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Abstract: Benzodiazepines (BZD) and Z-drugs (ZD) are often prescribed to treat psychiatric disorders. Despite the risk of dependency and serious adverse events, they are increasingly prescribed to outpatients. Yet little is known about the prescription to inpatients. In this article, we analyze the BZD and ZD prescription patterns in the routine data of 913 psychiatric and somatic inpatients treated in Bochum, Germany. BZD were prescribed more often as regular medication in psychiatry and ZD in somatic hospitals. ZD were more often used on demand, by female patients, and combined with other substances. Both were frequently prescribed to older adults, especially as part of somatic treatment and in combination with opioids. Prescription of sedative hypnotics is frequent in psychiatric and somatic inpatients. Their use seems to be partially independent of recorded psychiatric indications.

Zusammenfassung Ziel der Studie Die vorliegende Studie untersuchte mit einer angestrebten Vollerhebung den Dokumentationsstatus bezüglich Unterbringungen und Zwangsmaßnahmen in psychiatrischen Kliniken in Deutschland. Methodik Im Rahmen der ZIPHER-Studie wurde eine Fragebogenerhebung hinsichtlich der Dokumentation, Anwendung und Bemühungen zur Reduktion von Zwang durchgeführt (N = 147, Rücklaufquote = 34,4 %). Ergebnisse Die teilnehmenden Kliniken berichteten überwiegend von einer umfassenden Dokumentation von Zwangsmaßnahmen, jedoch zeigten sich sowohl diesbezüglich als auch für den Einsatz von Leitlinien erhebliche regionale Unterschiede. Die Unterbringungsquote lag bei M = 13,4 % (± 10,9). Von diesen waren 33,9 % (± 22,2) von Fixierung betroffen, 8,9 % (± 17,2) von Isolierung und 11,8 % (± 18,0) von Zwangsmedikation. Schlussfolgerung Die regionalen Unterschiede rufen zu einer Vereinheitlichung der rechtlichen Grundlagen und praktischen Anwendung sowie einer flächendeckenden Zusammenführung der entsprechenden Daten auf.

Autoimmune encephalitis (AE) can rarely manifest as a predominantly psychiatric syndrome without overt neurological symptoms. This study’s aim was to characterize psychiatric patients with AE; therefore, anonymized data on patients with suspected AE with predominantly or isolated psychiatric syndromes were retrospectively collected. Patients with readily detectable neurological symptoms suggestive of AE (e.g., epileptic seizures) were excluded. Patients were classified as “probable psychiatric AE (pAE),” if well-characterized neuronal IgG autoantibodies were detected or “possible pAE” (e.g., with detection of nonclassical neuronal autoantibodies or compatible cerebrospinal fluid (CSF) changes). Of the 91 patients included, 21 (23%) fulfilled our criteria for probable (autoantibody-defined) pAE and 70 (77%) those for possible pAE. Among patients with probable pAE, 90% had anti-NMDA receptor (NMDA-R) autoantibodies. Overall, most patients suffered from paranoid-hallucinatory syndromes (53%). Patients with probable pAE suffered more often from disorientation (p p = 0.001) than patients with possible pAE. Immunotherapies were performed in 69% of all cases, mostly with high-dose corticosteroids. Altogether, 93% of the patients with probable pAE and 80% of patients with possible pAE reportedly benefited from immunotherapies (p = 0.251). In summary, this explorative, cross-sectional evaluation confirms that autoantibody-associated AE syndromes can predominantly manifest as psychiatric syndromes, especially in anti-NMDA-R encephalitis. However, in three out of four patients, diagnosis of possible pAE was based on nonspecific findings (e.g., slight CSF pleocytosis), and well-characterized neuronal autoantibodies were absent. As such, the spectrum of psychiatric syndromes potentially responding to immunotherapies seems not to be limited to currently known autoantibody-associated AE. Further trials are needed.

