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1. Remission with or without comorbid substance use disorders in early psychosis: long-term outcome in integrated care (ACCESS III study)

Author

Friederike Rühl, Martin Lambert, Anja Rohenkohl, Vivien Kraft, Anne Daubmann, Brooke C. Schneider, Daniel Luedecke, Anne Karow, Jürgen Gallinat, Gregor Leicht, and Daniel Schöttle

Subjects
first episode psychosis, substance use, integrated care, assertive community treatment, remission, recovery, Psychology, BF1-990
Abstract

IntroductionSchizophrenia-Spectrum-Disorders are associated with poor long-term outcome as well as disability and often severely affect the lives of patients and their families often from symptom onset. Up to 70% of first episode psychosis (FEP) patients suffer from comorbid substance use disorders (SUD). We aimed at studying the course of illness in FEP patients within evidence-based care, with and without comorbid SUD, to examine how decreased, remitted or persistent substance use impacted rates of a combined symptomatic and functional long-term recovery compared with patients without SUD.MethodsACCESS III is an integrated care model for FEP or patients in the early phase of non-affective and affective psychotic disorders. Treatment trajectories of patients, who had been in ACCESS care for 1 year, with and without SUD were compared with regard to the course of illness and quality of life using Mixed Model Repeated Measures (MMRM) and recovery rates were compared using binary logistic regression. Change in substance use was coded as either persistent, decreased/remitted or no use.ResultsACCESS III was a prospective 1-year study (N = 120) in patients aged 12–29 years. Of these, 74 (61.6%) had a comorbid SUD at admission. There were no group differences regarding the course of illness between patients with or without comorbid SUD or between patients with a substance abuse or substance dependence. The only outcome parameter that was affected by SUD was quality of life, with larger improvement found in the group without substance use (p = 0.05) compared to persistent and remitted users. Using LOCF, 44 patients (48.9%) fulfilled recovery criteria at the endpoint; recovery did not differ based on substance use status.DiscussionSUD and especially substance dependence are common in psychotic disorders even in FEP patients. Evidence-based integrated care led to long-term improvement in patients with comorbid SUD and rate of recovery did not differ for patients with substance use.

Published
2023
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2. Mediators of quality of life change in people with severe psychotic disorders treated in integrated care: ACCESS II study

Author

Romy Schröter, Martin Lambert, Anja Rohenkohl, Vivien Kraft, Friederike Rühl, Daniel Luedecke, Jürgen Gallinat, Anne Karow, and Stefanie J. Schmidt

Subjects
Assertive Community Treatment, bipolar disorder, quality of life, schizophrenia, severe mental illness, Psychiatry, RC435-571
Abstract

Abstract Background Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood. Methods The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models. Results The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = −0.20, p < 0.001) to QoL (12 months, β = −0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05). Conclusions Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.

Published
2023
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3. The use of long-acting Aripiprazole in a multi-center, prospective, uncontrolled, open-label, cohort study in Germany: a report on global assessment of functioning and the WHO wellbeing index

Author

Daniel Schöttle, Wolfgang Janetzky, Daniel Luedecke, Elmar Beck, Christoph U. Correll, and Klaus Wiedemann

Subjects
Long-acting injectable, LAI, Naturalistic, Schizophrenia, Schizoaffective, Patient perspective, Psychiatry, RC435-571
Abstract

Abstract Background In this non-interventional study, the functionality and well-being of patients with schizophrenia with aripiprazole once-monthly (AOM) was evaluated under real-life conditions in a naturalistic population. Methods This non-interventional, prospective, multicenter 6-month study included 242 predominantly symptomatically stable patients (mean age 43.1 ± 15.1 years, 55% male) who switched their treatment to AOM after 9.7 (± 22.3) months of oral treatment. Outcome parameters included functionality (Global Assessment of Functioning, GAF), patient’s wellbeing (WHO-5 Well-Being Index, WHO-5), and both patient’s and clinician’s assessment of efficacy and tolerability of AOM. Treatment emergent adverse events (TRAE) were also recorded. Results At baseline, the mean GAF score was 47.0 (±13.9), indicating that patients experienced serious impairment in functioning. A continuous increase to 60.2 (±17.0) during treatment was found, with a robust and significant increase already after 4 weeks. At study start, patients reported diminished wellbeing, with a mean score of 10.6 (±5.6) on the WHO-5 scale. During treatment, patient wellbeing increased continuously with strong and significant improvements even after 4 weeks and an overall improvement of 4.8 (±6.9) over the course of 6 months with an endpoint of 15.4 (±5.5). Stratification of these results showed that more pronounced effects were achieved in younger patients ≤35 years (p

