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Among the many reasons for the stigmatization of mental illnesses and those affected by it, the supposedly insufficient treatability plays a central role. In fact, treatability is not worse compared to various somatic diseases, although different factors impair the use and thus the effect of optimal treatment options. This is where measures to optimize treatment and care within the framework of quality psychiatry and psychotherapy come into play, whose resource-backed systematic introduction and implementation can contribute to overcoming stigma.This article examines whether and how the quality of psychiatric treatment and care can contribute to reducing stigmatizing attitudes in the general public and the stigma experienced or anticipated by persons with mental illnesses.Components of quality assured psychiatric treatment and care were identified at the conceptual level, which can hypothetically contribute to the destigmatization of persons with mental illnesses.The components of quality psychiatry that can contribute to the destigmatization of persons with mental illnesses include the implementation of regularly updated evidence-based treatment guidelines, the individualization of psychiatric treatment (precision psychiatry) and the application of quality indicators within the framework of comprehensive quality management. The postulated relationships must be empirically verified, further analyzed and communicated to the public to be made systematically useful for the destigmatization of mental illnesses.

Summary Background: The internal market of the European Union allows medical professionals, like psychiatrists, to work in their country of choice. Although the medical qualification is recognized in other countries, considerable differences in education remain. Objective: This article gives an overview of the current state of psychiatric training in Europe, previous efforts to harmonize it and future directions for action. Results: Psychiatric training in Europe is highly diverse. There is no official body within the European Union (EU) that is responsible for training harmonization. Despite previous efforts to generate common European standards for post-graduate training in psychiatry, the implementation continues to be a major challenge. Conclusion: The European Psychiatric Association (EPA), the European Union of Medical Specialists (UEMS), the World Health Organization (WHO) Europe and the European Federation of Psychiatric Trainees (EFPT) have decided to revive previous work on harmonized post-graduate education and created the Task Force on Education in European Psychiatry (TFEEP) in order to reach a training and education consensus in Europe. The creation of an attractive and high quality framework which is based on the needs of modern psychiatric practice and sensitive to European traditions and values is the main aim to be pursued in future.

Summary Background: After acute treatment of a first episode in schizophrenia, continued antipsychotic maintenance treatment (MT) is effective regarding (positive) symptom remission and relapse prevention. Nevertheless, due to unwanted effects patients and clinicians sooner or later are faced with the decision to continue or discontinue antipsychotics. Evidence indicates that risk for relapse or symptom recurrence is 2- to 5-times higher after personalized dose-reduction (PDR) or complete drug discontinuation, even if early intervention in case of early warning signs of relapse is applied. Method: A recent 7-year follow up of an 18 months RCT comparing MT with PDR however, revealed advantages of PDR regarding functional outcome and recovery. Although only one study with its specific characteristics limits generalization, the findings have newly fueled the debate whether early drug discontinuation-strategies have more risks or benefits. Result: The paper discusses the pros and cons of early drug discontinuation-strategies, in particular of PDR, after a first episode in schizophrenia and summarizes the empirical evidence to support patients and clinicians in this essential treatment decision.

Summary Introduction: The current refugee situation in Europa also leads to an increasing number of people with mental disorders. Which measures need to be taken to ascertain adequate mental healthcare for refugees during and after fleeing from their home countries? Methods: Review of the current tasks, areas of action and future challenges of refugee mental healthcare. Results: Refugee healthcare poses new challenges for the receiving and the transit countries. Besides dealing with the acute refugee situation, long term aspects of mental and general healthcare for refugees need to be considered. This will also include the reconstruction of the healthcare systems in the countries of origin of refugees.

Summary Background: One of the main measures of improving the quality of mental healthcare in Europe is to promote the implementation of effective healthcare services. The evaluation of such health-care models is needed to assess their effectiveness and efficiency. Objectives: The article points out the main methodological challenges of demonstrating the effectiveness and efficiency of mental healthcare models. Results: Implementing healthcare models is complex and includes several components and a high number of confounding variables. This makes it difficult to identify the “active ingredients”. The range of evaluation criteria is wide. Therefore, it is crucial to define the main aim of the intervention clearly and to choose evaluation assessments with relevance for these aims. Conclusion: Addressing the question how to evaluate mental healthcare models, evaluation studies have to provide information not only about the chosen evaluation criteria but also about the context, in which a healthcare model works.

