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Fritz S, Kösters M, Allgöwer A, Becker T, Kilian R, Gühne U, Riedel-Heller SG, Hasan A, Falkai P, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Breilmann J. [Influence of guideline recommendations, care structures and individual factors on the use of psychosocial therapies in severely mentally ill people]. Psychiatr Prax 2024; 51:129-138. [PMID: 37813363 DOI: 10.1055/a-2133-3527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The influence of guideline recommendations and other factors on the utilization of psychosocial interventions in people with severe mental illness was examined. METHODS Data from a cross-sectional study of 397 people with severe mental illness were analysed descriptively. RESULTS Patients are less likely to receive therapies with a strong recommendation compared to other levels of recommendation. Various other factors are diffusely associated with utilization rates, but no ubiquitous predictors could be identified across all therapies. CONCLUSION Current practice in the use of psychosocial interventions does not follow guideline recommendation strength. Interventions with strong recommendations are probably not available across services. Consequently, routine practice is not able to follow guideline recommendations according to their strength. Other consistent predictors could not be identified.
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Affiliation(s)
- Sarah Fritz
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
| | - Markus Kösters
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Chemnitz
| | | | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Reinhold Kilian
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Alkomiet Hasan
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Augsburg
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
| | - Klemens Ajayi
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Jessica Baumgärtner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Augsburg
| | - Peter Brieger
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Karel Frasch
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Donauwörth
| | - Stephan Heres
- kbo-Klinik für Psychiatrie und Psychotherapie Nord, kbo-Isar-Amper Klinikum Region München
| | - Markus Jäger
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kempten
| | - Andreas Küthmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Memmingen
| | - Albert Putzhammer
- Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kaufbeuren
| | - Bertram Schneeweiß
- kbo-Klinik für Psychosomatik, Psychiatrie und Psychotherapie Taufkirchen/Vils, kbo-Isar-Amper Klinikum Region München, Taufkirchen/Vils
| | - Michael Schwarz
- kbo-Isar-Amper-Klinik für Psychiatrie und Psychotherapie Ost, kbo-Isar-Amper Klinikum Region München, Haar
| | - Johanna Breilmann
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg
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Lang A, Klocke L, Menzel S, Ketisch E, Brieger P, Hamann J. [When does StäB (not) Work? A Qualitative, Multi-Perspective Survey on Factors that can Affect the Outcome of Inpatient-Equivalent Home Treatment (IEHT)]. Psychiatr Prax 2024. [PMID: 38359871 DOI: 10.1055/a-2248-6280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE There are always cases in which an already started inpatient equivalent home treatment is terminated. Aim of our study was to reach a better understanding of the circumstances leading to a termination of IEHT that has already begun. METHODS 17 qualitative interviews were conducted with patients, relatives as well as practitioners and therapists. Data analysis was performed by means of qualitative content analysis. RESULTS Our data shows, that there are further factors, besides the formal exclusion criteria for IEHT, that can complicate or prevent an inpatient equivalent home treatment or lead to its termination. CONCLUSION IEHT offers many patients the possibility of an intensive treatment in their own home. However, there our various constellations that can lead to a complication or termination of an inpatient equivalent home treatment.
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Affiliation(s)
- Anne Lang
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
| | - Luisa Klocke
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
| | - Susanne Menzel
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
| | - Eva Ketisch
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
| | - Johannes Hamann
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Haar
- Klinik für Psychiatrie und Psychotherapie, Bezirkslinikum Mainkofen, Deggendorf, Germany
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Leucht S, Siafis S, Rodolico A, Peter NL, Müller K, Waibel J, Strube W, Hasan A, Bauer I, Brieger P, Davis JM, Hamann J. Shared Decision Making Assistant (SDMA) and other digital tools for choosing antipsychotics in schizophrenia treatment. Eur Arch Psychiatry Clin Neurosci 2023; 273:1629-1631. [PMID: 38017193 PMCID: PMC10713760 DOI: 10.1007/s00406-023-01712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit, DZPG), Munich, Germany.
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit, DZPG), Munich, Germany
| | - Alessandro Rodolico
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Natalie L Peter
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Katharina Müller
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum München, Munich, Germany
| | - Jakob Waibel
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Wolfgang Strube
- Psychiatry, Psychotherapy and Psychosomatics, University Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit, DZPG), Munich, Germany
- Psychiatry, Psychotherapy and Psychosomatics, University Augsburg, Augsburg, Germany
| | - Ingrid Bauer
- Psychiatry, Psychotherapy and Psychosomatics, University Augsburg, Augsburg, Germany
| | - Peter Brieger
- Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum München, Munich, Germany
| | - John M Davis
- Department of Psychiatry, University of Chicago at Illinois, Chicago, USA
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Psychiatry, Bezirkskrankenhaus Mainkofen, Deggendorf, Germany
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Längle G, Raschmann S, Heinsch A, Großmann T, Fischer L, Timm J, Bechdolf A, von Peter S, Weinmann S, Nikolaidis K, Brieger P, Hamann J, Waldmann T, Schwarz J, Rout S, Herwig U, Richter J, Hirschmeier C, Baumgardt J, Holzke M. [Does Inpatient Equivalent Home Treatment lead to higher satisfaction? Results on satisfaction of persons involved in treatment within the Multi-center AKtiV Study]. Psychiatr Prax 2023. [PMID: 37989203 DOI: 10.1055/a-2179-6983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
This part of the AKtiV Study focuses on treatment satisfaction of patients and their relatives within Inpatient Equivalent Home Treatment (IEHT) and regular treatment. Stress of relatives and job satisfaction and workload of employees in IEHT is also considered. Relevant Parameters were collected via established as well as newly adapted questionnaires at the end of treatment. Patients and relatives in IEHT are significantly more satisfied. The stress experienced by relatives is reduced in both forms of treatment. Employees in IEHT are generally very satisfied, although there is no correlation with the satisfaction of relatives and patients. Known limitations of satisfaction surveys must be taken into account. In general these results encourage the expansion and continuous development of this new form of treatment in Germany.
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Affiliation(s)
- Gerhard Längle
- Klinik für Psychiatrie und Psychotherapie Zwiefalten, ZfP Südwürttemberg
- Klinik für Psychiatrie und Psychosomatik Reutlingen, Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Akademisches Lehrkrankenhaus der Universität Tübingen
- Allgemeine Psychiatrie und Psychotherapie mit Poliklinik, Medizinische Fakultät Eberhard-Karls-Universität Tübingen
| | - Svenja Raschmann
- Klinik für Psychiatrie und Psychotherapie Zwiefalten, ZfP Südwürttemberg
| | - Anna Heinsch
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, ZfP Südwürttemberg, Weissenau
| | - Tamara Großmann
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, ZfP Südwürttemberg, Weissenau
| | - Lasse Fischer
- Kompetenzzentrum für Klinische Studien Bremen, Universität Bremen
| | - Jürgen Timm
- Kompetenzzentrum für Klinische Studien Bremen, Universität Bremen
| | - Andreas Bechdolf
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Klinik für Psychiatrie und Psychotherapie, Charite Universitätsmedizin Berlin
| | - Sebastian von Peter
- Abteilung für Psychiatrie und Psychotherapie, Zentrum für seelische Gesundheit, Immanuel Klinikum Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Ruppiner Kliniken GmbH, Neuruppin
| | - Stefan Weinmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, MediClin Klinik an der Lindenhöhe, Offenburg
- Universitäre Psychiatrische Kliniken (UPK) Basel, Medizinische Fakultät Universität Basel
| | - Konstantinos Nikolaidis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Klinik für Psychiatrie und Psychotherapie, Charite Universitätsmedizin Berlin
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum Haar, akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität München
| | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Mainkofen, Deggendorf
| | - Tamara Waldmann
- Klinik für Psychiatrie und Psychotherapie II (Günzburg), Medizinische Fakultät Universität Ulm, Günzburg
| | - Julian Schwarz
- Abteilung für Psychiatrie und Psychotherapie, Zentrum für seelische Gesundheit, Immanuel Klinikum Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Ruppiner Kliniken GmbH, Neuruppin
| | - Sandeep Rout
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Neukölln, Berlin
| | - Uwe Herwig
- Zentrum für Psychiatrie Reichenau, Akademisches Lehrkrankenhaus der Universität Konstanz, Reichenau
- Klinik für Psychiatrie und Psychotherapie III, Universität Ulm
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Janina Richter
- Allgemeine Psychiatrie und Psychotherapie mit Poliklinik, Medizinische Fakultät Eberhard-Karls-Universität Tübingen
| | | | - Johanna Baumgardt
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
| | - Martin Holzke
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, ZfP Südwürttemberg, Weissenau
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Opgen-Rhein M, Brieger P, Baur A, Henking T. [Are too Many Temporarily Placed Non-culpable Offenders Committed to Forensic Psychiatric Hospitals in Germany? Thoughts on the Relationship of Forensic and General Psychiatry]. Psychiatr Prax 2023; 50:440-445. [PMID: 37160155 DOI: 10.1055/a-2053-7144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
From the perspective of the forensic clinics, the judiciary is increasingly ordering temporary placements according to Sec. 126a of the Code of Criminal Procedure. Three hypotheses are proposed that could (partly) explain this increase: 1) Courts' tendency to hand down this decision even in cases involving minor offences. 2) Courts' tendency to hand down this decision despite positive prognoses. 3) Changes in the reporting practices of psychiatric clinics. Overly simple explanations for the increase in temporary placements, therefore, fall short. This makes it more urgent to strengthen the primary-prevention approach. It is imperative that the small percentage of people with mental illness and an increased propensity to violence be identified and treated to prevent violence in the general psychiatric care stage. For this forensic psychiatry and general psychiatric care must be interlinked more closely.
