Search

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.

Background: The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD). Methods: Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results: Three main themes were identified. First, ‘Pandemic life is deprived, lonely and surreal – though certain aspects can be perceived as positive’. Second, ‘Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised’. Last, ‘There is a complex interplay between one’s prior experience of psychosis and the experience of the COVID-19 pandemic’. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis. Conclusion: Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

In increasingly multi-ethnic societies fostering cultural awareness and integration of immigrants is not only a political duty but also an obligation for social and healthcare systems. Importantly, cultural beliefs and needs strongly impact on the quality of life of cancer patients and may become even more crucial at the end of life. However, to date, ethnic and cultural aspects of palliative care are insufficiently researched. This qualitative study at the Medical University of Vienna included 21 staff members from different disciplines in oncology and palliative care working with patients with various cultural backgrounds at the end of life. Semi-structured interviews were performed to gain insights into specific aspects of palliative care that are important in the clinical encounter with terminally ill cancer patients with migrant backgrounds and their relatives. Interviews revealed specific aspects of palliative care, which fell into four fundamental categories and were all perceived as beneficial in the clinical encounter with migrant clients: (A) structural and (B) personal conditions of the palliative care setting, (C) specific care and treatment intentions and (D) personnel requirements and attitudes. This study revealed first insights into possibilities and prospects of transcultural palliative care for migrants and their relatives. The results might have important implications for the end of life care in this growing population.

Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time.

Uberzeugungen zum Stimmenhoren sind ein wesentlicher Faktor fur Belastung, Coping und therapeutische Interventionen bei verbalen akustischen Halluzinationen. Ziel dieser Studie war es, den international etablierten Beliefs About Voices Questionnaire-Revised (BAVQ-R) in einer deutschen Ubersetzung bei Personen mit Psychosen aus dem schizophrenen Formenkreis einzusetzen und zu validieren. 93 Personen mit Erkrankungen aus dem schizophrenen Formenkreis und aktuellen verbalen akustischen Halluzinationen fullten den BAVQ-R fur ihre dominante Stimme selbststandig aus. Weiters wurden soziodemographische und klinische Daten sowie Daten zum Schweregrad der Erkrankung (Clinical Global Impression-Schizophrenie) und symptomspezifische Dimensionen des Stimmenhorens (Psychotic Symptoms Rating Scale) erhoben. Konstruktvaliditat, Reliabilitat und Test-Retest-Reliabilitat wurden berechnet. Alle BAVQ-R Subskalen (Boswilligkeit, Wohlwollen, Widerstand, Bindung) auser der Subskala Omnipotenz zeigten zufriedenstellende interne Konsistenz. Gute Test-Retest-Reliabilitat ergab sich in den Uberzeugungssubskalen (Boswilligkeit, Wohlwollen, Omnipotenz), aber nicht in Emotionen und Verhalten im Hinblick auf Widerstand und Bindung. Die signifikanten Korrelationen zwischen den Subskalen zeigten Ergebnisse, vergleichbar mit den jenen aus der Originalstudie des BAVQ-R. Es ergaben sich keine Korrelationen mit dem Schweregrad der Erkrankung, sondern mit Ausmas und Intensitat der Belastung durch Stimmen sowie deren negativen Inhalten. Die einzuschatzenden Dimensionen bilden relevante Aspekte des subjektiven Erlebens des Stimmenhorens ab. Sowohl aus therapeutischer Sicht als auch als Forschungsbedarf stellt sich weiterhin aktuell die Frage nach der Konzeptualisierung vom Zusammenhang zwischen Kognition, Emotion und Verhalten.

Purpose The purpose of this paper is to evaluate the usefulness of the first Trialogue Meetings throughout Ireland for individuals from mental health communities by using a participatory action research (PAR) framework. Design/methodology/approach Seven communities participated in monthly Trialogue Meetings as a community-based PAR project. A mixed-methods PAR evaluation was performed on data from 48 participants (service users, service providers, family members/friends and interested community members) who participated in the final Trialogue Meetings. Findings Participants identified that Trialogue increased knowledge/awareness of mental health, irrespective of gender, mental health role, age or employment status. Trialogue Meetings provided a supportive environment for many, where men may be comfortable talking and where service providers may benefit from exposure to broader perspectives on mental health. Participants also perceived that Trialogue Meetings deconstructed pre-existing mental health power structures, allowed them to understand mental health from different perspectives and express themselves better. Research limitations/implications The study identifies barriers to Trialogue efficacy such as low service provider engagement and political dynamics extraneous to the meetings themselves. Practical implications Where desirable conditions are present, Trialogue Meetings appear to be sustainable community development initiatives where pre-existing mental health power dynamics may be levelled and knowledge/communication surrounding mental health may be enhanced. Originality/value This is the first large-scale evaluation of the innovative Trialogue method among mental health stakeholders using a PAR approach.

