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Importance: Home treatment (HT) has been associated with fewer inpatient treatment (IT) readmission days but lacks evidence on reducing combined psychiatric hospital service use (IT, HT, day clinic)., Objective: To assess the association of intensive home treatment (IHT) compared with IT regarding readmission rate, social outcomes, and clinical outcomes., Design, Setting, and Participants: This quasi-experimental, nonrandomized trial was conducted from 2020 to 2022 in 10 psychiatric hospitals in Germany. Propensity score (PS) matching was used to compare both treatment models at the 12-month follow-up using standardized instruments and routine hospital data. All patients were screened until the target sample size was reached, based on these criteria: stable residence with privacy for sessions, no child welfare risk, primary diagnosis within International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F0X to F6X, residence in the catchment area, no commitment order, no acute suicidality or severe aggression requiring hospitalization, capacity to consent, not participating in other interventional studies, sufficient German language skills, no substantial cognitive deficits or intellectual impairment, and no more than 7 days in IHT or IT before recruitment. Statistical analysis was performed from February to November 2023., Intervention: IHT provided daily acute psychiatric treatment at home, while IT was psychiatric inpatient treatment as usual. The mean treatment duration of the index treatment was 37.2 days for IHT and 28.2 days for IT., Main Outcomes and Measures: The inpatient readmission rate was the primary outcome. Secondary outcomes were combined readmission rate, total inpatient days, job integration, quality of life, psychosocial functioning, symptom severity, and recovery., Results: Of 1396 individuals, 200 patients receiving IHT and 200 patients receiving IT were included (264 female [65%]; mean [SD] age, 45.45 [15.83] years [range, 18-88 years]). Baseline sociodemographic and psychometric characteristics did not differ significantly between the groups. At 12-month follow-up, patients in the IHT group had lower inpatient readmission rate (IHT vs IT: 31.12% vs 49.74% IT; mean difference, 18% [95% CI, 9%-28%; P < .001), combined readmission rate (mean difference, 13% [95% CI, 4%-24%; P < .001), and fewer inpatient days (mean difference, 6.82 days; P < .001) than the IT group., Conclusions and Relevance: This nonrandomized clinical trial found that patients receiving IHT had a lower likelihood of utilizing hospital-based psychiatric services and spent fewer inpatient days, suggesting that IHT is a viable alternative to IT., Trial Registration: ClinicalTrials.gov Identifier: NCT04745507.

Objective: The study analyses the number, characteristics and reasons for a length of stay of patients in German psychiatric clinics in excess of 6 months., Methods: The study was implemented in the form of a nationwide online survey, which was addressed to chief physicians of psychiatric clinics., Results: In the sample, 174 patients in 80 psychiatric clinics were identified who could not be discharged because no suitable follow-up services were available in the region. The majority of patients are male, often have an F2 diagnosis and exhibit aggressive behaviour during their hospital stay., Conclusion: To avoid inappropriate health care and prevent prolonged stays for a subgroup of mentally ill people, individual complex services should be implemented in community psychiatry., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Evaluation of the practice of coercive treatment in Germany after the Constiutional Court's decision in 2011., Methods: The documented emergency treatments (N=86) and judicially approved compulsory treatments (N=62) in 2015 and 2016 at 6 hospital locations in Baden-Württemberg were retrospectively analysed., Results: Patients had an average of 8 previous psychiatric hospitalisations with a cumulative duration of 645 days on average and 87% had a psychotic disorder. 34% received subsequent compulsory treatment within one year. The median duration of compulsory treatment was 15 days. 92% of the patients were taking an antipsychotic at discharge, 45% received further treatment in a day hospital or a psychiatric outpatient clinic., Conclusion: Coercive treatment affects a relatively small, chronically severely ill group of patients and is frequently recurrent among them. For considerable part, no consecutive treatment setting can be established after discharge., Competing Interests: Die Autor*innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Major lockdowns were imposed in Germany from March until May 2020 and from December 2020 until May 2021. We studied the influence of these lockdowns, the strain on intensive care units and the strictness of COVID-19-related containment strategies on the utilization of mental health care among patients with severe mental disorders., Methods: We used health insurance claims data to identify n = 736,972 patients with severe mental disorders shortly before the pandemic and n = 735,816 patients a year earlier. We applied entropy balancing to adjust for baseline differences by district. For a 12-month follow-up, we modeled monthly changes in utilization through meta-analytic models using both the COVID-19 stringency index and intensive care unit cases per 100,000 inhabitants as predictors. Our outcomes were changes in psychiatric hospital days and time treated by outpatient psychiatrists., Results: Psychiatric hospital days declined by at least 7.7% in all calender month during the pandemic. Peak reduction rates were observed in April (- 27.9%), May (- 22.3%) 2020 and January 2021 (- 18.3%). Utilization changes were associated with the stringency index and the second lockdown. Time treated by psychiatrists was shorter in April (- 16.2%) and May (- 11.5%) 2020 and in January 2021 (- 10.5%), which was partially offset by higher utilization in June and September 2020. These utilization changes were associated with the stringency index and the strain on intensive care units during both lockdowns., Conclusion: Hospitals did not maintain the level of utilization during the pandemic, while outpatient psychiatrists adapted more quickly, presumably due to digital and telemedical care., (© 2023. The Author(s).)

