Markus Kösters

Psychopathological long-term outcome of schizophrenia – a review

In the past, the comparability of empirical studies that examined the course and outcome of schizophrenia was limited by their use of different diagnostic systems. Focussing on the psychopathological long‐term outcome, the present article aims to review follow‐up studies that used modern operationalized diagnostic criteria for schizophrenia (DSM‐III, DSM‐III‐R, DSM‐IV and ICD‐10).

Preliminary study of patterns of medication use for depression treatment in China

This systematic review investigated drug utilization for depression and assessed trends in prescriptions in China. Major Western and Chinese electronic databases were searched without language restriction for studies reporting defined daily doses. A total of 76 studies published between 2000 and 2010 reporting data on prescriptions for depression in China between 1996 and 2008 were included. All studies were published in Chinese. Most trials were conducted in urban areas in south and east China. Twenty‐nine drugs were reported as antidepressants. On the basis of defined daily doses, melitracen/flupentixol combination, fluoxetine, and paroxetine were the most frequently prescribed compounds. According to published evidence, selective serotonin reuptake inhibitors have become the most commonly prescribed class of antidepressant drugs in China.

Challenging mental health related stigma in China: Systematic review and meta-analysis. II. Interventions among people with mental illness

People with mental illness often face different types of mental illness stigma that may affect their lives, including perceived stigma, self-stigma, harmful coping strategies and poor quality of life. Although anti-stigma interventions for people with mental illness from Western countries have been identified by recent systematic reviews, their efficacy in China is unknown. This review evaluates the efficacy of anti-stigma interventions among people with mental illness in Mainland China, Hong Kong, Taiwan and Macau. A systematic search of 8 electronic databases in English and Chinese yielded 17 randomized and non-randomized controlled trials. Standardized mean differences (SMDs) were calculated wherever possible. Psychoeducation was the most commonly used intervention. SMDs were large and significant for perceived/experienced/anticipated stigma, self-prejudice and coping with stigma, as well as for depression and anxiety symptoms and quality of life. Both Cognitive Behavioral Therapy and psychoeducation had positive effects on perceived/experienced/anticipated stigma. The quality of studies was modest and heterogeneity across studies was high. Anti-stigma interventions demonstrated promise to reduce stigmas negative impact on people with mental illness in China, but more high-quality intervention research is needed.

Qualitätsindikatoren für die Behandlung von Menschen mit Schizophrenie – Ergebnisse einer Anwendungsstudie

Objective The study aimed to evaluate the applicability of a set of quality indicators to assess models of integrated care for patients with a diagnosis of schizophrenia. We report first values for these indicators in routine care in Germany. Methods The study is based on a cohort of adult patients with schizophrenia insured by one large German statutory health insurance company, which were assessed two times and gave consent to evaluate their routine claims data. The study tried to use 12 basic and 22 quality indicators from claims data. Results It was possible to estimate most structural indicators using available data, but only half of the quality indicators. This means that while assessment of quality indicators is feasible in general, routine claims data needs to be supplemented by additional (primary) data. Four of the calculated quality indicators had clear targets or red-flag values, which were not met in our cohort in all four indicators. None of the patients had an outpatient mental health related contact within one week (target > 90 %). The readmission rate within 30 days (21 %) was twice as high as the proposed red-flag value of 10 %. Similar figures were seen for antipsychotic polypharmacy (25 %, red-flag value > 10 %) and the proportion of patients with compulsory treatment (15 %) exceeded the red-flag value by 5 %. Conclusion The study shows that it is possible to measure quality indicators, but also demonstrates considerable limitations. There is a need to validate indicators in routine care.

Challenging mental health related stigma in China: Systematic review and meta-analysis. I. Interventions among the general public

Mental illness stigma is widely endorsed by the general public in China. Evidence-based anti-stigma interventions to reduce public stigma are needed. However, most studies on the efficacy of anti-stigma interventions took place in Western countries and existing Chinese studies were often not included in recent systematic reviews. This review evaluates the efficacy of anti-stigma interventions among the general population in Mainland China, Hong Kong, Taiwan and Macau. Eight databases in English and Chinese were searched for randomized and non-randomized controlled trials. Subgroup analyses compared interventions with and without consumer contact. Standardized mean differences were calculated from eligible studies where possible. We included 9 trials involving 2041 participants. Interventions yielded a small effect on stereotypes reduction and a similar effect on improving mental health literacy. No study assessed discrimination outcomes. Interventions with consumer contact were not superior to those without. There were insufficient data on medium and long term effects. Heterogeneity across studies was moderate. Quality of studies was modest. Further research using rigorous methods is required.