Die psychiatrische Tagesklinik hat eine lange Tradition als Alternative zur vollstationaren Behandlung. Auserdem kann die Tagesklinik in der Folge einer stationaren Aufnahme die Aufenthaltsdauer verkurzen und den ublichen harten Schnitt zwischen Rund-um-die-Uhr-Betreuung im Spital und der ambulanten Betreuung durch einen Zwischenschritt uberwinden helfen. Die multiprofessionelle Diagnostik und Behandlung profitiert von der alltagsnahen Situation und kann gezielt in die Lebensgestaltung zu Hause hineinwirken. Die pharmakologische Behandlung kann schrittweise und personlich fein abgestimmt an das Leben unter Bedingungen auserhalb des Krankenhauses angepasst werden. Die Tagesstruktur, die sich aus storungsspezifischen Gruppentherapien zu fur Erkrankung, Behandlung, Rehabilitation und Recovery relevanten Themen sowie Ergo- und Physiotherapie und den gemeinsamen Mahlzeiten zusammensetzt, ist ein wesentlicher Wirkfaktor. Kompetenzen fur die Wiederaufnahme einer regelmasigen weiterfuhrenden Tagesstruktur, oft in Richtung Arbeitsrehabilitation, konnen entwickelt werden. Drei Fallbeispiele beleuchten typische Behandlungssituationen an der Tagesklinik der Abteilung fur Sozialpsychiatrie an der Universitatsklinik fur Psychiatrie und Psychotherapie in Wien, die auf die Behandlung von Personen mit Psychosen spezialisiert ist.

Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future. We (DG, PH, and SP) did a survey of professional stakeholders and then used a scenario planning technique in an international expert workshop to address this question. The workshop developed four distinct but not mutually exclusive scenarios in which the social aspect is central: mental health care will be patient controlled; it will target people's social context to improve their mental health; it will become virtual; and access to care will be regulated on the basis of social disadvantage. These scenarios are not intended as fixed depictions of what will happen. They could, however, be useful in guiding further debate, research, and innovation.

Objective In increasingly globalized societies, patient-centered cancer care requires culture-sensitive approaches in order to ensure patients well-being. While migrant patients' needs are frequently reported in the literature, staff members' perception of work with migrant patients, associated challenges, or individual work approaches are largely unknown. This study addresses this research gap through qualitative exploration of experiences of multicultural health care professionals in supportive oncology and palliative care, working with patients from different cultural backgrounds. This study aims to understand staff experience of the impact of culture on cancer care. Methods This study was conducted at the Medical University of Vienna, including staff from different settings of oncology and palliative care, in different professional positions, and with a range of individual migration backgrounds. Semistructured interviews were conducted with 21 staff members working with patients from different cultural backgrounds. Interviews explored views on the impact of culture on care were audio-taped, transcribed, and analyzed using a rigorous method of thematic analysis, enhanced with grounded theory techniques. Results Interviews revealed 4 key topics: culture-specific differences, assumed reasons for differences, consequences of multicultural care, and tools for culture-sensitive care. Strategies to better deal with migrant patients and their families were suggested to improve work satisfaction amongst staff. Conclusions This study identifies relevant staff challenges in work with migrant patients. Concrete suggestions for improvement include measures on an organizational level, team level, and personal tools. The suggested measures are applicable to improve work satisfaction and culture-sensitive care not only in cancer care but also in other areas of medicine.

