement und erlebte damit Einschränkungen in ihrer Alltagsfunktionalität. Untersuchung Nach Aufnahme wurde bei der Patientin kein Blutzuckerwert unter 3,7 mmol/l (70 mg/dl) gemessen, allerdings zeigten sich Symptome einer leichten Hypoglykämie schon bei Blutzuckerwerten im unteren Normbereich. HbA1c bei Aufnahme bei 54 mmol/mol, 7,1 %. Diagnosen Diabetes mellitus Typ 1, Panikstörung und übersteigerte Angst vor Hypoglykämien. Therapie und Verlauf Kombination aus kontinuierlicher Glukosemessung (CGM) und Beschwerdeprotokollen als Methode der kognitiven Verhaltenstherapie (KVT) in Ergänzung zu einem multimodalen Akzeptanz- und Commitment-Therapie (ACT)-basierten Gruppenpsychotherapieprogramm. Dies führte zur Verbesserung der Symptomdiskrimination und zur Reduktion von Sicherheits- und Vermeidungsverhalten. Folgerung Die Kombination von psychotherapeutischen Maßnahmen mit CGM erscheint als hilfreicher Ansatz zur Behandlung krankheitsspezifischer psychischer Störungen bei Diabetes mellitus.

Zusammenfassung. Theoretischer Hintergrund: Therapeutische Adhärenz ist eine zentrale Voraussetzung zur Sicherung der Validität von Psychotherapiestudien. Bisher existieren im deutschsprachigen Raum keine Skalen zur Erfassung der Adhärenz im Bereich der Akzeptanz- und Commitmenttherapie (ACT). Fragestellung: Ziel war es, Skalen zur Erfassung der Adhärenz von Therapeut_innen für ACT und der Kognitiven Verhaltenstherapie (KVT) zu entwickeln und deren Gütekriterien zu überprüfen. Methode: Die Validierung der Adhärenzskalen basierte auf n=38 ACT- und n=31 KVT-Gruppentherapiesitzungen zur Behandlung von depressiven und gemischten Störungsbildern. Die Adhärenz wurde durch zwei Rater_innen anhand von Audioaufzeichnungen bewertet. Ergebnisse: Sowohl für die ACT-Adhärenzskala (ICC=.96) als auch für die KVT-Adhärenzskala (ICC=.98) konnten hohe Interraterreliabilitäten erreicht werden. Die konvergente Validität konnte anhand einer negativen Korrelation zwischen den beiden Skalen sichergestellt werden ( r=-.95). Schlussfolgerungen: Beide Adhärenzskalen bieten eine erste Möglichkeit, um manualgetreues Therapeut_innenverhalten in ACT- und KVT-Gruppentherapien für Patient_innen mit gemischten Störungsbildern zu erfassen. Zudem geben die Ergebnisse einen Hinweis darauf, dass sich die beiden Methoden voneinander differenzieren lassen.

Initial studies have presented the Music-based Scale for Autism Diagnostics (MUSAD) as a promising DSM-5-based observational tool to identify autism spectrum disorder (ASD) in adults with intellectual disability (ID). The current study is the first to address its clinical utility in a new sample of 124 adults with ID (60.5% diagnosed with ASD). The derived diagnostic algorithm differentiated well between individuals with and without ASD (sensitivity 79%, specificity 74%, area under the curve = 0.81). Inter-rater reliability, assessed by the scorings of four independent experts in 22 consensus cases, was excellent (ICC = 0.92). Substantial correlations with scores from other ASD-specific measures indicated convergent validity. The MUSAD yields accurate and reliable scores, supporting comprehensive ASD diagnostics in adults with ID.

This study examines attitudes of the young Ghanaian population regarding the relationship between causal beliefs and desire for social distance from people with symptoms of schizophrenia and depression. Respondents (n = 507) were presented with depression and schizophrenia symptoms using unlabeled case vignettes. A factor analysis examined three factors for causal beliefs, and multiple linear regression analysis on the desire for social distance was conducted. The desire for social distance was higher when symptoms in both case-vignettes were attributed to childhood adversities and overall lower when respondents lived in northern regions of Ghana. Only, for vignettes depicting schizophrenia, mental illness attribution was associated with more desire for social distance. Significant gender effects were found for depression vignettes only: female respondents reported significantly more desire for social distance, whereas female gendered vignettes were associated with less desire for social distance by respondents of both genders.

Objective Numerous studies support the effectiveness of acceptance and commitment therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). Subjects Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. Methods Pre- to posttreatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. Results Pre- to posttreatment effect sizes were mostly moderate to large (r between 0.21 and 0.62). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between 0.30 and 0.54) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). Conclusion The present investigation suggests that changes in pain acceptance, mindfulness, and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients who often have a severe course of illness and have seldom been studied.

