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Zusammenfassung Studienziel Implementierung und Evaluation eines sektorübergreifenden Komplexmodells für Menschen mit schwerer psychischer Erkrankung („severe mental illness“, SMI). Methodik Das Versorgungsmodell wurde an einer psychiatrisch-psychotherapeutischen Fachklinik implementiert. Mithilfe eines intensiven Fallmanagements setzte das patientenzentrierte und bedarfsorientierte Komplexmodell für Menschen mit SMI am Übergang zwischen stationärer und ambulanter Behandlung an. Die Evaluation erfolgte mittels einer gematchten Kontrollgruppe (Interventionsgruppe: n = 46; Kontrollgruppe: n = 21). Ergebnisse Nach klinischer Einschätzung profitierten zwei Drittel der Patient*innen vom Versorgungsmodell. Bei den Betroffenen zeigte sich im Behandlungsverlauf eine signifikante Reduktion der Inanspruchnahme stationär-psychiatrischer Versorgungsstrukturen sowie eine Verbesserung der klinischen Symptomatik. Schlussfolgerung Für Menschen mit SMI besteht eine Versorgungslücke beim Übergang von der stationären in die ambulante Versorgung, die durch das Versorgungsmodell partiell geschlossen werden konnte.

BackgroundDuring the first phase of the Coronavirus-19 disorder (COVID-19) pandemic in the spring of 2020, utilization of inpatient mental healthcare was significantly reduced. We now report on a long-term observational study of inpatient mental healthcare in a large psychiatric hospital association in North Rhine-Westphalia, Germany, covering the second and third pandemic waves of autumn and winter 2020 followed up until June 2021.ObjectivesAnalysis of the changes of inpatient and day patient mental healthcare utilization in an association of psychiatric hospitals during the COVID-19 pandemic from January 2020 until June 2021.Materials and methodsWe used the statistics database of the association of the nine psychiatric hospitals of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR). We compared the case numbers of the pandemic period with previous years and analyzed changes in the diagnostic spectrum, rates of coercion and therapeutic outcomes. We also analyzed age, gender, diagnoses and coercive measures of patients tested positive for COVID-19 during inpatient psychiatric healthcare.ResultsCase rates were reduced during and after the COVID-19 pandemic episodes of 2020 and the following months of spring and summer 2021. Changes varied between diagnostic groups, and there were even increases of case numbers for acute psychotic disorders. Coercive measures increased during the pandemic, but therapeutic outcomes were maintained at the pre-pandemic level. Women and patients of higher ages were overrepresented among psychiatric inpatients with COVID-19.ConclusionThe COVID-19 pandemic led to over during reductions of inpatient psychiatric hospital admissions and changes of the diagnostic spectrum accompanied by increased rates of coercive measures. These effects may reflect an overall increased severity of mental disorders during the COVID-19 pandemic, deferrals of inpatient admissions or a lack of outpatient mental healthcare services utilization. To differentiate and quantitate these potential factors, further studies in the general population and in the different mental healthcare sectors are needed. In order to reduce the number of COVID-19 cases in psychiatric hospitals, vaccination of people of higher ages and with dementias seem to be the most needed strategy.

Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.Menschen mit Behinderung finden im Hinblick auf ihre individuellen Bedürfnisse bislang wenig Berücksichtigung in der Gesundheitsversorgung. Die Studie erhebt die Innenperspektive von Brustkrebspatientinnen mit einer vorbestehenden Behinderung in Bezug auf Bedarfe und Barrieren in der onkologischen Versorgung. Hierzu wurden qualitative, leitfadengestützte Interviews geführt und mittels qualitativer Inhaltsanalyse ausgewertet. Eingeschlossen wurden 23 Patientinnen mit körperlichen Behinderungen, chronischen körperlichen Erkrankungen, Sinnesbehinderungen, psychischen Erkrankungen und/oder geistiger Behinderung. In Abhängigkeit von der Art der Behinderung standen für Patientinnen unterschiedliche Barrieren im Vordergrund. Um die von Menschen mit Behinderung erlebten Barrieren in der Versorgung abzubauen, ist es notwendig, die Kooperation von Versorgenden aus verschiedenen Versorgungsbereichen zu fördern sowie Versorgende im Umgang mit Menschen mit Behinderung zu schulen.

ZusammenfassungMenschen mit Behinderung finden im Hinblick auf ihre individuellen Bedürfnisse bislang wenig Berücksichtigung in der Gesundheitsversorgung. Die Studie erhebt die Innenperspektive von Brustkrebspatientinnen mit einer vorbestehenden Behinderung in Bezug auf Bedarfe und Barrieren in der onkologischen Versorgung. Hierzu wurden qualitative, leitfadengestützte Interviews geführt und mittels qualitativer Inhaltsanalyse ausgewertet. Eingeschlossen wurden 23 Patientinnen mit körperlichen Behinderungen, chronischen körperlichen Erkrankungen, Sinnesbehinderungen, psychischen Erkrankungen und/oder geistiger Behinderung. In Abhängigkeit von der Art der Behinderung standen für Patientinnen unterschiedliche Barrieren im Vordergrund. Um die von Menschen mit Behinderung erlebten Barrieren in der Versorgung abzubauen, ist es notwendig, die Kooperation von Versorgenden aus verschiedenen Versorgungsbereichen zu fördern sowie Versorgende im Umgang mit Menschen mit Behinderung zu schulen.