Background: Hyperkinetic disorders (HKD, ICD-10 F90.‑) have increasingly been the focus of research literature in recent years. Empirical studies analyzing the care situation in psychiatric clinics are so far primarily available for a few health insurances. This study analyzed a German sample from 2015 consisting of inpatient as well as day care psychiatric treatment cases from all statutory health insurances focusing on the care situation and differentiating between minor vs. adult patients with the main diagnosis HKD., Material and Methods: The study was based on the treatment relevant indicators in psychiatry and psychosomatics (VIPP) database, which contains data according to §21 of the Hospital Remuneration Act (KHEntgG). A total of 896 treatment cases with the diagnosis of HKD from the year 2015, based on anonymized routine records from 41 psychiatric clinics, were analyzed., Results: The basic conditions for inpatient/day care psychiatric treatment significantly differed between minor vs. adult patients. Minors travelled greater distances to the treatment site, received more therapy units and stayed longer in the psychiatric clinic than adults. Significant differences were also found between the subgroups concerning the main diagnoses according to ICD-10 coding as well as comorbid mental disorders., Conclusion: Due to greater distances from their residence to a psychiatric hospital for minors, extension of capacities with a focus on child and youth psychiatry seems to be a reasonable conclusion. Simultaneously, the intensity of treatment seems to be lower for adult patients, despite a greatly increased number of secondary diagnoses and thus anticipated psychological stress. Transition difficulties from child and youth psychiatry to adult psychiatry may be a possible explanation for this discrepancy.

Neuroleptic malignant syndrome (NMS) is a rare, but severe adverse drug reaction of drugs with anti-dopaminergic properties. The main symptoms are fever and rigor. In addition, other symptoms such as creatine kinase elevation, alteration of consciousness and various neurological symptoms may occur. A total of 52 NMS cases have been documented in the drug safety program 'Arzneimittelsicherheit in der Psychiatrie' from 1993 to 2015. We calculated incidences and analyzed imputed substances and additional risk factors to study the impact of changing therapy regimes. The overall incidence was 0.16‰. High-potency first-generation antipsychotics (FGAs) had the highest incidences, e.g. flupentixol with 0.61‰. Second-generation antipsychotics (SGAs) had lower incidences. Low-potency FGAs had very low incidences, comparable to SGAs, but in contrast to SGAs, had not been imputed alone in any case of NMS. Preexisting organic pathologies of the central nervous system, lithium treatment, infection/exsiccosis and the withdrawal of medication with anticholinergic properties or alcohol were found to be additional risk factors. With the increasing use of SGAs, one should always be aware of the risk of NMS. Better suited diagnostic criteria for 'atypical NMS' would lead to a better understanding and, therefore, to improved treatment possibilities.