Schizophrenia research is providing an increasing number of studies and important insights into the condition's etiopathogenesis based on genetic, neuropsychological and cranial neuroimaging studies. However, research progress has not yet led to the incorporation of such findings into the revised classification criteria of mental disorders or everyday clinical practice. By 2020, schizophrenia will most likely still be a clinically defined primary psychotic disorder. While there is some hope that treatment will be improved with new antipsychotic drugs, drugs addressing negative symptoms, more refined psychotherapy approaches and the introduction of new treatment modalities like transcranial magnetic stimulation, an additional hope is to improve early detection and prevention. As the results of new research into the etiopathogenesis of schizophrenia are promising to improve diagnosis, classification and therapy in the future, a picture of complex brain dysfunction is currently emerging requiring sophisticated mathematical methods of analysis. The imminent clinical challenge will be to develop comprehensive diagnostic and treatment modules individually tailored to the time-variable needs of patients and their families.

SummaryFor the development of ICD-11, the World Health Organization (WHO) has inaugurated a Working Group on the Classification of Psychotic Disorders (WGPD). A range of changes of the classification of primary psychotic disorders was developed by this group. While DSM-5 was published in 2013, the ICD-11 proposals are currently undergoing internet-based and clinical field trials and the final version is due in 2017. Among the major changes suggested by the WGPD for ICD-11 are the chapter titles, the replacement of the current schizophrenia subtypes by a number of symptom specifiers, a new set of course specifiers harmonized with DSM-5, transsectional diagnostic criteria for schizoaffective disorder, and a reorganization of the acute and transient psychotic disorders and delusional disorders.

Zusammenfassung Ausgangslage: Für den Bereich der psychischen Störungen wird ein innovatives Versorgungsmodell zur bedarfsorientierten Behandlung psychischer Erkrankungen (BBPE) vorgestellt, das aus den Kernelementen eines die Versorgung steuernden und koordinierenden Fall-managements, einem die stationäre und ambulante Versorgung integrierenden Community Mental Health Center und leitlinienorientierten Diagnostik- und Behandlungsmodulen besteht. Damit stellt dieses Versorgungsmodell auch eine mögliche Alternative zum derzeit in Entwicklung befindlichen neuen Entgeltsystem für die psychiatrisch-psychosomatisch-psychotherapeutische (PEPP) Versorgung dar. Methodik: Der Gesetzgeber hat über den § 64b SGB V die Voraussetzungen geschaffen, solche innovativen Ansätze im geschützten Rahmen eines Modellvorhabens zwischen Leistungsanbieter und Kostenträger im „Echtbetrieb“ erproben zu können. Innerhalb eines solchen Modellvorhabens bietet es sich an, in einer ersten Entwicklungsstufe die stationären, tagesklinischen und ambulanten Tätigkeiten einer psychiatrischen Klinik in einem Versorgungsbudget zusammenzufassen und die Leistungserbringung und Abrechnung über Behandlungsmodule abzubilden. Diese sind beispielhaft leitlinienbasiert für von einer Schizophrenie Betroffene entwickelt. Ziel: Ziel ist es, die Ergebnisse wissenschaftlich zu evaluieren, um die Grundlagen für eine Ausweitung des Modells auf andere psychische Störungen und eine Implementierung in anderen Regionen zu legen

SummaryThe European Psychiatric Association (EPA) is an association of individual members and national psychiatric societies with the aim to improve mental health care in Europe. In the last years, EPA has developed from an association of individuals into a representative stakeholder for European psychiatry and European psychiatrists. EPA is well connected with other stakeholders in the field of European psychiatry. To make good use of the potential of experts and experiences in the EPA in order to improve mental health care in Europe will be a challenge for the next years.

