Search

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.

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.

In current diagnostic systems, schizophrenia and bipolar disorder are still conceptualized as distinct categorical entities. Recently, both clinical and genomic evidence have challenged this Kraepelinian dichotomy. There are only few longitudinal studies addressing potential overlaps between these conditions. Here, we present design and first results of the PsyCourse study (N = 891 individuals at baseline), an ongoing transdiagnostic study of the affective-to-psychotic continuum that combines longitudinal deep phenotyping and dimensional assessment of psychopathology with an extensive collection of biomaterial. To provide an initial characterization of the PsyCourse study sample, we compare two broad diagnostic groups defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, that is, predominantly affective (n = 367 individuals) versus predominantly psychotic disorders (n = 524 individuals). Depressive, manic, and psychotic symptoms as well as global functioning over time were contrasted using linear mixed models. Furthermore, we explored the effects of polygenic risk scores for schizophrenia on diagnostic group membership and addressed their effects on nonparticipation in follow-up visits. While phenotypic results confirmed expected differences in current psychotic symptoms and global functioning, both manic and depressive symptoms did not vary between both groups after correction for multiple testing. Polygenic risk scores for schizophrenia significantly explained part of the variability of diagnostic group. The PsyCourse study presents a unique resource to research the complex relationships of psychopathology and biology in severe mental disorders not confined to traditional diagnostic boundaries and is open for collaborations.

IMPORTANCE: Identifying psychosis subgroups could improve clinical and research precision. Research has focused on symptom subgroups, but there is a need to consider a broader clinical spectrum, disentangle illness trajectories, and investigate genetic associations. OBJECTIVE: To detect psychosis subgroups using data-driven methods and examine their illness courses over 1.5 years and polygenic scores for schizophrenia, bipolar disorder, major depression disorder, and educational achievement. DESIGN, SETTING, AND PARTICIPANTS: This ongoing multisite, naturalistic, longitudinal (6-month intervals) cohort study began in January 2012 across 18 sites. Data from a referred sample of 1223 individuals (765 in the discovery sample and 458 in the validation sample) with DSM-IV diagnoses of schizophrenia, bipolar affective disorder (I/II), schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder were collected from secondary and tertiary care sites. Discovery data were extracted in September 2016 and analyzed from November 2016 to January 2018, and prospective validation data were extracted in October 2018 and analyzed from January to May 2019. MAIN OUTCOMES AND MEASURES: A clinical battery of 188 variables measuring demographic characteristics, clinical history, symptoms, functioning, and cognition was decomposed using nonnegative matrix factorization clustering. Subtype-specific illness courses were compared with mixed models and polygenic scores with analysis of covariance. Supervised learning was used to replicate results in validation data with the most reliably discriminative 45 variables. RESULTS: Of the 765 individuals in the discovery sample, 341 (44.6%) were women, and the mean (SD) age was 42.7 (12.9) years. Five subgroups were found and labeled as affective psychosis (n = 252), suicidal psychosis (n = 44), depressive psychosis (n = 131), high-functioning psychosis (n = 252), and severe psychosis (n = 86). Illness courses with significant quadratic interaction terms were found for psychosis symptoms (R(2) = 0.41; 95% CI, 0.38-0.44), depression symptoms (R(2) = 0.28; 95% CI, 0.25-0.32), global functioning (R(2) = 0.16; 95% CI, 0.14-0.20), and quality of life (R(2) = 0.20; 95% CI, 0.17-0.23). The depressive and severe psychosis subgroups exhibited the lowest functioning and quadratic illness courses with partial recovery followed by reoccurrence of severe illness. Differences were found for educational attainment polygenic scores (mean [SD] partial η(2) = 0.014 [0.003]) but not for diagnostic polygenic risk. Results were largely replicated in the validation cohort. CONCLUSIONS AND RELEVANCE: Psychosis subgroups were detected with distinctive clinical signatures and illness courses and specificity for a nondiagnostic genetic marker. New data-driven clinical approaches are important for future psychosis taxonomies. The findings suggest a need to consider short-term to medium-term service provision to restore functioning in patients stratified into the depressive and severe psychosis subgroups.

Background: Patients with severe mental illness (SMI) have worse physical health and reduced life expectancy compared to the general population. Individuals with mental disorders also more often suffer from influenceable risk factors such as obesity, smoking, diabetes, arterial hypertension and dyslipidaemia. Moreover, they have more difficulties to access health services and fewer opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. Therefore, we aimed to investigate the somatic care situation of psychiatric patients. Methods: This study used a 14-item-questionnaire to survey the physical status of hospital patients with SMI. Main subjects were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care (by general practitioners and specialists), and routine check-ups. Data collection underwent pseudonymisation and descriptive analysis. Outcome: 350 patients (49.1% male, mean age 46,31 ±16,02 years) were included. More than three quarters had access to a general practitioner (78.2%), whom most of the patients reported to see quite regularly. Patients with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, compared to other diagnostic subgroups. Nearly all of the patients received psychiatric medication, but some had never before a blood sample taken or received an ecq. Interpretation: Although the access to a general practitioner is quite high, it can be concluded, that the interaction of patient, provider, and system factors has created a situation in which access to and quality of health care is problematic for individuals with especially a SMI. Funding: None. Declaration of Interest: The authors declare that they have no conflict of interest. Ethical Approval: The analysis has been performed in accordance with the Declaration of Helsinki. The Ruhr-University Bochum ethics committee approved the analysis, and written informed consent was obtained from the patient.

