Ulrich Junghan

Multiple sclerosis and other immunologic diseases

A characteristic feature of immunologic diseases is their association with each other. For multiple sclerosis (MS), several retrospective studies reported increased as well as expected coincidence rates with other immunologic diseases. We conducted a prospective case‐control study of MS patients and healthy volunteers and found 13/101 MS patients and 2/97 controls with such diseases (P= 0.009, chi‐square test), as well as 47/88 MS patients versus 31/95 controls with a variety of circulating autoantibodies (P= 0.004, chi‐square test). These results speak for an increased coincidence of MS with other immunologic diseases and support the idea that MS is also an immunologic disease.

Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: a pooled analysis.

Subjective quality of life (SQOL) is an important outcome in the treatment of patients with schizophrenia. However, there is only limited evidence on factors influencing SQOL, and little is known about whether the same factors influence SQOL in patients with schizophrenia and other mental disorders. This study aimed to identify the factors associated with SQOL and test whether these factors are equally important in schizophrenia and other disorders. For this we used a pooled data set obtained from 16 studies that had used either the Lancashire Quality of Life Profile or the Manchester Short Assessment of Quality of Life for assessing SQOL. The sample comprised 3936 patients with schizophrenia, mood disorders, and neurotic disorders. After controlling for confounding factors, within-subject clustering, and heterogeneity of findings across studies in linear mixed models, patients with schizophrenia had more favourable SQOL scores than those with mood and neurotic disorders. In all diagnostic groups, older patients, those in employment, and those with lower symptom scores had higher SQOL scores. Whilst the strength of the association between age and SQOL did not differ across diagnostic groups, symptom levels were more strongly associated with SQOL in neurotic than in mood disorders and schizophrenia. The association of employment and SQOL was stronger in mood and neurotic disorders than in schizophrenia. The findings may inform the use and interpretation of SQOL data for patients with schizophrenia.

Reduced perception of the motion-induced blindness illusion in schizophrenia

Motion-induced blindness (MIB) occurs when target stimuli are presented together with a moving distractor pattern. Most observers experience the targets disappearing and reappearing repeatedly for periods of up to several seconds. MIB can be viewed as a striking marker for the organization of cognitive functioning. In the present study, MIB rates and durations were assessed in 34 schizophrenia-spectrum disorder patients and matched controls. The results showed that positive symptoms and excitement enhanced MIB, whereas depression and negative symptoms attenuated the illusion. MIB was more frequently found in normal subjects. The results remained consistent after adjusting for reaction time and error rates. Hence, MIB may provide a valid and reliable measure of cognitive organization in schizophrenia.

Gemeindeintegrierte Akutversorgung Möglichkeiten und Grenzen

ZusammenfassungDie Verlagerung der psychiatrischen Versorgung in das Gemeindeumfeld der Patienten ging einerseits mit einer Reduktion der Anzahl Klinikbetten und der stationären Behandlungsdauer einher, war gleichzeitig aber mit einer Zunahme stationärer Aufnahmen verbunden. Zu dieser Entwicklung scheint insbesondere die primäre Ausrichtung von gemeindepsychiatrischen Diensten auf die Nachsorge beigetragen zu haben. Für die Weiterführung der psychiatrischen Versorgungsreformen erscheint daher von zentraler Bedeutung, ob durch einen stärkeren Einbezug von gemeindenahen Ansätzen zur Behandlung akuter Krankheitsepisoden dieses “Drehtürsystem” durchbrochen werden kann. Seit Mitte der 60er-Jahre haben sich durch eine Reihe kontrollierter Studien vor allem 2 Modelle gemeindeintegrierter Akutversorgung etabliert: die Akutbehandlung im häuslichen Umfeld der Patienten und die Behandlung akuter Krankheitsepisoden in einer Tagesklinik. Diese beiden Ansätze erzielen bei einem Teil der Patienten im Allgemeinen die gleiche Wirkung wie die vollstationäre Akutbehandlung, deren Bedarf sie entsprechend senken. Sie stellen damit eine kosteneffektive Ergänzung der bestehenden psychiatrischen Regelversorgung dar.SummaryThe shift of psychiatric care from the hospital to the community has been accompanied by a reduction of hospital beds and shortened durations of inpatient treatment, but also by an increase in admissions. This evolution may be largely attributed to the prime focus of community mental health institutions on rehabilitation. The continued implementation of reforms in psychiatric care is contingent upon effectively halting the “revolving door phenomenon” by incorporating community-integrated treatment approaches into the care of acutely ill patients. Since the mid-1960s, a series of studies have established the efficacy of two community-integrated modalities for the treatment of acute psychiatric illness, i. e. home-based and day hospital treatment. In general, these approaches not only seem to be as effective as inpatient care for certain groups of patients but also reduce their need of hospitalisation, thereby contributing towards a cost effective, comprehensive psychiatric care system.