In recent years, telemedicine has been developing very dynamically. The development of new technologies allows their use in the treatment of dermatological, cardiological, endocrine and other diseases. However, there are few reports on the use of digital technologies in the mental health care of people with intellectual disabilities. Intellectual disability is a disease that affects a large number of people. Patients suffering from intellectual disability encounter barriers that make it difficult for them to fully use telemedicine, however, these barriers can be overcome with appropriate support and adaptation. A review of the literature on telemedicine solutions in the care of people with intellectual disabilities indicates that the applications support the communication of these people with the doctor, enable simple behavioral interventions, stimulate cooperation in treatment, provide simple medical education as well as record medical data for the doctor. The authors present the potential risks related to the use of telemedicine solutions for people with intellectual disabilities as well as the project of creating a new, multi-module telemedicine system.

This study evaluates the usefulness of a modified version of "AMDP Interview Guidance", the established German instrument in simple language for psychopathological examination. A total of 19 patients with intellectual disabilities underwent psychopathological examination with the help of the original version of the AMDP interview guidance, a modified version and a free, non-standardised and the three versions were assessed. With the original version of the AMDP interview guidance, 50% of the patients with intellectual disabilities were able to answer in a proper way and delivered an appropriate result for the psychopathological assessment. Of the remaining patients 85-90% could handle the questions of the modified version with success. The modified version of the AMDP interview guidance in simple language seems to contribute to a better psychopathological examination compared with the original version. Further studies with a statistically appropriate number of patients need to be carried out in the future.Die Studie überprüft Praktikabilität einer modifizierten Version des AMDP-Interviewleitfadens (AMDP-ILF) in der Anwendung bei Menschen mit geistiger Behinderung (MmgB). Bei 19 Patienten wurden die Symptome für Selbst- und Selbst-/Fremdbeurteilung gemäß des AMDP-ILF in der Original-, in der modifizierten Version und in freier Frageform auf Verständlichkeit bei Menschen mit geistiger Behinderung überprüft. Mit dem Original-AMDP-ILF konnten 50% der MmgB eine verwertbare Antwort zu den Fragen der jeweiligen Items geben, weitere 85–90% konnten zusätzlich mit der Version in leichter Sprache erreicht werden. Die Studie zeigte deutliche Hinweise, dass der modifizierte AMDP-ILF ein geeignetes Instrument zur psychopathologischen Befundung bei MmgB ist.

Background and objectives Recently, several publications have addressed interactions between selected factors related to the role of consultation–liaison (CL) psychiatric interventions and length of stay (LOS) in the general hospital anew. Yet at present, recent available research is restricted in the scope of factors studied. This study aims at providing an analysis of factors associated with LOS in a large sample of patients, with a broad set of variables and by accounting for the complex relationships between them. Methods Retrospective cohort analysis of n = 3190 adult patients referred to the CL-psychiatry service of a general hospital. Univariate statistics and multiple regression were used to assess the association between patient characteristics and LOS. Path analysis was used to elucidate the mediating role of time-to-referral (TTR). Results Univariate analysis and multiple regression showed that TTR, age, and poor general functioning were associated with longer LOS. Diagnosis on Axis I + II (according to DSM), suicidal ideation and somatic diagnosis had no significant association with LOS. The four variables with the strongest total effect on LOS in the path analysis were TTR, the year of consultation, age and general functioning. Age had a higher indirect effect on LOS, while general functioning had a higher direct effect on LOS. Conclusions In the path model, TTR is a highly significant predictor of LOS and also a mediator of other predictors. This highlights the role of the CL-psychiatrist in the management of patients in the general hospital. Further research should investigate how referrals are prioritized by consultees and which different effects consultation recommendations might have on LOS.

