Susanne Jaeger

Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment.

Längle G, Steinert T, Weiser P, Schepp W, Jaeger S, Pfiffner C, Frasch K, Eschweiler GW, Messer T, Croissant D, Becker T, Kilian R. Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment.

Behandlungsvereinbarungen in der Psychiatrie

OBJECTIVE To give an overview about definitions, practice and effects of joint crisis plans in psychiatry. METHOD Systematic literature review. RESULTS Different types of joint crisis plans have been emerging within the last decade mostly in North America and Great Britain. So far, scientific literature stems nearly exclusively from those countries. There is evidence from one RCT that joint crisis plans can reduce involuntary hospitalisation and involuntary treatment. In Germany, joint crisis plans are increasingly in use, but legal regulations do not exist and research is missing. CONCLUSIONS Joint crisis plans are considered as a useful instrument by service users and some professionals. Research is needed on target groups, acceptance, implementation strategies, and outcomes in Germany.

Basisdokumentation in der klinischen Praxis: Wie zuverlässig sind BADO-Daten?

OBJECTIVES To assess the quality of data recorded using a modified version of the German Psychiatric Basic Documentation (BADO) and to use this assessment as the basis for the development of a short version of the BADO. METHODS BADO codings of a random sample of 200 admitted cases in 2007 were compared to information retrieved from computer-based records for the same patients. RESULTS In general, the quality of data recorded using the BADO was good, particularly in terms of the accuracy and the completeness of the data. However, a comparative analysis of the data suggests that ambiguities in the coding of particular BADO items might reduce their sensitivity and precision. CONCLUSIONS Data recorded using the BADO is fit for the purposes of quality management and, with some limitations, for research applications. The short version of the BADO developed using the results of the evaluation, significantly enhances its user-friendliness and increases the reliability of the coded data.

Impact of the UN convention on the rights of persons with disabilities (UN-CRPD) on mental health care research - a systematic review.

BackgroundThe United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) aims at stimulating profound changes and social development in many areas of the society. We wanted to examine the impact of the convention on mental health care research up to now by a systematic review.MethodsWe searched relevant electronic databases for empirical studies from the area of mental health which focused directly on the content of the UN-CRPD.ResultsOne thousand six hundred ten articles were screened, 36 of which fulfilled the inclusion criteria and came from 22 different countries. 25 studies (69 %) are related to persons with intellectual disabilities, only 11 to other mental disorders. Study designs were quantitative and qualitative as well. Issues were realisation of the UN-CRPD, implementation and financing, development of instruments, and attitudes towards the UN-CRPD.ConclusionsIn contrast to possible wide-reaching consequences for the organisation of mental health care, theoretical debates prevail as of yet and empirical research is still scarce. Research on the UN-CRPD is more advanced for intellectual disabilities and provides good suggestions for relevant research aspects in major mental disorders.

Identification of psychopathological course trajectories in schizophrenia.

Course trajectory analyses have been performed primarily for treatment response in acute episodes of schizophrenic disorders. As yet, corresponding data for the long-term course are lacking. Within a multicenter prospective observational study, 268 patients with schizophrenia were assessed at discharge from hospital and followed up after 6, 12, 18, and 24 months. A latent class growth analysis was performed on the scores from the Positive and Negative Syndrome Scale (PANSS). A two-class conditional latent class model showed the best data fit (Entropy: 0.924). The model divided the sample into a group with amelioration in all PANSS subscales (60%) and a group with stable positive/negative and deteriorating general psychopathology symptoms (40%). Global functioning (GAF score), gender, age, living situation and involuntary admission predicted course trajectory class membership. The model was predictive of significant differences between the two groups in health care service costs and quality of life. The results underline the heterogeneous course of the illness, which ranged from amelioration to deterioration over a 2-year period. Statistical models such as trajectory analysis could help to identify more homogenous subtypes in schizophrenia.

Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland

AIMS Informal coercion is a frequently used form of communication among mental health professionals to influence treatment outcomes. This study investigates the recognition, attitude, and application of different forms of informal coercion by mental health professionals. METHODS Mental health professionals of five psychiatric institutions in Germany and Switzerland (n = 424) took part in an online survey assessing the recognition of, attitudes towards, and application of different forms of informal coercion. RESULTS Mental health professionals did not recognize the extent of informal coercion adequately; especially stronger forms were underestimated. Recognition and application of informal coercion was predicted by attitudes towards coercion. Furthermore, there were differences between profession of participants regarding the recognition and application of informal coercion. CONCLUSIONS It is important to realize that the extent of applied informal coercion in therapeutic communication is often not recognized by practitioners, although it might interfere with a sound therapeutic relationship.