Objective Home care of advanced cancer patients often has adverse effects on physical and mental health of family caregivers. Little is known about the long-term effects of continuous caregiving on mental health as compared with the effects of bereavement. The objectives of this study were to describe the course of psychiatric morbidity in family caregivers over time, to identify the impact of the patients' death on caregivers, and to explore possible predictor variables for psychiatric morbidity. Methods This multi-institutional, prospective study included 80 family caregivers of 80 advanced cancer patients for baseline and 9 months follow-up assessment. Possible psychiatric disorders (ie, depression, anxiety, posttraumatic stress disorder, and alcohol abuse/dependence) as well as potentially predictive factors (ie, sociodemographic factors, burden, hope, and coping mechanisms) were assessed. Results Follow-up assessment was conducted on average 9.2 months (±2.9) after baseline assessment. Prevalence rates of anxiety and posttraumatic stress disorder decreased significantly over time, whereas depression and alcoholism remained stable. Bereavement was experienced by 53% of caregivers in the follow-up period. The patients' death had no influence on psychiatric morbidity at follow-up. Predictors for the development of a psychiatric disorder varied according to condition, with hope and emotion-oriented coping identified as important influences, especially for anxiety and depression. Conclusion Family caregivers with certain psychiatric disorders might need targeted psychosocial support to ensure their mental well-being and prevent long-term disability. Supporting hope and functional coping strategies early after the patient's diagnosis might limit development and extent of psychiatric morbidity.

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.

Beliefs about voices are a determining factor with regards to distress, coping and therapeutic interventions in verbal auditory hallucinations. Aim of the present study was to use and validate the internationally well established Beliefs About Voices Questionnaire-Revised (BAVQ-R) in a German translation with people suffering from schizophrenic psychoses.93 participants with a diagnosis of schizophrenia and current verbal auditory hallucinations completed the BAVQ-R autonomously for their dominant voice. Sociodemographic and clinical data as well as data concerning the severity of illness (CGI-Sch) and symptom specific dimensions of voice-hearing (PSYRATS-AH) were collected. Construct validity, reliability and test-retest-reliability were calculated.Each of the subscales (malevolence, benevolence, resistance, engagement) with the exception of the subscale omnipotence showed satisfying internal consistency. Good test-retest-reliability was shown for the belief-subscales but not for emotion and behaviour in resistance and engagement. Significant correlations between the subscales showed the expected results, comparable to the results of the original BAVQ-R study. No correlations with severity of the illness, but with amount and intensity of distress through voices and their negative contents correlations were found.The BAVQ-R is a feasible instrument to collect data about beliefs about voices in a valid and reliable way in people with a diagnosis of schizophrenia. From a therapeutic as well as from a scientific point of view, the question about the conceptualization of the relationship between cognition, emotion and behaviour stays relevant.

In the long history of human rights advocacy in psychiatry, the Convention on the Rights of Persons with Disabilities (CRPD) sets an important balancing point between the right to adequate care and all human rights and fundamental freedoms and draws on cross-cutting themes including empowerment, citizenship, recovery and community living as a viable alternative to institutional living. Coercion in care, such as restraints, seclusion, forced medications, locked inpatient units, warehousing and forensic institutions, must be curtailed. The optimal attainment of liberty and freedom in care processes entails change, substitution and systematization of availability of practical alternatives: open doors, open communities, open dialogues, free access, community engagement, advance directives, joint decision-making and co-production of policy with stakeholders and recovery orientation of all services. Absolutist and idealistic insistence on the abandonment of all forms of involuntary treatments straight away will not work, but CRPD has undoubtedly opened a new debate and is definitely setting a new horizon for psychiatry to approach. Deinstitutionalization is a necessary step, by substituting community for hospital care and voluntary for involuntary care wherever possible and changing legislations accordingly. Widening the new frontier involves creating a convergence of clinical and support services with strong advocacy for rights. There is an emerging evidence base for the proposition that optimizing human rights is inherently therapeutic and contributes to healing. In this framework, the WHO has launched The QualityRights Programme for improving quality of care and implementation of core articles of CRPD. An effective action includes challenging social exclusion and inequality, by acting on social determinants of health like quality and stability of home, work, income, supports, relationships and social participation. Political, legal and social action has to be combined with our own emancipation from institutional thinking and practices in mental health and social care, to vastly improve the prospects of a whole life and full citizenship and rights for persons with psychosocial disabilities.

Introduction: Community-based participatory approaches are valuable methods for improving outcomes and effectively integrating care among mental health communities. Trialogue is one such approach which uses Open Dialogue methods with groups of three or more people from different backgrounds who deal with mental health systems. Theory and Method: The current study employed a participatory action research design, which prospectively documented the processes and challenges of participating in Trialogue Meetings. Individuals from participating communities took part in interviews, focus groups or Open Dialogue discussions across three cycles of research. Results: Three prospective themes were identified from participants’ dialogue across the three cycles of research relating to the experience of participating in Trialogue, the development of Open Dialogue skills and the growth of individual Trialogue communities. Conclusions and Discussion: The findings demonstrate that, where desirable conditions are present, Trialogue Meetings are worthwhile and sustainable community-based participatory approaches which encourage disclosure and dialogue surrounding mental health, and may assist in improved integration of care between mental health stakeholders. In particular, Trialogue Meetings stimulate the development of Open Dialogue skills, provide a platform for “vital” and “transformative” self-expression with the potential for positive mental health outcomes and may facilitate the growth of communities surrounding mental health.

