Hermann Spiessl

Suicidal behaviour of psychiatric in‐patients

Objective: The study aimed to examine suicidal behaviour before and during in‐patient care in a psychiatric state hospital.

Cyber-support: An analysis of online self-help forums (online self-help forums in bipolar disorder)

Background: The Internet is becoming increasingly important in psychiatry and psychotherapy. Aims: The objective of this study was to evaluate if and how online self-help forums are used by patients with bipolar disorders, their relatives and treating professionals. Methods: A total of 2400 postings in two online forums were analysed qualitatively and quantitatively. Results: “Disclosure”, “friendship” and “online-group cohesion” were the main self-help mechanisms. The topics most discussed were “social network”, “symptoms of the illness” and “medication”. Factor analyses revealed three factors concerning self-help mechanisms: “group cohesion”, “emotional support” and “exchange of information”, as well as three factors concerning fields of interest: “illness-related aspects”, “social aspects” and “financial and legal issues”. Conclusion: We infer that the main interest in participating in online forums for patients with bipolar disorders and their relatives is to share emotions and to discuss their daily struggles with the illness. Our study also reveals that social networking is very important for patients coping with bipolar disorders. Psycho-educative programmes should focus on those aspects.

Burden, rewards, and coping--the ups and downs of caregivers of people with mental illness.

Abstract Besides burden, we need to examine potential rewards of caregiving and coping strategies to determine effective means of supporting caregivers of people with mental illness. Therefore, we conducted semistructured interviews with 60 caregivers of patients with mental illness and analyzed the transcripts with a summarizing content analysis. The interviews focused on negative and positive aspects of providing care and on coping strategies; the latter was also evaluated with the Freiburg Questionnaire on Coping with Illness. The caregivers named 787 individual statements of burden and 413 individual statements of rewards. A factor analysis of the rewards identified growth in character as the main factor. The items with the highest factor loading are increase in self-confidence, inner strength, maturity, and life experience. Linear regression and regression tree analysis identified predictors for caregiver burden. To effectively reduce the burden on caregivers, we need knowledge about their concrete burdens. However, to optimize resource orientation, we must also pay much more attention to the potential rewards of caring.

The forgotten caregivers: Siblings of schizophrenic patients

Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: “Handling the symptoms of illness” (100%), “Emotional burden due to the illness of the sibling” (100%) and “Uncertainty in judging what amount of stress the patient can cope with” (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.

Wer kommt woher, wer geht wohin? : Behandlungswege stationär-psychiatrischer Patienten

ZusammenfassungAuf Grundlage der psychiatrischen Basisdokumentation wurden Prädiktoren für Einweisung und ambulante Weiterbehandlung in Regressionsmodellen an 4066 Patienten analysiert. 25,7% der Patienten kamen ohne Einweisung selbstständig zur Aufnahme, 18,4% wurden vom Allgemeinarzt, 9,8% vom Nervenarzt/Psychiater überwiesen. Vom Allgemeinarzt kamen vermehrt Bewohner von Alten-/Pflegeheimen und Patienten mit affektiver Störung oder Schizophrenie. Von Nervenärzten/Psychiatern eingewiesene Patienten waren häufiger Bewohner therapeutischer Wohnheime, länger als 3 Monate erkrankt und mit Atypika oder SSRI vorbehandelt. Für 83,1% aller Patienten wurde eine Weiterbehandlung eingeleitet, meist durch den Allgemeinarzt (49,4%) oder Nervenarzt/Psychiater (32,1%). Die Weiterbehandlung durch den Allgemeinarzt erfolgte häufiger bei älteren Patienten und Suchterkrankungen. Eine Einweisung durch den Nervenarzt/Psychiater und die Diagnose einer Schizophrenie oder affektiven Störung führten vermehrt zur Weiterversorgung durch den Facharzt. Angesichts der geringen Zuweisungsrate von Allgemeinärzten und Nervenärzten/Psychiatern muss eine Verbesserung der Zusammenarbeit angestrebt werden.SummaryBased on data of the psychiatric basic documentation of 4066 patients, predictors of type of referral as well as outpatient aftercare were analyzed by means of logistic regression analyses. Of the patients, 25.7% were admitted without any referral, 18.4% were referred by a general practitioner, and 9.8% by a psychiatrist in private practice. Patients referred by a general practitioner suffered more frequently from an affective disorder or schizophrenia and were residents of senior citizen homes. Inpatients sent by a psychiatrist were more often residents of sheltered homes, showed a present episode lasting more than 3 months, and had undergone psychopharmacological pretreatment with an atypical antipsychotic or SSRI. Outpatient aftercare was recommended to 83.1% of inpatients: 49.4% by a general practitioner and 32.1% by a psychiatrist in private practice. Outpatient aftercare by a general practitioner was more frequent in the elderly and patients with addiction disorders. Referral by a psychiatrist in private practice as well as schizophrenia or an affective disorder led more often to outpatient aftercare by a psychiatrist. The small number of patients referred by general practitioners and psychiatrists in private practice has to become the focus of quality management.