Published
2020
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4. Autoantibody-associated psychiatric symptoms and syndromes in adults: A narrative review and proposed diagnostic approach

Author

Niels Hansen, Michael Lipp, Jonathan Vogelgsang, Ruth Vukovich, Tristan Zindler, Daniel Luedecke, Stefan Gingele, Berend Malchow, Helge Frieling, Simone Kühn, Johannes Denk, Jürgen Gallinat, Thomas Skripuletz, Nicole Moschny, Jens Fiehler, Christian Riedel, Klaus Wiedemann, Mike P. Wattjes, Inga Zerr, Hermann Esselmann, Stefan Bleich, Jens Wiltfang, and Alexandra Neyazi

Subjects
Autoimmunity, Psychiatric symptoms, Autoantibodies, Psychiatric syndrome, Autoimmune psychosis, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Background: Autoimmune-mediated encephalitis is a disease that often encompasses psychiatric symptoms as its first clinical manifestation’s predominant and isolated characteristic. Novel guidelines even distinguish autoimmune psychosis from autoimmune encephalitis. The aim of this review is thus to explore whether a wide range of psychiatric symptoms and syndromes are associated or correlate with autoantibodies. Methods: We conducted a PubMed search to identify appropriate articles concerning serum and/or cerebrospinal fluid (CSF) autoantibodies associated with psychiatric symptoms and syndromes between 2000 and 2020. Relying on this data, we developed a diagnostic approach to optimize the detection of autoantibodies in psychiatric patients, potentially leading to the approval of an immunotherapy. Results: We detected 10 major psychiatric symptoms and syndromes often reported to be associated with serum and/or CSF autoantibodies comprising altered consciousness, disorientation, memory impairment, obsessive-compulsive behavior, psychosis, catatonia, mood dysfunction, anxiety, behavioral abnormalities (autism, hyperkinetic), and sleeping dysfunction. The following psychiatric diagnoses were associated with serum and/or CSF autoantibodies: psychosis and schizophrenia spectrum disorders, mood disorders, minor and major neurocognitive impairment, obsessive-compulsive disorder, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), anxiety disorders, eating disorders and addiction. By relying on these symptom clusters and diagnoses in terms of onset and their duration, we classified a subacute or subchronic psychiatric syndrome in patients that should be screened for autoantibodies. We propose further diagnostics entailing CSF analysis, electroencephalography and magnetic resonance imaging of the brain. Exploiting these technologies enables standardized and accurate diagnosis of autoantibody-associated psychiatric symptoms and syndromes to deliver early immunotherapy. Conclusions: We have developed a clinical diagnostic pathway for classifying subgroups of psychiatric patients whose psychiatric symptoms indicate a suspected autoimmune origin.

Published
2020
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5. Effectiveness of aripiprazole once-monthly in schizophrenia patients pretreated with oral aripiprazole: a 6-month, real-life non-interventional study

Author

Daniel Schöttle, Wolfgang Janetzky, Daniel Luedecke, Elmar Beck, Christoph U. Correll, and Klaus Wiedemann

Subjects
Long-acting injectable, LAI, Naturalistic, Schizophrenia, Schizoaffective, Psychiatry, RC435-571
Abstract

Abstract Background In this study, the treatment of schizophrenia patients with aripiprazole once-monthly (AOM) was evaluated under real-life conditions in a naturalistic setting. Methods This multicenter, prospective, non-interventional study included 242 patients (age = 43.1 ± 15.1 years, 55.0% male) who were monitored during 6 months of AOM treatment. Endpoints included measurements of psychopathology (Brief Psychiatric Rating Scale, BPRS) and severity of illness scales (Clinical Global Impressions-Severity, CGI-S, and -Improvement, CGI-I). Furthermore, treatment-related adverse events (TRAEs) were recorded. Results At baseline, the mean BPRS total score was 54.1 ± 15.6, the mean CGI-S was 4.8 ± 0.8 and the most frequent illness category was ‘markedly ill’ (41.7%). Patients had been pretreated with oral aripiprazole for a mean duration of 9.7 months (SD: 22.3) and 87.9% were deemed by their clinician as “clinically stable” and for a mean of 5.9 months. The difference in global BPRS after 6 months was − 13.8 (SD: 16.0; 95% CI: [− 15.9; − 11.7]; p