Altered perception of apparent motion in schizophrenia spectrum disorder

Apparent motion (AM), the Gestalt perception of motion in the absence of physical motion, was used to study perceptual organization and neurocognitive binding in schizophrenia. Associations between AM perception and psychopathology as well as meaningful subgroups were sought. Circular and stroboscopic AM stimuli were presented to 68 schizophrenia spectrum patients and healthy participants. Psychopathology was measured using the Positive and Negative Syndrome Scale (PANSS). Psychopathology was related to AM perception differentially: Positive and disorganization symptoms were linked to reduced gestalt stability; negative symptoms, excitement and depression had opposite regression weights. Dimensions of psychopathology thus have opposing effects on gestalt perception. It was generally found that AM perception was closely associated with psychopathology. No difference existed between patients and controls, but two latent classes were found. Class A members who had low levels of AM stability made up the majority of inpatients and control subjects; such participants were generally young and male, with short reaction times. Class B typically contained outpatients and some control subjects; participants in class B were older and showed longer reaction times. Hence AM perceptual dysfunctions are not specific for schizophrenia, yet AM may be a promising stage marker.

Integrierte psychotherapeutische Behandlung von schwer psychisch Kranken

Psychiatric care for severe and persistent mentally ill individuals has considerably changed over the last three decades. Striving for improvement in services provision for these patients has led to the emergence of various specialized community services, suited housing and supported work offers. Moreover, community-based treatment is also offered during acute episodes of mental illness. At the same time a range of evidence-based psychotherapeutic approaches targeting treatment needs of people with severe mental illness were developed in a process independent of the rise of community psychiatry. At present, however, a sufficient level of coordination of psychiatric services and integration of evidence-based psychological treatment into psychiatric care has not been achieved. Thus, these issues represent important steps in the further development.This paper discusses recent developments in psychiatric care of people with severe mental illness and reviews the evidence-based psychotherapy approaches suited to fit the needs of patient-centered integrated care.

The Importance of Cognitive Processes for the Integrative Treatment of Persons with Schizophrenia

Cognitive impairment is a hallmark of schizophrenia. Such impairment precedes the onset of the illness and typically endures over time.1 Alterations in cognitive processing, such as deficient source monitoring2,3 or lack of connectivity,4 are considered essential pathologic mechanisms involved in the development of schizophrenia. Reasoning biases such as “externalization” or “jumping to conclusions” contribute to the emergence and maintenance of delusions and hallucinations.5 Most important, however, cognitive impairment substantially interferes with everyday functioning. Deficits in everyday functioning are associated with the pervasive disability seen in schizophrenia. In recent years, research has increasingly shown that cognitive impairment is at the base of the skill deficits observed in schizophrenia patients and, thus, is a barrier to functional recovery.6–8

[Integrating psychotherapeutic treatment of severe mental illness: between desirability and clinical practice].

Psychiatric care for severe and persistent mentally ill individuals has considerably changed over the last three decades. Striving for improvement in services provision for these patients has led to the emergence of various specialized community services, suited housing and supported work offers. Moreover, community-based treatment is also offered during acute episodes of mental illness. At the same time a range of evidence-based psychotherapeutic approaches targeting treatment needs of people with severe mental illness were developed in a process independent of the rise of community psychiatry. At present, however, a sufficient level of coordination of psychiatric services and integration of evidence-based psychological treatment into psychiatric care has not been achieved. Thus, these issues represent important steps in the further development.This paper discusses recent developments in psychiatric care of people with severe mental illness and reviews the evidence-based psychotherapy approaches suited to fit the needs of patient-centered integrated care.