Time patterns of inpatient suicides

Abstract Objective. Time patterns of suicides have been investigated in many population-based studies, but there are no studies exploring time patterns of suicides during psychiatric inpatient stay up to now. Methods. All inpatient suicides (1998–2007) of a psychiatric university hospital were identified by the German psychiatric basic documentation system (DGPPNBADO). Descriptive and univariate analyses were performed to analyse time patterns of inpatient suicides. Results. No significant differences could be found for the occurrence of the 37 inpatient suicides due to season (χ2=1.595, P=0.696), month (χ2=4.838, P=0.958) or weekday (χ2=5.189, P=0.550) of suicide. Furthermore, we could not find an unequal distribution of suicides due to month of birth (χ2=12.622, P=0.337). 78.4% of inpatient suicides occurred within 50 days after admission. Fourteen inpatients committed suicide around public holidays, two around their birthday. Conclusions. Apart from a notably enhanced risk of suicide in the period after admission, we could not find any time patterns to be of high relevance to inpatient suicides. There may be more relevant risk factors than cyclic or temporal variations.

[Who comes from where and who goes where? Treatment methods for psychiatric inpatients].

ZusammenfassungAuf Grundlage der psychiatrischen Basisdokumentation wurden Prädiktoren für Einweisung und ambulante Weiterbehandlung in Regressionsmodellen an 4066 Patienten analysiert. 25,7% der Patienten kamen ohne Einweisung selbstständig zur Aufnahme, 18,4% wurden vom Allgemeinarzt, 9,8% vom Nervenarzt/Psychiater überwiesen. Vom Allgemeinarzt kamen vermehrt Bewohner von Alten-/Pflegeheimen und Patienten mit affektiver Störung oder Schizophrenie. Von Nervenärzten/Psychiatern eingewiesene Patienten waren häufiger Bewohner therapeutischer Wohnheime, länger als 3 Monate erkrankt und mit Atypika oder SSRI vorbehandelt. Für 83,1% aller Patienten wurde eine Weiterbehandlung eingeleitet, meist durch den Allgemeinarzt (49,4%) oder Nervenarzt/Psychiater (32,1%). Die Weiterbehandlung durch den Allgemeinarzt erfolgte häufiger bei älteren Patienten und Suchterkrankungen. Eine Einweisung durch den Nervenarzt/Psychiater und die Diagnose einer Schizophrenie oder affektiven Störung führten vermehrt zur Weiterversorgung durch den Facharzt. Angesichts der geringen Zuweisungsrate von Allgemeinärzten und Nervenärzten/Psychiatern muss eine Verbesserung der Zusammenarbeit angestrebt werden.SummaryBased on data of the psychiatric basic documentation of 4066 patients, predictors of type of referral as well as outpatient aftercare were analyzed by means of logistic regression analyses. Of the patients, 25.7% were admitted without any referral, 18.4% were referred by a general practitioner, and 9.8% by a psychiatrist in private practice. Patients referred by a general practitioner suffered more frequently from an affective disorder or schizophrenia and were residents of senior citizen homes. Inpatients sent by a psychiatrist were more often residents of sheltered homes, showed a present episode lasting more than 3 months, and had undergone psychopharmacological pretreatment with an atypical antipsychotic or SSRI. Outpatient aftercare was recommended to 83.1% of inpatients: 49.4% by a general practitioner and 32.1% by a psychiatrist in private practice. Outpatient aftercare by a general practitioner was more frequent in the elderly and patients with addiction disorders. Referral by a psychiatrist in private practice as well as schizophrenia or an affective disorder led more often to outpatient aftercare by a psychiatrist. The small number of patients referred by general practitioners and psychiatrists in private practice has to become the focus of quality management.