Dissociation in patients with borderline personality disorder in acute inpatient care – A latent profile analysis

PURPOSE Dissociation is a common symptom in Borderline Personality disorder (BPD) and its consideration is important for the therapeutic outcome. The aim of this cross-sectional study was to scrutinize the co-occurrence of BPD symptoms and dissociative experiences. In particular, we were interested in the occurrence of specific symptom clusters characterizing qualitatively different patient groups in a clinical sample of BPD patients. BASIC PROCEDURES We analyzed the data of 103 patients in a specialized acute inpatient care crisis intervention unit. Measures were the Borderline Symptom List (BSL-95), a German adaption of the Dissociative Experience Scale (FDS), and the Symptom Checklist SCL-90-R. We applied a Latent Profile Analysis (LPA) using the subscales of BSL-95 and FDS to investigate the existence of distinct latent classes of symptom profiles. Afterwards, we related the obtained profiles to other clinical and demographic characteristics. MAIN FINDINGS Dissociative experiences of moderate to severe intensity were common among patients with BPD. LPA revealed that a model of three classes fitted the data best: one class was characterized by co-occurrence of severe borderline symptoms and frequent dissociative experiences, one class showed low symptom burden in both measures, and one class showed considerable borderline symptoms but only moderate dissociative experiences. The classes were closely related to the severity of other self-rated psychological problems and showed significantly different occurrences of stress-related comorbid disorders. PRINCIPAL CONCLUSIONS The results underline that dissociation is an important factor in many (but not all) BPD patients. This should be addressed by increased attention to dissociative symptoms in the diagnostic process and the adjustment of treatment plans.

Pregabalin Use Among Users of Illicit Drugs: A Cross-Sectional Survey in Southern Germany

BackgroundThe antiepileptic drug pregabalin is one of the best-selling pharmaceutical products worldwide. There are increasing concerns about its potential for misuse and dependence especially among patients with former or current substance use disorders (SUDs).ObjectiveOur objective was to clarify the extent and pattern of pregabalin use as well as motives and predictors in this population.MethodsWe conducted a cross-sectional study with patients on a detoxification ward for illicit drugs at the Center for Psychiatry, Südwürttemberg, Ravensburg in southern Germany from August 2012 until July 2013. We used an extensive questionnaire, part of the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) Axis I Disorders (SCID-I) and urine samples.ResultsOf the 253 participating patients, 56% had used pregabalin at least once. Of these, 92% had acquired it at least in part from illegal sources. The main motives for the use of pregabalin were the attenuation of opioid withdrawal symptoms, the augmentation of other psychotropic substances, and the psychotropic effects of pregabalin itself. Predictors for pregabalin use were opioid and sedative use as well as younger age. The criteria of dependency according to DSM-IV was met by 11% of pregabalin users and 13% of urine samples were positive for pregabalin.ConclusionsUse of pregabalin is common among users of illicit drugs in large parts of southern Germany, with motives for use, acquisition, and mode of use suggesting misuse. The mode of use, especially intake of high doses and concomitant use of other drugs, poses a serious risk to this population, including the development of dependency.

In depression, increased psychological reactance is associated with poorer treatment compliance

Commentary on : De Las Cuevas C, Penate W, Sanz EJ. The relationship of psychological reactance, health locus of control and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression. BMC Psychiatry 2014;14:324.[OpenUrl][1][CrossRef][2][PubMed][3] Although it is a challenge to successful treatment of depression, medication non-adherence is a prevalent phenomenon. There is evidence that attitudes and beliefs are at least as important as side-effects in … [1]: {openurl}?query=rft.jtitle%253DBMC%2BPsychiatry%26rft.volume%253D14%26rft.spage%253D324%26rft_id%253Dinfo%253Adoi%252F10.1186%252Fs12888-014-0324-6%26rft_id%253Dinfo%253Apmid%252F25412702%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1186/s12888-014-0324-6&link_type=DOI [3]: /lookup/external-ref?access_num=25412702&link_type=MED&atom=%2Febnurs%2F18%2F4%2F113.atom

W05-03 - A Multi-Centre Pragmatic Trial of Antipsychotic Drug Treatment

The ELAN study is a prospective multi centre observational trial on the effectiveness and safety of long-term antipsychotic treatment of people with schizophrenia or schizoaffective disorders with quetiapine in comparison to olanzapine and risperidone under real world treatment conditions. 374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine or risperidone were included at discharge from inpatient treatment. Psychotropic regimen, psychopathological symptoms, general and cognitive functioning, negative side-effects and quality of life were assessed before discharge and at 6, 12, 18 and 24 month follow-up assessments. Intention-to-treat analyses and crossover analyses were conducted by mixed-effects regression models including random linear time effects and time x treatment effects, controlling for baseline differences and additional psychotropic medication and using propensity scores to control for selection bias. As indicated by significant linear time effects the patients improved with regard to psychopathological symptoms, general functioning, subjective quality of life and cognitive processing speed. No change of extrapyramidal motor side-effects, body mass index or waist circumference was obtained. The lack of any significant time x treatment interaction effects indicated no differences in the safety or effectiveness between the three antipsychotics. Nevertheless, the average hospital admission rate of patients receiving olanzapine was lower in comparison to patients receiving quetiapine or risperidone.