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Untersuchungsziel war der Zusammenhang zwischen einer Behandlung mit Risperidon in Depotform (RLAI), der Krankenhaustage und der Gesamtkosten bei schizophrenen Patienten. Hierfür wurden Hospitalisierungsraten, Dauer der Krankenhausaufenthalte und Gesamtkosten der Behandlung nach 12 und 18 Monaten nach Umstellung auf RLAI untersucht. Bei Patienten, die RLAI für mindestens 12 Monate erhielten konnte eine Reduktion der Krankenhausbehandlungstage und der Gesamtkosten gezeigt werden., The aim of the study was to assess the association between a long-term treatment with risperidone long-acting injectable (RLAI), inpatient care and cost-effektiveness of patients suffering in schizophrenia. Hospitalisation rates, the duration of inpatient treatment and the overall treatment costs were assessed 12 and 18 month after switching to RLAI in a mirror-image design. Patients receiving RLAI for at least 12 month showed a reduction in inpatient days and lower overall treatment costs.

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 sickness leave is critical to avoid unfavourable courses of disease, longer inability to work, long payment of sickness benefits and unemployment. Existing return-to-work (RTW) programs have mainly focussed 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: N=268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 months and at 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.

Ziel dieser Studie war es, die Einbeziehung von Angehörigen in die stationär-psychiatrische Routineversorgung anhand einer repräsentativen Stichprobe unter Beteiligung aller drei Parteien (Patienten, Psychiater und Angehörige) zu untersuchen. Insgesamt konnten 247 Patienten, 106 Psychiater sowie 94 Angehörige in diese Querschnittsstudie eingeschlossen werden. Laut Patienten und Psychiater fand ein Kontakt zwischen Angehörigen und Psychiatern nur in einem Drittel der Fälle statt., The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). This cross-sectional survey included 247 patients, 106 psychiatrists and 94 informal caregivers. It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases.

Background and Hypothesis Meta-analyses have shown that the majority of patients with schizophrenia who have not improved after 2 weeks of treatment with an antipsychotic drug are unlikely to fully respond later. We hypothesized that switching to another antipsychotic with a different receptor binding profile is an effective strategy in such a situation. Study Design In total, 327 inpatients with an acute exacerbation of schizophrenia were randomized to double-blind treatment with either olanzapine (5-20 mg/day) or amisulpride (200-800 mg/day). Those patients who had not reached at least 25% Positive-and-Negative-Syndrome-Scale (PANSS) total score reduction from baseline after 2 weeks (the non-improvers) were rerandomized double-blind to either staying on the same compound (stayers) or to switching to the other antipsychotic (switchers) for another 6 weeks. The primary outcome was the difference in the number of patients in symptomatic remission between the combined switchers and the stayers after 8 weeks of treatment, analyzed by logistic regression. Study Results A total of 142 nonimprovers were rerandomized at week two. 25 (45.5 %) of the 'stayers' compared to 41 (68.3 %) of the switchers reached remission at endpoint (p = .006). Differences in secondary efficacy outcomes were not significant, except for the PANSS negative subscore and the Clinical-Global-Impression-Scale. Switchers and stayers did not differ in safety outcomes. Conclusions Switching non-improvers from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.

Ziel dieser Studie war es, die Einbeziehung von Angehörigen in die stationär-psychiatrische Routineversorgung anhand einer repräsentativen Stichprobe unter Beteiligung aller drei Parteien (Patienten, Psychiater und Angehörige) zu untersuchen. Insgesamt konnten 247 Patienten, 106 Psychiater sowie 94 Angehörige in diese Querschnittsstudie eingeschlossen werden. Laut Patienten und Psychiater fand ein Kontakt zwischen Angehörigen und Psychiatern nur in einem Drittel der Fälle statt., The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). This cross-sectional survey included 247 patients, 106 psychiatrists and 94 informal caregivers. It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases.