A patient with T1DM, panic disorder and hypoglycaemia fear diabetes duration 4 years, BMI 25. 6, was treated in the day clinic psychosomatics with a multimodal treatment approach. She reports severe fear of hypoglycaemia and repeated hypoglycaemia. Fearing hypoglycaemia, the patient changed her diabetes self-management and thus experienced limitations in her everyday functionality.Diabetes mellitus type 1, panic disorder and exaggerated fear of hypoglycaemia.The combination of continuous glucose monitoring (CGM) and a symptom record diary from classical cognitive-behavioural therapy (CBT) and in addition a multimodal psychotherapeutic group intervention based on Acceptance and Commitmenttherapy (ACT) were applied. The patient learned to differentiate between symptoms of panic attacks and symptoms due to low blood glucose levels.The combination of psychotherapeutic measures with CGM appears to be a helpful approach to the treatment of disease-specific mental disorders in diabetes mellitus.Eine Patientin mit T1DM, Panikstörung und Hypoglykämieangst (Diabetesdauer 4 Jahre, BMI 25,6) wurde in der Tagesklinik Psychosomatik mit einem multimodalen Behandlungsansatz behandelt. Sie berichtet von ausgeprägter Angst vor Hypoglykämie und von wiederholten Hypoglykämien. Aus Angst vor Hypoglykämien veränderte die Patientin ihr Diabetes-Selbstmanagement und erlebte damit Einschränkungen in ihrer Alltagsfunktionalität.Nach Aufnahme wurde bei der Patientin kein Blutzuckerwert unter 3,7 mmol/l (70 mg/dl) gemessen, allerdings zeigten sich Symptome einer leichten Hypoglykämie schon bei Blutzuckerwerten im unteren Normbereich. HbA1c bei Aufnahme bei 54 mmol/mol, 7,1 %.Diabetes mellitus Typ 1, Panikstörung und übersteigerte Angst vor Hypoglykämien.Kombination aus kontinuierlicher Glukosemessung (CGM) und Beschwerdeprotokollen als Methode der kognitiven Verhaltenstherapie (KVT) in Ergänzung zu einem multimodalen Akzeptanz- und Commitment-Therapie (ACT)-basierten Gruppenpsychotherapieprogramm. Dies führte zur Verbesserung der Symptomdiskrimination und zur Reduktion von Sicherheits- und Vermeidungsverhalten.Die Kombination von psychotherapeutischen Maßnahmen mit CGM erscheint als hilfreicher Ansatz zur Behandlung krankheitsspezifischer psychischer Störungen bei Diabetes mellitus.

First lines: Artificial intelligence (AI) is inducing a profound transformation of both the practice and structure of medicine. This implies changes in tasks, where certain processes may be taken over by AI applications, as well as novel ways of collaborating and integrating information. Consider a recent example where AI is used to avoid suicide attempts by using smartphones’ native sensors and signal processing techniques [1]. This new suicide prevention technique requires the psychiatrist to acquire new skills (handling and interpreting continuous patient data sent by a dedicated application) and interact with new actors (programmers, data managers, etc.). Further, the abundance of individual patient data may contribute to a shift in conceptualizing care—from the traditional identification of general risk factors towards more tailored prevention strategies in the sense of personalized medicine

Erfassung der Haufigkeiten und klinischen Charakteristika von Autismusspektrumstorungen (ASS) bei Personen mit Intelligenzminderung (IM). Querschnittliche Datenanalyse einer klinisch-psychiatrischen Stichprobe von 710 Menschen mit IM. Die Haufigkeit von ASS in einer Stichprobe Erwachsener mit IM betrug 19 %. ASS war assoziiert mit einem hoheren Schweregrad der IM, mannlichem Geschlecht (bei leichter bis mittelgradiger IM), Behandlung mit Antikonvulsiva und einer selteneren Beschaftigung in Werkstatten. ASS ist eine haufige klinische Diagnose bei Erwachsenen mit IM.

Background and objectives Acceptance and Commitment Therapy (ACT) is a young psychotherapeutic approach. It expands traditional Cognitive Behavioral Therapy (CBT) especially by mindfulness and valued living. Available research findings indicate ACT to be generally efficacious compared to control conditions. Even though ACT is increasingly applied in clinical practice, only little research has been conducted in this field. Hence, to examine the effectiveness of ACT, the present study aims to compare treatment outcome of group ACT and group CBT+, which consists of CBT and Interpersonal Psychotherapy (IPT) sessions, within a naturalistic setting. Methods Sixty-seven inpatients of a German psychiatric department were assigned to either ACT or CBT+ condition and assessed with respect to symptom measure as well as ACT-specific outcomes. Results Both groups improved on measures of symptom severity as well as ACT-specific components. There were no significant between-group differences. Conclusion Results indicate that ACT appears to show comparable results as CBT+. Findings are discussed in terms of to what extend outcomes of ACT and CBT+ are distinct and which possibly influencing factors could be considered in future research and treatment.

Zusammenfassung Einleitung Diese Studie untersucht die Prävalenz und klinischen Charakteristika von Demenzen bei psychiatrisch vorgestellten Erwachsenen mit Down-Syndrom und leitet Konsequenzen für die klinische Praxis ab. Methodik Die Patientenmerkmale und Prävalenz von Demenz wurden retrospektiv (2005–2012, N = 75) bei Erwachsenen mit Down-Syndrom im klinisch-psychiatrischen Setting untersucht. Ergebnisse Bei jedem 3. Patienten mit Down-Syndrom wurde – in der Regel erst nach einer Verlaufsuntersuchung von 6 bis 12 Monaten – eine Demenz diagnostiziert. Patienten mit Demenz waren älter und häufiger weiblich, während sich der Grad der Intelligenzminderung nicht unterschied. Die Schilddrüsen- und Calciumwerte waren bei Menschen mit wie ohne Demenz häufig auffällig. Diskussion Demenz ist ein häufiger psychiatrischer Vorstellungsgrund bei Menschen mit Down-Syndrom, insbesondere bei Frauen und im höheren Lebensalter. Die Versorgungsstrukturen in Deutschland sollten bedarfsgerecht angepasst werden.