SummaryWithin the efforts to revise ICD-10, the World Health Organization (WHO) has appointed a disorder-specific Working Group on the Classification of Psychotic Disorders (WGPD). The WGPD has proposed several changes to the classification criteria of schizophrenia and other primary psychotic disorders in order to increase the clinical utility, reliability and validity of the diagnostic classification. The main proposals include changes to the chapter title, the replacement of existing schizophrenia subtypes with symptom specifiers, stricter diagnostic criteria for schizoaffective disorder, a reorganization of the delusional disorders and the acute and transient psychotic disorders, as well as the revision of course specifiers. These proposed revisions are subject to field trials with the aim of studying whether they will lead to an improvement of the classification system in comparison to its previous version. The proposals are compared with revisions of the according DSM-5 chapter. The impact of novel results from neuroscience and genetics on the current proposals is discussed, also with respect to future classification strategies such as the Research Domain Criteria (RDoC) project.

In spite of a well-developed and complex mental healthcare system in Germany, problems remain in the capacity of psychotherapeutic care with an undersupply and long waiting times for provision of outpatient psychotherapeutic care.The analyses address the current level of psychotherapeutic care and the role of individual medical specialties in outpatient psychotherapeutic care in Germany.The analyses are based on secondary data from three statutory health insurance companies and the German pension funds for the years 2005-2007. Anonymized treatment data from 3.3 million insured persons with a diagnosis of a mental disorder (ICD-10 groups F0-F5) were analyzed.In outpatient treatment 9,670,588 psychotherapeutic accounting codes were analyzed of which 33 % were psychiatric, psychosomatic or psychotherapeutic consultations that are not covered by the scope of psychotherapy according to the standard regulations (psychotherapy guidelines). The most frequently used psychotherapeutic services were verbal interventions (accounting codes 35.100 and 31.110) and psychiatric consultations (accounting codes 14.220, 21.220 and 21.221), independent of the mental disorder. Of the patients 5.9 % received directive psychotherapy. The provider-specific analysis showed a great variation in the kind of accounting codes, which were brought into account by the different providers.With regard to the reform efforts in psychotherapeutic care, longitudinal trends in the utilization and quality of psychotherapeutic care in the individual fields of treatment should be analyzed in follow-up studies.

R. G. M. Morris, W. Oertel, W. Gaebel, G. M. Goodwin, A. Little, P. Montellano, M. Westphal, D. J. Nutt and M. Di Luca Federation of European Neuroscience Societies (FENS), Bruxelles, Belgium European Academy of Neurology (EAN), Vienna, Austria European Psychiatric Association (EPA), Strasburg, France European College of Neuropsychopharmacology (ECNP), Utrecht, The Netherlands European Federation of Neurological Associations (EFNA), Bruxelles, Belgium Global Alliance of Mental Illness Advocacy Networks-Europe (Gamian-Europe), Bruxelles, Belgium European Association of Neurosurgical Societies (EANS), Gent, Belgium European Brain Council, Bruxelles, Belgium Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9-20133 Milan, Italy

Schennach R, Riesbeck M, Mayr A, Seemuller F, Maier W, Klingberg S, Heuser I, Klosterkotter J, Gastpar M, Schmitt A, Sauer H, Schneider F, Jager M, Wolwer W, Gaebel W, Moller H-J, Riedel M. Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients? Objective: To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2). Method: Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition. Results: Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition. Conclusion: Regarding long-term treatment, it seems more appropriate to base predictions of the patient’s maintenance of response not before 6 weeks of treatment.

ZusammenfassungDie Entwicklung von sektorenübergreifenden Qualitätsindikatoren für die Versorgung von Menschen mit psychischen Störungen wurde durch den Gemeinsamen Bundesausschuss auf den Weg gebracht. Wir beschreiben diese aktuelle Entwicklung und informieren über den Stand des Projektes zur Entwicklung von Qualitätsindikatoren durch die DGPPN für vier häufige psychische Störungen: Schizophrenie, Demenzen, Alkoholabhängigkeit und unipolare Depressionen.