Ziel der Untersuchung ist die Validierung einer deutschsprachigen Skala zur Messung der selbsteingeschätzten spirituellen Kompetenz von Arbeitenden im Gesundheitswesen. Dazu wurde der Spiritual Care Competence Questionnaire (SCCQ) an Gesundheitseinrichtungen in Deutschland und Österreich verteilt. An einem Sample von n=717 wurde eine Faktorenanalyse durchgeführt. Diese ergab ein Modell mit 7 Faktoren. Die interne Konsistenz belief sich auf Werte für Cronbach’s alpha von 0.73 bis 0.86. Nach Anwendung des Maximum Likelihood Schätzers ergab sich ein guter Model-Fit (cfi=0.96, tli=0.95, rmsea=0.04, srmr=0.05). Die Diskriminanzvalidität des SCCQ mit dem SWE von Jerusalem und Schwarzer zeigte signifikant negative Korrelationen., The aim of this study is to validate a German instrument to measure the spiritual competence of people working in the health care system. To achieve that, the spiritual care competence questionnaire (SCCQ) was distributed to health care institutions in Germany and Austria. On a sample of n=717 factor analysis was conducted which produced a model with 7 factors. Internal consistency was assessed using Cronbach’s alpha (0.73 to 0.86). Maximum-Likelihood estimation showed good model-fit (cfi=0.96, tli=0.95, rmsea=0.04, srmr=0.05) and the discriminant validity with the SCCQ and the SWE by Jerusalem and Schwarzer showed significant negative results.

Ziel der Untersuchung ist die Validierung einer deutschsprachigen Skala zur Messung der selbsteingeschätzten spirituellen Kompetenz von Arbeitenden im Gesundheitswesen. Dazu wurde der Spiritual Care Competence Questionnaire (SCCQ) an Gesundheitseinrichtungen in Deutschland und Österreich verteilt. An einem Sample von n=717 wurde eine Faktorenanalyse durchgeführt. Diese ergab ein Modell mit 7 Faktoren. Die interne Konsistenz belief sich auf Werte für Cronbach’s alpha von 0.73 bis 0.86. Nach Anwendung des Maximum Likelihood Schätzers ergab sich ein guter Model-Fit (cfi=0.96, tli=0.95, rmsea=0.04, srmr=0.05). Die Diskriminanzvalidität des SCCQ mit dem SWE von Jerusalem und Schwarzer zeigte signifikant negative Korrelationen., The aim of this study is to validate a German instrument to measure the spiritual competence of people working in the health care system. To achieve that, the spiritual care competence questionnaire (SCCQ) was distributed to health care institutions in Germany and Austria. On a sample of n=717 factor analysis was conducted which produced a model with 7 factors. Internal consistency was assessed using Cronbach’s alpha (0.73 to 0.86). Maximum-Likelihood estimation showed good model-fit (cfi=0.96, tli=0.95, rmsea=0.04, srmr=0.05) and the discriminant validity with the SCCQ and the SWE by Jerusalem and Schwarzer showed significant negative results.

John FP Bridges,1 Kathleen Beusterien,2 Stephan Heres,3 Pedro Such,4 Joaquín Sánchez-Covisa,5 Anna-Greta Nylander,4 Elcie Chan,6 Anne de Jong-Laird5 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Outcomes Research Strategies in Health, Washington DC, USA; 3Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany; 4Global Medical Affairs, H. Lundbeck A/S, Valby, Denmark; 5Medical Department, Otsuka Pharmaceutical Europe Ltd., Wexham, UK; 6HEOR/Market Access, Otsuka Pharmaceutical Europe Ltd., Wexham, UK Objective: This study seeks to quantify the treatment goals of people recently diagnosed with schizophrenia and explore their impact on treatment plan.Methods: People aged 18–35 years with a confirmed diagnosis of schizophrenia within the past 5 years were surveyed in the UK, Germany, and Italy. Treatment goals were assessed via a validated best–worst scaling instrument, where participants evaluated subsets of 13 possible treatment goals identified using a balanced incomplete block design. Participants identified the most and least important goals within each task. Data were also collected on current treatment and preference for daily oral versus long-acting injectable (LAI) treatment. Hierarchical Bayes was used to identify preference weights for the goals, and latent class analysis was used to identify segments of people with similar goals. The segments were compared with the current treatment and preference for oral versus LAI treatment.Results: Across 100 participants, the average age was 26 years, 75% were male and 50% were diagnosed within 2 years ago. Overall, preferences were most favorable for reduced disease symptoms, think clearly, reduced hospitalizations, reduced anxiety, and take care of self. A total of 61% preferred oral medication and 39% LAI. Two groups were identified with different treatm