Background and Goal: According to § 136a (2) SGB V (volume V of the German Social Security Code) the German legislator instructed the Federal Joint Committee (G-BA) to specify binding minimum standards for the staff needed for the treatment in inpatient psychiatric and psychosomatic facilities. This induced the expert associations/organizations to develop their own conceptional approach as to the future organization of staffing., Method: Organization of regular expert workshops, the results of which were systematically documented and validated by the experts., Results: The essential elements of the concept are: the starting points for the calculation are the needs of all patients treated in the institution. The need for treatment has three dimensions: (a) psychiatric psychotherapeutic/psychosomatic psychotherapeutic/pediatric and adolescent psychiatric-psychotherapeutic, (b) somatic and (c) psychosocial needs. The model developed by the platform distinguishes between staff requirements being directly related to the treatment of the individual patient, staff requirements caused by the treatment setting and such staff requirements arising at an institutional level. Minimum staff requirement is understood as the staff structure which is, among others, needed to guarantee the multiprofessional, physician-led treatment and the required medical care services for all patients specified by the existing guidelines or an expert consensus as well as to ensure the protection of the patient, fellow patients and the employees working in the facility against hazards., Conclusion: This model considers the medical progress within the meaning of the evidence-based guidelines and the modified healthcare practice including sociopolitical standards aimed at the patients' self-determination.

Background: The German Law for the Development of Care and Funding for Psychiatric and Psychosomatic Services (PsychVVG) has established a new regulation for the mental healthcare system. In the future, characteristics of hospitals and catchment areas will be an elementary part of negotiations on remuneration., Objective: The aim of this study was to identify structural and regional characteristics of psychiatric hospitals in Germany that contribute to increased average costs according to the views of clinical managers and directors., Methods: In this study 37 guided expert interviews were conducted with business managers, financial controllers, leading medical and nursing personnel from psychiatric hospitals and the characteristics relevant for the budget and increased average costs were collated., Results: Important factors with top priority were hospital infrastructure, characteristics of the catchment area and specialties of inpatient services provided. Obligatory service for a defined catchment area, increased documentation requirements and infrastructure of buildings and grounds were estimated as being associated with the highest additional financial expenditure., Conclusion: It is a challenge for clinics to prove increased average costs due to the respective hospital structural and regional characteristics. This study shows which characteristics should be considered as most cost-relevant from the perspective of hospital management.

Background: The percentage of patients subjected to coercive measures has been proposed as 1 of 10 quality indicators for psychiatric inpatient treatment by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN). Internationally, there are similar recommendations and corresponding reporting systems., Methods: The registry of coercive measures of psychiatric hospitals in Baden-Württemberg that was established in 2015, yields the possibility to examine the appropriateness of this indicator, based on raw data of 108,863 cases in 2016. This study investigated how the indicator is influenced by patient variables and characteristics of hospital structure., Results: The percentage of cases exposed to coercive measures was strongly (r = 0.6) correlated with the percentage of involuntarily treated cases. With respect to the latter, hospitals varied widely with a range from 0.7% up to 24.1%. Specialized wards serving patients outside the catchment area with a high number of coercive measures also had a strong influence on the results of a benchmarking comparison., Conclusion: The indicator is a good instrument for longitudinal evaluation of an institution; however, due to a high number of known and unknown confounding factors, it is inappropriate for the purpose of comparing psychiatric hospitals.

Background: The study aimed to investigate severe hair loss related to psychotropic drugs (PDs) by using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie (AMSP)., Methods: Data on PD utilization and reports of severe PD-related hair loss were collected in 83 psychiatric hospitals in Austria, Germany and Switzerland during the period 1993-2013., Results: Out of 432,215 patients under surveillance, 404,009 patients were treated with PDs for the main indications of depression, schizophrenic disorder, neurosis, mania, and organic psychosis. Severe hair loss related to PD treatment was reported in 43 cases (0.01%). The rates of hair loss under antipsychotic drugs were slightly lower than the mean rates of all PDs and antidepressant drugs. Valproic acid was related to the highest risk. In 6 of the 43 cases, hair loss was imputed to multiple drugs, with 4 cases imputed to double drug combinations and 2 cases to triple combinations. Rates of severe hair loss under valproic acid (VPA) and lithium salts were distinctly lower as compared with the overall rates reported in literature. Severe hair loss under PD treatment was reported significantly more often in female patients than in male patients (p < 0.01)., Conclusion: The rate of severe PD-related hair loss was very low in the present survey. The large number of patients included in this multicentre study allows for assessment and comparison of hair loss rates related to different PDs and groups of PDs and provides new and supplementary information on PD-related hair loss., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

