Uta Gühne

Akutbehandlung im häuslichen Umfeld: Systematische Übersicht und Implementierungsstand in Deutschland

OBJECTIVE To report about existing evidence of effectiveness of home treatment for severely mentally ill adults and implementation in Germany. METHODS Systematic electronic and manual literature search. RESULTS Compared to standard care, home treatment was equally or more efficacious with respect to general state of health and mental health. Home treatment was superior with regard to other outcomes. So far, implementation in Germany is limited. CONCLUSIONS Home treatment can be seen as an effective addition to existing approaches of psychiatric care. It may be cost-effective also in Germany. Reasons for limited implementation in routine care are discussed.

Incident dementia cases and mortality. Results of the leipzig Longitudinal Study of the Aged (LEILA75

Mortality caused by dementia has mainly been examined in population-based studies relying on prevalent cases. This study aims to investigate the impact of incident dementia on mortality as well as to identify factors influencing the course of dementia and those predicting early death in demented individuals. A representative community sample of 1,692 individuals aged 75 years and over was examined by neuropsychological testing in a four-wave study. Data were analyzed with the Cox proportional hazards model after making necessary adjustments for potential covariates. At the third follow-up 51% of the incident demented and 19% of the participants without dementia had died. The mean survival time was 3.1 years (95% CI = 2.8–3.4) for the demented subjects and 4.0 years (95% CI = 3.9–4.0) for those without dementia (p < 0.001). In the total sample, the relative risk of dying after developing dementia was estimated to be 2.4 (95% CI = 1.6–3.6) with age, sex, education, co-morbidity, and institutionalization being taken into consideration. Those persons with incident dementia who died had a more severe dementia. Population-based studies relying on incident cases are especially valuable in describing course and outcome of dementia. Studies relying on prevalent cases and clinical samples tend to overestimate mortality and propose course-modifying factors that are challenged by studies relying on incident cases.

S3 guideline on psychosocial therapies in severe mental illness: evidence and recommendations

Abstract The burden of severe and persistent mental illness is high. Beside somatic treatment and psychotherapeutic interventions, treatment options for patients with severe mental illness also include psychosocial interventions. This paper summarizes the results of a number of systematic literature searches on psychosocial interventions for people with severe mental illness. Based on this evidence appraisal, recommendations for the treatment of people with severe mental illness were formulated and published in the evidence-based guideline series of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) as an evidence-based consensus guideline (“S3 guideline”). Recommendations were strongly based on study results, but used consensus processes to consider external validity and transferability of the recommended practices to the German mental healthcare system. A distinction is made between system-level interventions (multidisciplinary team-based psychiatric community care, case management, vocational rehabilitation and participation in work life and residential care interventions) and single psychosocial interventions (psychoeducation, social skills training, arts therapies, occupational therapy and exercise therapy). There is good evidence for the efficacy of the majority of psychosocial interventions in the target group. The best available evidence exists for multidisciplinary team-based psychiatric community care, family psychoeducation, social skills training and supported employment. The present guideline offers an important opportunity to further improve health services for people with severe mental illness in Germany. Moreover, the guideline highlights areas for further research.

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.

Künstlerische Therapien bei schweren psychischen Störungen

Arts therapies are widely used treatment strategies for people with severe mental illness. Generally, only a few randomized trials are available, however, the studies show that additional use of arts therapies reduces the appearance of negative symptoms among people with schizophrenia. The most significant evidence can be seen with music therapy. The treatment of severe depression has shown that additional music therapy improves depression. The S3 guidelines on psychosocial therapies in severe mental illness of the Germany Society for Psychiatry, Psychotherapy and Neurology (DGPPN) recommended arts therapies are with recommendation level B.

Depression im Alter – Herausforderung langlebiger Gesellschaften

Besides dementia, depressive disorders belong to the most common mental disorders in the elderly. Along with the demographic change and the associated increasing proportion of older people aged 65 and more they become a central and urgent challenge. Depressive disorders in old age are treatable, although they involve special features when compared to younger adults. Guidelines are considered to be of great importance in the optimization of treatments. But how will the treatment of depressive disorders in the elderly displayed in the current guidelines? A systematic search for treatment recommendations in current evidence- and consensus-based guidelines regarding psychotherapeutic and psychosocial treatment approaches indicates that this highly relevant patient group has been strongly neglected so far.

Das Training sozialer Fertigkeiten bei schweren psychischen Erkrankungen – ist es wirksam?

Skills Training in Severe Mental Illness – Is it Effective? – A Systematic Review

[Arts therapies in severe mental illness: are they effective?].

Arts therapies are widely used treatment strategies for people with severe mental illness. Generally, only a few randomized trials are available, however, the studies show that additional use of arts therapies reduces the appearance of negative symptoms among people with schizophrenia. The most significant evidence can be seen with music therapy. The treatment of severe depression has shown that additional music therapy improves depression. The S3 guidelines on psychosocial therapies in severe mental illness of the Germany Society for Psychiatry, Psychotherapy and Neurology (DGPPN) recommended arts therapies are with recommendation level B.

Psychosoziale Therapien bei schweren psychischen Erkrankungen – Die S3-Leitline der DGPPN: Stand der Forschung, Behandlungsempfehlungen und Desiderate für die Versorgungsforschung

Severe mental illness is associated with long-lasting symptoms and various impairments including individual, social and occupational aspects. The S3 guideline on psychosocial therapies in severe mental illness of the Germany Society for Psychiatry, Psychotherapy and Neurology (DGPPN) offers recommendations for psychosocial interventions. This paper emphasizes specific characteristics of the S3 guidelines on psychosocial therapies in severe mental illness and summarizes the primary results. Areas of future mental health service research are identified.

Psychosoziale Interventionen bei schweren psychischen Störungen

ZusammenfassungDer Beitrag fasst die systematisch recherchierte Evidenz zu drei gängigen psychosozialen Interventionen zusammen: psychoedukative Interventionen für Betroffene und ihre Angehörigen, Training sozialer Fertigkeiten und Sport- und Bewegungsinterventionen. Die im Konsensusprozess zur S3-Leitlinie „Psychosoziale Therapien bei Menschen mit schweren psychischen Störungen“ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) abgeleiteten Empfehlungen werden dargestellt und diskutiert. Die Ergebnisse zeigen das Potenzial für psychosoziale Interventionen auf und verweisen auf Forschungslücken insbesondere bei den Sport- und Bewegungsinterventionen.SummaryThis paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.