Published
2018
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6. Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment

Author

Daniel Schöttle, Friederike Ruppelt, Benno G. Schimmelmann, Anne Karow, Alexandra Bussopulos, Jürgen Gallinat, Klaus Wiedemann, Daniel Luedecke, Anja Christine Rohenkohl, Christian G. Huber, Thomas Bock, and Martin Lambert

Subjects
psychosis, involuntary admissions, coercive, multiple episodes, follow-up, Psychiatry, RC435-571
Abstract

Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years.Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement.Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons.Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01888627.

Published
2019
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7. Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.

Author

Daniel Schöttle, Benno G Schimmelmann, Friederike Ruppelt, Alexandra Bussopulos, Marietta Frieling, Evangelia Nika, Luise Antonia Nawara, Dietmar Golks, Andrea Kerstan, Matthias Lange, Michael Schödlbauer, Anne Daubmann, Karl Wegscheider, Anja Rohenkohl, Gizem Sarikaya, Mary Sengutta, Daniel Luedecke, Linus Wittmann, Gunda Ohm, Christina Meigel-Schleiff, Jürgen Gallinat, Klaus Wiedemann, Thomas Bock, Anne Karow, and Martin Lambert

Subjects
Medicine, Science
Abstract

The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required.Clinical Trial Registration Number: NCT01888627.

Published
2018
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8. Neurocognitive deficits are relevant for the jumping-to-conclusions bias, but not for delusions: A longitudinal study

Author

Christina Andreou, Brooke C. Schneider, Ryan Balzan, Daniel Luedecke, Daniela Roesch-Ely, and Steffen Moritz

Subjects
Schizophrenia, Delusions, Cognitive biases, Metacognitive training, Cognitive remediation, Neurology. Diseases of the nervous system, RC346-429
Abstract

Patients with delusions exhibit an increased tendency to arrive at decisions based on very limited evidence (jumping-to-conclusions; JTC), making this reasoning bias relevant for the treatment of delusions. Neurocognitive deficits contribute to JTC, but it is not known whether this has any bearing on the clinical syndrome of delusions. We addressed this question by reanalyzing data from an efficacy study of non-pharmacological interventions as adjunctive treatments in schizophrenia. We investigated the longitudinal associations of cognitive functioning, JTC and delusions in patients with psychotic disorders receiving either a metacognitive intervention addressing reasoning biases (n = 59), or cognitive remediation (n = 58). Both interventions improved JTC; in the cognitive remediation group, tentative evidence suggested that better neurocognitive performance contributed to this improvement. However, JTC gains were associated with delusion improvement only in the metacognitive intervention group, suggesting a content-specific mechanism of action.

Published
2015
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11. [Characteristics of psychoses in adolescence-Longitudinal data of integrated care]

Author

Anne, Karow, Daniel, Luedecke, Daniel, Schöttle, Anja, Rohenkohl, Benno, Schimmelmann, Jürgen, Gallinat, and Martin, Lambert

Subjects
Young Adult, Adolescent, Psychotic Disorders, Delivery of Health Care, Integrated, Mental Disorders, Schizophrenia, Humans, Community Mental Health Services
Abstract