We assessed whether an Assertive Outreach (AO) program for patients with schizophrenia implemented in German routine care in rural areas reduces psychiatric hospital admissions and/or psychiatric hospital days. We conducted a quasi-experimental controlled study with 5 assessments in 12 months. Data collection included health care utilization (Client Sociodemographic and Service Receipt Inventory), and clinical parameters. The assessments took place in the practices of the psychiatrists. Admission incidence rates were calculated. For bivariate group comparison, we used U-tests, T-tests and Chi(2)-Tests, multivariate analysis was conducted using zero-inflated regression models. For hospital outcomes, data of 295 patients was analysed. No statistically significant differences between AO and TAU patients in terms of hospital admissions or hospital days were found. Overall hospital utilization was low (8%). Advantages of AO over TAU referring to hospital utilization were not found. However, a spill-over effect might have reduced hospital utilization in both groups. Further research should differentiate patient subgroups. These two appear to be key factors to explain effects or absence of effects and to draw conclusions for the mental health care delivery., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate multiple efforts of the last decade to reduce the use of coercive measures in psychiatric hospitals., Method: A working group for the prevention of violence and coercion in psychiatric hospitals has compared several outcome indicators since the year 2000 and repeatedly has provided evidence-based recommendations for clinical practice. We present data from those 5 hospitals with complete data sets recorded by an identical method over 9 years., Results: The percentage of admissions exposed to any kind of coercive measure decreased from 8.2 % in 2004 to 6.2 % in 2012. The standard deviation of outcomes between hospitals decreased by 20 %. Changes in the duration of measures were mostly insignificant., Conclusions: Measures to reduce the use of coercion are effective in clinical practice, but to less extent than in clinical studies. A ban on all forced and non-consensual medical interventions, as being stipulated by the UN Special Rapporteur on Torture, has so far not materialized in the participating psychiatric institutions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed., Method: A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork., Results: Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate., Conclusion: Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role., (© The Author(s) 2013.)

No empirical data about the topic "Mental Disability and Dementia" in Germany exist. The aim of this survey was to obtain current data about mentally disabled people with dementia. Therefore, the following questions need to be clarified: how many mentally disabled people are affected with dementia, which difficulties occur regarding the diagnosis of dementia and what challenges have to be solved in upcoming years. In all, 45 organisations for the mentally disabled took part in the survey, showing that dementia amongst people with mental disabilities appeared largely starting at the age of 50. Standardized diagnostics are seldom used by these organisations. Instead, observation of behaviour by care attendants plays a central role, due to the fact that speaking and introspection are not possible for a majority of the patients. In general, institutions for people with mental disabilities do not have specific offers for people with dementia, occasionally there are offers regarding their living situation and free time activities.

Objective: 10-year follow-up of the psychogeriatric inpatient care at the University Psychiatric Hospitals Basel following the establishment of an outpatient care service for the elderly (ADA)., Method: Standardized chart review of a random sample of psychogeriatric cases (≥ 65 y) of the years 1997 and 2007 (n = 100 each) in terms of socio-demographic, diagnostic, therapeutic und administrative data., Results: The number of patients with contact to both inpatient and outpatient services prior to admission increased. There was no change regarding the amount of unvoluntary admissions. As expected more complex cases were treated. The case management showed changes towards greater guideline conformity., Conclusion: The 10-year follow-up shows a better outpatient treatment and the provision of inpatient facilities for complex multimorbid and emergency patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: There is considerable variance in involuntary psychiatric hospital admission rates both in Europe and Germany. In a prospective comparison between five hospitals in three German federal states we assessed and analyzed involuntary psychiatric hospital admissions, including the patient's perspective., Material and Method: All involuntarily admitted patients were assessed by an independent researcher. Clinical data, patient and psychiatrist views were documented with different instruments including the McArthur admission experience survey., Results: In this study 104 out of 244 involuntarily admitted patients gave informed consent. We found considerable differences between study centres concerning involuntary admission quotas (3.2-25.8% of all hospital admissions) and involuntary admission rates (16.6-97.6 per year per 100,000 inhabitants). Hospitals in the state of Baden-Württemberg had the lowest involuntary admission rates while they were highest in Bavaria. In Baden-Württemberg involuntarily admitted patients were more likely to suffer from chronic schizophrenia, they were more severely ill and experienced the involuntary hospital admission as more strenuous. There were no differences between centres concerning frequency of dangerous behavior or self-harm., Conclusion: We found a high variance across regions concerning the reasons for, frequencies and legal basis of involuntary hospital admissions. Regional differences of legal frameworks and service organization can explain this only to a limited amount. Transparency, legal certainty and reflection of stakeholder roles are a future necessity. Furthermore, there is a need for stringent compliance with legal regulations and coherent documentation.