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Affiliation(s)
- Markus Opgen-Rhein
- Klinik für Forensische Psychiatrie, kbo-Isar-Klinikum Region München, Haar bei München
| | - Peter Brieger
- Kbo-Isar-Amper-Klinikum Region München, Haar bei München
| | | | - Tanja Henking
- Institut für Angewandte Sozialwissenschaften (IFAS), Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg
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Nikolaidis K, Weinmann S, von Peter S, Längle G, Brieger P, Timm J, Waldmann T, Fischer L, Raschmann S, Schwarz J, Holzke M, Rout S, Hirschmeier C, Hamann J, Herwig U, Richter J, Baumgardt J, Bechdolf A. [IEHT or inpatient treatment? - First results of the multicenter AKtiV study on inpatient-equivalent home treatment regarding the study population and index treatment]. Psychiatr Prax 2023; 50:407-414. [PMID: 37683674 DOI: 10.1055/a-2138-8920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
AIM The quasi-experimental AKtiV study investigates the effects inpatient-equivalent home treatment (IEHT). This paper describes the study population based on demographic and clinical parameters at baseline and compares the index treatment. METHODS Over a period of 12 months 200 IEHT users were included in the intervention group (IG) and 200 inpatients were included in the control group (CG). The comparability of the two groups was ensured by propensity score matching (PSM). RESULTS In addition to the PSM variables, IG and CG did not differ significantly from each other variables at study inclusion. The duration of the index treatment was significantly longer in the IG (M=37.2 days) compared to the CG (M=27.9 days; p<0.001). CONCLUSION The similarity of the two groups enables comparisons over 12 months, investigating IEHT effects on long-term outcomes.
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Affiliation(s)
- Konstantinos Nikolaidis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Klinik für Psychiatrie und Psychotherapie, Charite Universitätsmedizin Berlin
| | - Stefan Weinmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, MediClin Klinik an der Lindenhöhe, Offenburg
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Universitäre Psychiatrische Kliniken (UPK) Basel, Universität Basel, Medizinische Fakultät, Basel, Schweiz
| | - Sebastian von Peter
- Hochschulklinik für Psychiatrie, Psychotherapie und Psychosomatik, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg CAMPUS GmbH, Rüdersdorf bei Berlin
| | - Gerhard Längle
- Klinik für Psychiatrie und Psychotherapie Zwiefalten, ZfP Südwürttemberg, Zwiefalten
- Klinik für Psychiatrie und Psychosomatik Reutlingen, Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Reutlingen
| | - Peter Brieger
- Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität München, Kbo-Isar-Amper-Klinikum Haar, Haar bei München
| | - Jürgen Timm
- Kompetenzzentrum für Klinische Studien Bremen, Universität Bremen
| | - Tamara Waldmann
- Klinik für Psychiatrie und Psychotherapie II (Günzburg), Universität Ulm Medizinische Fakultät, Günzburg
| | - Lasse Fischer
- Kompetenzzentrum für Klinische Studien Bremen, Universität Bremen
| | - Svenja Raschmann
- Klinik für Psychiatrie und Psychotherapie Zwiefalten, ZfP Südwürttemberg, Zwiefalten
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Hochschule Brandenburg CAMPUS GmbH, Rüdersdorf bei Berlin
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Ruppiner Kliniken GmbH, Neuruppin
| | - Martin Holzke
- Klinik für Psychiatrie und Psychotherapie I, Universität Ulm, ZfP Südwürttemberg, Weissenau
| | - Sandeep Rout
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Neukölln, Berlin
| | | | - Johannes Hamann
- Klinik fur Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München
- Klinik für Psychiatrie und Psychotherapie, Kbo-Isar-Amper-Klinikum Haar, Haar bei München
- Klinik für Psychiatrie und Psychotherapie, Bezirkslinikum Mainkofen, Deggendorf
| | - Uwe Herwig
- Ärztliche Direktion, Zentrum für Psychiatrie, Reichenau
- Klinik für Psychiatrie und Psychotherapie III, Universität Ulm Medizinische Fakultät, Ulm
- Psychiatrische Universitätsklinik Zürich, Psychiatrische Universitätsklinik Zürich, Schweiz
| | - Janina Richter
- Allgemeine Psychiatrie und Psychotherapie mit Poliklinik, Eberhard-Karls-Universität Tübingen, Medizinische Fakultät, Tübingen
| | - Johanna Baumgardt
- Betriebliche Gesundheitsförderung und Heilmittel, Wissenschaftliches Institut der AOK (WIdO), Berlin
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
| | - Andreas Bechdolf
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin
- Klinik für Psychiatrie und Psychotherapie, Charite Universitätsmedizin Berlin
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Blank D, Lang A, Brucks A, Riedl L, Brieger P, Hamann J. [Return-to-Work - The Transition after Psychiatric Inpatient Treatment]. Psychiatr Prax 2023; 50:344-352. [PMID: 37160158 DOI: 10.1055/a-2070-7451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Workers on sick-leave due to a mental illness have enormous problems to return to work. The main objective of the present study is to examine, how individuals experience the transition from the mental health system to their workplace. METHODS A qualitative research design guided by a grounded theory approach was used. Narrative interviews with ten workers on sick leave and four semi-structured interviews with return-to-work-experts were conducted. RESULTS Relevant for returning to work is the interplay between the involved persons. Essential is the interpretation of the transition and as a result, which calls for action are made to the participants. CONCLUSION Clinical interventions for returning to work should focus the support on the expectations of the participants and stimulate a common interpretation.
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Affiliation(s)
- Daniela Blank
- Akademisches Lehrkrankenhaus der LMU, Kbo-Isar-Amper-Klinikum, Haar
| | - Anne Lang
- Akademisches Lehrkrankenhaus der LMU, Kbo-Isar-Amper-Klinikum, Haar
| | - Adele Brucks
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
| | - Lina Riedl
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
| | - Peter Brieger
- Akademisches Lehrkrankenhaus der LMU, Kbo-Isar-Amper-Klinikum, Haar
| | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
- Bezirksklinikum Mainkofen, Deggendorf
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Weinmann S, Nikolaidis K, Längle G, von Peter S, Brieger P, Timm J, Fischer L, Raschmann S, Holzke M, Schwarz J, Klocke L, Rout S, Hirschmeier C, Herwig U, Richter J, Kilian R, Baumgardt J, Hamann J, Bechdolf A. Premature termination, satisfaction with care, and shared decision-making during home treatment compared to inpatient treatment: A quasi-experimental trial. Eur Psychiatry 2023; 66:e71. [PMID: 37681407 PMCID: PMC10594305 DOI: 10.1192/j.eurpsy.2023.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates. METHODS A total of 200 service users receiving IEHT were compared with 200 matched statistical "twins" in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9). RESULTS Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients. CONCLUSIONS Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.
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Affiliation(s)
- Stefan Weinmann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hospital an der Lindenhöhe, Offenburg, Germany
- University Psychiatric Hospital Basel, University of Basel, Basel, Switzerland
| | - Konstantinos Nikolaidis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité University Medicine Berlin, Berlin, Germany
- Department for Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Gerhard Längle
- Centre for Psychiatry Suedwuerttemberg, Zwiefalten, Germany
- Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Region München, Munich, Germany
| | - Jürgen Timm
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Lasse Fischer
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | | | - Martin Holzke
- Centre for Psychiatry Suedwuerttemberg, Ravensburg, Germany
- Department of Psychiatry and Psychotherapy I, Ulm University, Ravensburg, Germany
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Luisa Klocke
- kbo-Isar-Amper-Klinikum, Region München, Munich, Germany
| | - Sandeep Rout
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Neukölln, Berlin, Germany
| | - Constanze Hirschmeier
- Department for Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Uwe Herwig
- Center for Psychiatry Reichenau, Reichenau, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tübingen, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, GünzburgGermany
| | - Johanna Baumgardt
- Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | | | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité University Medicine Berlin, Berlin, Germany
- Department for Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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9
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Seemüller F, Schennach R, Musil R, Obermeier M, Adli M, Bauer M, Brieger P, Laux G, Gaebel W, Falkai P, Riedel M, Möller HJ. A factor analytic comparison of three commonly used depression scales (HAMD, MADRS, BDI) in a large sample of depressed inpatients. BMC Psychiatry 2023; 23:548. [PMID: 37507656 PMCID: PMC10386606 DOI: 10.1186/s12888-023-05038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Quantifying depression mainly relies on the use of depression scales, and understanding their factor structure is crucial for evaluating their validity. METHODS This post-hoc analysis utilized prospectively collected data from a naturalistic study of 1014 inpatients with major depression. Confirmatory and exploratory factor analyses were performed to test the psychometric abilities of the Hamilton Depression Rating Scale, the Montgomery Asberg Depression Rating Scale, and the self-rated Beck Depression Inventory. A combined factor analysis was also conducted including all items of all scales. RESULTS All three scales showed good to very good internal consistency. The HAMD-17 had four factors: an "anxiety" factor, a "depression" factor, an "insomnia" factor, and a "somatic" factor. The MADRS also had four factors: a "sadness" factor, a neurovegetative factor, a "detachment" factor and a "negative thoughts" factor, while the BDI had three factors: a "negative attitude towards self" factor, a "performance impairment" factor, and a "somatic" factor. The combined factor analysis suggested that self-ratings might reflect a distinct illness dimension within major depression. CONCLUSIONS The factors obtained in this study are comparable to those found in previous research. Self and clinician ratings are complementary and not redundant, highlighting the importance of using multiple measures to quantify depression.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Kbo-Lech-Mangfall-Klinik, Auenstrasse 6, 82467, Garmisch-Partenkirchen, Germany.