Es wird eine 22-jahrige Frau nach einer manisch-psychotischen Episode vorgestellt. Seit funf Jahren sind mehrere manisch-psychotische und depressive Episoden, teilweise mit psychotischen Symptomen und unterschiedlichen Diagnosen dokumentiert. Es stellt sich nun die Frage der Differenzialdiagnose zwischen einer bipolaren Storung und einer schizoaffektiven Storung. Je nach Klassifikation (ICD-10 versus DSM-5) ist die schizoaffektive Storung unterschiedlich definiert. So kann nach ICD-10 eine schizoaffektive Episode diagnostiziert werden, wenn affektive und schizophrene Symptome gleichzeitig auftreten. DSM‑5 hingegen orientiert sich hauptsachlich am Verlauf und verlangt fur die Diagnose schizoaffektive Storung das Vorliegen von schizophrener Symptomatik ohne affektive Storung fur mindestens zwei Wochen im Verlauf der Erkrankung.

Objective Female family caregivers consistently report higher levels of stress and burden compared to male caregivers. Explanations for the apparently higher psychological vulnerability of female caregivers are largely missing to date. This study assesses the correlates and determinants of caregiver burden in family caregivers of advanced cancer patients with a specific focus on gender differences. Methods Three hundred and eight self-identified main informal caregivers of advanced cancer patients were cross-sectionally assessed using structured questionnaires for caregiver burden and hypothesised determinants of burden, including sociodemographic characteristics, caring arrangements, support needs, hope and coping style. Gender differences and predictors of burden were assessed using t-tests, chi-squared tests and univariate linear regression. Significant univariate predictors were entered in an analysis of covariance separately for men and women. Results Burden was significantly higher in women. Hope was the most significant protective factor against burden in both genders, together with perceived fulfilment of support needs. Only in women emotion-oriented coping and being in employment while caring were significantly predictive of higher burden in the multivariate analysis. The model explained 36% of the variance in burden in men and 29% in women. Conclusion Psychological support interventions for family caregivers should take gender-specific risk factors into account. Interventions focusing on keeping up hope while caring for a terminally ill family member may be a valuable addition to palliative services to improve support for family carers. Women may benefit from interventions that address adaptive coping and strategies to deal with the dual demands of employment and caring. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Informal caregivers of advanced cancer patients are known to suffer from high distress due to their caregiving responsibilities. Nevertheless, a comprehensive evaluation of psychiatric morbidity is often missing in clinical practice due to time resources, and mental health problems may be unnoticed in this population. A feasible approach is needed to identify caregivers at risk for psychiatric disorders to offer targeted interventions and enhance their well-being. This cross-sectional, multi-institutional study screened 345 caregivers of advanced cancer patients for psychiatric disorders (i.e., depression, anxiety, posttraumatic stress disorder, and alcohol abuse/dependence) and assessed factors potentially associated with mental health diagnoses (including socio-demographic factors, burden, hope, caring-related quality of life, and coping preferences). Overall, almost 52 % of participants had one or more suspected psychiatric disorders, with anxiety being the most prevalent. Perceived hope, higher burden, and more emotion-oriented coping were associated with psychiatric morbidity in this sample. Spouses and parents showed significantly more symptoms of psychiatric disorders than other relatives. This study confirms the high risk of informal caregivers of advanced cancer patients to develop psychiatric disorders and suggests a practically feasible approach to identify at risk caregivers to offer support.