Zusammenfassung Ziel der Studie Erstellung eines testtheoretisch fundierten Fragebogens, der die Einstellungen des Personals psychiatrischer Einrichtungen zur Anwendung von Zwang erfasst. Methodik Eine Erstversion des Fragebogens mit 43 Items wurde auf Basis der inhaltsanalytischen Auswertung von 20 leitfadengestützten Interviews entwickelt. Anschließend wurden alle Ärzt*innen und Pflegekräfte eines psychiatrischen Krankenhauses zur anonymen Teilnahme eingeladen und danach die Endfassung des Fragebogens KEZ nach testtheoretischer Analyse erstellt. Ergebnisse 226 Mitarbeitende nahmen teil (Rücklaufquote 32,3 %). Die testtheoretische Überprüfung führte zu einem 39-Item-Set mit hoher Konsistenz (Cronbach’s α = 0,904) und 3 Faktoren: 1) Akzeptanz; 2) Sinnhaftigkeit/Legitimation und 3) Sicherheit/Ordnung durch Zwangsmaßnahmen. Schlussfolgerung Mit dem KEZ steht ein Instrument zur Verfügung, das die Haltung des psychiatrischen Personals zur Anwendung von Zwang in ihren verschiedenen Facetten erfasst.

Versorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegrundete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und fur dieses Feld besondere Themenstellungen vorgestellt und diskutiert.

To describe examples of adapting apps for use in mental healthcare and to formulate recommendations for successful adaptation in mental healthcare settings.International examples are given to explore implementation procedures to address this multitude of challenges. There are only few published examples of adapting apps for use in mental healthcare. From these examples and from results of studies in implementation science in general clinical settings, it can be concluded that the process of adapting apps for mental healthcare needs to address clinician training and information needs, user needs which include cultural adaptation and go beyond mere translation, and organizational needs for blending app use into everyday clinical mental healthcare workflows.

Zusammenfassung Hintergrund Für die Behandlung von Menschen mit Schizophrenien wird vorrangig antipsychotische Monotherapie empfohlen. Antipsychotische Polypharmazie (APP) wird dennoch oft eingesetzt und dient als Qualitätsindikator. Ziel der Arbeit Das Auftreten von APP an 9 psychiatrischen Kliniken des LVR zu untersuchen und die Nutzbarkeit als Qualitätsindikator zu diskutieren. Material und Methoden Es wurden Behandlungsdaten von stationären und teilstationären Fällen mit der Hauptdiagnose ICD-10 F20.x im Zeitraum 6/2016 bis 6/2017 hinsichtlich der APP-Rate analysiert. Ergebnisse Bei 6788 Behandlungsfällen wurde eine APP-Rate von 55,5 % ermittelt. Männliches Geschlecht, längere Verweildauer, keine Zwangsunterbringung und der Standort der Klinik waren mit APP assoziiert. Diskussion Die APP-Rate ist im Vergleich bisherigen Ergebnissen hoch und weist erhebliche Unterschiede zwischen den Kliniken auf. Die Verwendung des Qualitätsindikators APP wird diskutiert.

Zusammenfassung Ziel Seit 2016 sind Genesungsbegleitende (GB) in einem Klinikverbund mit 9 psychiatrischen Kliniken im Einsatz. Ziel dieser Untersuchung war es, Erwartungen und Erfahrungen mit Genesungsbegleitung zu erheben. Methodik Bei einem Projekttag erfolgte eine anonyme Befragung von 12 GB und 32 klinisch tätigen Personen (Schlüsselpersonen: SP) aus allen Kliniken. Ergebnisse Die Bedeutung der Genesungsbegleitung, die Zusammenarbeit mit Stationsteams und die Unterstützung durch Vorgesetzte wurden positiv bewertet. SP schätzten die Bedeutung der GB höher ein als die GB selbst. GB wünschten sich tendenziell mehr Selbstständigkeit als von SP gewünscht. Im Vergleich zur Selbstwahrnehmung erlebten SP die GB als etwas unsicherer und belasteter. Schlussfolgerung Es zeigte sich eine hohe Zufriedenheit mit der Arbeit der GB, aber auch Unterschiede zwischen Fremd- und Selbstwahrnehmung. Benötigt werden qualitative und umfangreichere quantitative Befragungen.

Background We aimed to identify differences in predictors of involuntary psychiatric hospitalisation depending on whether the inpatient stay was involuntary right from the beginning since admission or changed from voluntary to involuntary in the course of in-patient treatment. Methods We conducted an analysis of 1,773 mental health records of all cases treated under the Mental Health Act in the city of Cologne in the year 2011. 79.4% cases were admitted involuntarily and 20.6% were initially admitted on their own will and were detained later during the course of in-patient stay. We compared the clinical, sociodemographic, socioeconomic and environmental socioeconomic data (ESED) of the two groups. Finally, we employed two different machine learning decision-tree algorithms, Chi-squared Automatic Interaction Detection (CHAID) and Random Forest. Results Most of the investigated variables did not differ and those with significant differences showed consistently low effect sizes. In the CHAID analysis, the first node split was determined by the hospital the patient was treated at. The diagnosis of a psychotic disorder, an affective disorder, age, and previous outpatient treatment as well as the purchasing power per 100 inhabitants in the living area of the patients also played a role in the model. In the Random Forest, age and the treating hospital had the highest impact on the accuracy and decrease in Gini of the model. However, both models achieved a poor balanced accuracy. Overall, the decision-tree analyses did not yield a solid, causally interpretable prediction model. Conclusion Cases with detention at admission and cases with detention in the course of in-patient treatment were largely similar in respect to the investigated variables. Our findings give no indication for possible differential preventive measures against coercion for the two subgroups. There is no need or rationale to differentiate the two subgroups in future studies.

Background Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. Methods We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered “homeless” if they had no fixed unique address. Results About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2–6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. Conclusions Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.

