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

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

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

Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles “real-life interpersonal interactions.” Although gender influences social functioning in “real-life situations,” little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers’ individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.

Assisted suicide is currently still prohibited in Austria. However, following a finding of the Austrian Constitutional Court it would be completely legal from 2022. A statutory regulation defining the limits between legal ways of assistance and the conditions therefor on the one hand and, on the other hand, assistive actions that shall remain prohibited is currently not in sight. However, a suicidal action performed upon the request of the person willing to die solely by someone else will remain illegal; this also applies if the person willing to commit suicide is physically unable to participate in her or his killing. In several European countries euthanasia and/or assisted suicide has already been legalized and in some countries, Switzerland for example, assisted suicide is a legal option even for patients without suffering from a life-limiting disease, unbearable suffering and insufficient treatment options are the only criteria. In this case report the clinical case of an Austrian patient will be presented, suffering from a personality disorder, who planed an assisted suicide in Switzerland. Ethic and legal backgrounds are discussed.The possibility of assisted suicide bears the danger that people suffering from psychiatric disorders, especially current major depressive episode, could refuse treatment options and choose suicide trough a commercial provider of assisted suicide.In particular it must be considered that currently severely depressed people usually suffer from limited insight and judgement as well as from limited freedom of choice.Aktive Sterbehilfe ist aktuell in Österreich noch gesetzlich verboten. Aufgrund einer Entscheidung des Verfassungsgerichtshofs wäre assistierter Suizid ab dem Jahr 2022 gänzlich legal. Eine gesetzliche Regelung, die Grenzen zwischen legalen Formen einer Assistenz sowie deren Voraussetzungen und weiterhin unerlaubten Assistenzleistungen zieht, ist derzeit noch nicht in Sicht. Ein Suizid, der auf Verlangen des Suizidenten von fremder Hand herbeigeführt wird, bleibt jedenfalls weiterhin strafbar; dies auch dann, wenn der Suizident physisch nicht mehr in der Lage ist, bei seiner Tötung mitzuwirken. In mehreren europäischen Ländern wurde aktive Sterbehilfe bereits legalisiert und in manchen Ländern, wie zum Beispiel der Schweiz, kann assistierter Suizid auch ohne lebenszeitlimitierende Grunderkrankung, bei unerträglichem Leid und insuffizient vorhandenen weitere Behandlungsmöglichkeiten in Anspruch genommen werden. In diesem Fallbericht wird die Kasuistik einer Patientin geschildert welche, als Grunderkrankung an einer Persönlichkeitsstörung leidend, einen assistierten Suizid in der Schweiz geplant hatte. Es werden die ethischen und juristischen Hintergründe dieses Fallberichts diskutiert.Das zur Verfügung stellen assistierter Suizidmöglichkeiten birgt die große Gefahr, dass Menschen mit psychischer Erkrankung, insbesondere bei schweren depressiven Episoden, Behandlungsangebote ablehnen und anstelle Suizid durch einen professionellen Sterbehilfeanbieter wählen könnten. Insbesondere gewarnt werden muss vor der Tatsache, dass Menschen in aktuell schwer depressivem Zustandsbild aufgrund dessen zumeist unter eingeschränkter Entscheidungsfähigkeit leiden und nur bedingt über die Möglichkeit der freien Willensentscheidung verfügen.

Identification of intrinsic motivators involved in choosing psychiatry as a career path.14 qualitative in-depth interviews were analysed systematically using coding frames.Positive findings were the interpersonal focus and the holistic approach of psychiatry. Negative dimensions were the unfavorable image among colleagues, the lack of precision, prejudices and stigmatization. To interest more medical students, cases should be presented weighing psychiatric aspects as equally important to other medical aspects.To increase the popularity of psychiatry, the prejudices inherent in the medical system need urgent addressing. Teaching should be conducted in case presentations. Psychiatric conditions, which are highly prevalent across all medical fields, need to be adequately represented.ZIEL: Identifikation von intrinsischen Motivatoren, die bei der Berufswahl Psychiatrie eine Rolle spielen.14 leitfadengestützte Tiefeninterviews wurden mithilfe von Codierungsrahmen systematisch ausgewertet.Positive Aspekte waren der zwischenmenschliche Fokus und der ganzheitliche Ansatz. Negative Dimensionen waren das schlechte Image unter Kolleg*innen, Vorurteile und Stigma. Die Entstigmatisierung der Psychiatrie und die Gleichstellung psychiatrischer mit somatischen Aspekten in Fallberichten wurden als Möglichkeiten vorgeschlagen, das Interesse am Fach Psychiatrie zu erhöhen.Um die Beliebtheit der Psychiatrie bei Mediziner*innen zu steigern, bedarf es Maßnahmen zur Bekämpfung von mit Psychiatrie verbundenem Stigma im Gesundheitswesen. Im Rahmen der medizinischen Lehre müssen psychiatrische Störungen, welche durch ihre hohe Prävalenz alle medizinischen Disziplinen betreffen, entsprechende Gewichtung erhalten.