BACKGROUND: No established treatment algorithm exists for patients with schizophrenia. Whether switching antipsychotics or early use of clozapine improves outcome in (first-episode) schizophrenia is unknown.METHODS: This three-phase study was done in 27 centres, consisting of general hospitals and psychiatric specialty clinics, in 14 European countries and Israel. Patients aged 18-40 years who met criteria of the DSM-IV for schizophrenia, schizophreniform disorder, or schizoaffective disorder were treated for 4 weeks with up to 800 mg/day amisulpride orally in an open-label design (phase 1). Patients who did not meet symptomatic remission criteria at 4 weeks were randomly assigned to continue amisulpride or switch to olanzapine (≤20 mg/day) during a 6-week double-blind phase, with patients and staff masked to treatment allocation (phase 2). Randomisation was done online by a randomisation website; the application implemented stratification by site and sex, and applied the minimisation method for randomisation. Patients who were not in remission at 10 weeks were given clozapine (≤900 mg/day) for an additional 12 weeks in an open-label design (phase 3). The primary outcome was the number of patients who achieved symptomatic remission at the final visits of phases 1, 2, and 3, measured by intention-to-treat analysis. Data were analysed with a generalised linear mixed model, with a logistic link and binomial error distribution. This trial is registered with ClinicalTrials.gov, number NCT01248195, and closed to accrual.FINDINGS: Between May 26, 2011, and May 15, 2016, we recruited 481 participants who signed informed consent. Of the 446 patients in the intention-to-treat sample, 371 (83%) completed open-label amisulpride treatment, and 250 (56%) achieved remission after phase 1. 93 patients who were not in remission continued to the 6-week double-blind switching trial, with 72 (77%) patients completing the trial (39 on olanzapine and 33 on amisulpride)

Diese Dissertation hatte das Ziel, die Auswirkungen der Polypharmakotherapie auf das QTc-Intervall im klinischen Alltag zu analysieren.Im Rahmen einer retrospektiven statistischen Analyse wurden 200 Patientendaten der Klinik für Psychiatrie und Psychotherapie der Technischen Universität ausgewertet. Die Korrelationsanalyse der Risikofaktoren im Bezug auf ein verlängertes QTc-Intervall ergab eine positive Korrelation für die Verordnung von einem oder mehreren QTc-Intervall beeinflussenden Medikamenten, Geschlecht, Alter, Raucherstatus, Medikamentenmissbrauch/-abhängigkeit und Herzfrequenz., This dissertation tried to show the effects of polypharmacotherapy to the QTc-Interval in a clinical day to day setting. We used the data of 200 patients for a retrospective statistical analysis of the Hospital for Psychiatry and Psychotherapy of the Technical University Munich. We could show a positive correlation for a prolongation of the QTc-Interval and the following factors: the prescription of one or more QTc medications, gender, age, smoking, abuse of medication and heart rate.

Diese Dissertation hatte das Ziel, die Auswirkungen der Polypharmakotherapie auf das QTc-Intervall im klinischen Alltag zu analysieren.Im Rahmen einer retrospektiven statistischen Analyse wurden 200 Patientendaten der Klinik für Psychiatrie und Psychotherapie der Technischen Universität ausgewertet. Die Korrelationsanalyse der Risikofaktoren im Bezug auf ein verlängertes QTc-Intervall ergab eine positive Korrelation für die Verordnung von einem oder mehreren QTc-Intervall beeinflussenden Medikamenten, Geschlecht, Alter, Raucherstatus, Medikamentenmissbrauch/-abhängigkeit und Herzfrequenz., This dissertation tried to show the effects of polypharmacotherapy to the QTc-Interval in a clinical day to day setting. We used the data of 200 patients for a retrospective statistical analysis of the Hospital for Psychiatry and Psychotherapy of the Technical University Munich. We could show a positive correlation for a prolongation of the QTc-Interval and the following factors: the prescription of one or more QTc medications, gender, age, smoking, abuse of medication and heart rate.