Implementation and evaluation of a cross-sectoral complex care model for persons with severe mental illness (SMI).The care model was implemented at a psychiatric-psychotherapeutic specialized clinic. Within this patient-centered and needs-oriented complex care model, intensive case management was applied to transition persons with SMI between inpatient and outpatient mental health care. Evaluation was conducted using a matched control group design (n = 46/21).According to clinical assessment, two thirds of the patients benefited from the care model. In the course of treatment, the patients showed a significant reduction in the use of inpatient psychiatric care structures and an improvement in clinical symptoms.For people with SMI, there is a care gap in the in the transition from inpatient to outpatient care, which could be partially closed.Implementierung und Evaluation eines sektorübergreifenden Komplexmodells für Menschen mit schwerer psychischer Erkrankung („severe mental illness“, SMI).Das Versorgungsmodell wurde an einer psychiatrisch-psychotherapeutischen Fachklinik implementiert. Mithilfe eines intensiven Fallmanagements setzte das patientenzentrierte und bedarfsorientierte Komplexmodell für Menschen mit SMI am Übergang zwischen stationärer und ambulanter Behandlung an. Die Evaluation erfolgte mittels einer gematchten Kontrollgruppe (Interventionsgruppe: n = 46; Kontrollgruppe: n = 21).Nach klinischer Einschätzung profitierten zwei Drittel der Patient*innen vom Versorgungsmodell. Bei den Betroffenen zeigte sich im Behandlungsverlauf eine signifikante Reduktion der Inanspruchnahme stationär-psychiatrischer Versorgungsstrukturen sowie eine Verbesserung der klinischen Symptomatik.Für Menschen mit SMI besteht eine Versorgungslücke beim Übergang von der stationären in die ambulante Versorgung, die durch das Versorgungsmodell partiell geschlossen werden konnte.

Background This study aims to provide a transparent and replicable documentation approach for the cultural adaptation of a cognitive-behavioural transdiagnostic intervention (Common Elements Treatment Approach, CETA) for Arabic-speaking refugees with common mental disorders in Germany. Method A mixed-methods approach was used, including literature review, interviews, expert decisions and questionnaires, in order to adapt the original CETA as well as an internet-based guided version (eCETA). The process of cultural adaptation was based on a conceptual framework and was facilitated by an adaptation monitoring form as well as guidelines which facilitate the reporting of cultural adaptation in psychological trials (RECAPT). Results Consistent with this form and the guidelines, the decision-making process of adaptation proved to be coherent and stringent. All specific CETA treatment components seem to be suitable for the treatment of Arabic-speaking refugees in Germany. Adaptations were made to three different elements: 1) Cultural concepts of distress: a culturally appropriate explanatory model of symptoms was added; socially accepted terms for expressing symptoms (for eCETA only) and assessing suicidal ideation were adapted; 2) Treatment components: no adaptations for theoretically/empirically based components of the intervention, two adaptations for elements used by the therapist to engage the patient or implement the intervention (nonspecific elements), seven adaptations for skills implemented during sessions (therapeutic techniques; two for eCETA only) and 3) Treatment delivery: 21 surface adaptations (10 for eCETA only), two eCETA-only adaptations regarding the format. Conclusion The conceptual framework and the RECAPT guidelines simplify, standardise and clarify the cultural adaptation process.

Combining antipsychotics is common in schizophrenia treatment, despite evidence-based guidelines generally not recommending such practice. Otherwise, evidence remains inconclusive, especially regarding specific combinations. The trial aimed to test whether a combination of amisulpride plus olanzapine is more effective than either intervention as a monotherapy.A multicentre, 16-week, randomised, double-blind, controlled trial was done at 16 psychiatric in-patient centres throughout Germany. Inclusion criteria were adults aged 18-65 years with non-first episode schizophrenia or schizoaffective disorder and with a Positive and Negative Syndrome Scale (PANSS) total score of at least 70 and at least two items of the positive symptoms subscale rated at least 4. Patients were randomly assigned to receive 16 weeks of treatment with either amisulpride plus olanzapine, amisulpride plus placebo, or olanzapine plus placebo (1:1:1), and block randomisation was stratified by study site. To keep patients and investigators masked throughout the duration of the trial, amisulpride, olanzapine, and placebo were administered as identical capsules. Flexibly dosed monotherapy of oral amisulpride (amisulpride plus placebo, 200-800 mg per day) or olanzapine (olanzapine plus placebo, 5-20 mg per day) was compared with a combination of amisulpride plus olanzapine. The primary outcome was symptom reduction measured by the PANSS total score after 8 weeks, in the modified intention-to-treat population (all patients randomly assigned to an intervention and receiving at least one study drug dose). As determined a priori, group differences were examined by t tests (Bonferroni-Holm-adjustment) followed by pre-planned Bayesian analyses as well as imputation methods based on mixed models to account for missing values and post-hoc ANCOVA adjusting for PANSS baseline scores. The study was registered on ClinicalTrials.gov, NCT01609153; the German Clinical Trials Register, DRKS00003603; and the European Union Drug Regulating Authorities Clinical Trials Database, EudraCT-No. 2011-002463-20.Between June 15, 2012, and Dec 15, 2018, 13 692 patients were assessed for eligibility. 13 364 patients were excluded (including for not meeting inclusion criteria, declining to participate, or inappropriate reasons for changing pharmacological treatment), and 328 were then randomly assigned to an intervention group. 112 patients were randomly assigned to receive amisulpride plus olanzapine, 109 were randomly assigned to receive amisulpride plus placebo, and 107 were randomly assigned to receive olanzapine plus placebo. 321 patients were analysed for the primary outcome in the modified intention-to-treat population after exclusion of screening failures and patients who did not receive the intervention (110 for amisulpride plus olanzapine, 109 for amisulpride plus placebo, and 102 for olanzapine plus placebo). Among the 321 patients who were randomly assigned to intervention groups and analysed for the primary outcome, 229 (71%) were male, 92 (29%) were female; the mean age was 40·2 years (SD 11·7); and 296 (92%) were White and 25 (8%) were classified as other ethnicity. PANSS total score improved significantly more at 8 weeks in the amisulpride plus olanzapine group (-29·6 [SD 14·5]) than in the olanzapine plus placebo group (-24·1 [13·4], p=0·049, Cohen's d=0·396). A significant difference was not observed in reduction of PANSS total score between the amisulpride and olanzapine group compared with the amisulpride and placebo group (-25·2 [SD 15·9], p=0·095, Cohen's d=0·29). After 8 weeks and 16 weeks, sexual dysfunction, weight, and waist circumference increase were significantly higher for patients receiving amisulpride plus olanzapine than for those receiving amisulpride plus placebo, with no differences in serious adverse events. Two patients died during study participation; one randomly assigned to the amisulpride plus olanzapine group, and one assigned to the olanzapine plus placebo group (both assessed with no relation to treatment).The advantages of amisulpride plus olanzapine have to be weighed against a higher propensity for side-effects. The use of this specific combination therapy could be an alternative to monotherapy in certain clinical situations, but side-effects should be considered.German Federal Ministry of Education and Research.