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Charité Mitte (CCM), CampusCharitéplatz 1, 10117, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Markgrafenstrasse 34, 10117, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Psychiatry and Psychotherapy, Kbo-Isar-Amper-Klinikum Region Munich, Vockestrasse 72, 85540, Haar, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Institute of Psychological Medicine (IPM), Nussbaumstrasse 9, 83564, Soyen, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Bergische Landstrasse 2, 40629, Düsseldorf, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
- Centre for Disturbance of Memory and Demetia, Marion von Tessin Memory-Centre, Nymphenburgerstrasse 45, 80636, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany
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10
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Waldmann T, Riedl L, Brieger P, Lang A, Blank D, Kohl M, Brucks A, Bühner M, Hamann J, Kilian R. The cost-utility of a return-to-work intervention in comparison to routine care for patients with mental disorders in Germany: Results from the RETURN project. Eur Psychiatry 2023; 66:e55. [PMID: 37486071 PMCID: PMC10486254 DOI: 10.1192/j.eurpsy.2023.2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Only two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU). METHODS We used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU. RESULTS No significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU. CONCLUSIONS The employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.
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Affiliation(s)
- Tamara Waldmann
- Department of Psychiatry and Psychotherapy II,
University of Ulm and BKH Günzburg, Günzburg,
Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Peter Brieger
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Anne Lang
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Daniela Blank
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Monika Kohl
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Adele Brucks
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Markus Bühner
- Department of Psychology, Ludwig-Maximilians
University, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
- Bezirksklinikum Mainkofen,
Deggendorf, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II,
University of Ulm and BKH Günzburg, Günzburg,
Germany
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11
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Krumm S, Krieg G, Lamp N, Marek F, Nickel P, Panzirsch M, Stiawa M, Beschoner P, Brieger P, Frasch K, Gertzen M, Gündel H, Hasan A, Jäger M, Kling-Lourenco P, Koussemou JM, Steber R, Kilian R. The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study. BMC Psychiatry 2023; 23:492. [PMID: 37430236 DOI: 10.1186/s12888-023-04979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Masculinity norms play a crucial role in men's help-seeking behaviors, service-use, and coping strategies for depression. While previous studies provided evidence for the association between gender role orientations, work related attitudes, stigmatization of men with depression and depressive symptoms, it remains unclear to what extent gender role orientations change over time and whether psychiatric and psychotherapeutic treatment have an impact on these transformations. Additionally, the role of partners in supporting depressed men and the impact of dyadic coping on these processes have not been explored. The aim of this study is to investigate how masculinity orientations and work-related attitudes change over time in men treated for depression, and to examine the role of their partners and dyadic coping in these transformation processes. METHODS TRANSMODE is a prospective longitudinal mixed-methods study investigating the transformation of masculinity orientations and work-related attitudes in men treated for depression between the ages of 18 and 65 from different settings in Germany. The study will recruit 350 men from various settings for quantitative analysis. By applying a latent transition analysis, the primary outcome are changes in masculine orientations and work-related attitudes over time, measured at four times (t0, t1, t2, t3) with intervals of 6 months. Qualitative interview with a subsample of depressed men selected using latent profile analysis, will be conducted between t0 and t1 (a1) with a follow-up of 12 months (a2). In addition, qualitative interviews with the partners of depressed men will be conducted between t2 and t3 (p1). Qualitative data will be analysed using qualitative structured content analysis. DISCUSSION A comprehensive understanding of the transformation processes of masculinity orientations over time including the impact of psychiatric/psychotherapeutic treatment and the role of partners can lead to the development of gender-sensitive depression treatment tailored to the unique needs of men with depression. Thus, the study can promote more effective and successful treatment outcomes and further contribute to reducing the stigma surrounding mental health issues among men and encourage them for mental health service use. TRIAL REGISTRATION This study is registered in the German Clinical Trail Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (Date of registration 06 February 2023).
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany.
| | - Gironimo Krieg
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Natalie Lamp
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Franziska Marek
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Paul Nickel
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Maria Panzirsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Donauwörth, Donauwörth, Germany
| | - Maja Stiawa
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Christophsbad Clinic, Göppingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | | | - Karel Frasch
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Donauwörth, Donauwörth, Germany
| | - Marcus Gertzen
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alkomiet Hasan
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | | | - José Marie Koussemou
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Heidenheim Clinic, Heidenheim, Germany
| | | | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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12
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Richter D, Riedel-Heller S, Breilmann J, Hasan A, Falkai P, Kilian R, Allgoewer A, Ajayi K, Baumgaertner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Kösters M, Gühne U. [Patient Preferences for Exercise Therapy in People with Severe Mental Illness in Germany]. Fortschr Neurol Psychiatr 2023; 91:191-198. [PMID: 35961322 DOI: 10.1055/a-1854-5174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE Assessing the experience with and the attitudes towards exercise therapy in persons with severe mental illness (SMI). Furthermore, potential variables of high preference towards exercise therapy are investigated. METHODS Cross-sectional observational study of SMI patients aged between 18 and 65 years (n=385). Patients were interviewed by trained staff using standardised instruments. Potential variables were analysed using a hierarchic binary logistic regression model. RESULTS 84,4% of SMI patients had a high preference for exercise therapy; of these, 44,1% exercised regularly. Among patients with severe mental illness especially a higher value in the GAF-assessment (p=0,041) and living in a metropolitan area (p=0,011) predict a high preference for exercise therapy. CONCLUSION Most of the patients with severe mental illness interviewed in this study place a surprisingly high value on sports and exercise therapy. Due to the increasing evidence with regard to positive effects of these therapies, it may be an excellent starting point to expand sports and exercise therapy as part of a comprehensive treatment plan. At the same time, strategies for everyday transfer need to be implemented more rigorously.
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Affiliation(s)
- Daniel Richter
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Germany
| | - Steffi Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Germany
| | - Johanna Breilmann
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Germany
| | - Alkomiet Hasan
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik der Universität Augsburg, Medizinische Fakultät, Universität Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie am Klinikum der Universität München, Germany
| | - Reinhold Kilian
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Germany
| | - Andreas Allgoewer
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Germany
| | | | - Jessica Baumgaertner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik der Universität Augsburg, Medizinische Fakultät, Universität Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Germany
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Donauwörth, Germany
| | | | - Markus Jäger
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Germany
- Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kempten, Germany
| | - Andreas Küthmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Memmingen, Germany
| | - Albert Putzhammer
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kaufbeuren, Germany
| | | | | | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie der Universität Leipzig, Medizinische Fakultät, Universität Leipzig, Germany
| | - Markus Kösters
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Germany
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Germany
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13
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Kuhn J, Brieger P, Härter M, Riedel-Heller S. [Public mental health: development of a research and action field]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:353-355. [PMID: 36995392 PMCID: PMC10063470 DOI: 10.1007/s00103-023-03681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Joseph Kuhn
- GP 1 Gesundheitsberichterstattung, Epidemiologie, Sozialmedizin, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764, Oberschleißheim, Deutschland.
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Vockestr. 72, 85540, Haar bei München, Deutschland.
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie und Institut für Psychotherapie (IfP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52 (W26) I, 20246, Hamburg, Deutschland.
| | - Steffi Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland.
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14
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Müller K, Schuster F, Krumm S, Leucht S, Siafis S, Heres S, Brieger P, Hamann J. Informing the development of a decision aid: Expectations and wishes from service users and psychiatrists towards a decision aid for antipsychotics in the inpatient setting. Health Expect 2023; 26:1327-1338. [PMID: 36916673 PMCID: PMC10154827 DOI: 10.1111/hex.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES Decision aids (DAs) are promising tools to foster evidence-based shared decision-making between practitioners and service users. Nevertheless, it is still obscure how an evidence-based DA for people with severe mental illness, especially psychosis, should look in an inpatient treatment setting to be useful and feasible. Therefore, we conducted focus groups with psychiatrists and service users to collect and assess their expectations and wishes regarding an evidence-based DA. From these findings, we derived immediate recommendations for the future development of DAs. METHODS We held two group interviews with service users (n = 8) and three group interviews with psychiatrists (n = 10). We used an open, large-scale topic guide. First, we presented data from a current meta-analysis on antipsychotics to the interviewees and, in a second step, asked for their expectations and wishes towards a DA that integrates these data. RESULTS Our thematic analysis revealed six key themes addressed by the respondents: (1) general considerations on the importance and usefulness of such a DA, (2) critical comments on psychiatry and psychopharmacotherapy, (3) communicative prerequisites for the use of a DA, (4) form and content of the DA, (5) data input, data processing and output as well as (6) application of the DA and possible obstacles. CONCLUSIONS Participants identified several important features for the development of DAs for selecting antipsychotics in inpatient psychiatric treatment. The digital format was met with the greatest approval. Especially the adaptability to different needs, users and psychopathologies and the possibility to outsource information dissemination via app seemed to be a decisive convincing argument. Further research is required to test specific features of DAs to be developed in clinical settings.
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Affiliation(s)
- Katharina Müller
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.,kbo-Isar-Amper-Klinikum München, Munich, Germany
| | - Florian Schuster
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.,Schön Klinik Bad Aibling Harthausen, Bad Aibling, Germany
| | - Silvia Krumm
- Department of Psychiatry II, Bezirkskrankenhaus Günzburg, Ulm University, Günzburg, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | | | | | - Johannes Hamann
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.,Bezirkskrankenhaus Mainkofen, Deggendorf, Deutschland
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15
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Brieger P, Henking T, Schmitt-Schäfer T, Klemmt M, Röhrig ED, Hamann J. [Closed facilities for people with intellectual or mental disabilities-Characteristics of residents based on file analyses]. Nervenarzt 2023; 94:240-242. [PMID: 36692529 PMCID: PMC9992238 DOI: 10.1007/s00115-022-01437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Peter Brieger
- kbo-Isar-Amper-Klinikum Region München, Akademisches Lehrkrankenhaus der LMU, Vockestr. 72, 85540, Haar, Deutschland.
| | - Tanja Henking
- Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Deutschland
| | | | - Malte Klemmt
- Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Deutschland
| | | | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, TU München, München, Deutschland.,Bezirksklinikum, Ärztliche Direktion, Mainkofen, Deutschland
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16
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Hamann J, Lang A, Riedl L, Blank D, Kohl M, Brucks A, Goretzko D, Bühner M, Waldmann T, Kilian R, Falkai P, Hasan A, Keck ME, Landgrebe M, Heres S, Brieger P. Supporting return to work after psychiatric hospitalization-A cluster randomized study (RETURN-study). Eur Psychiatry 2023; 66:e9. [PMID: 36621009 PMCID: PMC9879869 DOI: 10.1192/j.eurpsy.2022.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on "common mental disorders" and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment. METHODS The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued. RESULTS A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040). CONCLUSIONS The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.