Objective:Our aim was to evaluate the frequency and treatment of psychiatric symptoms in patients at palliative care units (PCUs).Method:Patients admitted to one of five participating PCUs in Austria were included. The short version of the Patient Health Questionnaire (PHQ–D) was used to evaluate their mental health status. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 by patients and physicians. Patients with a previously diagnosed psychiatric disorder were compared to those without or with newly diagnosed psychiatric symptoms, based on PHQ–D results. Pain and psychopharmacological medication were assessed. Opioid doses were converted into oral morphine equivalents (OMEs).Results:Some 68 patients were included. Previously undetected psychiatric symptoms were identified in 38% (26 of 68), preexisting psychiatric comorbidities were evident in 25% (17), and no psychiatric symptoms were observed in 37% (25). Patients with a preexisting psychiatric comorbidity received antidepressants and benzodiazepines significantly more often than patients without or with previously undetected psychiatric symptoms (p < 0.001). Patient and physician median NRS ratings of pain intensity correlated significantly (p = 0.001). Median NRS rating showed no significant difference between patients with preexisting, previously undetected, or without psychiatric symptoms. OMEs did not differ significantly between preexisting, without, or previously undetected psychiatric symptoms. Patients with undetected and preexisting psychiatric comorbidities had a greater impairment in their activities of daily living than patients without psychiatric symptoms (p = 0.003).Significance of Results:Undetected psychiatric comorbidities are common in patients receiving palliative care. Screening for psychiatric symptoms should be integrated into standard palliative care to optimize treatment and reduce the psychosocial burden of the disease.

Now in a new Fourth Edition, Psychiatry remains the leading reference on all aspects of the current practice and latest developments in psychiatry. From an international team of recognised expert editors and contributors, Psychiatry provides a truly comprehensive overview of the entire field of psychiatry in 132 chapters across two volumes. It includes two new sections, on psychosomatic medicine and collaborative care, and on emergency psychiatry, and compares Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD10) classifications for every psychiatric disorder. Psychiatry, Fourth Edition is an essential reference for psychiatrists in clinical practice and clinical research, residents in training, and for all those involved in the treatment psychiatric disorders.

Voice power is an important concept in daily life of voice hearers and in the support and therapy for voice hearers who seek help. Therefore, the ability to examine voice power differentials between a voice and a voice hearer is essential. The present study aimed to collect data on voice power differentials and to further validate the Voice Power Differential Scale (VPD). 105 participants aged ≥ 18 with an ICD10 F2-diagnosis that included hearing voices were included in this study. Internal consistency was good (alpha = 0.792), as well as test-retest-reliability (r = 0.855) and correlations with other constructs were generally as expected. The VPD questionnaire results correlated negatively with the Beliefs About Voices Questionnaire-Revised's (BAVQ-R) items of Benevolence and Engagement-emotion. It correlated positively with Omnipotence and Resistance-emotion, as well as with Negative Content on the Psychotic Symptoms Rating-Scale (PSYRATS). Unexpectedly, no correlations were found with overall severity and command hallucinations. The Voice Power Differential Scale is an important tool for assessing and formulating a voice hearer's experience when they seek treatment or support for their verbal auditory hallucinations. The results of this study enrich the on-going discussion about the importance of voice power for voice hearers.

Hintergrund Seit Jahrzehnten nehmen die Verschreibungen von Psychopharmaka uberproportional zu. Auf diesem Hintergrund stellt sich die Frage, ob ApothekerInnen ihr Beratungsverhalten bei KundInnen mit Psychopharmakaverordnungen anders sehen als bei solchen mit anderen Verordnungen. Dieses Selbstverstandnis wurde mittels einer Befragungsstudie eruiert.

Objective:Caregivers of cancer patients are faced with significant demands that can seriously impact their physical and mental health. It is important for healthcare professionals to be aware of caregivers' support needs in order for these to be adequately addressed. Our study develops a German version of the Family Inventory of Needs (FIN) and provides a comprehensive evaluation of its acceptability and psychometric properties.Method:Cross-sectional data from 308 participants were taken from the baseline assessment of an ongoing prospective study. Retests were completed by 46 participants approximately one week after baseline. Informal caregivers of terminally ill cancer patients were recruited from three hospitals in Vienna. Questionnaires for hope (IHS), traumatic stress (IES–R), and depression and anxiety (HADS) were employed together with the translated FIN to assess concurrent and discriminant validity.Results:The internal consistency of FIN–Importance had a Cronbach's α of 0.94, and that for FIN–Fulfillment was α = 0.96. Retest reliability for FIN–Importance was r = 0.97, while that for FIN–Fulfillment could not be calculated due to missing responses to this subscale. Concurrent and discriminant validity tests for the scale and the discriminative power of items were adequate. However, missing responses may limit the feasibility of using this scale in research settings. We identified six questions that could be excluded from the scale in order to increase its acceptability and further improve its psychometric properties.Significance of results:Our results suggest that the FIN is suitable for clinical settings. For use in research, we suggest four adaptations to increase the scale's acceptability and psychometric properties. The FIN can be a valuable tool for informing the emotional, physical, and psychological support provided to family carers of people who are terminally ill with cancer.