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

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

Summary Objective Based on the research version of the Carers’ Needs Assessment for Schizophrenia (CNA-S) a shortened clinical version was developed for routine assessment of interventions needed by the caregivers of schizophrenia patients in everyday clinical work. Methods The development of this questionnaire (including a manual explaining its use) was based on results from earlier studies and suggestions from Austrian researchers involved in previous studies using the research version. Based on discussions with researchers the questionnaire and the manual were improved step by step. A clinical test version was investigated for feasibility and practicability in two waves of 15 caregivers of schizophrenia patients each. Results More than 90% of caregivers perceived the clinical version of the CNA-S as a useful instrument to assess all relevant aspects of caregivers’ needs and problems. They reported feeling well during the interview for the CNA-S. Clinicians using the clinical version of the CNA-S reported similar views. Conclusion These results suggest that the clinical version of the CNA-S is both feasible and practicable in everyday clinical work.

Aims The way an individual handles the experience of psychosis, the so-called ‘recovery style’, has been shown to substantially affect long-term outcomes. The Recovery Style Questionnaire (RSQ) measures this psychological dimension. The aim of this study was to provide a validation of the German version of the RSQ and to raise awareness for recovery-oriented approaches. Methods The RSQ was translated into German according to the guidelines of the WHO and patients were administered this questionnaire and measures of internalised stigma, psychotic symptoms, illness concept, empowerment, self-esteem and quality of life. Descriptive statistics were demonstrated to characterise the sample. Reliability was assessed in different forms: internal consistency, test–retest reliability and split-half reliability. Items were evaluated with descriptive data and item-total correlations. Convergent and discriminant validity were shown, and a confirmatory factor analysis was performed. In order to ameliorate the model, a post hoc model modification was done. Results The sample consisted of 138 patients diagnosed with schizophrenia spectrum disorders (mean age: 35.7 years; 53.6% men; mean duration of illness: 20.6 years) with a mean RSQ overall percentage of 66.12 (s.d. ± 17.43%), mainly representing the categories ‘mixed picture’ and ‘tends towards integration’. The reliability of the RSQ was acceptable with a Cronbach's α of 0.741 and a test–retest coefficient of 0.502. Item-total correlations were not acceptable for 27 of 39 items. Moderate evidence for convergent validity of the RSQ was found. Confirmatory factor analysis revealed that the 13-factor model with 39 items originally proposed was partially poorly replicated in the present sample (χ2 ratio to degrees of freedom (χ2/df) of 1.732, Comparative Fit Index (CFI) of 0.585, Normed Fit Index (NFI) of 0.414, Tucker–Lewis Index (TLI) of 0.508, root mean square error of approximation (RMSEA) of 0.095). The RSQ was modified based on item-total correlations and path coefficients of the single items. The confirmatory factor analysis of the resulting one-factor model with 11 items showed adequate fit to the data (χ2/df of 1.562, CFI of 0.936, NFI of 0.847, TLI of 0.910, RMSEA of 0.083) and demonstrated good model fit. Conclusions Despite partially insufficient psychometric data of the original RSQ, the concept of recovery style is beneficial to psychiatric research and clinical practice. The underlying idea is valuable, and the questionnaire needs further development. Therefore, a short version of the RSQ is proposed.