ZusammenfassungEs wird die Frage untersucht, ob und wie sich mit den bisher vorliegenden Routinedaten aus der stationären psychiatrischen und psychosomatischen Versorgung und deren – unter der Entwicklung eines neuen Entgeltsystems sich abzeichnenden – Erweiterungen sowie unter den gegenwärtigen gesetzlichen Voraussetzungen ihrer Nutzbarkeit eine aussagefähige Versorgungsforschung durchführen lässt. Es wird skizziert, welche Untersuchungen bereits mit den bisherigen Daten möglich waren und welche Untersuchungen bereits realisiert wurden. Ferner wird analysiert, inwieweit die künftigen Erweiterungen der Routinedatenerhebung darüber hinausgehen werden und welche zusätzlichen Daten realistischerweise wünschenswert zu inkludieren wären.

ZusammenfassungMit Einführung des neuen Entgeltsystems in Psychiatrie und Psychosomatik sowie der Einführung neuer Versorgungsmodelle stellt sich die Frage, wie sich diese Entgelt- und Versorgungsmodelle auf die Qualität der psychiatrisch-psychotherapeutischen sowie der psychosomatischpsychotherapeutischen Behandlung auswirken. Darum bedarf es begleitend zur gegenwärtigen Einführung eines neuen Entgeltsystems für die Bereiche Psychiatrie und Psychosomatik auch der Einführung von qualitätsorientierten Versorgungsanalysen, wobei als eine der wichtigsten Voraussetzungen für eine sektorenübergreifende Qualitätsmessung konsentierte und valide Qualitätsindikatoren zu entwickeln sind. Dabei spielen neben der Abbildung der Strukturqualität psychiatrischer und psychosomatischer Versorgungseinrichtungen insbesondere Indikatoren der Prozess- und Ergebnisqualität eine zentrale Rolle, die nach Möglichkeit mit den routinemäßig verfügbaren Daten gut messbar sind, eine hohe Aussagekraft besitzen und Aspekte der Qualität der Behandlung über den gesamten Krankheitsverlauf und, wenn möglich, über Grenzen der Versorgungssektoren ambulant vs. stationär hinweg darstellen können. Dabei ist darauf zu achten, dass es nicht zu einem übermäßigen Dokumentationsaufwand zu Lasten der Behandlungsqualität kommt. In dem vorliegenden Beitrag wird ein möglicher Entwicklungsprozess für Qualitätsindikatoren in der Psychiatrie skizziert. Weiterhin werden einige Beispiele für bereits vorgeschlagene Qualitätsindikatoren für die Diagnostik und Behandlung der Schizophrenie und Depression vorgestellt. Abschließend bleibt festzuhalten, dass die aus der Entwicklung der Leitlinien abgeleiteten Qualitätsindikatoren ihre Praxistauglichkeit erst unter Beweis stellen müssen, um sinnvolle Steuerungswirkungen entfalten zu können.

Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data.The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods.In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO.An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.

Patients with mental illnesses, especially with schizophrenia, suffer from stigma and discrimination. In addition, the stigma is a barrier to recognising and treating patients with first-episode psychosis; however, a self-rating instrument that assesses the general burden due to stigma experiences is still lacking.A total of N = 48 patients with first-episode schizophrenia who were participants in the multicenter first-episode (long-term) study within the German Research Network on Schizophrenia, completed a newly developed self-rating questionnaire to assess the burden due to stigma experiences (B-STE). The following variables were analyzed as possible correlates: psychopathology (CGI, PANSS, CDSS and HAM-D), global functioning (GAF), social adjustment (SAS), self-esteem (FSKN), as well as quality of life (LQLP), subjective well-being under neuroleptic treatment (SWN) and anticipated stigma (PDDQ).Of the participants 25 % showed an increased burden due to stigma experiences, which correlated with a lower quality of life, lower subjective well-being under neuroleptic treatment, lower self-esteem and higher anticipated stigma. The results indicate that patients rated higher on the CGI scale who are at the same time better socially adjusted (SAS), are more intensely affected by the burden due to stigma experiences.The short self-rating instrument burden due to stigma experiences (B-STE) can help to identify patients who might benefit from therapeutic or educational interventions to support coping with stigma experiences.