The association of somatic illness and personality disorders (PD) has important and potentially negative implications for patients. We compare characteristics and treatment variables of 3032 patients with and without PD in a large sample of consultation-liaison (CL) psychiatry patients. 2434 patients had a psychiatric disorder other than a PD, 66 a PD only, and 532 a combination of both. The most frequent combination of disorders on Axis I and II was that of a Cluster-B-PD and substance related disorders. CL-patients with PD were significantly younger, living alone more often, showed better general functioning and had a shorter length of stay.

Objectives Mental health associated stigmatization remains problematic in low and middle-income countries, thus preventing patients from adequate access to psychiatric care. Public attitudes towards psychiatrists have not been examined in many countries, especially not in Vietnam where merely one psychiatrist per 300.000 population is available. The study aims to explore attitudes towards psychiatrists in the Hanoi municipality and to identify socio-demographical factors that influence these attitudes. Methods Between April and August 2013, a general population-based survey was carried out in the greater Hanoi area, Vietnam. The sample of 817 participants was stratified according to the latest Vietnamese census (2009) and micro-census (2013) with regards to socio-demographic factors. Multivariate analyses were conducted to determine the influence of these factors on attitudes towards psychiatrists. Results Gender and religious beliefs significantly influenced public attitudes towards psychiatrists. Male participants reported significantly more negative perception towards psychiatrists compared to female respondents. Participants following a religion reported significantly more negative attitudes toward psychiatrists than those without self-reported religious attainment. Conclusions Negative attitudes towards psychiatrists are associated with religious beliefs and gender affiliation in the greater Hanoi area. A strategy that involves religious institutions in raising awareness about mental health issues while considering public's socio-cultural attitudes may pave the way for greater potentialities of adequate psychiatric care, destigmatize the mental health system, and care provider.

Objective Despite an extensive body of research on somatic symptom presentation among people of East- and Southeast-Asian descent, results are still inconclusive. Examining and comparing symptom presentation in clinically and ethnically well-characterized populations may constitute a step towards understanding symptom presentation between patients with a different cultural background. This study aims to compare Vietnamese and German patients regarding cultural dynamics of symptom presentation upon first admission to a psychiatric outpatient service. Methods 110 Vietnamese and 109 German patients seeking psychiatric treatment at two outpatient clinics completed the Patient Health Questionnaire (PHQ). The somatic symptom subscale (PHQ-15), the depression subscale (PHQ-9) and PHQ-subscales examining anxiety and psychosocial stress levels were analyzed and compared for both groups using multivariate analysis of covariance. Regression analysis was utilized to examine the influences of sociodemographic and migration specific factors. Results Vietnamese and German patients showed comparable Cronbach's alpha for all subscales. Vietnamese patients endorsed significantly higher levels of somatic symptoms overall and on certain items (as pain-related items, dizziness, and fainting spells) despite similar levels of depression severity in comparison with German patients. Vietnamese patients with poor German language skills showed a significantly higher focus on somatic symptoms. Conclusion Raising awareness for cultural dynamics of symptom presentation in patients with depression is indispensable. Cross-cultural symptom assessment using the PHQ seems feasible and expands our understanding of depressive and psychosomatic symptoms when assessed by clinicians.

Background Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population. Aims Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression. Methods A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)). Results Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression. Conclusions The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.

Menschen mit einer Intelligenzminderung (IM) haben eine geringere Lebenserwartung und hohere Mortalitatsrate. Ein wichtiger Risikofaktor fur eine Vielzahl korperlicher Krankheiten ist ein erhohtes Korpergewicht. Neben korperlichen Erkrankungen ist auch die Pravalenz psychischer Storungen bei Menschen mit IM erhoht (WHO: drei- bis vierfach). Ziel dieser Studie ist, das Korpergewicht und damit assoziierte Faktoren bei Menschen mit IM und psychischen Erkrankungen zu ermitteln. Auf Grundlage des Body-Mass-Index (BMI) wurde die Pravalenz von Untergewicht, Normalgewicht und Ubergewicht bei 633 Patienten einer psychiatrischen Institutsambulanz fur Menschen mit geistiger Behinderung festgestellt. Mittels multipler logistischer Regressionsanalysen wurden verschiedene fur das Korpergewicht relevante Patientenmerkmale ermittelt. Etwa jeder zweite Mann und ca. zwei von drei Frauen mit psychischer Storung und IM waren ubergewichtig. Mit Ubergewicht assoziierte Faktoren waren das weibliche Geschlecht, leichte und mittelgradige IM, zunehmendes Lebensalter, Down-Syndrom, schwere Verhaltensstorungen sowie teilbetreute Wohnformen. Demgegenuber waren Demenz und Autismusspektrumstorungen seltener mit Adipositas assoziiert. Besonders Frauen mit IM waren schon im jungen Erwachsenenalter haufig ubergewichtig. Ds Wissen uber damit assoziierte Faktoren kann dazu beitragen, geeignete Praventivmasnahmen zur Vermeidung von Ubergewicht und damit verbundenen Folgeerkrankungen zu entwickeln.

