Christian Schmidt-Kraepelin

Can an early weight management program (WMP) prevent olanzapine (OLZ)-induced disturbances in body weight, blood glucose and lipid metabolism? Twenty-four- and 48-week results from a 6-month randomized trial.

Abstract Objectives. This study was designed to investigate whether a preventive weight management program (WMP) reduces weight gain during olanzapine (OLZ) treatment. Moreover, we examined the effects of intervention on metabolic parameters. Methods. Patients (N = 100) with schizophrenia or schizoaffective disorder (DSM-IV) who had commenced treatment with OLZ were recruited. Following a run-in period of 4 weeks, 74 patients who had gained at least 1.5 kg body weight were randomized to receive either 12 bi-weekly WMP sessions (prevention group (PG), n = 36), or usual care (control group (CG), n = 38). Anthropometric and metabolic parameters were assessed after the 24-week intervention phase and a 24-week follow-up. Results. Forty-two percent of 74 participants (PG: 36.1%, CG: 47.4%) finished the 24-week intervention phase while 34% of them (PG: 30.6%, CG: 36.8%) completed the 48-week study. There was no significant difference in weight gain between groups (PG: + 3.4 ± 4.2 kg vs. CG: + 4.5 ± 6.1 kg, P = 0.184) after 24 weeks. Nevertheless, PG showed a significantly smaller increase in waist circumference than CG (PG: + 4.6 ± 8.3 cm, CG: + 10.1 ± 7.3 cm, P = 0.019) after 48 weeks. Furthermore, PG showed a significantly smaller increase in fasting glucose (P = 0.031) and 2-h glucose after oral glucose load (P = 0.018) than CG. Conclusions. These results suggest that preventive WMP may reduce the risk of abdominal obesity and deterioration of glucose metabolism in OLZ-treated patients.

Benchmarking in der psychiatrischen Akutbehandlung – Ein Modellprojekt im Klinikverbund☆

The aim of this project was to improve treatment processes and results in acutely ill inpatients within a network of nine psychiatric state hospitals of the Landschaftsverband Rheinland by introducing a benchmarking process. The project was based upon pre-existing measures of quality management. Patient groups were selected that were characterised by a severe clinical development or a high demand for mental health care services (alcohol abuse, depression of the elderly, schizophrenia). Room for improvement concerning specific hospitals and the overall hospital network were identified. The project was conducted with two patient cohorts before and after a quality-related intervention. Interventions were implemented for specific hospitals and the overall hospital network. Overall treatment documentations of 1,696 patients (1(st) cohort n=1,856, 2(nd) cohort n=1,696) were completed. Although there was no constant quantifiable statistically significant improvement of quality within the three patient groups (and certainly not with respect to the overall network), there was successful improvement of essential treatment processes for certain hospitals and the overall network under benchmarking. This was especially relevant where treatment recommendations were concerned. Future projects should focus on the conformance with treatment guidelines by defining both structural and process measures as a starting point and evaluation criterion.

Assessing the Intensity and Frequency of Symptoms of Mental Disorders in Patients with Neurological Disorders

Introduction Psychiatric comorbidity is an important aspect of neurological disorders. It affects about 30-50% of neurologic patients but is frequently underrecognized. Objectives Our objective was to determine the prevalence and severity of the symptoms of mental disorders in neurologic in-patients. Methods Between May and September 2014, all neurologic in-patients of a university neurologic center were asked to complete two self report questionnaires for assessing symptoms of mental disorders, namely the Beck Depression Inventory (BDI) and the Brief Symptom Inventory (BSI), which allow to assess a range of nine different psychiatric domains. We performed a multivariate covariance analysis in order to relate the type and frequency of symptoms of mental disorders with the neurological discharge diagnosis, while age, gender, and duration of in-patient treatment served as putative covariates. Results Of all responders (n = 157), 51% stated to have suffered from psychological distress within the past seven days, and 43% indicated depressive symptoms (21% mild, 17% moderate, 5% severe). The mean global severity index GSI (M = 0.64, SD = 0.52) exceeded the 1 SD range of healthy persons but was lower than that of psychiatric in-patients known from the literature. Furthermore, our subanalysis revealed different patterns of symptoms of mental disorders between neurologic patients with degenerative, vascular, demyelinating or epileptic disoders. Conclusion Psychometric measurement is useful to characterize the burden of the symptoms of mental disorders and will be used to further develop the psychiatric liaison services.

P03-239 - Complex intervention in schizophrenia. Results of an integrated care project in German psychiatry and psychotherapy

Introduction “High utilizing” schizophrenic patients are a problem in routine inpatient care. Objectives A complex intervention with improved cooperation between in- and outpatient services was applied to 46 “high utilizing” patients after discharge from inpatient care during an intervention phase of 6 months. The study was controlled by a matched group of 47 patients receiving treatment as usual. Aims The goal of this study was to prevent rehospitalizations and thus optimize satisfaction with treatment and quality of life in patients suffering from schizophrenia. Methods The intervention was based on a computerized decision support module. Eight psychiatrists in private practices were supplied with this software to obtain guideline-based recommendations according to current psychopathology and clinical state. A local hospital project team arranged specifically suggested interventions. Moderator variables such as socio-demographical aspects or influences of certain interventions to rehospitalization rate were analyzed Results Sociodemographical aspects showed no differences between both groups. The rehospitalization rate and the mean length of inpatient treatment were reduced to nearly 50% (Interventiongroup). The rate of readmissions increased in the control group, leading to a difference of 23% between both groups. Cost effectiveness was higher in the interventiongroup than in the controlgroup. Discussion The most important single factor was the participation in coping skills training, but only the guideline consistent complex therapies caused the significant overall result. Satisfaction increased during 6 months and remained constant during 12 months of follow up. The project described an important step to gain evidence for integrated care for patients with schizophrenia.