Integrated care according to the Hamburg model combines therapeutic assertive community treatment (TACT) with initiatives for early detection and early treatment of schizophrenia and affective psychoses. The aim of this study was to identify the clinical characteristics of adolescents in comparison to adult patients and to derive knowledge for transition-specific treatment approaches.Sociodemographic and clinical variables as well as treatment performance and clinical outcome were investigated over a period of 12 months in 167 patients with psychoses (16-25 years, n = 88; and25 years, n = 79).Patients with psychosis in adolescence had significantly more outpatient treatment contacts (3.5/week vs. 1.6/week; p 0.001), while adults were hospitalized for twice as long (10 days vs. 21 days; p = 0.003). The duration of untreated psychoses was significantly shorter in the adolescent group than in adults (122 weeks vs. 208 weeks; p = 0.002). The proportion of comorbid mental disorders was significantly higher in the adolescent group (87% vs. 63%; p 0.001). In addition, the adolescence patients already showed greater impairment of daily functions and a higher severity of illness at the start of treatment.The treatment of psychoses in adolescence was characterized by a particularly high need for flexibility across all sectors and support systems, taking comorbid problem areas into account. Care models for adolescents and young adults with psychoses should therefore combine treatment approaches for severely ill patients with transition psychiatric interventions to avoid breaks in care and to meet the complex requirements of young patients with severe mental illnesses.HINTERGRUND: Die „Integrierte Versorgung nach dem Hamburger Modell“ verbindet therapeutisches „assertive community treatment“ (TACT) mit Initiativen zur Früherkennung und Frühbehandlung für schizophrene und affektive Psychosen. Ziel der vorliegenden Arbeit war es, klinische Charakteristika speziell von Adoleszenten im Vergleich zu erwachsenen Patienten zu identifizieren und Erkenntnisse für transitionsspezifische Behandlungsansätze abzuleiten.Es wurden soziodemographische und klinische Variablen sowie Behandlungsleistungen und Behandlungsverlauf über einen Zeitraum von 12 Monaten bei 167 Patienten mit Psychosen untersucht (16–25 Jahre: n = 88,25 Jahre: n = 79).Patienten mit Psychosen in der Adoleszenz wiesen signifikant mehr ambulante Behandlungsleistungen auf (3,5 vs. 1,6/Woche; p 0,001), während Erwachsene doppelt so häufig stationär behandelt wurden (10 vs. 21 d; p = 0,003). Die Dauer der unbehandelten Psychose war in der Adoleszenzgruppe signifikant kürzer als bei den Erwachsenen (122 vs. 208 Wochen; p = 0,002). Der Anteil komorbider psychischer Störungen war in der Adoleszenzgruppe signifikant höher (87 % vs. 63 %; p 0,001). Darüber hinaus zeigten die adoleszenten Patienten bereits zu Beginn der Behandlung stärkere Einbußen ihrer Alltagsfunktionen und eine höhere Erkrankungsschwere.Die Behandlung von Psychosen in der Adoleszenz zeichnet eine besonders hohe Notwendigkeit der Flexibilität über Sektorengrenzen und Unterstützungssysteme hinweg unter Berücksichtigung komorbider Problembereiche aus. Versorgungsmodelle für Adoleszente und junge Erwachsene mit Psychosen sollten daher Behandlungsansätze für schwer erkrankte Patienten mit transitionspsychiatrischen Interventionen verbinden, um Brüche in der Versorgung zu vermeiden und den komplexen Anforderungen junger Patienten mit schweren psychischen Erkrankungen gerecht zu werden.

Published
2022

12. Autoantibody-associated psychiatric syndromes in children: link to adult psychiatry

Author

Johannes Denk, Michael Lipp, Simone Kühn, Jens Fiehler, Jens Wiltfang, Anne Karow, Klaus Wiedemann, Stefan Bleich, Inga Zerr, Charles Timäus, Stefan Gingele, Berend Malchow, Jürgen Gallinat, Luise Poustka, Nicole Moschny, Christian Heiner Riedel, Thomas Skripuletz, Tristan Zindler, Jonathan Vogelgsang, Hermann Esselmann, Niels Hansen, Helge Frieling, Mike P. Wattjes, Hans Hartmann, Alexandra Neyazi, and Daniel Luedecke