Purpose:To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.Methods:We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).Results:Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).Discussion:There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.Conclusion:Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.

Zusammenfassung Ausgangslage: Es gibt seit 2006 in Deutschland eine Leitlinie für die Behandlung der Schizophrenie auf dem S3-Niveau der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Fragestellung: Die im Jahre 2006 von der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) publizierte S3-Leitlinie Schizophrenie befindet sich derzeit in einem umfangreichen Revisionsprozess. Die Notwendigkeit der Aktualisierung ergibt sich daraus, dass seit 2006 eine Vielzahl neuer klinischer Studien durchgeführt und publiziert worden sind, die eine neue Bewertung der Evidenzen für viele Bereiche erfordern. Daneben wurden viele methodisch hochwertige Meta-Analysen publiziert, die in verschiedenen Bereichen der Therapie eine Anpassung der Evidenzbewertung gebieten. Ziele: Es stehen zunehmend Fragen nach einer verbesserten Funktionsfähigkeit im Alltag, dem subjektiven Wohlbefinden und der Lebensqualität im Fokus der klinischen Praxis. Diese sehr relevanten klinischen Endpunkte sind in der letzten Version der S3-Leitlinie zwar erwähnt worden, besaßen aber noch nicht die heute gesellschaftlich und im Fach geforderte Relevanz.

ZusammenfassungDie Frühintervention bei schizophrenen Psychosen kann entweder im initialen Prodrom oder in der beginnenden ersten Episode stattfinden. Dies setzt eine zuverlässige Früherkennung von Risikopersonen voraus. Wir berichten über den Aufbau des zweistufigen Früherkennungsinventars ERIraos, bestehend aus einer Checkliste als Screeninginstrument und einer umfassenden Symptomliste und weiteren modularen Komponenten. Es werden erste Ergebnisse zur Reliabilität der Checkliste und zu ihrer Übereinstimmungsvalidität mit den interventionsrelevanten Einschlusskriterien berichtet.

ZusammenfassungAntipsychotika haben sich in der Langzeitbehandlung schizophren erkrankter Patienten als sehr effektiv erwiesen. Dennoch bedarf es weiterer Forschung, um die medikamentöse Langzeitbehandlung, insbesondere bei ersterkrankten schizophrenen Patienten zu optimieren. Unter dieser Zielsetzung wurde eine multizentrische klinische Studie im Rahmen des Kompetenznetzes Schizophrenie durchgeführt, die zwei Hauptfragestellungen untersucht: Gibt es Unterschiede in der Rezidivrate a) der postakuten einjährigen Erhaltungsmedikation mit einem niedrigdosierten typischen versus atypischen Antipsychotikum und b) anschließendem Fortführen versus Absetzen der neuroleptischen Medikation, jeweils ergänzt durch prodromgestützte Frühintervention. Erste Ergebnisse der abgeschlossenen Studie sprechen für eine rezidivprophylaktische Effektivität beider Neuroleptika bei einer hohen Abbruchquote. Dies verweist auf einen Bedarf an speziellen Programmen, um (ersterkrankte) schizophrene Patienten in der effektiven Behandlung zu halten. Entsprechend werden in einer Transfer-Phase Informations-und Fortbildungsmaterialien entwickelt, die zu einer verbesserten Versorgung ersterkrankter Patienten beitragen sollen.