To develop a psychometric instrument for the assessment of the attitude of psychiatric staff towards the use of coercion.Based on a literature search, interviews (37 open questions) were carried out by representatives each of doctors and nurses. A first version was developed, all doctors and nurses in a psychiatric clinic were asked to answer the questionnaire anonymously.226 employees took part (response rate 32.3 %). A test-theoretical analysis led to a 39 item set with a high consistency of the overall scale (Cronbach's α =0 .904) and three factors: 1) Acceptance of coercive measures without questioning (Cronbach's α = 0.797); 2) Meaningfulness and legitimation of coercive measures (Cronbach's α = 0.812); and 3) Security and order through coercive measures (Cronbach's α = 0.791).With the KEZ an instrument is available that holistically presents the various aspects of the attitudes of psychiatric staff to the use of coercion.Erstellung eines testtheoretisch fundierten Fragebogens, der die Einstellungen des Personals psychiatrischer Einrichtungen zur Anwendung von Zwang erfasst.Eine Erstversion des Fragebogens mit 43 Items wurde auf Basis der inhaltsanalytischen Auswertung von 20 leitfadengestützten Interviews entwickelt. Anschließend wurden alle Ärzt*innen und Pflegekräfte eines psychiatrischen Krankenhauses zur anonymen Teilnahme eingeladen und danach die Endfassung des Fragebogens KEZ nach testtheoretischer Analyse erstellt.226 Mitarbeitende nahmen teil (Rücklaufquote 32,3 %). Die testtheoretische Überprüfung führte zu einem 39-Item-Set mit hoher Konsistenz (Cronbach’s α = 0,904) und 3 Faktoren: 1) Akzeptanz; 2) Sinnhaftigkeit/Legitimation und 3) Sicherheit/Ordnung durch Zwangsmaßnahmen.Mit dem KEZ steht ein Instrument zur Verfügung, das die Haltung des psychiatrischen Personals zur Anwendung von Zwang in ihren verschiedenen Facetten erfasst.

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.Versorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegründete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und für dieses Feld besondere Themenstellungen vorgestellt und diskutiert.

Eine Politik der offenen Turen wird zur Reduktion von Konflikten, Aggressivitat und Eindammungsmasnahmen in der Psychiatrie propagiert. Eine ehemals geschutzte Akutstation wurde (teil)geoffnet mit dem Ziel, Konflikte und freiheitsentziehende Masnahmen (FeM) zu reduzieren. Die Intervention wurde von intensiven Teamschulungen in Deeskalation und Kommunikation, einer konsequenten Uberprufung und Liberalisierung von Stationsregeln sowie baulichen Veranderungen begleitet (Offnung eines Time-out-Raums und eines geschutzten Stationsgartens). Die (Teil)offnung der Akutstation erwies sich als machbar und wurde nach der Pilotphase dauerhaft implementiert. Aggressive Zwischenfalle nahmen im Verlauf an Haufigkeit ab, FeM konnten aber nicht reduziert werden. Das Personal begruste die Veranderungen im Ganzen, bewertete aber die Turoffnung selbst als weniger bedeutsam. Die Offnung einer ehemals geschutzten psychiatrischen Akutstation kann nur als Teil einer komplexen, autonomiefokussierten Intervention verstanden werden. Andere Aspekte wie die personelle Besetzung, die Haltung des Personals sowie raumlich-bauliche Aspekte sind moglicherweise wichtiger als die Turoffnung selbst.

