Hans-Joachim Salize

Does the place of treatment influence the quality of life of schizophrenics

Rossler W, Salize HJ, Cucchiaro G, Reinhard 1, Kernig C. Does the place of treatment influence the quality of life of schizophrenics? Acta Psychiatr Scand 1999: 100: 142–148.

Prisoners with mental disorders in Europe.

The prevalence of psychiatric disorders in prisoners is substantially higher than in the general population.[1][1] Additionally, there is scientific evidence that the number of prison inmates with mental disorders is rising. As a consequence, the World Psychiatric Association has repeatedly voiced

What works for whom in a computer-mediated communication intervention in community psychiatry? Moderators of outcome in a cluster randomized trial

Objective:  An intervention to structure patient–key worker communication has been tested in a randomized controlled trial. The aim of this paper was to investigate effectiveness of the intervention in terms of moderators of effectiveness.

Wie viele Menschen in Deutschland sind schwer psychisch krank

OBJECTIVE Severe and chronic mental illness (SMI) is associated with complex care needs. Mental health care planning requires exact estimates of the number of SMI patients. METHODS Systematic search for conceptual and epidemiological work on SMI prevalence (age group 18 - 65 years) in Medline, Embase and PsycInfo. RESULTS To date there is no international consensus on the definition of severe mental illness, however, there are a number of international studies allowing an estimate for Germany. The number of those affected with a severe mental illness based on the present findings is estimated at 1% to 2% of adults between 18 and 65 years. This means, that in Germany, about 500,000 to 1 million people are in need for complex mental health care interventions. CONCLUSIONS The numbers estimated may serve as a first orientation in the field. Further research on SMI prevalence is urgently needed in order to inform a more precise mental health care planning process for people with SMI in Germany.

Exercise versus Nonexercise Activity: E-diaries Unravel Distinct Effects on Mood.

Introduction The association between physical activity and mood is of major importance to increase physical activity as a prevention strategy for noncommunicable diseases and to improve mental health. Unfortunately, existing studies examining how physical activity and mood wax and wane within persons over time in everyday life do show ambiguous findings. Taking a closer look at these studies reveals that the aggregation levels differ tremendously. Whereas mood is conceptualized as a three-dimensional construct, physical activity is treated as a global construct not taking into account its distinct components like exercise (such as jogging) and nonexercise activity (NEA; such as climbing stairs). Methods To overcome these limitations, we conducted an ambulatory assessment study on the everyday life of 106 adults over 7 d continuously measuring NEA via accelerometers and repeatedly querying for mood in real time via GPS-triggered e-diaries. We used multilevel modeling to derive differential within-subject effects of exercise versus NEA on mood and to conduct analyses on the temporal course of effects. Results Analyses revealed that exercise increased valence (beta = 0.023; P < 0.05) and calmness (beta = 0.022; P < 0.05). A tendency of decreasing energetic arousal (beta = −0.029) lacked significance. NEA, parameterized as 15-min episodes of physical activity intensity in everyday life, increased energetic arousal (beta = 0.135; P < 0.001) and decreased calmness (stand. beta = −0.080; P < 0.001). A tendency of increasing valence (beta = 0.014) lacked significance. Using longer time intervals for NEA revealed similar findings, thus confirming our findings. Conclusion Exercise and NEA differed regarding their within-subject effects on mood, whereas exercise increased valence and calmness, NEA increased energetic arousal and decreased calmness. Therefore, it appears necessary to clearly differentiate between exercise and NEA regarding their within-subject effects on mood dimensions in both research and treatment.

Within-Subject Associations between Mood Dimensions and Non-exercise Activity: An Ambulatory Assessment Approach Using Repeated Real-Time and Objective Data