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Affiliation(s)
- Johannes Hamann
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Bezirksklinikum Mainkofen, Deggendorf, Germany
| | - Anne Lang
- Kbo-Isar-Amper-Klinikum, Haar, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Monika Kohl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Adele Brucks
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - David Goretzko
- Psychological Methods and Assessment, Ludwig-Maximilians-Universität München, München, Germany
| | - Markus Bühner
- Psychological Methods and Assessment, Ludwig-Maximilians-Universität München, München, Germany
| | - Tamara Waldmann
- Klinik für Psychiatrie II am BKH Günzburg, Sektion Gesundheitsökonomie und Versorgungsforschung, Günzburg, Germany
| | - Reinhold Kilian
- Klinik für Psychiatrie II am BKH Günzburg, Sektion Gesundheitsökonomie und Versorgungsforschung, Günzburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Alkomiet Hasan
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Martin E Keck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Klinik Seewis, Seewis, Switzerland
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, kbo Lech-Mangfall-Hospital, Agatharied, Germany
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Brucks A, Lang A, Blank D, Lincke HJ, Riedl L, Siafis S, Brieger P, Hamann J. How do employees currently admitted to acute psychiatric inpatient units rate their psychosocial working conditions with the COPSOQ (Copenhagen Psychosocial Questionnaire). Int J Soc Psychiatry 2023:207640221143914. [PMID: 36591697 DOI: 10.1177/00207640221143914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In recent years it could be shown that psychosocial working conditions and mental health of employees are closely correlated. One well-established instrument to measure psychosocial stress at work is the COPSOQ (Copenhagen Psychosocial Questionnaire, German Standard Version). It is an 84 item self-rating instrument addressing several domains of psychosocial working conditions and is generally used for risk assessments in companies. AIMS To examine associations between COPSOQ ratings with clinical features and symptoms of employees who currently suffer from an episode of a mental illness requiring inpatient treatment. METHOD For 265 inpatients with mental disorders who participated in a cluster randomized trial (RETURN-study) COPSOQ-data were available as part of the baseline data acquisition. These data were compared with the German COPSOQ validation sample of the Freiburg research center for occupational sciences (FFAW; approximately 250,000 participants). For subdomains of the COPSOQ that showed major and significant differences between the two samples regression analyses were done to predict COPSOQ scores within the RETURN-sample. RESULTS Psychiatric inpatients did not assess their working conditions significantly different compared to the population based FFAW sample. However, with regard to the effects of working conditions (general health, burnout, presenteeism, and intention to leave the job) there were major differences between the two samples with the clinical sample expressing more negative views. In the RETURN sample these were predicted by a greater expression of depressive symptoms. CONCLUSIONS The linkage between work and mental wellbeing is complex. Mental illness is not necessarily a result of poor working conditions, while good working conditions may not in every case prevent symptoms of bad health, even if such associations exist.
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Affiliation(s)
- Adele Brucks
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany
| | - Anne Lang
- Kbo-Isar-Amper-Klinikum Region München, Germany
| | | | - Hans-Joachim Lincke
- Freiburger Forschungsstelle für Arbeitswissenschaften GmbH, Freiburg, Germany
| | - Lina Riedl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany
| | - Spyridon Siafis
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany
| | | | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Germany
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18
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Frank A, Flissakowski O, Eyer F, Brieger P, Hamann J. [Use of presuicide crisis services: a data collection in a maximum care hospital]. Nervenarzt 2023; 94:34-36. [PMID: 35635578 PMCID: PMC9859889 DOI: 10.1007/s00115-022-01325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Andreas Frank
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
- Fachklinik für Psychiatrie und Psychotherapie, Klinikum Fünfseenland Gauting, Gauting, Deutschland.
| | - Oscar Flissakowski
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Florian Eyer
- Abteilung für klinische Toxikologie & Giftnotruf München der II. Medizinischen Klinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum Region München, München, Deutschland
| | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Abstract
PURPOSE OF REVIEW Mental illnesses are among the most common diseases worldwide. Cases of inability to work caused by mental illness are frequent and the related economic burden is immense. A successful reintegration into their work environment of those patients who were on sick leave due to a mental illness is an important prognostic factor for the further course of the disease and helps reducing financial consequences. It was the aim of the present review to give an overview of the status quo of return-to-work interventions in the international literature. RECENT FINDINGS Main themes of interventions addressing return to work of persons with mental illnesses are the provision of psychotherapeutic support with or without combining these approaches with work directed interventions. Personal contact of employees, mental healthcare staff and supervisors may be helpful with regard to facilitating return to work. SUMMARY Current return to work interventions are mostly elaborate, extensive and expensive without convincing results regarding work related outcome parameters. A variety of reasons might be responsible for this finding, including heterogeneity of outcomes, a poor definition of return-to-work-interventions and the complexity of the issue (involving multiple stakeholders).
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Affiliation(s)
- Johannes Hamann
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich
| | - Anne Lang
- kbo-Isar-Amper-Klinikum München-Ost, Haar, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich
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20
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Siafis S, Bursch N, Müller K, Schmid L, Schuster F, Waibel J, Huynh T, Matthes F, Rodolico A, Brieger P, Bühner M, Heres S, Leucht S, Hamann J. Evidence-based Shared-Decision-Making Assistant (SDM-assistant) for choosing antipsychotics: protocol of a cluster-randomized trial in hospitalized patients with schizophrenia. BMC Psychiatry 2022; 22:406. [PMID: 35715740 PMCID: PMC9204887 DOI: 10.1186/s12888-022-04036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Choosing an antipsychotic medication is an important medical decision in the treatment of schizophrenia. This decision requires risk-benefit assessments of antipsychotics, and thus, shared-decision making between physician and patients is strongly encouraged. Although the efficacy and side-effect profiles of antipsychotics are well-established, there is no clear framework for the communication of the evidence between physicians and patients. For this reason, we developed an evidence-based shared-decision making assistant (SDM-assistant) that presents high-quality evidence from network meta-analysis on the efficacy and side-effect profile of antipsychotics and can be used as a basis for shared-decision making between physicians and patients when selecting antipsychotic medications. METHODS The planned matched-pair cluster-randomised trial will be conducted in acute psychiatric wards (n = 14 wards planned) and will include adult inpatients with schizophrenia or schizophrenia-like disorders (N = 252 participants planned). On the intervention wards, patients and their treating physicians will use the SDM-assistant, whenever a decision on choosing an antipsychotic is warranted. On the control wards, antipsychotics will be chosen according to treatment-as-usual. The primary outcome will be patients' perceived involvement in the decision-making during the inpatient stay as measured with the SDM-Q-9. We will also assess therapeutic alliance, symptom severity, side-effects, treatment satisfaction, adherence, quality of life, functioning and rehospitalizations as secondary outcomes. Outcomes could be analysed at discharge and at follow-up after three months from discharge. The analysis will be conducted per-protocol using mixed-effects linear regression models for continuous outcomes and logistic regression models using generalised estimating equations for dichotomous outcomes. Barriers and facilitators in the implementation of the intervention will also be examined using a qualitative content analysis. DISCUSSION This is the first trial to examine a decision assistant specifically designed to facilitate shared-decision making for choosing antipsychotic medications, i.e., SDM-assistant, in acutely ill inpatients with schizophrenia. If the intervention can be successfully implemented, SDM-assistant could advance evidence-based medicine in schizophrenia by putting medical evidence on antipsychotics into the context of patient preferences and values. This could subsequently lead to a higher involvement of the patients in decision-making and better therapy decisions. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00027316 , registration date 26.01.2022).