BACKGROUND: Most of the 13 542 trials contained in the Cochrane Schizophrenia Group's register just tested the general efficacy of pharmacological or psychosocial interventions. Studies on the subsequent treatment steps, which are essential to guide clinicians, are largely missing. This knowledge gap leaves important questions unanswered. For example, when a first antipsychotic failed, is switching to another drug effective? And when should we use clozapine? The aim of this article is to review the efficacy of switching antipsychotics in case of nonresponse. We also present the European Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia.METHODS: We searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined switching the drug in nonresponders to another antipsychotic. We described important methodological choices of the OPTiMiSE trial.RESULTS: We found 10 RCTs on switching antipsychotic drugs. No trial was conclusive and none was concerned with first-episode schizophrenia. In OPTiMiSE, 500 first episode patients are treated with amisulpride for 4 weeks, followed by a 6-week double-blind RCT comparing continuation of amisulpride with switching to olanzapine and ultimately a 12-week clozapine treatment in nonremitters. A subsequent 1-year RCT validates psychosocial interventions to enhance adherence.DISCUSSION: Current literature fails to provide basic guidance for the pharmacological treatment of schizophrenia. The OPTiMiSE trial is expected to provide a basis for clinical guidelines to treat patients with a first episode of schizophrenia.

Ziel der Studie war die Beschreibung der Aufnahme von H-3 Leucin in B-Lymphomzellen und deren Änderung durch Behandlung mit Vincristin. Im Vordergund stand hierbei die Abwägung der Eignung der Aminosäure zur Bewertung der Effektivität einer Tumortherapie mittels PET. Lymphomzellen des Typs Su DHL-4 wurden in RPMI 1640-Medium auf 3, 75 x 10^6 Zellen/ml eingestellt und mit einer 0,02 pg/l Vincristinlösung für vier Stunden behandelt. 24 Stunden nach Therapiebeginn schloß sich eine Inkubation von je 100 ml der Zellsuspension mit 100 ml H-3 Leucin und 100 ml Kulturmedium bei variierender Aminosäurekonzentration über unterschiedliche Zeiträume im Schüttelbad (37°C) an. Eine Abtrennung der Zellfraktion erfolgte durch Zentrifugation auf 2200 rpm und anschließendem dreimaligem Waschen mit eiskaltem PBS. Parallel dazu wurde eine zweifache TCA Fällung mit Zentrifugierung bei 6000 rpm zur Bestimmung des Proteineinbaus durchgeführt. Nach der Lysierung des Pellets mit 0,1 N NaOH + 1% SDS konnte die aufgenommene Aktivität im Flüssig-Szintillationszähler gemessen werden. Die Aufnahme von Leucin verlief sowohl linear mit der Zeit als auch mit der jeweiligen Aminosäurekonzentration im Inkubationsmedium. Der Einbau in Proteine nimmt nur linear mit der Zeit zu, nicht aber mit der jeweiligen Aminosäurekonzentration. Nach Behandlung mit Vincristin konnte eine signifikante Verminderung sowohl der Aufnahme, wie auch des Einbaus von Leucin nachgewiesen werden. Die Aufnahme und der Einbau von Leucin werden durch die Behandlung mit Vincristin signifikant herabgesetzt, wobei keine Änderung des Transpoits der Aminosäuren als ursächlich anzusehen ist., The aim of the study was to examine the uptake of H-3 leucine into B-lymphoma cells and measure the effect of treatment with vincristine on the uptake of the aminoacid. Of further interrest was the possible usage of the aminoacid by PET as a predictor for effectiveness of a tumor therapy. Lymphoma cells Typ Su DHL-4 were cultivated in RPMI 1640 media, leveled to a concentration of 3,75 x 10^6 cells/ml and treated with a suspension of vincristine of 0,02 pg/l for four hours. 24 hours after the beginning of the treatment phase, 100 ml of the cell suspension, 100 ml of H-3 leucine and 100 ml of media with alternating concentrations of leucine were incubated at a temperature of 37°C. The cell fraction was first separated by using a biofuge at 2200 rpm and subsequently washed with ice-cold PBS three times. By using TCA twice followed by centrifugation at 6000 rpm the acid solvable fraction was separated leaving the protein fraction behind. After lysis with 0,1 N NaOH + 1% SDS the uptake of leucine was measured using a liquid szintillation counter. Uptake of leucine increased linear refering to time of incubation and concentration of leucine in the media. The acid refractory fraction could not be altered with different concentrations of leucine but increased only refering to the time of incubation. After treatment with vincristine a significant decrease of uptake and acid refractory fraction was measured. The decrease was not due to altered capability of the aminoacid transport system.