A physically active lifestyle has been related to positive health outcomes and high life expectancy, but the underlying psychological mechanisms maintaining physical activity are rarely investigated. Tremendous technological progress yielding sophisticated methodological approaches, i.e., ambulatory assessment, have recently enabled the study of these mechanisms in everyday life. In practice, accelerometers allow to continuously and objectively monitor physical activity. The combination with e-diaries makes it feasible to repeatedly assess mood states in real-time and real life and to relate them to physical activity. This state-of-the-art methodology comes with several advantages, like bypassing systematic distortions of retrospective methods, avoiding distortions seen in laboratory settings, and revealing an objective physical activity assessment. Most importantly, ambulatory assessment studies enable to analyze how physical activity and mood wax and wane within persons over time in contrast to existing studies on physical activity and mood which mostly investigated between-person associations. However, there are very few studies on how mood dimensions (i.e., feeling well, energetic and calm) drive non-exercise activity (NEA; such as climbing stairs) within persons. Recent reviews argued that some of these studies have methodological limitations, e.g., scarcely representative samples, short study periods, physical activity assessment via self-reports, and low sampling frequencies. To overcome these limitations, we conducted an ambulatory assessment study in a community-based sample of 106 adults over 1 week. Participants were asked to report mood ratings on e-diaries and to wear an accelerometer in daily life. We conducted multilevel analyses to investigate whether mood predicted NEA, which was defined as the mean acceleration within the 10-min interval directly following an e-diary assessment. Additionally, we analyzed the effects of NEA on different time frames following the e-diary prompts in an exploratory manner. Our results revealed that valence significantly and positively predicted NEA within persons (p = 0.001). Feeling more energetic was associated with significantly increased NEA (p < 0.001), whereas feeling calmer was associated with significantly decreased NEA (p < 0.001) on the within-person level. The analyses on different time frames of NEA largely confirmed our findings. In conclusion, we showed that mood predicted NEA within adults but with distinct magnitudes and directions of effects for each mood dimension.

Evaluation of a DVD-Based Self-Help Program in Highly Socially Anxious Individuals--Pilot Study.

High social anxiety is a risk factor for the incidence of social anxiety disorder (SAD). Early diagnosis and intervention may prevent more severe psychiatric courses. Self-help programs may be a convenient, accessible, and effective intervention. This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety. A total of 24 highly socially anxious individuals were randomly assigned to a DVD-based self-help program or to a wait-list control group. The self-help program is based on the cognitive model according to Clark and Wells (1995; adapted to German by Stangier, Clark, & Ehlers, 2006) and comprises eight sessions. ANOVAs based on an intention-to-treat model were used for data analyses. The self-help program was well accepted; just one person withdrew during the intervention. There were significant Time× Group interactions on all primary outcome measures. For the intervention group moderate to high within-groups effect sizes up to Cohens d = 1.05 were obtained. Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention. The newly developed DVD-based self-help program seems to be a promising intervention for highly socially anxious individuals as it reduces social anxiety symptoms.

Evidence-based mental health services research. The contribution of some recent EU-funded projects

Thornicroft and Tansella [1] have addressed the issue of how community-based and hospital-based mental health care can be balanced. In looking at the prerequisites they emphasise (a) needs assessment at the country/regional level, the local level and the individual level, (b) strengthening the evidence base on treatment effectiveness, and (c) the task of looking at various interfaces between (i) the various components of the mental health service, (ii) those within the health service, i.e. between mental health and other health services, and (iii) those between health and other public services, including social services and housing departments.

INFOPAT-Projekt: Gesundheitsökonomische Evaluation einer IT-gestützten, praxisnetzbasierten komplexen Intervention für multimorbide DMP-Diabetes mellitus Typ 2 Patienten/innen

Mit dem Wettbewerb „Gesundheitsregionen der Zukunft: Fortschritt durch Forschung und Innovation“ unterstutzt das Bundesministerium fur Bildung und Forschung (BMBF) seit 2008 die Rolle des Gesundheitswesens in Deutschland als Wachstumsmarkt mit grosem Innovationspotenzial. Bisher haben Erfahrungen aus international erfolgreichen gesundheitswirtschaftlichen Modellen und vorangegangenen BMBF-geforderten Initiativen gezeigt, dass eine enge, regional fokussierte Vernetzung aller im Gesundheitswesen involvierten Akteure von besonderer Bedeutung fur eine optimale Nutzung vorhandener Innovationspotenziale in Wissenschaft und Wirtschaft sind. Genau diese Erkenntnis soll im Rahmen des BMBF-Wettbewerbs „Gesundheitsregionen der Zukunft“ aufgegriffen werden.

Psychiatrische Behandlungskosten von Patientinnen mit Posttraumatischer Belastungsstörung nach sexuellem Missbrauch vor und nach stationärer DBT-PTSD

Objective In Germany, patients with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (CSA) often receive inpatient treatment. However, data on utilization and costs of mental health care as well as on the impact of trauma-focused treatment are missing. Methods Within the context of a randomized controlled trial mental health service utilization was assessed in female patients with PTSD related to CSA. Data on psychiatric-psychotherapeutic inpatient and outpatient treatment and psychotropic medication was obtained for the year before and after inpatient DBT-PTSD. Results The mean total costs of utilization of psychiatric-psychotherapeutic care and use of psychotropics were € 18.100 per patient in the year before and € 7.233 in the year after DBT-PTSD. The significant cost decrease was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD), while outpatient treatment and psychotropic medication remained unchanged. Conclusion PTSD related to CSA is associated with high utilization and costs of mental health care. The results suggest that DBT-PTSD might contribute to reducing the mental health care costs.