Subjects
0301 basic medicine, Adult, medicine.medical_specialty, Psychosis, Obsessive-Compulsive Disorder, Neurology, Catatonia, Autism Spectrum Disorder, Psychiatry and Preclinical Psychiatric Studies - Review Article, Tourette syndrome, 03 medical and health sciences, 0302 clinical medicine, Obsessive compulsive, Medicine, Animals, Humans, ddc:610, Psychiatry, Child, Biological Psychiatry, Autoantibodies, Adult psychiatry, business.industry, Autoantibody, medicine.disease, Psychiatry and Mental health, 030104 developmental biology, Psychotic Disorders, Autism spectrum disorder, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Studies show that psychiatric symptoms in adults and children are sometimes associated with serum neural autoantibodies. The significance of serum neural autoantibodies associated with psychiatric symptoms in children remains often unclear, but might be relevant for the extent and occurrence of psychiatric disease manifestation in later life, as well as therapy and outcome. For this narrative review, we sought articles listed in PubMed and published between 1988 and 2020 addressing the maternal–fetal transfer of neural autoantibodies and psychiatric disorders associated with serum neural autoantibodies. We identified six major subgroups of psychiatric disorders in children that are associated with serum neural autoantibodies: patients with attentional deficit hyperactivity disorder, autism spectrum disorder, obsessive compulsive disorder, Gilles de la Tourette syndrome, psychosis and catatonia. Furthermore, we summarized study findings from maternal–fetal transfer of Contactin-associated protein-like 2, N-methyl-d-aspartate receptor and fetal brain autoantibodies associated with behavioral effects in animals and humans. We hypothesize that the maternal transfer of serum neuronal autoantibodies during or after birth could result (1) in the ignition of an autoimmune-mediated inflammation having neurodevelopmental consequences for their children (autoimmune-priming-attack hypothesis) and (2) has a potential impact on the later manifestation of psychiatric disorders. Through this narrative review, we propose a diagnostic pathway for the clinical diagnosis of a potentially autoimmune origin of psychiatric symptoms in children while considering recent guidelines.

Published
2021
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13. Factors Influencing Staff’s Attitude Toward Electroconvulsive Therapy

Author

Florian Hädrich, Janina Gornisch, Anne Deborah Scholz-Hehn, Heiko Albrecht, Nils Freundlieb, Ruben Deml, Daniel Luedecke, Gregory Hecht, Laura Stumm, Isabel Methfessel, Jana Christina Müller, and David Zilles

Subjects
medicine.medical_specialty, Nursing staff, Attitude of Health Personnel, medicine.medical_treatment, Neuroscience (miscellaneous), MEDLINE, Nurses, Mindset, Ambulatory Care Facilities, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, Electroconvulsive therapy, Clinical history, Germany, Physicians, Surveys and Questionnaires, mental disorders, Health care, medicine, Humans, Psychology, Electroconvulsive Therapy, business.industry, Mental Disorders, Psychiatric clinics, 030227 psychiatry, 3. Good health, Psychiatry and Mental health, Treatment Outcome, Family medicine, Positive attitude, business, 030217 neurology & neurosurgery
Abstract

Objectives Despite being a highly effective treatment, electroconvulsive therapy (ECT) is still stigmatized even among professionals. The aim of this study was to identify factors associated with a positive attitude toward ECT among health care workers. Methods We investigated staff's attitude and their self-assessment of knowledge while introducing ECT in 3 German psychiatric clinics. Furthermore, we compared this data to that of a clinic where ECT has been applied with a long tradition. An anonymous questionnaire was answered by n = 182 employees in the ECT-introducing clinics (novices) and n = 68 employees in the clinic with a long history of ECT (experts). Results Irrespective of the clinical history, the majority of participants approved the application of ECT in their clinic. Factors associated with a positive attitude were (a) profession (physicians presented a more positive mindset about ECT than nursing staff), (b) subjective feeling of being adequately informed, and (c) having had contact to patients undergoing ECT. Interestingly, the general attitude toward ECT did not differ between subjects who reported to have seen an ECT and those who had not. Conclusions When introducing ECT as a new treatment into a clinic, formal information should be adapted to the needs of each profession with a special emphasis on nurses. To further increase acceptance, contact to ECT-experienced patients (professionals taught by patients) might result in a more positive attitude toward ECT than participation in an ECT treatment itself.