Ziel der Studie war die Beschreibung der Aufnahme von H-3 Leucin in B-Lymphomzellen und deren Änderung durch Behandlung mit Vincristin. Im Vordergund stand hierbei die Abwägung der Eignung der Aminosäure zur Bewertung der Effektivität einer Tumortherapie mittels PET. Lymphomzellen des Typs Su DHL-4 wurden in RPMI 1640-Medium auf 3, 75 x 10^6 Zellen/ml eingestellt und mit einer 0,02 pg/l Vincristinlösung für vier Stunden behandelt. 24 Stunden nach Therapiebeginn schloß sich eine Inkubation von je 100 ml der Zellsuspension mit 100 ml H-3 Leucin und 100 ml Kulturmedium bei variierender Aminosäurekonzentration über unterschiedliche Zeiträume im Schüttelbad (37°C) an. Eine Abtrennung der Zellfraktion erfolgte durch Zentrifugation auf 2200 rpm und anschließendem dreimaligem Waschen mit eiskaltem PBS. Parallel dazu wurde eine zweifache TCA Fällung mit Zentrifugierung bei 6000 rpm zur Bestimmung des Proteineinbaus durchgeführt. Nach der Lysierung des Pellets mit 0,1 N NaOH + 1% SDS konnte die aufgenommene Aktivität im Flüssig-Szintillationszähler gemessen werden. Die Aufnahme von Leucin verlief sowohl linear mit der Zeit als auch mit der jeweiligen Aminosäurekonzentration im Inkubationsmedium. Der Einbau in Proteine nimmt nur linear mit der Zeit zu, nicht aber mit der jeweiligen Aminosäurekonzentration. Nach Behandlung mit Vincristin konnte eine signifikante Verminderung sowohl der Aufnahme, wie auch des Einbaus von Leucin nachgewiesen werden. Die Aufnahme und der Einbau von Leucin werden durch die Behandlung mit Vincristin signifikant herabgesetzt, wobei keine Änderung des Transpoits der Aminosäuren als ursächlich anzusehen ist., The aim of the study was to examine the uptake of H-3 leucine into B-lymphoma cells and measure the effect of treatment with vincristine on the uptake of the aminoacid. Of further interrest was the possible usage of the aminoacid by PET as a predictor for effectiveness of a tumor therapy. Lymphoma cells Typ Su DHL-4 were cultivated in RPMI 1640 media, leveled to a concentration of 3,75 x 10^6 cells/ml and treated with a suspension of vincristine of 0,02 pg/l for four hours. 24 hours after the beginning of the treatment phase, 100 ml of the cell suspension, 100 ml of H-3 leucine and 100 ml of media with alternating concentrations of leucine were incubated at a temperature of 37°C. The cell fraction was first separated by using a biofuge at 2200 rpm and subsequently washed with ice-cold PBS three times. By using TCA twice followed by centrifugation at 6000 rpm the acid solvable fraction was separated leaving the protein fraction behind. After lysis with 0,1 N NaOH + 1% SDS the uptake of leucine was measured using a liquid szintillation counter. Uptake of leucine increased linear refering to time of incubation and concentration of leucine in the media. The acid refractory fraction could not be altered with different concentrations of leucine but increased only refering to the time of incubation. After treatment with vincristine a significant decrease of uptake and acid refractory fraction was measured. The decrease was not due to altered capability of the aminoacid transport system.