In current diagnostic systems, schizophrenia and bipolar disorder are still conceptualized as distinct categorical entities. Recently, both clinical and genetic evidence have challenged this Kraepelinian dichotomy. There are only few longitudinal studies addressing the potential overlaps between these conditions. Here, we present design and first results of the PsyCourse study, an ongoing transdiagnostic study of the affective-to-psychotic continuum that combines longitudinal deep phenotyping and dimensional assessment of psychopathology with an extensive collection of biomaterial. Within the DSM-IV framework, we compare two broad diagnostic groups: one consisting of predominantly affective and one of predominantly psychotic disorders. Depressive, manic, and psychotic symptoms as well as global functioning over time were analyzed. Furthermore, we explore the effects of polygenic risk scores for schizophrenia on diagnostic group membership and address their effects on non-participation in follow-up visits. While phenotypic results show differences in both current psychotic and manic symptoms, depressive symptoms did not vary between both groups. Polygenic risk scores for schizophrenia significantly explained part of the variability of the diagnostic group. Furthermore, there was a trend that a higher polygenic loading for schizophrenia was associated with attrition. Because of its unique properties, the PsyCourse study presents a prime resource for the interrogation of complex genotype-phenotype relationships.

Ziel der Studie: Bundesweit hat die Zahl unfreiwilliger Aufnahmen von psychisch Kranken in psychiatrischen Krankenhausern nach PsychKG oder BtG zugenommen. Jedoch ist bislang wenig uber die Bedingungsfaktoren hierfur bekannt. Methodik: Anhand einer Stichprobe mit uber 200 000 Behandlungsfallen aus Nordrhein-Westfalen wurde dieses untersucht. Ergebnisse: Altere Patienten mit einer Demenz wurden am haufigsten nach PsychKG untergebracht. Das Vorhandensein einer geschlossenen Station spielte keine Rolle. Jedoch zeigte die Aktivitat des sozialpsychiatrischen Dienstes den grosten Einfluss. Schlussfolgerung: Die Rolle des sozialpsychiatrischen Dienstes sowie von Hometreatment ist zu starken, um das psychiatrische Qualitatsmerkmal von niedrigen Unterbringungsraten flachendeckend in Deutschland zu erreichen.

Ziel: In dieser Studie wurden 40 untergebrachte Patienten durchschnittlich 3 Wochen nach erfolgter Zwangsmasnahme zu ihrem Erleben befragt. Methode: Der Fragebogen umfasste 31 Items zu demografischen und krankheitsbezogenen Daten, Modalitaten der Unterbringung, Zwangsmasnahmen im Rahmen der Unterbringung und ihre Empfindung sowie Patientenzufriedenheit. Letzteres wurde bisher nicht detailliert untersucht. Schlussfolgerung: Als fuhrende Emotionen in der Zwangssituation wurden Wut, Arger und Verzweiflung benannt, retrospektiv jedoch auch Verstandnis. Klinisch stabilere Patienten bewerteten das Erlebte insgesamt negativer.

Background The determination of Intraepidermal Nerve Fiber Density (IENFD) in skin biopsy is a useful method for the evaluation of different types of peripheral neuropathies. To allow a reliable use of the method it is necessary to determine interobserver reliability. Previous studies dealing with this topic used limited suitable statistical methods. Methods In the present study three observers determined the IENFD and estimated the staining quality of the basement membrane for an adequate quantity of 120 skin biopsies (stained with indirect immunofluorescence technique) from 68 patients. More adequate statistical methods like intraclass correlation coefficient and Bland Altman Plot were chosen to estimate interobserver reliability. Results We found an unexpected significant difference in IENFD between the observers (p < 0.05) and so the results of this study are not in line with the high interobserver reliability reported before (intraclass correlation coefficient: 0.73). The Bland Altmann Plot showed a variance growing with rising mean. The difference in IENFD between the observers and the resulting low interobserver reliability is likely caused by different interpretations of the standard counting rules. There was no significant difference in IENFD between observers for biopsies with a well-defined basement membrane. Thus skin biopsies with an inexactly defined basement membrane should not be used diagnostically for the determination of IENFD. Conclusion These results emphasise that standardisation of the method is extremely important and at least two observers should analyse skin biopsies with critical IENFD near the cut-off values.