Research concerning the spatial orientation in patients with schizophrenia has demonstrated a state independent deficit in inhibition of return (IOR), which has been discussed as a vulnerability marker for schizophrenia. Other recent investigations on brain structure and cognitive processing have revealed less deficits in schizophrenia patients with comorbid cannabis use (SCH + CUD) compared to abstinent schizophrenia patients (SCH). It was hypothesized that these results may reflect a premorbid lower vulnerability in at least a subgroup of comorbid patients. The aim of the present study is to extend previous work by investigating IOR functioning in patients with schizophrenia and cannabis use. This in turn should supplement the existing studies on the vulnerability of this patient group. Therefore, we compared IOR functioning in four groups: 62 patients with schizophrenia and 46 healthy controls, both with and without cannabis use. Participants underwent a covert orienting of attention task (COVAT) with peripheral cues and three stimulus onset asynchronies (SOAs: 200 ms, 400 ms and 800 ms). Both schizophrenia groups displayed delayed IOR with a more pronounced IOR effect in SCH + CUD compared to SCH. In healthy controls, IOR did not seem to be significantly affected by cannabis use. Significant IOR-differences between groups were only seen between SCH patients without cannabis use and both healthy groups at SOA 400 ms. Patterns of cannabis use as well as clinical parameters of psychoses did not affect IOR. Our results may support the hypothesis of IOR as a vulnerability marker for schizophrenia and of a lower biological vulnerability in at least a subgroup of SCH + CUD.

Antipsychotics are the cornerstone in the treatment of schizophrenia and are primarily recommended as monotherapy by evidence-based guidelines. Nevertheless, antipsychotic polypharmacy (APP) is prevalent in routine practice and APP is also used as a quality indicator since 2016 in quality management programs.Based on routine data of nine psychiatric hospitals of the Landschaftsverband Rheinland (LVR)/Germany the prevalence of APP was determined and correlated with factors of routine healthcare in order to monitor the adoption of APP and to discuss its feasibility as a quality indicator.All cases with schizophrenia (ICD-10 F20.x; ≥ 18 years) discharged between June 1st, 2016, and June 1st, 2017, (in-patient and day clinic) were extracted from an established research database shared by all nine hospitals and analyzed regarding APP prevalence at the time of discharge.Based on 6,788 cases, the prevalence of APP was 55.5 % with an average of 2.4 antipsychotics (SD = 0.6) administered simultaneously. In multivariate analyses, significant predictors for APP were: gender (male female), the number of days in hospital (long short), involuntary treatment (no yes) and the location of the hospital.We found a high proportion of polypharmacy in inpatient schizophrenia patients and significant differences between hospitals. The use of the results as a quality indicator (criteria ≥ 2 antipsychotics) remains dependent on the background of the individual treatment courses, which cannot be adequately represented by the existing routine data. The LVR has been using the quality indicator of ≥ 3 antipsychotics since 2018, which is discussed as a more appropriate approach for future evaluations.Für die Behandlung von Menschen mit Schizophrenien wird vorrangig antipsychotische Monotherapie empfohlen. Antipsychotische Polypharmazie (APP) wird dennoch oft eingesetzt und dient als Qualitätsindikator.Das Auftreten von APP an 9 psychiatrischen Kliniken des LVR zu untersuchen und die Nutzbarkeit als Qualitätsindikator zu diskutieren.Es wurden Behandlungsdaten von stationären und teilstationären Fällen mit der Hauptdiagnose ICD-10 F20.x im Zeitraum 6/2016 bis 6/2017 hinsichtlich der APP-Rate analysiert.Bei 6788 Behandlungsfällen wurde eine APP-Rate von 55,5 % ermittelt. Männliches Geschlecht, längere Verweildauer, keine Zwangsunterbringung und der Standort der Klinik waren mit APP assoziiert.Die APP-Rate ist im Vergleich bisherigen Ergebnissen hoch und weist erhebliche Unterschiede zwischen den Kliniken auf. Die Verwendung des Qualitätsindikators APP wird diskutiert.

Background Amphetamine-type stimulants (ATS) have become a critical public health issue. Animal models have indicated a clear neurotoxic potential of ATSs. In humans, chronic use has been associated with cognitive deficits and structural brain abnormalities. However, cross-sectional retrospective designs in chronic users cannot truly determine the causal direction of the effects. Objective To prospectively determine effects of occasional ATS use on cognitive functioning and brain structure. Methods In a prospective longitudinal study design, cognitive functioning and brain structure were assessed at baseline and at 12-month follow-up in occasional ATS users (cumulative lifetime use Results Examination of change scores between the initial examination and follow-up revealed declined verbal memory performance and putamen volume in users with high relative to low interim ATS exposure. In the entire sample, interim ATS use, memory decline, and putamen volume reductions were strongly associated. Conclusions The present findings support the hypothesis that ATS use is associated with deficient dorsal striatal morphology that might reflect alterations in dopaminergic pathways. More importantly, these findings strongly suggest that even occasional, low-dose ATS use disrupts striatal integrity and cognitive functioning.

Background The purpose of this study was to identify factors associated with a high risk of involuntary psychiatric in-patient hospitalization both on the individual level and on the level of mental health services and the socioeconomic environment that patients live in. Methods The present study expands on a previous analysis of the health records of 5764 cases admitted as in-patients in the four psychiatric hospitals of the Metropolitan City of Cologne, Germany, in the year 2011 (1773 cases treated under the Mental Health Act and 3991 cases treated voluntarily). Our previous analysis had included medical, sociodemographic and socioeconomic data of every case and used a machine learning-based prediction model employing chi-squared automatic interaction detection (CHAID). Our current analysis attempts to improve the previous one through (1) optimizing the machine learning procedures (use of a different type of decision-tree prediction model (Classification and Regression Trees (CART) and application of hyperparameter tuning (HT)), and (2) the addition of patients’ environmental socioeconomic data (ESED) to the data set. Results Compared to our previous analysis, model fit was improved. Main diagnoses of an organic mental or a psychotic disorder (ICD-10 groups F0 and F2), suicidal behavior upon admission, admission outside of regular service hours and absence of outpatient treatment prior to admission were confirmed as powerful predictors of detention. Particularly high risks were shown for (1) patients with an organic mental disorder, specifically if they were retired, admitted outside of regular service hours and lived in assisted housing, (2) patients with suicidal tendencies upon admission who did not suffer from an affective disorder, specifically if it was unclear whether there had been previous suicide attempts, or if the affected person lived in areas with high unemployment rates, and (3) patients with psychosis, specifically those who lived in densely built areas with a large proportion of small or one-person households. Conclusions Certain psychiatric diagnoses and suicidal tendencies are major risk factors for involuntary psychiatric hospitalization. In addition, service-related and environmental socioeconomic factors contribute to the risk for detention. Identifying modifiable risk factors and particularly vulnerable risk groups should help to develop suitable preventive measures.