Byline: Afzal. Javed, M. Amering The concept of human rights increasingly defines the discourse on ethical, moral, and legal frameworks of nations as well as international organizations. Their international and universal character was set out in the 1948 Universal Declaration of Human Rights and reinforced consistently ever since. At the same time, discussions on differences regarding their interpretation and application involve all of us on a daily basis on a political, professional, and personal level. Although human rights are promoted in a wider perspective and all population groups fall under their protection, there are on-going discourses around the world over the human rights needs of individuals diagnosed with psychiatric disorders and those experiencing mental health problems. Reports have confirmed the severity of human rights violations among this group almost in all cultures and countries though there are variations in frequency, intensity or severity. The practices and policies to follow human rights also change from one country to another with a number of concerns for disparities. Recent Historic Firsts In recent years, several historic firsts occurred, which have a strong bearing on the current developments in mental health and human rights: *For the first time in history, the human rights for persons with disabilities were specifically formulated in the 2006 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). This was deemed necessary because persons with disabilities have been denied their human rights on many levels and in all cultures and societies despite the fact that all prior human rights legislation, of course, applies to persons with disabilities in the same way as to every human being. This process of assessing the human rights situation of a particular group of people responding to the documented need for extra attention can be understood in analogy with the formulation of the UN-Convention on the Elimination of All Forms of Discrimination against Women in 1979 or the UN-Convention on the Rights of the Child in 1989 *For the first time in history persons with a lived experience of disability were part of the negotiating process at the United Nations. This brought about a plethora of novel experiences and “New Diplomacy” strategies with remarkable successes and only partly overcome stumble blocks [sup][1] *For the first time in history persons with a lived experience of disabilities from mental health problems (psychosocial disabilities) joined the movement of disability activists and were equal partners in the process of drafting the UN-CRPD. As a result, the convention obliges states to involve persons with disabilities in policy development. Therefore, from now on, people with a lived experience background will as rights-holders be part of the activities of international and national monitoring bodies with regard to UN-CRPD as well as all negotiating processes of international, national or local policies that concern their care and their lives in their communities. Furthermore, the UN-CRPD has a place in history with an exceptionally fast ratification process. By June 2016, 165 States Parties have ratified the UN-CRPD, thereby making it applicable in their countries. The consequent changes in policy and practice of mental health care concern high-as well as low- and middle-income countries.[sup][2] As a majority of people will be experiencing some form of disability either personally or as a family carer or friend at some point in time in their lives and disabilities from mental health problems affect millions of people all around the globe the significance of the claims and consequences of a successful meeting of the obligations of this particular UN-Convention can hardly be overestimated. The Un-Convention on the Rights of Persons With Disabilities The UN-CRPD includes freedom rights, such as the right to be free from exploitation, violence and abuse and requests nondiscrimination in terms of capacity and equal recognition before the law. …

Internalized stigma is a complicating feature in the treatment of schizophrenia spectrum disorders and considerably hinders the recovery process. The empowerment and recovery-oriented program of our day clinic might contribute to a reduction in internalized stigma. The aim of the study was to explore the influence of this day clinic program on internalized stigma and other subjectively important outcome measures such as quality of life and psychopathology. Data from two groups of patients had been collected twice, at baseline and after 5 weeks. The experimental group attended the day clinic treatment (N=40) and the control group waited for the day clinic treatment (N=40). The following significant differences between the two groups were found: Patients in day clinic treatment showed a reduction in internalized stigma while the control group showed a minimal increase (Cohen's d=0.446). The experimental group as compared with the control group also showed a greater improvement in the quality of life domain psychological health (Cohen's d=0.6) and in overall psychopathology (Cohen's d=0.452). Interestingly, changes in internalized stigma and psychological quality of life were not associated with changes in psychopathology. Results are encouraging but have to be confirmed in a randomized design.