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Nicola Bursch
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Lisa Schmid
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Schuster
- grid.476609.a0000 0004 0477 3019Schön Klinik Roseneck, Rosenheim, Germany
| | - Jakob Waibel
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Tri Huynh
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Florian Matthes
- grid.6936.a0000000123222966Department of Informatics, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- grid.8158.40000 0004 1757 1969Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | | | - Markus Bühner
- grid.5252.00000 0004 1936 973XPsychological Methodology and Diagnostics, Ludwig Maximilian University, Munich, Germany
| | | | - Stefan Leucht
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Hamann
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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21
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Seemüller F, Kolter M, Musil R, Schennach R, Adli M, Bauer M, Brieger P, Laux G, Riedel M, Falkai P, Möller HJ, Padberg F. Chronic vs non-chronic depression in psychiatric inpatient care - Data from a large naturalistic multicenter trial. J Affect Disord 2022; 299:73-84. [PMID: 34800575 DOI: 10.1016/j.jad.2021.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/16/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Around 20% - 30% of depressed individuals experience a chronic form of depression lasting two or more years. This naturalistic study investigates the characteristics and the course of chronic depressed patients (CD) during standard antidepressant treatment in comparison to not chronically depressed (NCD) patients. METHODS Data of 954 patients were drawn from the prospective naturalistic, multicenter study of the German research network on depression, CD was met as classifier by 113 patients (11.8%), whereas 841 patients (88.2%) had non-chronic courses (NCD). RESULTS CD was significantly associated with a low age at onset, use of benzodiazepines, psychotherapy at baseline, substance abuse, a depressive personality disorder and a low degree of extraversion. CD patients showed a longer hospital stay, lower remission rates, increased rates of suicidal ideation as well as higher depression scores at discharge. In addition, individuals with chronic depression continued to obtain higher neuroticism scores and lower extraversion scores at discharge. LIMITATION Results were assessed by a post-hoc analysis, based on prospectively collected data. CONCLUSION CD patients have an inferior outcome in clinical measures as well as personality dimensions (i.e. low extraversion) compared to non-CD patients. These findings support the notion that CD patients entering a setting of standard psychiatric inpatient care will show less benefit compared to non-CD patients, and that this difference as such may be used as a stratifying marker for providing specialized psychiatric treatment with optimized pharmacological and psychotherapeutic protocols.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen, Auenstrasse 6, 82467 Garmisch-Partenkirchen, Germany.
| | - Miriam Kolter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus, Charité Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany; Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Markgrafenstrasse 34, 10117 Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Region Munich, Vockestr. 72, 85540 Haar, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry and Psychotherapy and Psychosomatic Medicine, kbo-Inn-Salzach-Klinikum. Gabersee 7, 83512 Wasserburg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Centre for Disturbance of Memory and Demetia, Marion von Tessin Memory-Centre, Nymphenburgerstrasse 45, 80636 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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22
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Gaigl G, Täumer E, Allgöwer A, Becker T, Breilmann J, Falkai P, Gühne U, Kilian R, Riedel-Heller SG, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Kösters M, Hasan A. The role of migration in mental healthcare: treatment satisfaction and utilization. BMC Psychiatry 2022; 22:116. [PMID: 35168572 PMCID: PMC8845273 DOI: 10.1186/s12888-022-03722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare.In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients' satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients' needs were measured via CAN-EU.In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment).Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings.
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Affiliation(s)
- Gabriele Gaigl
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany.
| | - Esther Täumer
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | | | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
- District hospital Donauwörth, Donauwörth, Germany
| | | | - Markus Jäger
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
- District hospital Kempten, Kempten, Germany
| | | | | | | | | | - Markus Kösters
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
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23
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Gühne U, Pabst A, Kösters M, Hasan A, Falkai P, Kilian R, Allgöwer A, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Breilmann J, Riedel-Heller SG. Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany. J Occup Med Toxicol 2022; 17:3. [PMID: 35042511 PMCID: PMC8767732 DOI: 10.1186/s12995-022-00345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI. Methods This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model. Results Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 – 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 – 0.71, p = 0.002). Conclusions Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning. Trial registration The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).
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Affiliation(s)
- Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Markus Kösters
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Donauwörth, Donauwörth, Germany
| | | | - Markus Jäger
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Kempten, Kempten, Germany
| | - Andreas Küthmann
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Memmingen, Memmingen, Germany
| | - Albert Putzhammer
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Kaufbeuren, Kaufbeuren, Germany
| | | | | | - Thomas Becker
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Johanna Breilmann
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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24
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Kuhn J, Härter M, Brieger P. [Ending your own life: suicide between medicine and ethics]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1-2. [PMID: 34985597 PMCID: PMC8732918 DOI: 10.1007/s00103-021-03459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph Kuhn
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764, Oberschleißheim, Deutschland.
| | - Martin Härter
- Zentrum für Psychosoziale Medizin, Institut und Poliklinik für Medizinische Psychologie und Institut für Psychotherapie (IfP), Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52 (W26), 20246, Hamburg, Deutschland.
| | - Peter Brieger
- Kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU, Vockerstr. 72, 85540, Haar, Deutschland.
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25
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Brucks A, Blank D, Kohl M, Riedl L, Lang A, Brieger P, Hamann J. [Development of a Return-to-work Intervention for Psychiatric Inpatients]. Gesundheitswesen 2021; 85:298-304. [PMID: 34921361 DOI: 10.1055/a-1690-7136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Patients with mental illnesses often face difficulties when returning to workplace after an episode of inpatient treatment. Available resources intended to support the return-to-work process are often not used. It was the aim of the present study to develop an intervention that facilitates the implementation of patient support at the interface of in- and outpatient care. METHODS We used a structured development process for the establishment of a return-to-work intervention for psychiatric inpatients. RESULTS The intervention consisted of the use of return-to-work experts who worked on the basis of a manual. In clearly defined modules, patients were given information on social law basics and details of the return process. Difficult situations (e. g., dealing with the disclosure of the diagnosis, return interview) were discussed and rehearsed. After discharge, further care took place, above all with regard to experiences on the first working day, accompaniment to discussions with the employer and support with any other upcoming difficulties. CONCLUSION The results of the ongoing study will show whether the chosen approach actually yields the expected results, namely an improvement of the return-to-work process.
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Affiliation(s)
- Adele Brucks
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TUM, München, Deutschland
| | - Daniela Blank
- Isar-Amper-Klinikum München Ost, Kliniken des Bezirks Oberbayern Kommunalunternehmen, München, Deutschland
| | - Monika Kohl
- Isar-Amper-Klinikum München Ost, Kliniken des Bezirks Oberbayern Kommunalunternehmen, München, Deutschland
| | - Lina Riedl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TUM, München, Deutschland
| | - Anne Lang
- Isar-Amper-Klinikum München Ost, Kliniken des Bezirks Oberbayern Kommunalunternehmen, München, Deutschland
| | - Peter Brieger
- Isar-Amper-Klinikum München Ost, Kliniken des Bezirks Oberbayern Kommunalunternehmen, München, Deutschland
| | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TUM, München, Deutschland
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Brieger P, Menzel S, Hamann J. [Is the role of mental illness in suicide overestimated?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:25-29. [PMID: 34874477 PMCID: PMC8650731 DOI: 10.1007/s00103-021-03464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
Die Aussage, dass Suizide zu 90 % Folge psychischer Erkrankungen sind, wird häufig in der wissenschaftlichen Literatur zitiert. Neuere Analysen und Kommentare ziehen das aber in Zweifel und betonen die Notwendigkeit, vielfältigere Ursachen für Suizidereignisse zu beachten, auch um die Prävention von Suiziden nicht auf das Erkennen und Behandeln psychischer Erkrankungen zu reduzieren. Das Ziel dieser Übersichtsarbeit ist die Darstellung und Bewertung wichtiger empirischer Befunde zu der Frage, ob die Rolle psychischer Störungen beim Suizid überbewertet wird. Psychische Störungen erhöhen das Risiko eines Suizides um das bis zu 30- bis 50-Fache gegenüber der Allgemeinbevölkerung, dennoch wird dadurch nur ein Teil aller Suizide erklärt. Aus Beobachtungs- und Therapiestudien ergeben sich deutliche Hinweise, dass psychische Störungen nur ein Faktor unter mehreren sind, die zu Suizid führen. Eine Rolle spielen beispielsweise auch Beziehungsprobleme, Substanzmissbrauch, Belastungen durch schwere körperliche Erkrankungen, akute Krisen im Beruf, Probleme mit Finanzen und juristische Belastungen. Suizidales Verhalten weist auf eine tiefe Unzufriedenheit hin, aber nicht notwendigerweise auf eine psychische Erkrankung. Viele Menschen mit einer psychischen Erkrankung zeigen kein suizidales Verhalten und nicht alle Menschen, die sich ihr Leben nehmen, haben eine psychische Erkrankung. Diese Erkenntnisse haben erhebliche Konsequenzen für die universale und indizierte Prävention von Suiziden.
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Affiliation(s)
- Peter Brieger
- Akadem. Lehrkrankenhaus der LMU, kbo-Isar-Amper-Klinikum Region München, Vockestr. 72, 85540, Haar (bei München), Deutschland.
| | - Susanne Menzel
- Akadem. Lehrkrankenhaus der LMU, kbo-Isar-Amper-Klinikum Region München, Vockestr. 72, 85540, Haar (bei München), Deutschland
| | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Gühne U, Richter D, Breilmann J, Täumer E, Falkai P, Kilian R, Allgöwer A, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Kösters M, Riedel-Heller SG. [Peer Support: Utilization and Benefit in Severe Mental Illness - Results from an Observational, Cross-Sectional Study]. Psychother Psychosom Med Psychol 2021; 71:499-507. [PMID: 34872153 DOI: 10.1055/a-1667-9966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Peer support is playing an increasing role in the treatment of severely mentally ill people. International findings are available on its effectiveness. However, little is known about knowledge, use and benefit assessment in Germany. This paper addresses this question and presents results from an observational study with 10 participating clinics in southern Germany. METHODS As part of the observational cross-sectional study with people with severe mental illness (IMPPETUS, N=359), sociodemographic and illness- and treatment-associated data were collected by trained study staff between March 2019 and September 2019. Binary logistic regression was used to analyse a possible association with peer support use. RESULTS 38% (N=138) of respondents reported knowledge about the possibility of peer support; 15% (N=55) affirmed its use. Use of peer support varied across sites (between 6.5 and 37.5%) and was associated with household income. Significantly less frequent use of peer support was among those with high versus low household income (OR=0.20 [95% CI: 0.06-0.68], p=0.01). Of respondents with peer support use (N=55), 78% reported perceiving peer support to be helpful or highly helpful. DISCUSSION Peer support not only proves to be effective under study conditions with regard to various outcomes, but is also assessed as beneficial under routine conditions in a defined care region by the majority of users. However, only a few respondents knew and used the possibility of peer support. CONCLUSION In order to implement peer support more strongly, information about this kind of service should be provided more effectively and a dialogue about successful implementation experiences should be initiated on a regional level.