Since 2016, peer support workers (PSW) have been working in a clinical group with nine psychiatric clinics. The aim of this study was to collect expectations and experiences with peer support work.Twelve PSW and 32 clinicians (key informants, KI) from all clinics participated in an anonymous, written survey.Both PSW and KI evaluated the overall importance of peer support, the cooperation between PSW and the clinical staff and the support from supervisors positively. KI rated the importance of peer support higher than the PSW themselves. PSW expressed the wish to act more independently. Compared to the self-perception of PSW, KI experienced them more insecure and burdened.Our findings speak in favor of a high level of satisfaction with peer support work, but they also point to critical differences between external and self-perceptions of PSW. Qualitative and more extensive quantitative surveys are required.ZIEL: Seit 2016 sind Genesungsbegleitende (GB) in einem Klinikverbund mit 9 psychiatrischen Kliniken im Einsatz. Ziel dieser Untersuchung war es, Erwartungen und Erfahrungen mit Genesungsbegleitung zu erheben.Bei einem Projekttag erfolgte eine anonyme Befragung von 12 GB und 32 klinisch tätigen Personen (Schlüsselpersonen: SP) aus allen Kliniken.Die Bedeutung der Genesungsbegleitung, die Zusammenarbeit mit Stationsteams und die Unterstützung durch Vorgesetzte wurden positiv bewertet. SP schätzten die Bedeutung der GB höher ein als die GB selbst. GB wünschten sich tendenziell mehr Selbstständigkeit als von SP gewünscht. Im Vergleich zur Selbstwahrnehmung erlebten SP die GB als etwas unsicherer und belasteter.Es zeigte sich eine hohe Zufriedenheit mit der Arbeit der GB, aber auch Unterschiede zwischen Fremd- und Selbstwahrnehmung. Benötigt werden qualitative und umfangreichere quantitative Befragungen.

E-mental health (eMH) encompasses the use of digital technologies to deliver, support, or enhance mental health services. Despite the growing evidence for the effectiveness of eMH interventions, the process of implementation of eMH solutions in healthcare remains slow throughout Europe. To address this issue, the e-Mental Health Innovation and Transnational Implementation Platform North-West Europe (eMEN) project was initiated to increase the dissemination and quality of eMH services in Europe. In this project, status analyses regarding eMH in the six participating countries (i.e., Belgium, France, Germany, Ireland, The Netherlands, and the UK) were conducted and eight recommendations for eMH were developed. Expert teams from the six participating countries conducted status analyses regarding the uptake of eMH based on a narrative literature review and stakeholder interviews. Based on these status analyses, the eMEN consortium developed eight policy recommendations to further support the implementation of eMH in Europe. The status analyses showed that the participating countries are in different stages of implementing eMH into mental healthcare. Some barriers to implementing eMH were common among countries (e.g., a limited legal and regulatory framework), while others were country-specific (e.g., fragmented, federal policies). The policy recommendations included fostering awareness, creating strong political commitment, and setting reliable standards related to ethics and data security. The eMEN project has provided the initial recommendations to guide political and regulatory processes regarding eMH. Further research is needed to establish well-tailored implementation strategies and to assess the generalizability of the recommendations beyond the countries involved in the eMEN project.

Background and objectives We investigated subjective reasons/motivation for cannabis use in patients with schizophrenia (n = 51) compared to otherwise healthy cannabis users (n = 109). Moreover, we explored possible changes in the motivational patterns of both groups over time. Methods A questionnaire was developed with six dimensions of motivations to use cannabis: affect regulation, relaxation, habit, structuring everyday life, creativity, and sociability. Participants filled out the instrument regarding their present and initial use of cannabis. Results At the time of onset of consumption, groups only differed significantly in habit with higher ratings for patients with schizophrenia and cannabis use (SCH+CAN group) and in sociability with higher ratings for otherwise healthy users (CAN group). In respect of present use, the motivation to consume cannabis was significantly higher for affect regulation and structuring everyday life in the SCH+CAN group and for relaxation and sociability in the CAN group. With reference to time-based variations, the SCH+CAN group reported increased relevance of structuring everyday life over time. Furthermore, the CAN group reported increased importance of habit over time, whereas the SCH+CAN patients showed decreased ratings of habit over time. Conclusions and scientific significance Our findings must be considered preliminary because of the retrospective nature of the assessment. Nevertheless, the present study provides an indication of the time-dependent variation of cannabis-use motivation in schizophrenia, which may provide a better understanding of the functions of cannabis use within the population. Results argue for specific motivational based interventions for the group of schizophrenia patients with regular cannabis use. (Am J Addict 2017;26:122-128).

The aim of this review is to evaluate recent literature on the use of telepsychiatry in mental crises or emergency situations. Results from recent studies which evaluated the implementation of a telepsychiatric consultation model in emergency departments point at a reduction of length of stay and a drop in admissions, increased cost-effectiveness, and improved satisfaction of patients and staff. There was almost no empirical evidence on videoconferencing in crisis intervention within the context of crisis resolution teams or online therapies. No study reporting on telepsychiatry videoconferencing in the context of disasters was found. There is still very little but increasing empirical evidence supporting the implementation of telepsychiatry in emergencies. Other mental crisis–related implementation settings remain to be researched. The implications and future research potential are discussed.