Psychosocial Interventions in People with Severe Mental Illness: A Bleulerian Perspective

Background: Eugen Bleuler, in his book Dementia praecox oder Gruppe der Schizophrenien, discussed issues of social psychiatry, and he considered complex interventions pivotal in the care for people with schizophrenia. Bleuler emphasised the potential of therapeutic communities in providing care, the drawbacks of extended hospitalisation and the therapeutic potential of planned ‘early discharge’ and job integration. Methods: Some of the current evidence on therapeutic communities, planned early hospital discharge, alternatives to inpatient care and job integration in people with severe mental illness are reviewed. Results: (i) Current evidence suggests that therapeutic communities (and new forms of milieu therapy, e.g. Soteria) are an effective ingredient of care; (ii) the evidence on planned early discharge suggests that there is scope for early discharge if continuity of care is ensured, and (iii) the evidence on supported employment suggests that there is scope for early job placement/supported employment among people with schizophrenia with little risk to clinical stability. Conclusion: Eugen Bleuler was a far-sighted social psychiatrist who concentrated on treatment issues and complex interventions that are considered cornerstones of care for people with severe mental illness one hundred years later.

The challenge of publishing clinically meaningful evidence

1. Depp CA, Bowie CR, Mausbach BT et al. Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness. Acta Psychiatr Scand 2015;131:333– 341. 2. ZinkM, Schirmbeck F, Rausch F et al. Obsessive-compulsive symptoms in at-risk mental states for psychosis: associations with clinical impairment and cognitive function. Acta Psychiatr Scand 2014;130:214–226. 3. Sandu AL, Paillere Martinot ML, Artiges E, Martinot JL. The 1910’s brains revisited. Cortical complexity in early 20th century patients with intellectual disability or with dementia praecox. Acta Psychiatr Scand 2014;130: 227–237.

Ethische Implikationen der psychiatrischen Versorgungsforschung

Das Kapitel widmet sich den allgemeinen und einigen speziellen ethischen Aspekten und Problemen der psychiatrischen Versorgungsforschung. Dabei wird ebenso auf die enge Verknupfung von (psychiatrischer) Versorgungsforschung mit der Versorgungspraxis eingegangen wie auf den Einfluss gesellschaftlicher Wertvorstellungen und (sozial)politischer Rahmenbedingungen, die in Form von (ethisch begrundeten) Qualitatsmerkmalen in Fragestellungen der psychiatrischen Versorgungs- und Evaluationsforschung uberfuhrt werden. Ihr besonderes Augenmerk richten die Autoren auf einige der konkreten ethischen Probleme, die sich in exemplarischen Teilbereichen der Versorgungsforschung (Metaanalyse, gesundheitsokonomische Studien, qualitative Verfahren) stellen und diskutieren diese unter Einbezug der zugrunde gelegten Theorien sowie eigener, praktischer Forschungserfahrungen.

Qualitätssicherung und psychiatrische Versorgungsforschung

Qualitatssicherung und psychiatrische Versorgungsforschung benotigen eine solide Evidenzbasis sowie Validitat von Qualitatsindikatoren, um eine praxisrelevante Beurteilung der Ergebnisqualitat zu ermoglichen. Dies wird anhand von methodischen Beispielen aus beiden Arbeitsgebieten untersucht und hergeleitet, wobei aufgrund der komplexen Behandlungsprozesse und der daraus resultierenden zahlreichen Einflussfaktoren der Expertenkonsens, theoretische Grundlagen und praktische Umsetzung groses Gewicht haben. Klinische Qualitatssicherung, Therapieprozessforschung und Studien zu komplexen Interventionen konnen sich gegenseitig bereichern. Hier besteht weiterer Forschungsbedarf.

P03-253 - Schizophrenia quality indicators for integrated care - results from a feasibility study

Introduction/objectives There is currently a variety of initiatives to improve the quality of care for schizophrenia, but there is no established core set of quality indicators in schizophrenia. In 2009, Weinmann and Becker published a set of indicators for quality monitoring of schizophrenia care. This study aims to evaluate the feasibility of these indicators. Methods Adult schizophrenic patients insured by the Federal Association of Local Health Insurance Funds (AOK) were recruited in two large psychiatric hospitals. Participants were evaluated using PANSS, CGI, Camberwell Assessment of Need-European Version (CAN-EU) and the Verona Service Satisfaction Scale (VSSS) at discharge and after six month. Furthermore, 18-month AOK administrative data was available for all patients included. Feasibility of structural and quality indicators described by Weinmann and Becker (2009) will be tested by applying the full set of indicators. Results 82 patients with a mean age of 40 and an average GAF score of 44.3 were included. We were able to calculate all indicators. Outpatient data was available with a delay of over six month. Patients had on average 1.6 additional psychiatric diagnoses (S1) and a mean length of stay of 44 days (S6). 67% of the patients were satisfied with the treatment received (Q17). 25% of the patients were re-admitted to an inpatient psychiatric care within 30 days after discharge. Conclusions The usage of Quality Indicators seems to be feasible in routine care. However, delay in the availability of outpatient data has to be considered if these indicators are implemented.