Background An estimated 1.5 million persons in Germany are intellectually disabled. Persons with intellectual disability (ID) are especially vulnerable to somatic and mental illnesses. Methods This review is based on pertinent literature retrieved by selective searches in PubMed and the Cochrane Library. Results Genetic abnormalities are a frequent cause of diseases that affect multiple organs and need interdisciplinary treatment. A number of somatic diseases are more common in persons with ID than in the general population, including epilepsy (30-50% in persons with severe or very severe ID, vs. 0.5% in the general popu- lation) and dementia (five times more common than in the general population). Patients with Down syndrome are 20 times more likely than the general population to develop acute lymphoblastic leukemia. Some mental illnesses, too, are more common in persons with ID, e.g., autism spectrum disorders (7.5-15% vs. 1% in the general population). The history and the findings of the physical and psychiatric examination are assessed in accordance with the biopsychosocial model of disease, and in the light of the patient's mental developmental age. Structured instruments for behavioral evaluation and diagnosis are an important additional component of the diagnostic assessment. A holistic approach is required that takes multiple life areas into account and involves the patient's familial and social environment, while obeying the rules of simple language. Psychotherapeutic and psychosocial measures must be adapted to the patient's cognitive abilities and mental developmental age. Conclusion Intellectually disabled persons can be treated in a multimodal, multiprofessional approach. As of early 2019, there were 38 medical centers for adults with intellectual disability or severe multiple disabilities in Germany (Medizinische Behandlungszentren fur Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen, MZEB), where they can be cared for with due attention to their special needs.

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Background As the elderly population increases, so, too, does the number of multimorbid patients and the risk of polypharmacy. The consequences include drug interactions, undesired side effects of medication, health impairment, and the need for hospital- ization. 5-10% of hospital admissions among the elderly are attributable to undesired side effects of medication. Methods This review is based on publications retrieved by a selective search in PubMed and the Cochrane Library that employed the search terms "drug interaction," "undesired side effect," "polypharmacy," "pharmacokinetics," and "pharmacody- namics." Results Elderly patients are particularly at risk of polypharmacy, both because of the prevalence of multimorbidity in old age and because of physicians' uncritical implementation of guidelines. The more drugs a person takes, the greater the risk of drug interactions and undesired side effects. Age-associated changes in pharmacokinetics and pharmacodynamics elevate this risk as well. Physicians prescribing drugs for elderly patients need to know about the drugs' catabolic pathways, protein binding, and inductive and inhibitory effects on cytochrome P450 in order to avoid drug interactions and polypharmacy. Conclusion Multiple aids and instruments are available to ensure practical and reasonable drug monitoring, so that the risks of drug interactions and undesired side effects can be detected early and avoided.

Migrants and ethnic minorities are at higher risk to develop mental disorders compared to native population. Culture has an important impact on the symptom presentation, diagnostic process and treatment strategies in all populations. Cultural competence represents good clinical practice and can be defined as a two-way learning encounter where clinician acknowledges the patient’s culture as well as his own cultural values and prejudices. Cultural competent response to the mental health care requires knowledge, skills and attitudes. Both individual and organizational cultural competences are needed to improve the effectiveness of psychiatric treatment. In this chapter, we revised the WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants and list a series of recommendations for policy-makers, service providers and clinicians. Cultural competent experiences in the treatment of somatization and other psychiatric disorders across several countries in Europe are also presented.