Published
2018
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14. Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study

Author

Jürgen Gallinat, Vivien Niehaus, Anne Karow, Daniel Schöttle, Klaus Wiedemann, Charlotte Gagern, Friederike Ruppelt, Linus Wittmann, Anne Daubmann, Thomas Bock, Anne-Lena Falk, Liz Rietschel, Benno G. Schimmelmann, Luise Antonia Nawara, Hans-Peter Unger, Karl Wegscheider, Sabine Ott, Georg Romer, Martin Lambert, Michael Schulte-Markwort, Anja Rohenkohl, Mary Sengutta, Christoph U. Correll, G Sarikaya, Britta Galling, and Daniel Luedecke

Subjects
Adult, medicine.medical_specialty, Adolescent, endocrine system diseases, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Early Medical Intervention, Internal medicine, medicine, Clinical endpoint, Humans, Prospective Studies, Bipolar disorder, Young adult, Psychiatry, medicine.disease, 030227 psychiatry, Integrated care, Psychiatry and Mental health, Early Diagnosis, Psychotic Disorders, Schizophrenia, dup, Linear Models, Female, Patient Care, Psychology, 030217 neurology & neurosurgery, Follow-Up Studies, Psychopathology
Abstract

Objective The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). Methods ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12–29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. Results In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15–14.53, P

Published
2017
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15. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III)

Author

Ute Handwerk, Benjamin Lange, Helmut Krüger, Sven Sippel, Daniel Schöttle, Friederike Ruppelt, Wiebke Rothländer, Charlotte Gagern, Dieter Naber, Britta Galling, Luise Antonia Nawara, Sabine Ott, Karl Wegscheider, Daniel Luedecke, Georg Romer, Jürgen Gallinat, Anne Daubmann, Anne-Lena Falk, Linus Wittmann, Anja Rohenkohl, Liz Rietschel, G Sarikaya, Martin Lambert, Hans-Peter Unger, Thomas Bock, Michael Schulte-Markwort, Christina Meigel-Schleiff, Christoph U. Correll, Vivien Niehaus, Anne Karow, Mary Sengutta, and Benno G. Schimmelmann

Subjects
medicine.medical_specialty, Assertive community treatment, Global Assessment of Functioning, medicine.disease, 030227 psychiatry, Integrated care, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Quality of life (healthcare), Schizophrenia, medicine, Bipolar disorder, Pshychiatric Mental Health, Psychiatry, Psychology, 030217 neurology & neurosurgery, Biological Psychiatry, Psychopathology, Cohort study
Abstract

Aim The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. Methods This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12–29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). Results Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. Conclusion To the authors’ knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.

Published
2016
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16. Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study

Author

Jürgen Gallinat, Marietta Frieling, Thomas Bock, Daniel Luedecke, Mary Sengutta, Alexandra Bussopulos, Luise Antonia Nawara, Gunda Ohm, Anne Karow, Andrea Kerstan, Anne Daubmann, Benno G. Schimmelmann, Linus Wittmann, Michael Schödlbauer, Daniel Schöttle, G Sarikaya, Friederike Ruppelt, Anja Rohenkohl, Dietmar Golks, Klaus Wiedemann, Martin Lambert, Evangelia Nika, Karl Wegscheider, Christina Meigel-Schleiff, and Matthias Lange

Subjects
Male, Pediatrics, Bipolar I disorder, Bipolar Disorder, lcsh:Medicine, Social Sciences, 0302 clinical medicine, Outpatients, Medicine and Health Sciences, Ambulatory Care, Psychology, lcsh:Science, Multidisciplinary, Pharmaceutics, Cognitive Neurology, Delivery of Health Care, Integrated, Community Mental Health Services, Hospitalization, Treatment Outcome, Neurology, Schizophrenia, Patient Satisfaction, Female, Psychopathology, Cohort study, Research Article, Adult, medicine.medical_specialty, Patient Dropouts, Patients, Assertive community treatment, Cognitive Neuroscience, 03 medical and health sciences, Patient satisfaction, Drug Therapy, Neuropsychology, Severity of illness, Mental Health and Psychiatry, medicine, Humans, Bipolar disorder, Neuropsychological Testing, Inpatients, business.industry, Mood Disorders, lcsh:R, Psychoses, Biology and Life Sciences, medicine.disease, Involuntary Treatment, 030227 psychiatry, Health Care, Psychotherapy, Psychotic Disorders, Quality of Life, Cognitive Science, lcsh:Q, business, Mental Health Therapies, 030217 neurology & neurosurgery, Neuroscience, Follow-Up Studies
Abstract

