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The equality of mentally ill people with somatically ill people and the provision of community care were central topics of the Psychiatry-Enquête. With regard to medical rehabilitation services, this goal has not been implemented to date. The amendments to the Ninth Book of the Social Code (SGB IX) made by the Federal Participation Act (BTHG) again open up the possibility of making outreach medical rehabilitation services accessible to people with severe mental illnesses., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: The COVID-19 pandemic represents a significant psychological burden for many people; however, especially during the first wave of the pandemic in Germany, little acute professional help was available for people in need., Objective: In southern Germany, a telephone hotline for psychological first aid for COVID-19-related burdens was set up under the lead of the Baden-Wuerttemberg Ministry of Social Affairs and Integration, opened to the entire population and evaluated in April 2020., Material and Methods: In the period from 22 April to 24 July 2020, 753 volunteer psychotherapeutically trained counselors from different professional groups answered a total of 8096 calls., Results: Depression symptoms (36%), anxiety symptoms (18%) and psychotic symptoms (19%) were most frequently reported. Every second call was related to a previous mental illness. During the counseling sessions, which lasted 25 min on average, a variety of psychological acute interventions were conducted. In the presence of unclear symptoms, psychotic symptoms or severe personality disorder symptoms, the counselors were able to help significantly less compared to the remaining calls in which other clearly defined symptoms were present., Conclusion: The results point to both the benefits and limitations of hotline services. The major benefits relate to the fast availability and effective professional help for people with clearly characterized symptoms. In the case of unclear or complex symptoms, immediate help by telephone seems to be possible only to a limited extent, but it could initiate access to further help offers. Overall, the results of this study provide a first indication that hotline services for psychological first aid are feasible under pandemic conditions., (© 2021. The Author(s).)

The development of treatment guidelines alone does not improve patient care. The implementation of guidelines depends on various conditions, including structural conditions. The update of the S3 guideline "Psychosocial therapies for severe mental illnesses" systematically describes very different psychosocial therapies and reviews their effectiveness. The implementation of the resulting recommendations, which are coordinated in a complex consensus process, is hampered by the structured social legislation in Germany. The present article shows to what extent the recommendations of the update of the S3 Guideline Psychosocial Therapies follow the Federal Participation Act (BTHG)., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Increasing stress-associated health problems in Germany often are attributed to problems on the job, in particular to rising work demands. The study includes several stress predictors from other results and from literature in one predictive model for the field of work of "psychiatric rehabilitation".A cross-sectional design was used to measure personal and organizational variables with quantitative standard questionnaires as self-ratings from n=243 pedagogically active employees from various professions. Overall stress and job stress were measured with different instruments.The sample showed above-average overall stress scores along with below-average job stress scores. The multivariate predictive model for explaining the heightened stress shows pathogenetic and salutogenetic main effects for organizational variables such as "gratification crisis" and personal variables such as "occupational self-efficacy expectations" as well as an interaction of both types of variables. There are relevant gender-specific results concerning empathy and differences between professions concerning the extent of occupational self-efficacy.The results are a matter of particular interest for the practice of workplace health promotion as well as for social work schools, the main group in our sample being social workers., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: This study analyzes, to which extent clients formerly detained in forensic psychiatric units can be integrated into the community and what kind of assistance they need., Methods: Analysis of basic documentation in community mental health care in 2 regions., Results: Integration into the community is feasible. Former forensic patients are more likely to show aggressive behaviour than clients without forensic history. These aggressive acts nevertheless can be handled. Aggressive acts decrease with the duration of integration. Crisis interventions are not more frequent in patients with forensic history., Conclusions: Integration of patients who are "difficult to place" into a community can be accomplished by community based services with obligation to provide assistance., (© Georg Thieme Verlag KG Stuttgart · New York.)

The examination of urine in children can be very complex, due to the difficulty to obtain clean urine specimens in infants and toddlers. Clean catch is an easy system to obtain urine but patience is needed. Transurethral catheterization or suprapubic aspiration is useful in infants and toddlers with sign of pyelonephritis. Urine bag specimens are not useful in the diagnosis of urinary tract infection because of the high rate of false positive cultures. The 24 hours urine collection is frequently replaced by a spot urine and the ratio of the measured substances with the urine creatinine are calculated. Urine microscopy is needed for the evaluation of pathological results in the dipstick testing: confirm that red urine is due to haematuria by demonstration of red blood cells on urine microscopy, dysmorphic cells and red-cell casts are pathognomonic of glomerular bleeding, white-cell casts signify glomerular inflammation and bacteria are easily seen in unstained urine. A urine culture is pathologic if the colony count exceeds 10(4) in the transurethral catheterization or clean void. In the suprapubic aspiration is any number of colony pathologic. Urate crystals in the urine of infants may cause a pink discoloration to nappies. Urine screenings are not very useful and should be performed only at the age of 5 years or by sexual-active adolescents.

Electrolyte disturbances are frequently encountered in pediatric patients, not only in those with critical illness. They can manifest as lethargy, seizures, vomiting and cardiac arrhythmias. In many cases, electrolyte abnormalities are secondary to other underlying conditions, therefore clinical signs and symptoms can be predominated by the primary disease and not by the electrolyte imbalance. Clinical and laboratory evaluation must consist of a detailed history including any drug treatment, evaluation of volume status, acid-base balance, electrolytes as well as plasma and urine osmolality. Before initiating treatment, potential risks of both, the electrolyte disorder itself and the treatment must be considered. Therefore, long lasting (chronic) disorders must in general be corrected very slowly, whereas in acute disturbances rapid correction is better tolerated.