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Affiliation(s)
- Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
| | - Daniel Richter
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland.,Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIQ), Berlin, Deutschland
| | - Johanna Breilmann
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Esther Täumer
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Reinhold Kilian
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Andreas Allgöwer
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - Klemens Ajayi
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Jessica Baumgärtner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Augsburg, Universität Augsburg, Deutschland
| | - Peter Brieger
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Karel Frasch
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Donauwörth, Deutschland
| | - Stephan Heres
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Markus Jäger
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland.,Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kempten, Deutschland
| | - Andreas Küthmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Memmingen, Deutschland
| | - Albert Putzhammer
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kaufbeuren, Deutschland
| | | | | | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Markus Kösters
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
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Stübner S, Yundina E, Mußmann L, Korbmacher J, Brieger P, Steinböck H. [Psychotropic Drugs - Comparison of Application Practice in Forensic and General Psychiatry]. Psychiatr Prax 2021; 49:255-261. [PMID: 34461658 DOI: 10.1055/a-1540-5186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The psychopharmacological application practice in forensic and general psychiatry should be investigated comparatively.The 2014-2019 Pharmaco-Epidemiology and Vigilance (Pharmako-EpiVig) surveys of the Bavarian Institute for Data, Analysis and Quality Assurance (BIDAQ) from forensic psychiatry (n = 4,590) and general psychiatry (n = 5,136) of the Isar-Amper-Klinikum Munich East were evaluated.Mean age and diagnosis distribution of the patient clientele differed, as did substance selection and dosage, which was almost consistently higher in forensic psychiatry. In schizophrenic forensic patients, clozapine was given most frequently. In both specialties, the frequent use of valproate was striking.The results could be interpreted as an indication that forensic patients have more severe and refractory illnesses, and that in clinical practice overall a symptom-related anti-aggressive treatment seems to be significant.
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Affiliation(s)
| | - Elena Yundina
- Klinik für Forensische Psychiatrie und Psychotherapie, kbo-Isar-Amper-Klinikum München Ost
| | - Lisa Mußmann
- Bayerisches Institut für Daten, Analysen und Qualitätssicherung
| | | | | | - Herbert Steinböck
- Klinik für Forensische Psychiatrie und Psychotherapie, kbo-Isar-Amper-Klinikum München Ost
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Klocke L, Brieger P, Ketisch E, Hamann J. [Inpatient-Equivalent Treatment - Direct Admission vs. Referral from Psychiatric Inpatient Units]. Psychiatr Prax 2021; 49:99-102. [PMID: 34102695 DOI: 10.1055/a-1492-1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The implementation of Inpatient-equivalent treatment (IET) is advocated. In the Munich IET-program about 50 % of the IET patients were admitted directly whereas 50 % were transferred from inpatient units. METHODS Data on the first N = 169 IET patients were used to compare patients being directly admitted with those who were transferred from inpatients units to IET. RESULTS Patients admitted directly to IET more often had an affective disorder, had lower CGI scores, had better German language skills and were more often competitively employed. Most patients referred to IET from inpatient units (66 %) did not fulfil IET inclusion criteria during inpatient admission. Regarding IET duration there were no major differences between patients being directly admitted vs. those being transferred from inpatient units. CONCLUSION Patients not fulfilling IET inclusion criteria may still profit from CHRT after stabilization on inpatient units.
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Affiliation(s)
- Luisa Klocke
- Kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU
| | - Peter Brieger
- Kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU
| | - Eva Ketisch
- Kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU
| | - Johannes Hamann
- Kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU.,Klinik für Psychiatrie und Psychotherapie, Technische Universität München
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Gottlob M, Holzke M, Raschmann S, Bechdolf A, Borbé R, Brieger P, Driessen M, Horter H, Weinmann S, Längle G. [Inpatient-Equivalent Treatment - How does it Work? Implementation Strategies from Eight Specialised Psychiatric Hospitals and Departments in Germany]. Psychiatr Prax 2021; 49:188-197. [PMID: 34015850 DOI: 10.1055/a-1406-7141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To get information about different ways inpatient equivalent treatment (IET) is implemented and organized eight specialized psychiatric hospitals and departments in Germany were asked to report on implementation details. OUTCOME: Organization and treatment processes depend on local conditions and existing structures. Legal barriers complicate the implementation process, however patients as well as team members report very positive experiences.Current data only give first hints but aren't sufficient to draw viable conclusions. Consequential issues will be picked up within the AKtiV-Study of the Innovationsfonds.
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Affiliation(s)
| | - Martin Holzke
- ZfP Südwürttemberg.,Klinik für Psychiatrie und Psychotherapie I der Universität Ulm
| | | | - Andreas Bechdolf
- Vivantes Klinikum am Urban und im Friedrichshain, Akademisches Lehrkrankenhaus Charité, Berlin
| | | | | | | | | | - Stefan Weinmann
- Vivantes Klinikum am Urban und im Friedrichshain, Akademisches Lehrkrankenhaus Charité, Berlin
| | - Gerhard Längle
- ZfP Südwürttemberg.,Klinik für Psychiatrie und Psychosomatik Reutlingen (PP.rt).,Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen
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Lang A, Brieger P, Menzel S, Hamann J. Differences between suicide note leavers and other suicides: A German psychological autopsy study. J Psychiatr Res 2021; 137:173-177. [PMID: 33677220 DOI: 10.1016/j.jpsychires.2021.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Suicide notes are not only the last personal message from the suicide victim to the bereaved, but are also a valuable source for research in preventing suicides. However, not all suicide victims leave a suicide note and it is unclear whether note leavers are representative of the general population of suicide victims. METHODS The aim of our study was to compare suicide victims who leave a suicide note compared to those who do not. Therefore, data from the Allgäu Suicide Study, which comprised detailed information on N = 626 suicides, were analysed using multiple regression analyses. RESULTS Of N = 612 cases with complete data, n = 255(42%) left a suicide note and n = 357 (58%) did not. Persons who wrote suicide notes before they killed themselves were more often female, less often married, found themselves more often in a financial or partnership crisis, and were more likely to suffer from a medical illness. They tended to poison themselves more often and were less likely to have a history of alcohol abuse disorder. CONCLUSION Suicide notes are one source to better understand the motives, which lie behind suicides and therefore may help to further develop and improve suicide prevention programs. Keeping in mind that suicide has heterogeneous reasons, the group of "note writers" might be one, which might especially have benefitted from psychosocial and psychotherapeutic interventions, as interpersonal relationships obviously played an important role even shortly before suicide.
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Affiliation(s)
- Anne Lang
- kbo-Isar Amper Klinikum, Region München, Munich, Germany.
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany.
| | - Susanne Menzel
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany; Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany.
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Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, Holzke M, Längle G, Richter J, Brieger P, Kilian R, Timm J, Hirschmeier C, Von Peter S, Weinmann S. Correction to: Implementation, efficacy, costs and processes of inpatient equivalent hometreatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry 2021; 21:199. [PMID: 33874936 PMCID: PMC8056574 DOI: 10.1186/s12888-021-03204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité – Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany ,grid.1008.90000 0001 2179 088XORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.411097.a0000 0000 8852 305XDepartment for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Konstantinos Nikolaidis
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité – Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany ,grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Martin Holzke
- grid.6582.90000 0004 1936 9748Center for Psychiatry Suedwuerttemberg, Department of Psychiatry I, Ulm University, Ravensburg, Weissenau Germany
| | - Gerhard Längle
- Center for Psychiatry Suedwuerttemberg, Zwiefalten, Germany ,Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany ,grid.411544.10000 0001 0196 8249Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Janina Richter
- grid.411544.10000 0001 0196 8249Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Reinhold Kilian
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Jürgen Timm
- grid.7704.40000 0001 2297 4381University of Bremen, Bremen, Germany
| | - Constance Hirschmeier
- grid.6363.00000 0001 2218 4662Department for Psychiatry and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Sebastian Von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Stefan Weinmann
- Psychiatric Hospital and Rehabilitation Unit, Rudolf-Sophien-Stift, Stuttgart, Germany ,University Psychiatric Hospital Basel, Basel, Switzerland
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Boyens J, Brieger P, Hamann J. Evaluation of a newly implemented crisis-resolution and home-treatment team in munich – a mixed-methods-analysis. Eur Psychiatry 2021. [PMCID: PMC9476093 DOI: 10.1192/j.eurpsy.2021.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Challenged by the lack of collaboration between treatment sectors in psychiatric care in Germany, a legal basis for the implementation of Stationsäquivalente Behandlung (StäB), a programme for crisis resolution and home treatment (CRHT), was formed in 2017. It offers intensive care to patients with severe mental illness in their own living environments, carried out by a team of diverse professionals. Objectives The present analysis is the first to evaluate the CRHT-program that has been established in the greater Munich area in 2018. Methods Qualitative and quantitative data were collected within the framework of a mixed-methods-analysis. Records of all patients (N=139) included in the CRHT over a thirteen-month period (’18–’19) were examined regarding sociodemographic, clinical parameters, and treatment data. A focus group with StäB-employees (N=8) and individual interviews with patients (N=10) were conducted, then transcribed, and analysed using thematic analysis. Results 139 patients (74% female) were treated in 164 cases for 38 days on average. Main diagnoses were schizophrenic diseases (43%) and mood disorders (35%), with patients ranging from markedly to severely ill (mean CGI-S: 5.8). 9.4% were in postpartum. Qualitative analysis is still in progress. Preliminary results demonstrate positive responses to individual treatment and environmental integration, whereas frequently changing contacts and the logistical effort were seen critically. Conclusions Work is still in progress. We expect StäB to be an adequate alternative to inpatient treatment for women in puerperium and a new opportunity for patients who need intensive treatment but refuse hospitalisation.