An open-door policy may help to reduce conflicts, aggression and containment measures in inpatient psychiatric care.A complex intervention was performed including opening the doors of an acute psychiatric ward. The aim was to deescalate conflicts and reduce containment measures.Along with opening of the doors, several other measures were taken including intensive training of staff in deescalating techniques and nonviolent communication, review and liberalization of rules of the ward, opening of a time-out room and access to a secure garden.The open-door policy proved to be feasible and was permanently established. Thereafter, incidents involving aggression decreased but containment measures did not. Overall, the staff appreciated the new concept but considered the opening of the doors to be of minor importance.The opening of a closed psychiatric ward should be understood as part of a complex, autonomy focused intervention. Other aspects such as sufficient numbers of well-trained staff and structural architectural features of the ward are possibly more important than opening of the doors.

Background The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. Methods We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID). Results Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered. Conclusions We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.

This report presents the rationale and design of a multi-center clinical trial that examines the efficacy and safety of antipsychotic combination treatment in acutely ill schizophrenia patients compared to antipsychotic monotherapy. Antipsychotic combination treatment is common in clinical practice worldwide, despite clinical guidelines generally not recommending such practice due to lacking evidence for its efficacy and safety. Olanzapine has a related chemical structure and comparable receptor-binding profile as clozapine, which demonstrated superior efficacy in combination studies, but has a more unfavorable side-effect profile compared to olanzapine. Amisulpride and olanzapine have shown promising therapeutic efficacy in meta-analyses in monotherapy for people with schizophrenia. Combining amisulpride and olanzapine, complementary receptor-binding properties may enhance efficacy and possibly reduce (or at least not augment) side effects due to the different receptor profiles and metabolization pathways. Accordingly, we hypothesize that patients treated with amisulpride plus olanzapine show greater improvement on the Positive and Negative Syndrome Scale total score after 8 weeks versus either monotherapy. A randomized, double-blind controlled trial is performed at 16 German centers comparing flexibly dosed monotherapy of oral amisulpride (400-800 mg/day), and olanzapine (10-20 mg/day) and amisulpride-olanzapine co-treatment. Sample size was calculated to be n = 101 per treatment arm, assuming an effect size of 0.500 and a two-sided alpha = 0.025 and beta = 0.90. Recruitment for this trial started in June 2012. Until December 2018, 328 patients have been randomized. Trial conduct has been extended to reach the projected sample size. Publication of the study results is expected in 2019 informing an evidence-based recommendation regarding specific antipsychotic combination treatment.

Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany.What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care.Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented.A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach.Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.Psychotherapie ist ein essenzieller Bestandteil in der Behandlung psychisch kranker Menschen, bleibt allerdings im Bereich der stationären psychiatrischen Behandlung hinter dem Bedarf zurück. Im Rahmen des ärztlichen Gesamtbehandlungsplans ist die Anwendung psychotherapeutischer Interventionen durch andere Berufsgruppen in Deutschland nicht regelhaft üblich.Welche Implikationen für die psychiatrische Pflege lassen sich aus internationalen Forschungsdaten zur Verbesserung der psychotherapeutischen Behandlung ableiten?Anhand einer Literaturrecherche werden internationale Entwicklungen analysiert und als Modell für ein deutsches Ausbildungscurriculum genutzt.Ein 18 Monate dauerndes Ausbildungsprogramm für Pflegefachpersonen wird vorgestellt. Dieses Curriculum vermittelt neben störungsspezifischen Kompetenzen auch störungsübergreifende psychotherapeutische Interventionen.Die Zusammenarbeit unterschiedlicher Gesundheitsberufe hat sich als wirksam und hilfreich in der Behandlung psychisch kranker Menschen erwiesen. Um den wachsenden Bedarf an Psychotherapie in der stationären Behandlung besser abdecken zu können, sollten Pflegefachpersonen zukünftig stärker einbezogen werden.

Etwa die Halfte der Menschen mit Psychosen aus dem schizophrenen Formenkreis entwickelt im Laufe ihres Lebens auch eine Suchterkrankung. Diese sog. Doppeldiagnose(DD)-Patienten gelten als schwer behandelbar. Sie haben einen durchschnittlich ungunstigen Verlauf mit unzureichender Compliance, haufigen Ruckfallen und schlechten langfristigen soziorehabilitativen Ergebnissen und sie zeigen haufig selbst- und fremdaggressive Verhaltensweisen. Im vorliegenden Beitrag werden die Modelle zur Erklarung der haufigen Komorbiditat zwischen Psychose und Sucht erlautert. Anschliesend werden erfolgversprechende Behandlungsansatze skizziert. In der Zusammenschau konnen niedrigschwellige, motivationsbasierte, integrative Behandlungsprogramme mit psychoedukativen und verhaltenstherapeutischen Elementen in der Behandlung von DD-Patienten hilfreich sein, allerdings mussen die Behandlungsplane langfristig angelegt und die Ziele realistisch und nicht zu hoch sein.