Transdiagnostic approaches are needed to effectively treat patients with a broad range of diagnoses and comorbidities in routine general hospital care. Yet the evidence for the effectiveness of treatments beyond Cognitive Behavioral Therapy (CBT) is largely lacking. We describe the process of implementing an interdisciplinary multi-professional Acceptance and Commitment Therapy (ACT)-based treatment for patients with psychiatric and physical health conditions and present outcomes before and after implementation.The present investigation was a naturalistic comparative study comparing ACT-based (n = 126) vs. CBT-based (n = 127) treatments in a psychiatric day hospital in Berlin, Germany. Within- and between-group changes (pre- to post-treatment) in everyday functioning and health-related quality of life (primary outcomes; assessed by the Short Form 36 (SF-36)), as well as anxiety and depressive symptoms (secondary outcomes; assessed by the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory-II (BDI-II)), were analyzed with Generalized Linear Models, and Wilcoxon signed-rank tests and effect size r.Data analysis showed statistically significant improvements from pre- to post-treatment (r ranging from 0.27 to 0.61, p 0.001) for most SF-36 scales as well as for all HADS and BDI-II scores (r ranging from 0.38 to 0.60, p 0.001) for both the ACT and CBT groups. ACT and CBT showed comparable effects in relation to clinical outcomes.An interdisciplinary multi-professional ACT-based group treatment is a valuable approach for patients with psychiatric and physical health conditions in real-life hospital settings, with effects equivalent to CBT interventions.

Zusammenfassung. Hintergrund: Autismus bleibt oft bis ins Erwachsenenalter unerkannt, sowohl bei Menschen mit als auch ohne zusätzliche Intelligenzminderung (IM). Daraus erwächst ein über das Kindes- und Jugendalter hinausgehender Bedarf nach diagnostischen Standards. Ziel dieser Studie ist die Entwicklung und Überprüfung eines multiprofessionellen Ansatzes zur Abklärung eines Autismusverdachts im Erwachsenenalter bei Menschen mit IM. Methodik. Eine wöchentliche, multiprofessionelle Konsensuskonferenz wurde 2008 zur klinischen Autismusabklärung bei Erwachsenen mit IM etabliert. Das Vorgehen sowie der diagnostische Beitrag der beteiligten Berufsgruppen wurden mittels eines Fragebogens evaluiert. Die Relevanz der umfassenden Autismusdiagnostik wurde konsekutiv von 1/2010 bis 12/2015 bei N = 274 Patienten anhand der Neudiagnosen überprüft. Ergebnisse. Durch die Integration von Pflegekräften, Pädagogen sowie Ergo- und Kreativtherapeuten in den diagnostischen Prozess resultierte ein umfassendes Bild diagnostisch relevanter Informationen. Wichtige Merkmale der Konsensuskonferenz waren der interdisziplinäre Austausch, Verbesserung des Informationsflusses sowie Qualitäts- und Fortbildungsaspekte. In 153 (56%) der untersuchten Fälle erfolgte eine Neudiagnose, von denen bei 149 Patienten (54%) erstmalig ein zusätzlicher Autismus identifiziert wurde. In 4 Fällen wurde eine vorbestehende Autismusdiagnose revidiert. Schlussfolgerung. Durch intersubjektiven Abgleich verschiedener Methoden und Personen kann die Autismusdiagnostik bei Erwachsenen mit IM auf eine objektivere Basis gestellt werden. Die Einführung multiprofessioneller Fallkonferenzen dient der Qualitätssicherung und steigert Wissen und Kompetenzen von Mitarbeitern.

Im Gegensatz zu konventionellen Therapien setzt sich die ­Akzeptanz- und Commitment-Therapie (ACT) bei chronischen Schmerzen nicht deren Minderung zum Ziel. Es geht vielmehr darum, eine ­annehmend-flexible Haltung gegenuber dem Schmerzerleben ­aufzubauen und dadurch eine neue Lebensperspektive zu entwickeln, die nicht mehr vom Schmerzerleben dominiert wird, sondern sich an selbst ­gewahlten Werten orientiert.

Im Rahmen intensivmedizinischer Behandlungen ist mit kognitiven Akut- und Langzeitfolgen zu rechnen. Diese treten insbesondere wahrend der intensivmedizinischen Behandlung nach Operationen auf. Dabei liegt der Fokus auf dem postoperativen Delir (POD) und der postoperativen kognitiven Dysfunktion (POCD). Beide sind mit gravierenden Einschrankungen der Lebensqualitat und des Langzeitoutcomes verbunden. Welche kognitive Akut- und Langzeitfolgen sind mit einer intensivmedizinischen Behandlung verbunden und wie beeinflussen diese das Outcome des Patienten? Wie ist dabei das POD von der POCD abzugrenzen? Es wurde eine selektive Literaturrecherche durchgefuhrt. Die POCD ist eine Storung, die innerhalb mehrerer Tage bis Wochen postoperativ beginnt, Wochen bis Monate anhalt und mit Einschrankungen der Aufmerksamkeitsleistung bei unauffalligem Bewusstsein einhergeht. Eine Remission ist moglich, jedoch mit langerer Latenz (Wochen bis Monate). Das POD ist ein Phanomen, das mit Bewusstseinstrubung und gestorter Aufmerksamkeit assoziiert ist. Es beginnt Stunden bis Tage postoperativ, ist durch einen akuten Beginn gekennzeichnet und halt Tage bis Wochen an. Eine Remission ist innerhalb weniger Tage bis Wochen zu erwarten. Wahrend das POD im Rahmen einer organischen Grunderkrankung (z. B. eines Infektes) nach Operation auftritt, ist die Pathogenese der POCD nicht ausreichend geklart. Sowohl die POD als auch die POCD konnen das postoperative Outcome deutlich verschlechtern. Praoperatives Screening von Risikofaktoren, konsequente Planung von Operations- und Narkosetechnik, Kompensation der Risikofaktoren sowie Begleitung des Patienten durch eine geschulte Pflegekraft (Delirpfleger) sind praventive Instrumente, die im klinischen Alltag einen groseren Stellenwert einnehmen sollten.