Aims.Insight, positive and negative symptoms, hope, depression and self-stigma are relevant variables in schizophrenia spectrum disorders. So far, research on their mutual influences has been patchy. This study simultaneously tests the associations between these variables.Methods.A total of 284 people with schizophrenia spectrum disorders were assessed using the Schedule for the Assessment of Insight, Positive and Negative Syndrome Scale, Integrative Hope Scale, Centre for Epidemiological Studies Depression Scale and Internalized Stigma of Mental Illness scale. Path analysis was applied to test the hypothesized relationships between the variables.Results.Model support was excellent. Strong and mutual causal influences were confirmed between hope, depression and self-stigma. The model supported the assumption that insight diminishes hope and increases depression and self-stigma. While negative symptoms directly affected these three variables, reducing hope and increasing depression and self-stigma, positive symptoms did not. However, positive symptoms diminished self-stigma on a pathway via insight.Conclusions.This study provides a comprehensive synopsis of the relationships between six variables relevant for schizophrenia spectrum disorders. Research implications include the need to investigate determinants of consequences of insight, and the sequence of influences exerted by positive and negative symptoms. Clinical implications include the importance of interventions against self-stigma and of taking a contextualized approach to insight.

Background:Within academic psychiatry, women are underrepresented in the higher academic ranks. However, basic determinants of women's lack of academic advancement such as publication activity are poorly understood. The present study examines women's publication activity in high-impact psychiatry journals over two decades and reports developments in the numbers of male and female authorship over time and across cultural areas.Methods:We conducted a retrospective bibliometric review of all articles published in 2004 and 2014 in three high-ranking general psychiatry journals. Statistical comparisons were made between the two years and with results from a baseline assessment in 1994.Results:The overall percentage of female authors increased from 24.6% in 1994 to 33.2% in 2004 to 38.9% in 2014. Though increases in female authorship were statistically significant for both decades, there was less difference between 2004 and 2014, indicating a possible ceiling effect. Rates of female first authors increased between 1994 and 2014, though to a lesser degree between 2004 and 2014. Numbers of female corresponding authors plateaued between 2004 and 2014. Within Europe, Scandinavia displayed the most balanced gender-wise first author ratios. Western European and Central European countries increased their rates of female first authors substantially between 2004 and 2014.Conclusions:Despite gains in some areas, our study reveals considerable deficits in the diversity of the current academic psychiatric landscape. Ongoing efforts and interventions to enhance the participation of underrepresented groups on institutional, political and editorial levels are necessary to diversify psychiatric research.

Recovery-orientation as the guiding principle of mental health policy is reshaping our scientific and clinical responsibilities. In contrast to a deficit model of mental illness recovery-orientation includes a focus on health promotion, individual strengths, and resilience. Patient self-determination, individual choice of flexible support in the community and opportunities, interventions to promote empowerment and hope also in the long-term are new indicators of quality of services. New tools and new rules for a partnership approach emerge allowing to tap the full potential of diverse experiences and forms of evidence. Cooperations outside therapeutic relationships concern participatory and user-led engagement in service development and evaluation as well as in mental health research. Recovery shares central elements and goals with those of human rights, particularly the UN-Convention on the Rights of Persons with Disabilities (CRPD), which specifically includes persons with disabilities from mental health problems.

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.

The active involvement of service users and relatives and friends is essential for the development of recovery-orientated mental health practice and research. However, accepting each other as equally entitled experts is still a challenge. In trialogue groups users, carers and friends and mental health workers meet regularly in an open forum that is located on 'neutral terrain' - outside any therapeutic, familial or institutional context - with the aim of discussing the experiences and consequences of mental health problems and ways forward. Trialogues offer new possibilities for gaining knowledge and insights and developing new ways of communicating beyond role stereotypes. They also function as the basis and starting point for trialogic activities on different levels, e.g. serving on quality control boards or teaching in trialogic teams, and different topics, e.g. a task force on stigma busting or a work group on trauma and psychosis. In German-speaking countries well over a hundred trialogue groups are regularly attended by altogether about 5,000 people. International interest and experiences are growing fast. Trialogues facilitate a discrete and independent form of acquisition and production of knowledge and drive relevant changes in forms of communication as well as in structures.