Background and Objectives Involuntary hospital admissions and coercive measures are a long-lasting burden in psychiatry. Many efforts have been undertaken to diminish these wearing circumstances. With the Bochum “track system,” which is structured in mental health teams across inpatient and outpatient clinics without any closed admission wards, we would like to present a new way of facing coercion. To examine the effects of establishing the so-called Bochum “‘track system”’ regarding the presumed reduction of coercive measures within a naturalistic, quantitative pre- and post- comparison. Methods Routine data on coercive measures (involuntary admissions, mechanical restraints, compulsory medications, one-to-one care) from two years of treatment (2011, 2017) are compared (N = 257 involuntary admissions) before and after the introduction of the track system. Results By changing the general conditions of the hospital, it was possible to reduce the number of coercive measures in the affected cases. The proportion of cases affected by coercion also tended to decrease, with women in particular appearing to benefit from introduction of the track system. Conclusion Structural changes in psychiatric hospitals can have a significant impact on one of the important quality parameters of psychiatric treatment, namely coercive measures.

ZusammenfassungEs ist gut belegt, dass Kindesmisshandlung mit der Entstehung und Aufrechterhaltung von psychischen Erkrankungen im Erwachsenenalter zusammenhängt. Das Ziel der vorliegenden Arbeit ist es, darüber zu reflektieren, ob diese negativen Erfahrungen in der psychiatrischen Praxis angemessen berücksichtigt werden. Die medizinischen Akten von 3680 stationär behandelten erwachsenen Patienten einer psychiatrischen Klinik wurden analysiert in Bezug auf Einträge, die sich auf Erfahrungen von Missbrauch und Vernachlässigung in der Kindheit beziehen. Patienten mit der Diagnose einer Störung durch psychotrope Substanzen, einer schizophrenen oder einer affektiven Störung wurden in dieser Arbeit betrachtet. Einträge, die sich auf traumatische Erfahrungen beziehen, wurden nach der Unterteilung in emotionalen, körperlichen und sexuellen Missbrauch sowie emotionale und körperliche Vernachlässigung klassifiziert. Nur in 6% der Fälle fanden sich Hinweise auf traumatische Erfahrungen in der Kindheit in den Akten. Die drei Arten von Missbrauch wurden am häufigsten dokumentiert, während sich nur wenige Einträge zu emotionaler und körperlicher Vernachlässigung fanden. Frühere Arbeiten legen allerdings nahe, dass die Häufigkeit von Missbrauch und Vernachlässigung in der Kindheit bei psychiatrischen Patienten deutlich höher ist als die Häufigkeit, die hier anhand der Akteneiträge ermittelt wurde. Diese negativen Kindheitserfahrungen wurden in den psychiatrischen Behandlungen offenbar wenig beachtet. Wegen ihrer Relevanz für das Verständnis psychischer Störungen empfehlen wir, sie in strukturierter Weise zu erfassen, entweder mit standardisierten Fragebögen oder mit Screening-Fragen in der Eingangsuntersuchung.

The newly developed app TellUs is a digital offering for psychiatric outpatient treatment that includes diagnostic and therapeutic tools. The aim of this study was to test the clinical efficiency and patient satisfaction of TellUs.Sixty-four patients with depressive disorder took part in the study for 3 months. The intervention group was treated digitally with TellUs and the control group received visiting treatment (treatment as usual) during that time.In both groups, a significant decrease of depressive symptoms and general strain through psychological symptoms, along with an increase of quality of life in the psychological domain, was shown. Furthermore, both groups were highly satisfied with the treatment.TellUs was shown to be equivalent to treatment as usual in terms of clinical efficiency and patient satisfaction.