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Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, Holzke M, Längle G, Richter J, Brieger P, Kilian R, Timm J, Hirschmeier C, Von Peter S, Weinmann S. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry 2021; 21:173. [PMID: 33781237 PMCID: PMC8008509 DOI: 10.1186/s12888-021-03163-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. METHODS/DESIGN The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders' experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical 'twins' receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. DISCUSSION By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. TRIAL REGISTRATION Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do ; 2) ClinicalTrials.gov, Identifier: NCT0474550 . Registered February 9th 2021.
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Affiliation(s)
- Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
- ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Konstantinos Nikolaidis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Martin Holzke
- Center for Psychiatry Suedwuerttemberg, Department of Psychiatry I, Ulm University, Ravensburg, Weissenau, Germany
| | - Gerhard Längle
- Center for Psychiatry Suedwuerttemberg, Zwiefalten, Germany
- Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | | | - Constance Hirschmeier
- Department for Psychiatry and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Sebastian Von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Stefan Weinmann
- Psychiatric Hospital and Rehabilitation Unit, Rudolf-Sophien-Stift, Stuttgart, Germany
- University Psychiatric Hospital Basel, Basel, Switzerland
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Gühne U, Pabst A, Löbner M, Breilmann J, Hasan A, Falkai P, Kilian R, Allgöwer A, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Kösters M, Riedel-Heller SG. Employment status and desire for work in severe mental illness: results from an observational, cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1657-1667. [PMID: 33860804 PMCID: PMC8429146 DOI: 10.1007/s00127-021-02088-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors. METHODS This is a cross-sectional observational study of patients with SMI aged 18-65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model. RESULTS Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work. CONCLUSION Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed. STUDY REGISTRATION The study was registered in the German Clinical Trials Register (DRKS) ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801 ) and under the WHO-Platform "International Clinical Trials Registry Platform" (ICTRP) ( https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801 ) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).
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Affiliation(s)
- Uta Gühne
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Alexander Pabst
- grid.9647.c0000 0004 7669 9786Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Margrit Löbner
- grid.9647.c0000 0004 7669 9786Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Johanna Breilmann
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Alkomiet Hasan
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- grid.411095.80000 0004 0477 2585Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Reinhold Kilian
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Andreas Allgöwer
- grid.6582.90000 0004 1936 9748Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jessica Baumgärtner
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany ,District Hospital Donauwörth, Donauwörth, Germany
| | | | - Markus Jäger
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany ,District Hospital Kempten, Kempten, Germany
| | | | | | | | | | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Markus Kösters
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Steffi G. Riedel-Heller
- grid.9647.c0000 0004 7669 9786Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
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Abstract
OBJECTIVE Workers on sick-leave due to a mental disorder have enormous problems to return to work. The main objective of this review is to examine different return-to-work (RTW) interventions. METHODS We conduct a systematic literature research. RESULTS 88 articles were screened and 29 studies included. The included RTW-interventions build on different approaches: 1) individual, 2) workplace, 3) mental health services. The majority of the interventions showed positive effects on the return-to-work process. CONCLUSION Even if not all interventions could be readily transferred to the German context, the findings indicate ways improving the transition from the mental health system to the workplace.
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Affiliation(s)
- Daniela Blank
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München, Akademisches Lehrkrankenhaus der LMU München
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München, Akademisches Lehrkrankenhaus der LMU München
| | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
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Boyens J, Hamann J, Ketisch E, Brieger P. [From Theory into Practice - Early Experiences with Home Treatment in Munich, Germany]. Psychiatr Prax 2020; 48:269-272. [PMID: 33232976 DOI: 10.1055/a-1276-6637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Stationsäquivalente Behandlung (StäB), a treatment for crisis-resolution and home-treatment has been established in the greater Munich area since 2018, after it was established by a federal law. Our aim was to characterise the patients treated and analyse how treatment was carried out, as well as determine future target groups. METHODS Quantitative data was gathered through examination of records from all patients included in StäB from 01.10.18-31.10.19. For analysis we used descriptive statistics. RESULTS We report data from 164 treatment cases. 50 % of the patients were admitted to StäB directly from the community, the other 50 % were transferred from inpatient units. More than 75 % had affective or schizophrenic disorders, with many patients in the puerperium. There were few emergencies during StäB-treatment, and the therapy was usually ended on a regular basis. When discharged, most of the patients were in improved condition according to clinicians' judgement. Severity of illness was comparable to inpatients. CONCLUSION Its successful implementation in Munich StäB offers an alternative and addition to inpatient treatment. There are certain needs which are specifically met such as mother-child treatment.
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Affiliation(s)
- Josefine Boyens
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
| | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München.,kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU München
| | - Eva Ketisch
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU München
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Akademisches Lehrkrankenhaus der LMU München
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38
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Abstract
Background The present study aimed at answering three research questions: (a) Does shared decision making (SDM) yield similar effects for patients with involuntary admission or incidents of aggression compared to patients with voluntary admission or without incidents of aggression? (b) Does SDM reduce the number of patients with incidents of aggression and the use of coercive measures? (c) Does the use of coercion have a negative impact on patients’ perceived involvement in decision making? Methods We used data from the cluster-randomized SDM-PLUS trial in which patients with schizophrenia or schizoaffective disorder in 12 acute psychiatric wards of 4 German psychiatric hospitals either received an SDM-intervention or treatment as usual. In addition, data on aggression and coercive measures were retrospectively obtained from patients’ records. Results The analysis included n = 305 inpatients. Patient aggression as well as coercive measures mostly took place in the first days of the inpatient stay and were seldom during the study phase of the SDM-PLUS trial. Patients who had been admitted involuntarily or showed incidents of aggression profited similarly from the intervention with regard to perceived involvement, adherence, and treatment satisfaction compared to patients admitted voluntarily or without incidents of aggression. The intervention showed no effect on patient aggression and coercive measures. Having previously experienced coercive measures did not predict patients’ rating of perceived involvement. Conclusion Further research should focus on SDM-interventions taking place in the very first days of inpatients treatment and potential beneficial long effects of participatory approaches that may not be measurable during the current inpatient stay.
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Affiliation(s)
- Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Miriam John
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Fabian Holzhüter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Spyridon Siafis
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Affiliation(s)
- Peter Brieger
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München
| | - Susanne Menzel
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München
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Abstract
People with mental illness must often decide the extent to which they want to disclose their mental illness publicly. Especially in the context of work, this is a complex and individual decision. This Open Forum discusses the importance of well-reasoned disclosure management to increase the chances of successful workplace reintegration after a leave of absence due to a mental illness. The authors posit that despite the risks of stigma and discrimination, disclosing a mental illness to an employer can benefit employees. However, proper support is often essential in establishing how to best manage disclosure or nondisclosure.
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Affiliation(s)
- Anne Lang
- kbo-Isar-Amper-Klinikum München Ost, Haar, Germany (Lang, Brieger); Department of Public Mental Health, Clinic for Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany (Rüsch); Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich (Hamann)
| | - Nicolas Rüsch
- kbo-Isar-Amper-Klinikum München Ost, Haar, Germany (Lang, Brieger); Department of Public Mental Health, Clinic for Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany (Rüsch); Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich (Hamann)
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum München Ost, Haar, Germany (Lang, Brieger); Department of Public Mental Health, Clinic for Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany (Rüsch); Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich (Hamann)
| | - Johannes Hamann
- kbo-Isar-Amper-Klinikum München Ost, Haar, Germany (Lang, Brieger); Department of Public Mental Health, Clinic for Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany (Rüsch); Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich (Hamann)
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41
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Affiliation(s)
- Peter Brieger
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München
| | - Susanne Menzel
- kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München
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Riedl L, Blank D, Kohl M, Lang A, Kehl V, Brieger P, Hamann J. Return-to-work-experts for inpatient treatment of patients with mental illnesses- a proof-of-concept-study (RETURN): the study protocol. BMC Psychiatry 2020; 20:177. [PMID: 32306925 PMCID: PMC7168961 DOI: 10.1186/s12888-020-02504-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with mental illnesses often have massive difficulties returning to work after inpatient treatment at a psychiatric clinic and are often at risk of losing their jobs. The psychosocial support for this patient group at the interface of clinic/outpatient care is often insufficient. METHODS/DESIGN The RETURN-study prospectively assesses and surveys 200 patients with mental disorders in a cluster randomized intervention study, i.e. treatment teams and patients from intervention wards receive a return-to-work (RTW) intervention. Patients in control wards obtain treatment as usual (TAU). Pairs of comparable wards (similar patient population, similar staff density) have been identified and then randomized for control and intervention (n = 14 for each condition). On intervention wards return-to-work experts (RTW experts) who focus treatment on the workplace-related needs of patients with mental illnesses have been established. These RTW experts ensure the use of available resources within the framework of work-related discharge management and should lead to a more successful return to the workplace. The days at work in the year after release will be evaluated in a mixed methods approach as well as the return rate in the year after release, disability days in the year after return, relapse rate after 12 months, cost-benefit ratio of the intervention, analysis of the predictors / barriers for a successful return to the workplace (e.g. psychopathology, cognition, stigma, social-psychiatric support, company support, etc.), possibilities to implement the concept of RTW experts in standard psychiatric care (TAU - treatment as usual), the impact of the RTW experts' approach on the treatment process in standard psychiatric care. DISCUSSION This approach is already internationally established in the field of somatic rehabilitation and supported employment [Am J Psychiatry 171:1183-90, 2014; Lancet 370:1146-52, 2007; Cochrane Database Syst Rev, doi:10.1002/14651858.CD006237.pub3, 2014]; the innovative aspect of this project is to implement and evaluate it in standard psychiatric care in Germany. This project requires no new interventions to be developed and tested, as the techniques of the case manager/job coach is applied to the field of return to work. TRIAL REGISTRATION The study was registered in Deutsches Register Klinische Studien searchable via its Meta-registry (http://apps.who.int/trialsearch/), Trial registration number: DRKS00016037, Date of registration: 21/12/2018, URL of trial registry record.