Background: Intercultural differences influence acute inpatient psychiatric care systems., Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital., Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatment processes and outcome indicators., Results: Schizophrenia and related psychosis was the most common diagnosis in both hospitals. Cases at the BKR were admitted more quickly after onset of the present episode. Global Assessment of Psychosocial Functioning (GAF) ratings at admission were lower at the HH. Most admissions to both hospitals received psychopharmacological treatment, but more at the HH received psychotherapy. Length of stay was significantly longer at the HH (75 days) than at the BKR (28 days). Admissions to the HH were more improved with regard to GAF and clinical global impression (CGI)., Conclusions: Acute admissions in Germany provide intensive care with short hospitalization as crisis intervention. For acute admissions in Japan, comprehensive care for severe mental illness precedes emergency admissions and achieves greater improvement with longer hospitalization.

Objective: Despite the recurring nature of the disease process in many psychiatric patients, individual careers and time to readmission rarely have been analysed by statistical models that incorporate sequence and velocity of recurrent hospitalisations. This study aims at comparing four statistical models specifically designed for recurrent event history analysis and evaluating the potential impact of predictor variables from different sources (patient, treatment process, social environment)., Method: The so called Andersen-Gil counting process model, two variants of the conditional models of Prentice, Williams, and Peterson (gap time model, conditional probability model), and the so called frailty model were applied to a dataset of 17’145 [corrected] patients observed during a 12 years period starting from 1996 and leading to 37’697 psychiatric hospitalisations Potential prognostic factors stem from a standardized patient documentation form., Results: Estimated regression coefficients over different models were highly similar, but the frailty model best represented the sequentiality of individual treatment careers and differing velocities of disease progression. It also avoided otherwise likely misinterpretations of the impact of gender, partnership, historical time and length of stay. A widespread notion of psychiatric diseases as inevitably chronic and worsening could be rejected. Time in community was found to increase over historical time for all patients. Most important protective factors beyond diagnosis were employment, partnership, and sheltered living situation. Risky conditions were urban living and a concurrent substance use disorder., Conclusion: Prognostic factors for course of diseases should be determined only by statistical models capable of adequately incorporating the recurrent nature of psychiatric illnesses.

Objectives: This article investigates the development of the inpatient treatment capabilities of older patients from the age of 50 onward in inpatient psychosomatic-psychotherapeutic departments over a period of 15 years., Method: A Germany-wide postal survey that was almost identical to two previously conducted cross-sectional surveys (Lange et al. 1995; Wenker 2010) was sent to psychosomatic-psychotherapeutic departments. This survey collected data on the status and concept of the department as well as on the number of patients, number of elderly people, programs for elderly people, and future concepts of the departments., Results: The response of psychosomatic departments was higher than in previous years. The forms of therapy used differ between the individual clinic subtypes. The programs for elderly people remained constant, as did the special qualification measures for employees. Proportionally more elderly patients from the age of 50 onward were treated in psychosomatic clinics and departments, two thirds of whom were women., Discussion: The survey revealed that psychosomatic-psychotherapeutic therapies for the treatment of elderly people increased over the last year. With regard to the demographic change and the future receptiveness of elderly people to psychotherapy, the inpatient sector seems to be prepared for the rising numbers of elderly people. How large the lack of therapy capacity needed for inpatient psychosomatic-psychotherapeutic treatment will be cannot be answered by this survey.

Background: Studies in urban areas identified environmental risk factors for mental illness, but little research on this topic has been performed in rural areas., Methods: Hospital admission rates were computed for 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg in years 2006 to 2009 and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models., Results: Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and traffic-related areas., Conclusions: Effects of wealth, economic inequality, population density and structural area characteristics influence psychiatric admission rates also in rural areas.