This nationwide full census survey investigated the documentation status regarding involuntary admissions and coercive measures in psychiatric hospitals in Germany.As part of the ZIPHER study, a questionnaire survey on the documentation, application and reduction of coercion was conducted (The majority of participating hospitals reported a comprehensive documentation of the use of coercion. However, substantial regional differences could be found in this regard as well as for the use of guidelines. The involuntary admission quote wasThe regional differences plead for a unification of legal bases and applied practice as well as for a merge of respective data on a nationwide level of the relevant stakeholders.Die vorliegende Studie untersuchte mit einer angestrebten Vollerhebung den Dokumentationsstatus bezüglich Unterbringungen und Zwangsmaßnahmen in psychiatrischen Kliniken in Deutschland.Im Rahmen der ZIPHER-Studie wurde eine Fragebogenerhebung hinsichtlich der Dokumentation, Anwendung und Bemühungen zur Reduktion von Zwang durchgeführt (Die teilnehmenden Kliniken berichteten überwiegend von einer umfassenden Dokumentation von Zwangsmaßnahmen, jedoch zeigten sich sowohl diesbezüglich als auch für den Einsatz von Leitlinien erhebliche regionale Unterschiede. Die Unterbringungsquote lag beiDie regionalen Unterschiede rufen zu einer Vereinheitlichung der rechtlichen Grundlagen und praktischen Anwendung sowie einer flächendeckenden Zusammenführung der entsprechenden Daten auf.

\(\bf Background\) Child maltreatment has been shown to be associated with a wide range of mental disorders, including bipolar disorders. In this 2-year follow-up study, recollections of emotional, physical and sexual abuse were related to bipolar symptoms, namely depressive, hypomanic and manic symptoms. \(\bf Methods\) The sample consists of 134 students who took part at five measurement times within the 2-year period. Data were collected with self-report scales. \(\bf Results\) The results show that recollections of abuse, particularly emotional abuse, were associated with more severe depressive symptoms; this finding, however, only applied to women. Hypomanic and manic symptoms were not associated with recollections of abuse. For hypomanic symptoms, however, a significant decrease over the 2 years was observed. \(\bf Conclusions\) The findings of this study suggest that recollections of abusive experiences in childhood combined with female gender increase the risk for depression, whereas hypomanic and manic states are probably better predicted by other factors, such as current life circumstances.

Schizophrenia has been shown repeatedly to be associated with a low level of psychosocial functioning. It is assumable that psychosocial functioning is related not only to current, but also to future symptom severity. To test this assumption, a follow-up study with two measurement time points with an interval of 18 months was conducted. In total, 154 inpatients from five psychiatric hospitals with a diagnosis of a schizophrenic disorder took part at both visits. Psychosocial functioning was measured with the Personal and Social Performance Scale (PSP scale) at baseline, and schizophrenic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at follow-up. Two PSP subscales, i.e. socially useful activities and control over disturbing and aggressive behavior, turned out to be significant predictors of symptom severity 18 months later. The findings reveal that personal resources in the occupational domain and in adequate interpersonal behavior can have a positive impact on the long-term course of schizophrenia.

BackgroundThe aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia.MethodsTwenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects.ResultsThere was a 3-year later age at onset for females (P P P P = .001). No significant effects were found concerning duration of illness.DiscussionOur results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Es ist gut belegt, dass Kindesmisshandlung mit der Entstehung und Aufrechterhaltung von psychischen Erkrankungen im Erwachsenenalter zusammenhängt. Das Ziel der vorliegenden Arbeit ist es, darüber zu reflektieren, ob diese negativen Erfahrungen in der psychiatrischen Praxis angemessen berücksichtigt werden. Die medizinischen Akten von 3680 stationär behandelten erwachsenen Patienten einer psychiatrischen Klinik wurden analysiert in Bezug auf Einträge, die sich auf Erfahrungen von Missbrauch und Vernachlässigung in der Kindheit beziehen. Patienten mit der Diagnose einer Störung durch psychotrope Substanzen, einer schizophrenen oder einer affektiven Störung wurden in dieser Arbeit betrachtet. Einträge, die sich auf traumatische Erfahrungen beziehen, wurden nach der Unterteilung in emotionalen, körperlichen und sexuellen Missbrauch sowie emotionale und körperliche Vernachlässigung klassifiziert. Nur in 6% der Fälle fanden sich Hinweise auf traumatische Erfahrungen in der Kindheit in den Akten. Die drei Arten von Missbrauch wurden am häufigsten dokumentiert, während sich nur wenige Einträge zu emotionaler und körperlicher Vernachlässigung fanden. Frühere Arbeiten legen allerdings nahe, dass die Häufigkeit von Missbrauch und Vernachlässigung in der Kindheit bei psychiatrischen Patienten deutlich höher ist als die Häufigkeit, die hier anhand der Akteneiträge ermittelt wurde. Diese negativen Kindheitserfahrungen wurden in den psychiatrischen Behandlungen offenbar wenig beachtet. Wegen ihrer Relevanz für das Verständnis psychischer Störungen empfehlen wir, sie in strukturierter Weise zu erfassen, entweder mit standardisierten Fragebögen oder mit Screening-Fragen in der Eingangsuntersuchung.