Die Rate komorbider psychischer Erkrankungen ist bei alkoholbezogenen Storungen hoch. Umgekehrt spielen Alkoholkonsumstorungen bei affektiven und Angsterkrankungen sowie schizophrenen Psychosen eine wichtige Rolle hinsichtlich des Krankheitsverlaufes. Im Rahmen der aktuellen S3-Leitlinienentwicklung wurde evidenzbasiertes Wissen zur Haufigkeit und Bedeutung komorbider Storungen bei Alkoholabhangigen zusammengestellt und es wurden Behandlungsempfehlungen erstellt. Fur die Erstellung der Leitlinie wurden ausgehend von spezifischen Fragestellungen bereits existierende Leitlinien aus verschiedenen Landern und systematische Literaturrecherchen berucksichtigt. Diese wurden nach Evidenzgrad bewertet und daraus Empfehlungen abgeleitet. Evidenz und Empfehlungen gliedern sich in Abschnitte zur Psycho-, Pharmako- und Kombinationstherapie, die jeweils differenziell auf die Wirksamkeit auf psychische Symptome und Trinkverhalten unterscheiden. Daruber hinaus wurde fur affektive Storungen ein Behandlungspfad fur das schrittweise Vorgehen bei beiden Komorbiditaten entwickelt. Erstmals wurden im Rahmen einer Leitlinie Behandlungsempfehlungen fur komorbide psychische Erkrankungen bei alkoholbezogenen Storungen differenziert erarbeitet. Diese erstrecken sich auf verschiedene Therapieansatze, schliesen auch Diagnostik und Settingbedingungen ein und ermoglichen dem Kliniker eine praxisnahe Berucksichtigung.

Drug addiction is a chronic, relapsing brain disorder. The identification of biomarkers that render individuals vulnerable for the transition from occasional drug use to addiction is of key importance to develop early intervention strategies. The aim of the present study was to prospectively assess brain structural markers for escalating drug use in two independent samples of occasional amphetamine-type stimulant users. At baseline occasional users of amphetamine and 3,4-methylenedioxymethamphetamine (cumulative lifetime use ≤10 units) underwent structural brain imaging and were followed up at 12 months and 24 months (Study 1, n = 38; Study 2, n = 28). Structural vulnerability markers for escalating amphetamine-type drug use were examined by comparing baseline grey matter volumes of participants who increased use with those who maintained or reduced use during the follow-up period. Participants in both samples who subsequently increased amphetamine-type drugs use displayed smaller medial prefrontal cortex volumes and, additionally, in the basolateral amygdala (Study 1) and dorsal striatum (Study 2). In both samples the baseline volumes were significantly negatively correlated with stimulant use during the subsequent 12 and 24 months. Additional multiple regression analyses on the pooled data sets revealed some evidence of a compound-specific association between the baseline volume of the left basolateral amygdala and the subsequent use of amphetamine. These findings indicate that smaller brain volumes in fronto-striato-limbic regions implicated in impulsivity and decision-making might render an individual vulnerable for the transition from occasional to escalating amphetamine-type stimulant use.

Hintergrund: Kinder psychisch Kranker sind besonders belastet und haben ein erhohtes Risiko, selbst psychisch zu erkranken. Methode: Es wurden psychisch kranke Eltern in einer sektorversorgenden psychiatrischen Klinik zu kindlichen Auffalligkeiten, Erziehungsstil und Hilfebedarf in Erziehungsfragen exploriert. Ergebnisse: Die Patienten beschrieben ihre Kinder auffalliger als eine Kontrollgruppe und sie wunschten sich mehr Hilfe in Erziehungsfragen. Diskussion: Elternschaft muss bei der Behandlung psychisch Kranker berucksichtigt werden. Erziehungshilfen konnten die Familien entlasten und sich praventiv auswirken.

Background Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad. Methods A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique. Results The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events. Conclusion Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.

It is still unknown whether psychopathological symptoms found in ecstasy and amphetamine users were apparent before the first use or developed subsequent to its use.The present study presents the third follow-up evaluation of a longitudinal study to assess the nature of the relationship between ecstasy, amphetamine (AMPH) and psychopathology.In this sample, 69 beginning ecstasy and AMPH users were followed over a period of 4 years. To explore different psychopathological dimensions, the Symptom Checklist-90-Revised was applied. Use of ecstasy, AMPH, cannabis and was gathered by structured interviews and use of cigarettes by a questionnaire. First, linear mixed models for repeated measures (unstructured covariance matrix) on the nine primary symptoms of the SCL-90-R with a separate model for each symptom category were performed. Second, linear regression analyses with the nine primary symptom categories of the baseline assessment (TNo significant associations between ecstasy, AMPH, and psychopathology were evident. However, a significant two-way interaction between ecstasy and cigarette use at the baseline assessment, as well as a three-way interaction effect between ecstasy, cigarette use, and time on obsessive-compulsive symptoms, were found.This study suggests that nicotine may moderate the effect of ecstasy on obsessive-compulsive symptoms. However, no associations between ecstasy, AMPH, and psychopathology have been found. This is one of the few studies, which highlights the role of nicotine in the study of psychopathology in beginning ecstasy and AMPH users.

Background and Objectives Clozapine is considered to be particularly effective in the treatment of dually diagnosed (DD) patients with psychosis and substance use disorders. However, its use is restricted by potentially severe side effects. The aim of the present pilot study was to compare the effects of clozapine with the newer second generation antipsychotic (SGA) ziprasidone in DD-patients. Methods Thirty (n = 30) patients with schizophrenia and cannabis abuse/dependence were randomized to ziprasidone or clozapine and were followed up for up to 12 months. Results Cannabis use was reduced in both groups during follow-up. Clozapine treatment was associated with less positive symptoms of schizophrenia, more side effects and poorer compliance with treatment. Conclusions Results from this small pilot RCT suggest beneficial effects of both clozapine and ziprasidone in the treatment of cannabis use disorders in psychotic patients. Larger-scale RCTs are needed in order to assess advantages and disadvantages of the different SGAs in dually diagnosed populations. (Am J Addict 2014;23:308–312)