The number of women in medicine generally and in psychiatry specifically has increased considerably during the past 40 years, but the lack of advancement of women in academic medicine is still concerning. This study explores the changes in female authorship patterns in three high-impact general psychiatric journals.The authors categorized articles published in 1994 and 2007 by the Archives of General Psychiatry, The American Journal of Psychiatry, and The British Journal of Psychiatry according to the characteristics of the psychiatric research and the gender of each author for all articles.Overall, the percentage of female authors increased from 24.6% in 1994 to 33.6% in 2007. The authors found the greatest increases in the percentages of female authors in the areas most relevant to an academic career-first authorship (from 17.1% in 1994 to 35.3% in 2007) and original research articles (from 18.4% in 1994 to 42.7% in 2007)-and in articles on the topic with the most growth over the same time frame-neuroimaging (from 14.7% in 1994 to 43.2% in 2007). The percentages of female authors of editorials rose from only 13.5% in 1994 to 26.2% in 2007. In 2007, women made up only 25% of the editorial boards of the journals under study (up from 16% in 1994).Despite considerable gains, women still are underrepresented in academic psychiatry, including in leadership positions. Ongoing efforts and interventions are required to promote further advances and gender equity.

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.

SummaryAims– To review developments in recovery-focussed mental health services internationally.Methods– Two forms of ‘recovery’ which have been used in the literature are considered, and international examples of recovery-focussed initiatives reviews. A ‘litmus test’ for a recovery-focussed service is proposed.Results– ‘Clinical recovery’ has emerged from professional literature, focuses on sustained remission and restoration of functioning, is invariant across individuals, and has been used to establish rates of recovery. ‘Personal recovery’ has emerged from consumer narratives, focuses on living a satisfying, hopeful and contributing life even with limitations caused by the illness, varies across individuals, and the empirical evidence base relates to stages of change more than overall prevalence rates. Clinical and personal recovery are different. Two innovative, generalisable and empirically investigated examples are given of implementing a focus on personal recovery: the Collaborative Recovery Model in Australia, and Trialogues in German-speaking Europe. The role of medication is an indicator: services in which all service users are prescribed medication, in which the term ‘compliance’ is used, in which the reasoning bias is present of attributing improvement to medication and deterioration to the person, and in which contact with and discussion about the service user revolves around medication issues, are not personal recovery-focussed services.Conclusions– The term ‘Recovery’ has been used in different ways, so conceptual clarity is important. Developing a focus on personal recovery is more than a cosmetic change – it will entail fundamental shifts in the values of mental health services.Declaration of Interest: None.

Recovery from psychiatric disability is related to the idea of developing personal potentials and regaining a valid social role even with limitations caused by mental illness. The concept of Recovery as a movement builds on the engagement and concepts developed by people with a lived experience of psychiatric diagnoses, treatment, and rehabilitation efforts. The current orientation toward empowerment and patient self-determination in medicine at large as well as in psychiatry in particular puts new emphasis on subjective and individualized assessments and treatment approaches. The concept and practice of person-centeredness not only respect these developments, but do need them, having thus the potential to establish new forms of collaboration among clinicians, service users, and families through a common natural language.

Objective To capture the views on user involvement among employees in community mental health services in Austria. Methods The Consumer Participation Questionnaire (CPQ), assessing views on user involvement in individual treatment as well as in planning, delivery and evaluation of mental health services, and basic information on the participants, was administered to 181 professionals. The data were analysed using descriptive statistical procedures. Differences in the opinions of four occupational groups - social workers, psychologists, psychiatrists and "other social professions" - were calculated. Results The majority was supportive of user involvement and the expected benefit for clients and employees outweighed the anticipated risks. Differences in the views of professional groups arose in regards to setting therapeutic goals, evaluating services and the reasons assumed for clients not wanting to be involved. Conclusions There is an inconsistency between the positive attitude of community mental health staff regarding user involvement and the actual lack of practical experience with such involvement in service planning and delivery in German-speaking countries.

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.

OBJECTIVE: The internet is an increasingly important source of information for patients concerning their illness. This has to be borne in mind concerning its growing influence on communications between patients and clinicians. The aim of this study is to assess the quality of German-language information on schizophrenia on the internet. METHOD: Two searches of the terms schizophrenia and psychosis were conducted, using the Google search engine set to produce only German hits. The quality of the first hundred resulting sites was assessed according to a range of criteria, including diagnosis and therapy, links and interactive offers. RESULTS: Evidence-based medical information was provided by more than half of the sites resulting from the search term schizophrenia and by less than one third of psychosis hits. Information and discussion on the relationship between drugs and psychosis appeared almost exclusively under the term psychosis. CONCLUSIONS: It is suggested that mental health care professionals can use knowledge on what sort of information their patients are confronted with on the internet in order to assist them in profiting from this source of information.