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Affiliation(s)
- Lina Riedl
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany.
| | - Daniela Blank
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Monika Kohl
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany
| | - Anne Lang
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Victoria Kehl
- Department of Psychiatry and Psychotherapie, Technische Universität München, School of Medicine, Munich, Germany
| | - Peter Brieger
- kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany
- Academic Teaching Hospital LMU, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany
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Seemüller F, Riedel M, Obermeier M, Schennach-Wolff R, Spellmann I, Meyer S, Bauer M, Adli M, Kronmüller K, Ising M, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Möller HJ. The validity of self-rated psychotic symptoms in depressed inpatients. Eur Psychiatry 2020; 27:547-52. [DOI: 10.1016/j.eurpsy.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 12/22/2022] Open
Abstract
AbstractBackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.
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Brieger P, Steck S, Kilian R, Hamann J. [Ward Atmosphere Before and After Relocation of a Psychiatric Hospital to a New Building]. Psychiatr Prax 2020; 47:154-157. [PMID: 32241027 DOI: 10.1055/a-1112-6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine effects on ward atmosphere of a relocation of a psychiatric hospital to a new building. METHODS Patients and employees of a psychiatric hospital rated their view of the ward atmosphere using the German version of the Ward Atmosphere Scale before and after relocation of the hospital to a new building. RESULTS 171 patients and 44 employees participated in the study. There was no influence of the relocation of the hospital on the ward atmosphere. However, working or being treated in the day clinic predicted significantly more positive ratings of the ward atmosphere. CONCLUSION Relocation to new buildings alone does not necessarily lead to better ratings of the ward atmosphere.
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Affiliation(s)
- Peter Brieger
- kbo-Isar-Amper-Klinikum München.,ehem. Bezirkskrankenhaus Kempten
| | - Sarah Steck
- ehem. Bezirkskrankenhaus Kempten.,Günztalklinik Allgäu, Bezirkskliniken Schwaben
| | - Reinhold Kilian
- Universität Ulm, Klinik für Psychiatrie und Psychotherapie II
| | - Johannes Hamann
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
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45
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Breilmann J, Kilian R, Riedel-Heller SG, Gühne U, Hasan A, Falkai P, Allgöwer A, Muche R, Becker T, Ajayi K, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schmauß M, Schneeweiß B, Schwarz M, Kösters M. Implementation of the patient version of the evidence-based (S3) guideline for psychosocial interventions for patients with severe mental illness (IMPPETUS): study protocol for a cluster randomised controlled trial. Trials 2020; 21:275. [PMID: 32183897 PMCID: PMC7079434 DOI: 10.1186/s13063-020-4200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care. METHODS The study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65 years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ≥ 18 years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups. DISCUSSION The study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.
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Affiliation(s)
- Johanna Breilmann
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rainer Muche
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Klemens Ajayi
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Peter Brieger
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Karel Frasch
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
- District hospital Donauwörth, Donauwörth, Germany
| | - Stephan Heres
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
- District hospital Kempten, Kempten, Germany
| | | | | | - Max Schmauß
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | | | | | - Markus Kösters
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
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Pfennig A, Soltmann B, Ritter P, Bschor T, Hautzinger M, Meyer TD, Padberg F, Brieger P, Schäfer M, Correll CU, Bauer M. [A review of the update of the German S3-guideline on diagnostics and therapy of bipolar disorders 2019]. Nervenarzt 2020; 91:193-206. [PMID: 32076760 DOI: 10.1007/s00115-020-00874-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since the first publication of the guideline in 2012, which included critically reviewed evidence up to 2010, several hundred articles with new evidence were published and some topics of the clinical consensus needed to be reconsidered. Therefore, it was urgently necessary to revise the guideline to bring them up to date. In this article important revisions and updates are presented and the chances and limitations of the development of the guidelines and their implementation are discussed.
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Affiliation(s)
- A Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - B Soltmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - P Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Bschor
- Abteilung für Psychiatrie, Schlosspark-Klinik Berlin, Berlin, Deutschland
| | - M Hautzinger
- Fachbereich Psychologie, Klinische Psychologie und Psychotherapie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - T D Meyer
- Department of Psychiatry & Behavioral Sciences, UT Health, McGovern Medical School, Houston, TX, USA
| | - F Padberg
- Psychiatrische Klinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - P Brieger
- kbo-Isar-Amper-Klinikum, Haar (München), Deutschland
| | - M Schäfer
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik und Suchtmedizin, Kliniken Essen-Mitte und Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C U Correll
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Bauer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Brieger P, Kaps B, Lohmann F, Kammerlander B, Hamann J. Wer nimmt sich das Leben? Ergebnisse einer psychologischen Autopsiestudie im Allgäu basierend auf Polizeiakten. Psychiat Prax 2020; 47:198-206. [DOI: 10.1055/a-1067-0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Ziel der Studie Erhebung von Suizidmotiven, Risikofaktoren und Ansatzpunkten für Prävention.
Methodik Psychologische Autopsiestudie basierend auf Akten der Kriminalpolizei Kempten 2001 bis 2009.
Ergebnisse Die meisten der 626 Suizidenten zeigten bekannte Risikofaktoren für Suizide. Häufig waren negative Lebensereignisse im Vorfeld und Ankündigungen des Suizids.
Schlussfolgerung Die Suizide sind Ergebnis eines Zusammenspiels psychopathologischer und psychosozialer Faktoren. Suizidprävention muss auf die bessere Erkennung von Suizidankündigungen zielen und klare Konzepte der spezifischen Krisenversorgung vorhalten.
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Hamann J, Kaps B, Brieger P. [Death certificates for suicides: quality investigation based on police records]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1422-1426. [PMID: 31690975 DOI: 10.1007/s00103-019-03039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Death certificates are the basis for German mortality statistics, including suicide statistics. OBJECTIVES To examine death certificates that are issued in the context of suicide with special focus on the quality of doctors' entries, especially indications of suicide and the stated association between underlying illness and cause of death. MATERIALS AND METHODS Data from the Allgäu Suicide Study were used. Police records (N = 626) containing the results of suicide investigations as well as death certificates were analysed. RESULTS There is great heterogeneity as to how physicians issue death certificates in the context of suicide. Clear indications of suicide are often missing and underlying illnesses are seldom mentioned. Nevertheless, there are only minor differences between the number of suicides recorded by the police compared to official statistics. CONCLUSIONS To improve the quality of death certificates in the context of suicide, physicians should give clearer indications of suicide and put more focus on logically explaining the causes of death. The mortality of mental illnesses might be underestimated when mental illnesses are not regularly mentioned as a potential cause for suicide.
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Affiliation(s)
- Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Beatrix Kaps
- Ehemals Bezirkskrankenhaus Kempten, Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, Kempten, Deutschland
| | - Peter Brieger
- Ehemals Bezirkskrankenhaus Kempten, Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, Kempten, Deutschland.,kbo-Isar-Amper-Klinikum München, München, Deutschland
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Brieger P, Menzel S. Multiprofessionelle Kooperation und Begegnung im Trialog erweitern die Kompetenz aller in der Psychiatrie Tätigen. Psychiat Prax 2019. [DOI: 10.1055/a-0897-7876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schennach R, Obermeier M, Spellmann I, Seemüller F, Musil R, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Bauer M, Adli M, Zeiler J, Bender W, Kronmüller KT, Ising M, Brieger P, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Remission in schizophrenia - What are we measuring? Comparing the consensus remission criteria to a CGI-based definition of remission and to remission in major depression. Schizophr Res 2019; 209:185-192. [PMID: 31138482 DOI: 10.1016/j.schres.2019.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 03/03/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite being recommended for use in clinical trials, the consensus remission criteria were found to leave patients with persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing. Therefore, to evaluate the appropriateness of the schizophrenia consensus criteria, a definition of remission based on the Clinical Global Impression Scale (CGI) was developed and remitter subgroups were compared. METHODS 239 patients with a schizophrenia spectrum disorder were evaluated regarding their remission status after inpatient treatment. Remission in schizophrenia was defined according to the symptom-severity component of the consensus criteria by Andreasen et al. and a CGI based definition was calculated using sensitivity and specificity using receiver operating curves (asymptomatic remitter). Both remitter groups (schizophrenia consensus versus asymptomatic remitters) were compared regarding different clinical variables at discharge as well as the likelihood to relapse within a 1-year follow-up period. Both schizophrenia remitter subgroups were compared to remitters in major depression as a reference value. RESULTS Following the consensus criteria, 63% of the schizophrenia patients were in remission compared to only 18% following the asymptomatic criterion. The schizophrenia consensus remitters were less likely to be concurrent treatment responders (p < 0.0001), had a significantly greater illness severity (p < 0.0001) and less functioning (p = 0.0358) as well as a significantly greater risk to relapse (p = 0.0174) compared to the schizophrenia asymptomatic remitters as well as the depressed remitters. CONCLUSION It should be critically re-evaluated if the currently proposed consensus criteria are adequate to measure what is traditionally understood to be remission.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Schön Clinic Roseneck, Germany.
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Special Psychiatry, Social Psychiatry and Psychotherapy, Klinikum Stuttgart, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry, Psychosomatic and Psychotherapy, Bezirkskrankenhaus Kempten, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital Wasserburg/Inn, Germany
| | - Herbert Pfeiffer
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Germany
| | - Lutz G Schmidt
- Department of Psychiatry and Psychotherapy, University of Mainz, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Dusseldorf, Germany
| | | | - Isabella Heuser
- Department of Psychiatry and Psychotherapy, Charite Berlin, Campus Benjamin Franklin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Joachim Zeiler
- Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus Berlin, Germany
| | - Wolfram Bender
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | | | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | | | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Markus Gastpar
- Department of Psychiatry and Psychotherapy, University of Essen, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Psychiatric Clinic Rodewisch, Rodewisch, Germany
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