ZusammenfassungDas Leben von Menschen mit einer psychischen Erkrankung wird nicht nur durch die Symptome und direkten Folgen der Erkrankung, sondern auch durch gesellschaftliche Stigmatisierung und Diskriminierung stark belastet. Unwissenheit, Vorurteile und Ängste vor psychisch Erkrankten führen nicht selten zu ihrer sozialen Ausgrenzung, Isolation und Benachteiligung auf allen Ebenen des gesellschaftlichen Lebens. Weltweit werden Antistigmaprogramme durchgeführt, um über Wesen und Behandlungsmöglichkeiten psychischer Erkrankungen aufzuklären und durch persönlichen Kontakt zu Betroffenen Stigmatisierung und Diskriminierung wirksam zu reduzieren. In Deutschland wurde im November 2004 in Berlin das “Nationale Programm zur Entstigmatisierung seelischer Erkrankungen” ins Leben gerufen. Das Programm ist eine Initiative der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) und des Vereins “Open the doors e.V.” unter Mitwirkung des Bundesgesundheitsministeriums für Gesundheit und Soziale Sicherung (BMGS). Schirmherrin ist Frau Bundesgesundheitsministerin Ulla Schmidt.

ZusammenfassungHintergrund: Zur Erfassung der psychiatrischen Versorgungsqualität bedarf es geeigneter Qualitätsindikatoren. Diese sollten neben der klinischen Relevanz die Perspektiven von Behandler und Patienten berücksichtigen, verschiedene Dimensionen der Behandlung abdecken und sich auf veränderbare Versorgungsaspekte beziehen. Ziel der Studie war die Entwicklung und Erprobung von Qualitätsindikatoren zur Erfassung von Prozess- und Ergebnisqualität in der stationären Depressionsbehandlung. Diese Indikatoren wurden für den systematischen Qualitätsvergleich zwischen den Kliniken (Benchmarking) genutzt. Methode: Eine Multicenter-Studie wurde von Oktober 2001 bis April 2004 in 10 psychiatrisch-psychotherapeutischen Kliniken durchgeführt. Ergebnisse: Die Behandlung von über 2000 depressiven Patienten wurde mittels BADO dokumentiert, die depressionsspezifisch modifiziert wurde. Die Ergebnisse für verschiedene Qualitätsindikatoren werden dargestellt und diese bezüglich Relevanz, Praktikabilität und Validität für die stationäre Depressionsbehandlung beurteilt. Diskussion: Die Ergebnisse bestätigen die in der Literatur diskutierten methodischen Schwierigkeiten von Qualitätsindikatoren. Für die stationäre Depressionsbehandlung werden sinnvolle Qualitätsindikatoren empfohlen. Ein Ausblick über den Nutzen der Qualitätsindikatoren und eines Krankenhausvergleichs wird gegeben.

Summary Objectives: In schizophrenia research, little attention yet has been directed on methods for analyzing data from studies with repeated measurements over time. Motivation for this research stems from a project within the German Research Network on Schizophrenia, in which an algorithm is developed to guide prodrome-based early intervention strategies in stable first episode patients. Methods: We present two different approaches for the analysis of correlated response data, the Generalized Estimating Equations (GEE) method and the Artificial Neural Network (ANN) approach. We illustrate the methods using the data of the A.N.I. study, which is one of the largest German multicenter treatment studies in regard to the long-term treatment of schizophrenia conducted between 1983 and 1989. Results: The results of statistical model selection prior to GEE analysis and various data presentation methods for ANNs are presented. The primary goal of our evaluation is to investigate if the defined prodromes are valid predictors for relapse. Additionally, it is shown that both methods are applicable on a realistic data set. Conclusions: It is concluded that both methods are suitable for predictor analysis especially since all variable time points of the patients are included instead of only selected, so that it can be assumed that results are not biased. With the GEE method a test of association for each predictor can be performed whereas with ANNs a general proposition can be made for pro-dromes depending on the type of data presentation. Using the A.N.I. data the prodrome ‘trouble sleeping’ seems to be the most informative predictor. Finally, the important differences of the two methods are discussed.