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

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

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

Ziel: Studierende unterliegen einem besonders hohen Risiko fur Substanzmissbrauch. Epidemiologische Daten uber regionale und geschlechtsspezifische Unterschiede bezuglich Substanzmissbrauchsmuster sind nur begrenzt vorhanden. Design: Standardisierte Erfassung von Pravalenzen, ohne Intervention. Setting: Die Daten wurden an Universitaten in Wien (Stadt) erhoben und mit Daten, die in gleicher Weise und in identen Studienrichtungen an Universitaten in Innsbruck (Land) erhoben wurden, verglichen. Teilnehmer: Von Mai bis Oktober 2010 wurden Daten von stadtischen Studierenden (n=1025; mittleres Alter: 21,03 Jahre; 62,7% weiblich) erhoben. Diese wurden mit Daten von landlichen Studierenden aus einer Vorstudie (2006) verglichen (n=873; mittleres Alter: 22,14 Jahre; 65,9% weiblich). Fragebogen: Anamnesefragebogen zum Sub­stanzkonsum, Fagerstrom-Test (Nikotinabhangigkeit), CAGE-Test (Alkoholscreening), SF-36 Fragebogen zum Gesundheitszustand, Beck-Depres­sions-Inventar, Zerssen-Beschwerdenliste (subjektive physische und psychische Beschwerden). Ergebnisse: Ein hervorstechendes Ergebnis war die hohe Pravalenz des Nikotinkonsums (38,2%), wobei eine signifikant hohere Rate von taglichem Nikotinkonsum bei landlichen Studierenden (p≤0,001) verglichen mit stadtischen gefunden wurde. 32,4% der Manner und 21,4% der Frauen zeigten Zeichen einer Alkoholabhangigkeit mit weiterem Abklarungsbedarf im CAGE-Test. 18,5% aller Studierenden berichteten Cannabiskonsum, 9,9% taglich. Manner berichteten signifikant haufiger taglichen Alkoholkonsum (p≤0,001) und taglichen Cannabiskonsum (p=0,007) als Frauen. 6,2% der Studierenden berichteten uber den Konsum von Benzodiazepinen. 35,4% aller Studierenden konsumierten Analgetika, wobei die Pravalenz bei Frauen signifikant hoher war als bei Mannern (p≤0,001). Schlussfolgerung: Das Ausmas des schadlichen Alkohol- und Nikotinkonsums in dieser Population ist betrachtlich. Signifikante Geschlechtsunterschiede bestehen. Besonders Alkoholabhangigkeit und die nicht-verordnete Einnahme von verschreibungspflichtigen Medikamenten sollten vermehrt in den Fokus von geschlechtssensitiven Gesundheitsinterventionen fur Studierende rucken.

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

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

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

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

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

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

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

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

Several authors pointed out that in the next decades dementia will affect a considerably increasing number of the elderly. The question was raised if life-expectancy was projected to conservative, resulting in revisions with higher life-expectancy and larger numbers of the oldest population. The present paper analyses the influence of such revisions on the future numbers of dementia sufferers in Austria.For this purpose we used meta-analyses of epidemiological studies and the population projections for the period until 2050 of the Austrian Bureau of Statistics as well as of the United Nations Population Division of the year 2001 as well of the year 2005.Using the extrapolations of the Austrian Bureau of Statistics of the year 1999 as well as of the United Nations Population Division of the year 2001, the number of dementia cases in Austria in the year 2050 will rise to about 233 thousands. According to the four years later performed extrapolations of the United Nations Population Division of the year 2005, dementia cases in Austria will raise to about 262 thousands in the year 2050.In the next decades, the number of persons suffering from dementia will rise considerably. Increasing life-expectancy will result in markedly higher numbers of persons with dementia than estimated from earlier population projections. Nevertheless, this is the first analysis of future dementia cases based on projections from two different dates, but using the same source. We must conclude that the dramatically increasing number of dementia cases requires comprehensive planning of the health and social care system.

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

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

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

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

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

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

The purpose of the present study was to investigate if depression symptomatology of patients' parents is predicted by the symptoms of schizophrenia.101 mothers and 101 fathers of the same patients suffering from schizophrenia were included into this study. Parents filled in the "Beck Depression Inventory". Patients were assessed by means of the "Positive and Negative Syndrome Scale". For statistical analyses a Multidimensional Random Coefficients Multinomial Logit Model was applied.We found a significant positive association between negative symptoms and depression severity of fathers and mothers. Further, a significant positive association between positive symptoms and depression severity of fathers, but not of mothers was found.Our results show that depression of mothers and of fathers is associated with symptoms of schizophrenia even when controlling for potential predictors.

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

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

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

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

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

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

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

Lessons learned in research and treatment of opioid dependence demonstrate the need to include pregnant women in clinical trials.Two double-blind, double-dummy, randomized controlled trials (Pilot study, European sample(†) of MOTHER-trial) comparing buprenorphine and methadone in opioid-dependent pregnant women were conducted. In both studies, participants received voucher-based incentives for attendance and completion of study assessments. In the MOTHER trial, participants additionally received escalating voucher incentives for drug-free urine samples. Neonatal abstinence syndrome was treated with oral morphine solution based on standardized modified Finnegan scores.After a mean treatment period of 13.79 weeks in the Pilot study (PS, n = 18) and 20.78 weeks in the MOTHER-trial (MT, n = 41), respectively (p0.001), PS patients delivered at mean doses of 14.00 mg buprenorphine/52.50 mg methadone and MT participants at 13.44 mg buprenorphine/63.68 mg methadone. Nonsignificant differences regarding dropout rates were found (22% in PS versus 10% in MT), but dropout was significantly earlier in the MT (p = 0.013). Significantly higher rates of concomitant consumption of opioids and benzodiazepines occurred in the PS compared with the MT (p0.001), however, with no significant differences in neonatal data between both settings.Early treatment enrolment combined with contingency management contributes to reduced illicit drug use throughout pregnancy, surprisingly without influencing neonatal outcome parameters.

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

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

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