Introduction Whereas instruments for the assessment of intellectual and social abilities are widely available, instruments for the evaluation of emotional development of persons with intellectual disabilities (ID) are rare. The Scheme of Appraisal of Emotional Development (SAED), an internationally used tool developed by Dosen (2005a. Journal of Intellectual Disability Research , 49, 1, 2005b. Journal of Intellectual Disability Research , 49, 9), is one of the latter and is based on interviews with caregivers. The present study aims to investigate the internal consistency and interrater-reliability by changing the interview procedure into a direct observation and evaluation approach by a whole team instead of by one expert. Method The level of emotional development of 175 patients admitted to a psychiatric inpatient unit specialized in the treatment of adults with ID was evaluated with the SAED by the treatment team after an observation period of up to two weeks. The inter- and intra-rater-reliability was assessed by direct observation of the behaviour of an additional 50 patients by two pairs of raters. Results The internal consistency of the SAED dimensions, once rated by team approach, is excellent, and the reliability measures show also good statistical results. Conclusion and implications The evaluation of the level of emotional development using the SAED by a group-led and/or direct observational procedure show to be a reliable and useful approach. The group-based procedure yields equal results compared with the usual interview guidelines and might lead to an additional training effect within the respective teams. The rater-reliability measures align with those reported in other studies.

Zusammenfassung. Studien in der Allgemeinbevölkerung zeigen uneinheitliche Ergebnisse bezüglich häufigerer Somatisierung bei Migranten. Vergleichende Untersuchungen fanden bei depressiven Patienten ostasiatischer Herkunft geringere Angaben von psychologischen Symptomen und häufigere somatische Beschwerden, als bei Patienten westlicher Herkunft. Aufgrund einer geringen Inanspruchnahme psychiatrischer Versorgungsangebote in Deutschland, insbesondere durch vietnamesische Migranten der ersten Generation, existieren bisher keine Studien zu einer psychischen und somatischen Symptomausprägung bei Patienten vietnamesischer Herkunft im Vergleich zu deutschen Patienten ohne Migrationshintergrund. Im Kontext kultursensibler Diagnostik von Migranten in Deutschland wurde als ausreichend messäquivalentes Selbstbeurteilungsinstrument insbesondere der Patient Health Questionnaire bzw. der Gesundheitsfragebogen für Patienten als ein valides und einfach verwendbares Instrument für eine Erfassung von Symptomen und Schweregraden häufiger psychischer Störungen, wie der Depression empfohlen. Im Rahmen der vorliegenden Untersuchung wurden bei 66 vietnamesischen Patientinnen der ersten Generation und 83 deutschen Patientinnen während des erstmaligen psychiatrischen Kontaktes psychische Symptome einer Depression mittels des PHQ-9 und somatische Symptome mittels des PHQ-15 in der jeweiligen Muttersprache erfasst. Für beide Gruppen fand sich für beide Instrumente eine zufriedenstellende interne Konsistenz. Ein möglicher Zusammenhang zwischen der Herkunft und dem Schweregrad der Ausprägung psychischer depressiver und somatischer Symptome bei diagnostizierter depressiver Episode erfolgte mittels einer multivariaten Analyse. Für die Selbstbeurteilung mittels des PHQ-9 fanden sich keine Gruppenunterschiede hinsichtlich des Gesamtsummenwertes und des Schweregrades psychischer depressiver Symptome. Dagegen berichteten vietnamesische Patientinnen in der Selbstwahrnehmung anhand des PHQ-15 von einem insgesamt höheren Schweregrad von somatischen Symptomen. Insbesondere waren bei depressiven vietnamesischen Patientinnen die Mittelwerte der Einzelitems Kopfschmerzen, Glieder- und Gelenkschmerzen, Schmerzen im Brustbereich sowie Schwindel und Ohnmachtsanfälle gegenüber deutschen Patientinnen deutlich erhöht. Entgegen der Untersuchungshypothese und früherer Studien ging die häufigere Selbstbeurteilung oder Aufmerksamkeit auf somatische Symptome bei vietnamesischen Patientinnen nicht mit einer verminderten Eigenwahrnehmung von psychischen Symptomen einer depressiven Episode anhand des PHQ-9 einher.