ResumenObjetivo:Se supone que el aumento global del alcoholismo femenino está asociado con el cambio del rol femenino tradicional, y se ve especialmente como consecuencia de la convergencia de los roles o los conflictos de los roles de género. El propósito del presente estudio piloto es explorar si el enfoque de la orientación del rol de género contribuiría de manera empíricamente útil a estas hipótesis.Método:Se exploró después de la destoxificación a 112 pacientes con dependencia del alcohol que cumplían los criterios del DSM-III-R; la orientación del rol de género se midió por una versión alemana del “Cuestionario de Atributos Personales Ampliado”, que clasifica la orientación del rol de género en cuatro subgrupos: masculino, femenino, andrógino e indiferenciado.Resultados:En comparación con una muestra basada en la población, hay diferencias significativas en la distribución de los cuatro subgrupos de orientación del rol de género, que muestran un predomino del autoconcepto indiferenciado en la muestra alcohólica (49%). Las mujeres alcohólicas se describen a sí mismas como más bien indiferenciadas, y más bien femeninas que masculinas. La masculinidad y la feminidad bajas, así como la feminidad alta, correlacionan positivamente con el sufrimiento, la depresividad, la ansiedad social, la inseguridad y los trastornos concomitantes de la personalidad.Conclusión:Nuestros datos no apoyan la hipótesis de la convergencia relacionada con la orientación del rol de género, pero apoyan el autoconcepto femenino tradicional como factor de riesgo inespecífico para la vulnerabilidad. Se debate la cuestión de si un autoconcepto indiferenciado podría ser un factor de riesgo específico para el alcoholismo.

The concept of schizophrenia has undergone many changes since its first inception in the early 20th century. Basically, the concept has stood the tests of time, as it provides useful information about the clinical picture, the clinical course and the available treatment modalities. Any alternative concept will need to show that it provides similar information. The concept has also been useful to establish evidence–based guidelines for diagnosis and treatment, and to provide valuable information as regards psychosocial outcomes. In addition, recent genetic and neurophysiological studies have shown that common grounds of aetiopathogenesis can be identified, in that schizophrenia is a mental disorder with some genetic influences and a common pathway in complex disturbances of brain circuits due to altered neurotranmission. Current research focuses on identifying biomarkers for early detection, another area of mental healthcare in which a staging model of schizophrenia proved useful. This presentation will highlight the most pertinent arguments for keeping schizophrenia as a useful diagnostic and therapeutic concept of a mental disorder.

Patients with psychotic disorders who were detained by public order because of endangerment, can be regarded as a population at risk of further endangerment, public order placements and a forensic course. Concepts of specific aftercare for this subgroup are lacking thus far. The present pilot study explores the feasibility of a modular therapeutic outpatient programme that is tailored to specific subgroup needs and is applied over six months. Readmission rates during the intervention period are regarded exploratively.Consecutive screening of all patients placed in general psychiatry by public order during 05 to 11/2012. Included patients received baseline measurements followed by six-month intervention. Individual utilisation of treatment modules and number of readmissions, differentiated according to legal bases were assessed.Inclusion rate: 17.4 % of all screened subjects (115) and 57 % of all potentially includable subjects, dropout rate: 15 %. Mean utilisation rate: 23.5 therapeutic contacts per 6 months. Readmission rate: 50 %, of these 60 % on voluntary legal basis.Study inclusion, mean utilisation and dropout rates attest the feasibility and acceptance of the intervention in the population under study. A preponderance of voluntary vs. compulsory readmissions to hospital during the intervention indicates that in the majority of patients a higher degree of therapeutic cooperativeness can be reached. Further study on reduction of compulsory readmissions and on avoidance of a forensic course by application of the here introduced intervention in combination with methods of risk assessment in a consecutive main project seems justified.