As early detection of symptoms in the subclinical to clinical psychosis spectrum may improve health outcomes, knowing the probabilistic susceptibility of developing a disorder could guide mitigation measures and clinical intervention. In this context, polygenic risk scores (PRSs) quantifying the additive effects of multiple common genetic variants hold the potential to predict complex diseases and index severity gradients. PRSs for schizophrenia (SZ) and bipolar disorder (BD) were computed using Bayesian regression and continuous shrinkage priors based on the latest SZ and BD genome-wide association studies (Psychiatric Genomics Consortium, third release). Eight well-phenotyped groups (n = 1580; 56% males) were assessed: control (n = 305), lower (n = 117) and higher (n = 113) schizotypy (both groups of healthy individuals), at-risk for psychosis (n = 120), BD type-I (n = 359), BD type-II (n = 96), schizoaffective disorder (n = 86), and SZ groups (n = 384). PRS differences were investigated for binary traits and the quantitative Positive and Negative Syndrome Scale. Both BD-PRS and SZ-PRS significantly differentiated controls from at-risk and clinical groups (Nagelkerke’s pseudo-R2: 1.3–7.7%), except for BD type-II for SZ-PRS. Out of 28 pairwise comparisons for SZ-PRS and BD-PRS, 9 and 12, respectively, reached the Bonferroni-corrected significance. BD-PRS differed between control and at-risk groups, but not between at-risk and BD type-I groups. There was no difference between controls and schizotypy. SZ-PRSs, but not BD-PRSs, were positively associated with transdiagnostic symptomology. Overall, PRSs support the continuum model across the psychosis spectrum at the genomic level with possible irregularities for schizotypy. The at-risk state demands heightened clinical attention and research addressing symptom course specifiers. Continued efforts are needed to refine the diagnostic and prognostic accuracy of PRSs in mental healthcare.

Coercive measures are a sensitive, much-discussed ethical and legal issue in the psychiatric context. Hence, the identification of their predictors and ways of prevention are of utmost importance. The present study aimed to determine the impact of the social-psychiatric services (SPS) in North Rhine Westphalia (NRW) on involuntary admissions according to the German Mental Health Act and to identify predictors for the reduction of these involuntary admissions. A dataset including details from 31 districts and 23 towns in NRW over a time period of 10 years (2005-2014) was analysed regarding the number of involuntary admissions, gender and age of admitted patients, and person/institution initiating the compulsory act. All 56 SPS in NRW were contacted for information on the number of clients/contacts, home visits, areas of responsibility and their involvement in involuntary admissions. Thirty SPS participated in the survey. We found a significant increase of involuntary admissions over time with significantly higher proportions of male patients and patients younger than 60 years in every year. Regarding the characteristics of SPS, a negative correlation between the number of clients contacting the SPS on their own initiative and low-income households was observed. Additionally, the number of clients contacting the SPS on their own initiative was significantly higher in districts/towns associated with lower involuntary admission rates. These data suggest that patient-based factors were of great importance in the context of involuntary admissions. Furthermore, the SPS and home treatment should be strengthened and intensified to achieve lower involuntary admission rates.