Collation of frequencies and clinical characteristics of autism spectrum disorders (ASD) in persons with intellectual disability (ID).Cross-sectional analysis of a clinical psychiatric sample of 710 adults with ID and mental disorders.The frequency of ASD in an adult sample with ID was 19%. The occurrence of ASD was associated with a higher severity of ID, male gender (in mild to moderate ID), anticonvulsive therapy and reduced employment rates in workshops.The ASD are a frequent clinical diagnosis in adults with ID.

This study aimed to assess the prevalence and clinical characteristics of dementia in a clinical sample of adults with Down syndrome. Consequences for clinical practice were deduced.Patient characteristics and prevalence rates of dementia were evaluated in adults with Down syndrome who were admitted to psychiatry from 2005 to 2012 (N = 75).In every third patient with Down syndrome, dementia was diagnosed in a second assessment 6 to 12 months after initial hospital admission. Patients with dementia were older and more often female, while no association was found with the level of intellectual disability. Thyroid function and calcium values were often abnormal in those with and without dementia.In persons with Down syndrome, dementia is a prevalent cause for admission to psychiatry, especially in females and those of advanced age. Services should be adapted to the increased demands.Diese Studie untersucht die Prävalenz und klinischen Charakteristika von Demenzen bei psychiatrisch vorgestellten Erwachsenen mit Down-Syndrom und leitet Konsequenzen für die klinische Praxis ab.Die Patientenmerkmale und Prävalenz von Demenz wurden retrospektiv (2005–2012, N = 75) bei Erwachsenen mit Down-Syndrom im klinisch-psychiatrischen Setting untersucht.Bei jedem 3. Patienten mit Down-Syndrom wurde – in der Regel erst nach einer Verlaufsuntersuchung von 6 bis 12 Monaten – eine Demenz diagnostiziert. Patienten mit Demenz waren älter und häufiger weiblich, während sich der Grad der Intelligenzminderung nicht unterschied. Die Schilddrüsen- und Calciumwerte waren bei Menschen mit wie ohne Demenz häufig auffällig.Demenz ist ein häufiger psychiatrischer Vorstellungsgrund bei Menschen mit Down-Syndrom, insbesondere bei Frauen und im höheren Lebensalter. Die Versorgungsstrukturen in Deutschland sollten bedarfsgerecht angepasst werden.

The MUSAD was developed as a diagnostic observational instrument in an interactional music framework. It is based on the ICD-10/DSM-5 criteria for autism spectrum disorder (ASD) and was designed to assess adults on a lower level of functioning, including individuals with severe language impairments. This study aimed to evaluate the psychometric properties of the newly developed instrument. Methods Calculations were based on a consecutive clinical sample of N = 76 adults with intellectual and developmental disabilities (IDD) suspected of ASD. Objectivity, test-retest reliability, and construct validity were calculated and a confirmatory factor analysis was applied to verify a reduced and optimized test version. Results The structural model showed a good fit, while internal consistency of the subscales was excellent ( ω > .92). Item difficulties ranged between .04 ≤ p i ≤ .82 and item-total correlation from .21 to .85. Objectivity was assessed by comparing the scorings of two external raters based on a subsample of n = 12; interrater agreement was .71 (ICC 2, 1). Reliability was calculated for four test repetitions: the average ICC (3, 1) was .69. Convergent ASD measures correlated significantly with the MUSAD, while the discriminant Modified Overt Aggression Scale (MOAS) showed no significant overlap. Conclusion Confirmation of factorial structure and acceptable psychometric properties suggest that the MUSAD is a promising new instrument for diagnosing ASD in adults with IDD.

Various approaches to the diagnosis of autism spectrum disorders (ASDs) in children use the non-verbal communicative quality of music. However, ASD is frequent but under-diagnosed in adults with intellectual developmental disabilities (IDDs), so valid diagnostic instruments are urgently needed. Against this background, the Music-based Scale for Autism Diagnosis (MUSAD) was developed. A course of 13 musical interactional situations associated with instruments and activities was created to elicit autism diagnostic relevant behaviours. Eighty-eight items were derived assessing social affect, inflexible behaviours and sensory–motor issues. The MUSAD was applied from January 2010 to December 2011 in n = 91 adults with IDD suspected of having ASD; feasibility was assessed in n = 80 (April 2010 to December 2011). Reasons for non-feasibility of the MUSAD and the Autism Diagnostic Observation Schedule (ADOS) were compared in n = 40. Interrater agreement was analysed for one case by 12 independent raters; plausibil...