For several years, there has been a significant increase of the utilization of health care due to mental disorders in Germany. Epidemiologic studies dealing with the prevalence of mental disorders show that the prevalence of mental disorders haven't increased. In consideration of the relative stable prevalence, currently there are only speculations about the reasons for the increasing service utilization. The capacity of psychiatric-psychosomatic-psychotherapeutic health care services is increasing. Despite the fact that capacity is increasing, in the outpatient and inpatient sector it comes apparent that there is an increasing burden, indicating that the demand for mental health care is not met by the capacity of psychiatric-psychosomatic-psychotherapeutic health care services. Health care provision by general practitioners and somatic disciplines predominate, going along with low cross-disciplinary and coordinated cooperation. So far, cooperative, intersectoral care models for mental disorders have been realized only in individual projects. Valid data are lacking, which need to reveal the causes and especially the consequences of this situation of mental health care provision and provide reference standards for an optimized, need-based care planning. For this reason, it is imperative to advance quality management for the care of mental disorders. With a view to the high rates of somatic comorbidity, an expansion of cooperative forms of mental health care appears essential.

The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17 % of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness.

The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The objectives and the structure of the network with its horizontal and vertical networking of German research and care facilities served for the scientific investigation of open research questions for schizophrenia, and the transfer of the results into clinical practice. In this paper, the functioning and results of the GRNS are described on the basis of selected research projects. Quantitative and qualitative evaluation parameters such as scientific publications and additional external funds, as well as promotion of young scientists, public relations activities, congress activities and foundation of an European Schizophrenia Association demonstrate the successful work of the network. As a final point, the funding programme of the BMBF is critically evaluated using the example of the GRNS and future funding prospects are outlined.

The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization.A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire.The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses).Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.

Durch den Einsatz der hochauflosenden Computertomographie in der Diagnostik intrakranieller Erkrankungen nimmt die Beobachtungshaufigkeit idiopathischer Stammganglienverkalkungen zu. Ziel der vorliegenden Arbeit war es, den Zusammenhang zwischen idiopathischen Stammganglienverkalkungen und klinischen Symptomen zu uberprufen. Bei 2318 computertomographisch untersuchten selektierten Patienten fand sich eine Pravalenz von 12,5%, sowohl beim psychiatrisch, wie auch beim nicht psychiatrisch erkrankten Teil der Patienten. Hauptlokalisation war der Globus pallidus (96,4%). Eine Korrelation der Verkalkungen zu den mit dem Begriff “Fahr-Syndrom” in Verbindung gebrachten Symptomen konnte, ebenso wie eine Grosenabhangigkeit, fur die beobachteten Auspragungen nicht hergestellt werden.

Treatment guidelines provide evidence-based recommendations for diagnosis and treatment to assist clinicians, care givers and patients in finding an optimized treatment option in given clinical situations. Specific treatment guidelines for schizophrenia issued by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and published under the auspices of the Working Group for Scientific Medical Specialist Societies (AWMF) (i.e. fulfilling the highest quality standards at the S3 level) have been available in Germany since 2006. Currently, a comprehensive revision process is ongoing to update these guidelines with the aim to publish the revision before 2014. However, since publication of the German treatment guidelines many clinical trials and meta-analyses have been published which appear to make a new evaluation of antipsychotic drug treatment necessary. Currently available national and international guidelines, such as the WFSBP, PORT and NICE guidelines, place less emphasis on the general superiority of atypical antipsychotic medication but support the idea to evaluate antipsychotic drugs based on the side effect profiles. The present overview discusses the recent guidelines development processes regarding schizophrenia and compares the available German treatment guidelines with recently published international guidelines. Current developments and issues for discussion are described in detail to provide possible implications for changes in treatment recommendations.

Multifaceted evidence suggests that patients in the early phase of a psychotic disorder need a specific treatment strategy meeting their specific needs and problems in this "critical" phase of the disorder. The present review summarises this evidence and presents early treatment approaches according to already internationally established different models, while in Germany comparable concepts are only in a pilot stage. Previous evaluation studies showed a superior efficacy of such early treatment approaches compared to conventional standard treatment in terms of both clinical outcome and in relation to the total costs of treatment. Questions remain, however, especially with regard to the specificity and durability of such effects, and with regard to the effective treatment components. Before similar programmes can be broadly established in Germany, a consensus on their indispensable characteristics and appropriate quality indicators should be achieved.

Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia).The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators.Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed.It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.