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

Published
2018

17. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III)

Author

Martin, Lambert, Daniel, Schöttle, Mary, Sengutta, Friederike, Ruppelt, Anja, Rohenkohl, Daniel, Luedecke, Luise Antonia, Nawara, Britta, Galling, Anne-Lena, Falk, Linus, Wittmann, Vivien, Niehaus, Gizem, Sarikaya, Ute, Handwerk, Wiebke, Rothländer, Liz, Rietschel, Charlotte, Gagern, Benjamin, Lange, Christina, Meigel-Schleiff, Dieter, Naber, Michael, Schulte-Markwort, Helmut, Krüger, Hans-Peter, Unger, Sven, Sippel, Sabine, Ott, Georg, Romer, Anne, Daubmann, Karl, Wegscheider, Christoph U, Correll, Benno G, Schimmelmann, Thomas, Bock, Jürgen, Gallinat, and Anne, Karow

Subjects
Adult, Male, Adolescent, Delivery of Health Care, Integrated, Cost-Benefit Analysis, Community Mental Health Services, Cohort Studies, Young Adult, Early Diagnosis, Treatment Outcome, Psychotic Disorders, Patient Satisfaction, Early Medical Intervention, Quality of Life, Humans, Female, Prospective Studies, Quality-Adjusted Life Years, Child, 610 Medicine & health, Quality of Health Care
Abstract

The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014.This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment).Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group.To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.

Published
2018
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18. Comorbidity of chronic somatic diseases in patients with psychotic disorders and their influence on 4-year outcomes of integrated care treatment (ACCESS II study)

Author

Daniel Schöttle, Friederike Ruppelt, Klaus Wiedemann, Daniel Luedecke, Anna-Katharina Siem, Anne Daubmann, Martin Lambert, Anne Karow, Mary Sengutta, Vivien Kraft, Christoph U. Correll, Jürgen Gallinat, Romy Schröter, and Anja Rohenkohl

Subjects
Adult, Male, Psychosis, medicine.medical_specialty, Adolescent, Disease, Comorbidity, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pharmacotherapy, International Classification of Diseases, Internal medicine, Medicine, Humans, In patient, Bipolar disorder, Longitudinal Studies, Psychiatry, Child, Somatoform Disorders, Biological Psychiatry, Retrospective Studies, Neurologic Examination, Psychiatric Status Rating Scales, business.industry, Middle Aged, medicine.disease, 030227 psychiatry, Integrated care, Psychiatry and Mental health, Psychotic Disorders, Schizophrenia, Chronic Disease, Female, business, 030217 neurology & neurosurgery
Abstract

People with psychotic disorders fulfilling criteria of a severe and persistent mental illness (SPMI) display a high risk of somatic comorbidity (SC).ACCESS II is a prospective, long-term study examining the effectiveness of Integrated Care for people with psychotic disorders fulfilling SPMI criteria. Chronic comorbid somatic disorders were systematically assessed according to ICD-10-GM criteria. Patients treated for ≥4years in ACCESS were categorized as early psychosis (treatment: ≤2years) or non-early psychosis (treatment:2years) patients.Of 187 patients treated in ACCESS for ≥4years (mean age=41.8years, males=44.4%), 145 (77.5%) had SC, (mean=2.1±2.1). Overall, 55 different diseases from 15 different ICD-10-GM disease areas were identified. Prevalence of ≥1 SC (p=0.09) and specific types of SC (p=0.08-1.00) did not differ between early and non-early psychosis patients, but non-early psychosis patients had a higher mean number of SC (2.3±2.2 vs. 1.3±1.3, p=0.002). SC patients had higher rates of comorbid mental disorders (93% vs. 81%, p=0.002), specifically posttraumatic stress disorder (23% vs. 7%, p=0.002), and suicide attempts (43% vs. 19%, p0.001). At the 4-year endpoint, both patients with and without comorbidity displayed major improvements in psychopathology, severity of illness, functioning, quality of life and satisfaction with care.SC is frequent in patients with severe psychotic disorders, even in the early psychosis phase. The magnitude of the problem underlines the need for regular screening, comprehensive assessment, preventive pharmacotherapy, and targeted SC management.

Published
2017

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