Objective: Are sheltered home residents and patients of an ambulant care unit distinguishable by measuring their need for care?, Method: N = 45 patients (30 patients of an ambulant care unit, among them 15 former residents of a sheltered home, and a parallelized sample of currently sheltered home residents) were examined with the "Integrierter Behandlungs- und Rehabilitationsplan" of the "Aktion Psychisch Kranke". Additionally, we assessed sociodemographic and illness related data and the reasons actually speaking against ambulant care., Results: In average need for care was estimated significantly higher for the residents of the sheltered home than for the patients of the ambulant care unit (F = 6.383; p = 0.004). However, 6 sheltered home residents could be identified, who had less need for care, but were not motivated to get discharged., Conclusion: In the mean sheltered home residents and patients of an ambulant care unit are distinguishable by their need for care. However, other important factors for an ambulant care are the discharge motivation and the patients' ability to live alone respectively the existence of his or her social net.

An introduction to the concept and practical implementation of a project entitled "Care in families for young people with mental disorders" is presented. In a project five adolescents were placed in fostering families. Continuous care is provided by a professional family care team and the treatment as out-patients at the Department of Child und Adolescent Psychiatry and Psychotherapy, in which they were previously treated, is continued.

The aim of the present study was to develop a new gait trainer for the rehabilitation of non-ambulatory patients. For the simulation of the gait phase, we used a commercially available fitness trainer (Fast Track) with two foot plates moving in an alternating fashion and connected to a servo-controlled propulsion system providing the necessary support for the movement depending on the patient's impairment level. To compensate deficient equilibrium reflexes, the patient was suspended in a harness capable of supporting some of his/her weight. Video analysis of gait and the kinesiological EMG were used to assess the pattern of movement and the corresponding muscle activity, which were then evaluated in healthy subjects, spinal cord injured and stroke patients and compared with walking on the flat or on a treadmill. Walking on the gait trainer was characterised by a symmetrical, sinusoidal movement of lower amplitude than in normal gait. The EMG showed a low activity of the tibialis anterior muscle, while the antigravity muscles were clearly activated by the gait trainer during the stance phase. In summary, the new gait trainer generates a symmetrical gait-like movement, promoting weight acceptance in the stance phase, which is important for the restoration of walking ability.

66 suicide attempters were interviewed with the European Parasuicide Study Interview Schedule (EPSIS) and characteristics of persons under the age of 26 were compared with those over 26.82% of the young suicide attempters gave interpersonal conflicts as reasons for their suicide attempts while most older persons gave psychiatric disorders as reasons. The younger group also had significantly lower scores on the Beck Depression Inventory and the Hopelessness Scale. While younger suicide attempters rarely had sought help from their GP within the month preceding the attempt one third of the older group had done so. It is concluded that in order to understand the reasons why people attempt suicide a differential approach combining the concept of crisis as well as the concept of illness is needed. Helpers should know that young suicide attempters rarely show signs of clear psychiatric disorder but usually attempt suicide because they are unable to cope with interpersonal conflicts.

Psychiatric family care is a therapeutic environment for mentally ill long-term patients that pays particular attention to the individuality of the patient, contrary to the hospitalising psychiatric clinic. The influence exercised by the host family on the positive development of the integration process is undisputed in literature, but has been hardly investigated so far in respect of its actual contents. Those who are practically engaged in family care have been discussing for some time whether successful integration is effected by "good host families" or by the special constellation that develops between the host family and the guest. The present article tries to emphasise (following a review of the literature) on the basis of a discontinued family care episode that integration into a host family is not a static affair but a highly sensitive process determined by the biography of the guest and the integration between host family and guest (or guests). The possible consequences for the care process are discussed.

Psychiatric foster family care of no more than two patients living in the foster family can be seen as a therapeutic setting, where longterm chronic patients can improve in their social functioning. Recent studies found the family characteristics as decisive for potential therapeutic effects. So the question arises how to select adequate foster family applicants. In an empirical study with 105 applicant-families we have tried to uncover the selection-procedures and mechanism of the foster care team that finally lead to adequate/non-adequate distinction. The results of the study show that the differences between the two applicant groups (selected vs non selected) are not identical with the intended selection criteria of the team members. Some major differences were found in areas that were totally independent from the team-criteria: the selected-as-adequate-families had a more intensive exchange with the outside world, educated more children and were therefore assumed to be socially more competent than the not selected applicant group. So selecting foster families comes up as a complicated decision making process that goes beyond checking up some criteria.

It is unfortunate that mental patients with long-term hospitalisation patterns are still necessarily scheduled for long-term stay in mental hospitals and institutions designed for the care and treatment of psychiatric cases, since such institutions are characterized by a rather sterile, low-stimulation atmosphere underlining rather than relieving the severity of the disease. This article presents a possible alternative, namely, care of mental patients within the framework of a foster family; these patients has been hospitalised for a long time and are now living in families who are remunerated for their efforts and are given medical assistance in performing their task as hosts. An attempt is made to describe the initial work in setting up such host patterns, particularly during the first year after initiation of the scheme, and to point out the mistakes that were committed and the resulting re-orientation efforts. Case reports on host families and "guests" illustrate the principles of psychiatric family care.