Are there associations between caregiver information and suicidal behavior in psychiatric inpatients

Objective: The study aimed at exploring associations between inpatient suicides/attempted suicides in a psychiatric hospital and involvement of family caregivers in treatment. Methods: Based on the German psychiatric basic documentation systems (DGPPN-BADO), we analyzed a total sample of 49,257 cases of inpatient care (1998–2007) from a large psychiatric tertiary care university hospital and as a subsample all cases of schizophrenia, depression, acute stress/adjustment disorders and personality disorders (n = 22,880). Involvement of family caregivers was evaluated according to the following variables: admission to hospital due to recommendation of caregiver, conversation between therapist and caregiver, psychoeducation of caregiver as well as psychopharmacological and/or psychotherapeutic non-compliance of patient. Descriptive and bivariate analyses were performed. Results: Of the 22,880 cases in the subsample, 31 inpatient suicides and 198 attempted inpatient suicides were recorded. We could not find any significant associations of caregiver involvement variables with inpatient suicide. In contrast, for the total sample (n = 49,257), attempted suicide was associated with more conversation between therapists and caregivers (χ2 = 3.863, df = 1, p = 0.049) and with psychopharmacological (χ2 = 4.822, df = 1, p = 0.028) and psychotherapeutic (χ2 = 13.041, df = 1, p = 0.000) non-compliance of the patients. Conclusion: Further research is needed regarding the influence of caregivers on suicidal behavior of mentally ill inpatients.

[Documentation in psychiatry and psychotherapy: prerequisites and clinical practice].

BACKGROUND As a result of changes to the legal and economic framework over the past years, medical documentation has changed substantially. METHODS Based on a literature search of important medicolegal studies and appeal decisions, an overview is given of legal principles and their practical consequences, especially for the fields of psychiatry and psychotherapy. RESULTS Documentation is a contractual and crime-related duty arising from the professional code for doctors and the legal obligation to provide documentation. In addition to being a memory aide for the doctor, its purposes are to safeguard and justify the treatment and to provide legal evidence. The documentation should be provided in a format that is sufficiently clear for specialist staff, using keywords, possibly handwritten, and use contemporary terminology. All important diagnostic and therapeutic measures must be documented. This is particularly important when the treatment deviates from standard treatment and in medical procedures aiming to protect the patient. CONCLUSIONS The legal requirements for documentation are becoming more stringent. The time spent on such activities has so far not been reimbursed by the financing bodies.ZusammenfassungHintergrundUnter den sich in den letzten Jahren gewandelten rechtlichen und ökonomischen Rahmenbedingungen haben sich erhebliche Änderungen für die (ärztliche) Dokumentation ergeben.MethodeBasierend auf einer Literaturrecherche wesentlicher medizinjuristischer Arbeiten und Gerichtsurteile höherer Instanzen wird eine Übersicht zu rechtlichen Grundlagen und ihren praktischen Konsequenzen insbesondere für das Fachgebiet Psychiatrie und Psychotherapie gegeben.ErgebnisseDie Dokumentationspflicht ergibt sich als vertraglich und deliktisch begründete Pflicht, aus der Berufsordnung für Ärzte sowie als gesetzliche Dokumentationspflicht. Zweck der Dokumentation sind neben der Gedächtnisstütze des Arztes die Therapiesicherung, Rechenschaftslegung und Beweissicherung. Die Dokumentation soll in einer für Fachpersonen hinreichend klaren Form erfolgen, in Stichworten, auch handschriftlich und immer zeitnah. Es müssen alle wesentlichen diagnostischen und therapeutischen Maßnahmen dokumentiert werden. Dies ist besonders wichtig bei Abweichen von der Standardbehandlung.SchlussfolgerungenDie Rechtsprechung stellt immer höhere Anforderungen an die Dokumentation. Der hierzu notwendige Zeitaufwand wird bisher von den Kostenträgern nicht finanziert.SummaryBackgroundAs a result of changes to the legal and economic framework over the past years, medical documentation has changed substantially.MethodsBased on a literature search of important medicolegal studies and appeal decisions, an overview is given of legal principles and their practical consequences, especially for the fields of psychiatry and psychotherapy.ResultsDocumentation is a contractual and crime-related duty arising from the professional code for doctors and the legal obligation to provide documentation. In addition to being a memory aide for the doctor, its purposes are to safeguard and justify the treatment and to provide legal evidence. The documentation should be provided in a format that is sufficiently clear for specialist staff, using keywords, possibly handwritten, and use contemporary terminology. All important diagnostic and therapeutic measures must be documented. This is particularly important when the treatment deviates from standard treatment and in medical procedures aiming to protect the patient.ConclusionsThe legal requirements for documentation are becoming more stringent. The time spent on such activities has so far not been reimbursed by the financing bodies.