Objective: The study aimed at exploring associations between inpatient suicides/attempted suicides in a psychiatric hospital and involvement of family caregivers in treatment., Methods: Based on the German psychiatric basic documentation systems (DGPPN-BADO), we analyzed a total sample of 49,257 cases of inpatient care (1998-2007) from a large psychiatric tertiary care university hospital and as a subsample all cases of schizophrenia, depression, acute stress/adjustment disorders and personality disorders (n = 22,880). Involvement of family caregivers was evaluated according to the following variables: admission to hospital due to recommendation of caregiver, conversation between therapist and caregiver, psychoeducation of caregiver as well as psychopharmacological and/or psychotherapeutic non-compliance of patient. Descriptive and bivariate analyses were performed., Results: Of the 22,880 cases in the subsample, 31 inpatient suicides and 198 attempted inpatient suicides were recorded. We could not find any significant associations of caregiver involvement variables with inpatient suicide. In contrast, for the total sample (n = 49,257), attempted suicide was associated with more conversation between therapists and caregivers (χ(2) = 3.863, df = 1, p = 0.049) and with psychopharmacological (χ(2) = 4.822, df = 1, p = 0.028) and psychotherapeutic (χ(2) = 13.041, df = 1, p = 0.000) non-compliance of the patients., Conclusion: Further research is needed regarding the influence of caregivers on suicidal behavior of mentally ill inpatients.

Purpose: Little is known about psychopharmacological prescription practice in low-income countries. The present study aimed for an analysis of pharmacological treatment strategies for inpatients with schizophrenia in Tashkent, the capital city of Uzbekistan, facing a low-income situation as compared with four German cities in a high-income Western situation., Methods: We conducted a cross-sectional quantitative survey of age, gender, diagnoses, and psychotropic medication of 845 urban psychiatric inpatients of the Tashkent psychiatric hospital and of 922 urban psychiatric inpatients in four German cities on 1 day in October 2008. We compared the current treatment strategies for specific diagnostic categories between the two settings., Results: In Tashkent, patients diagnosed with schizophrenia were treated with clozapine (66%), haloperidol (62%), or both (44%). More than one-third of the patients treated for schizophrenia were prescribed amitriptyline. The usual treatment strategy for schizophrenia was the combination of two or more antipsychotics (67%). In German cities, the preferred antipsychotics for the treatment of schizophrenia were olanzapine (21%), clozapine (20%), quetiapine (17%), risperidone (17%), and haloperidol (14%); the most common treatment strategy for patients with schizophrenia was the combination of antipsychotics and benzodiazepines; 44% of the patients were treated with two or more antipsychotics at a time., Conclusions: In both settings, psychotropic combination treatments are common for the treatment of schizophrenia contrasting current guideline recommendations. Its rationale and effectiveness needs to be tested in further studies., (Copyright © 2011 John Wiley & Sons, Ltd.)

Introduction: There is an ongoing debate about a possibly enhanced risk of suicidal behaviour in some psychiatric patients due to psychopharmacotherapy. Our retrospective study aimed at analyzing the psychopharmacotherapy of 133 inpatient suicides and 133 controls by a matched pair design., Methods: We analyzed all suicides (n = 133) reported in the AGATE study from 1991 to 2008. Besides evaluation of sociodemographic variables and suicide methods, we compared psychopharmacotherapy of suicides with schizophrenia (n = 59) and affective disorders (n = 59) to that of a matched control group., Results: Most suicides (n = 102, 76.7%) were judged not to be related to psychopharmacotherapy. In general, more psychopharmacological drugs were prescribed for suicides than for controls. Schizophrenic suicides received more low potency FGAs than their controls. More suicides with affective disorders than controls were treated with NASSAs, SNRIs, and high or low potency FGAs. In contrast to their controls, none of the suicides with affective disorders received lithium. NASSAs, SNRIs, and high or low potency FGAs predicted suicide in regression analysis for inpatients with affective disorders., Discussion: Differences in psychopharmacotherapy might mainly result from a recognized risk of suicide or a more severe degree of illness. However, the underrepresentation of lithium in the suicide groups is noticeable., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In order to identify psychiatric patients who have a higher risk of being aggressive towards others, a risk checklist, the "Bremen Risk Assessment Scale for General Psychiatry" (BRAS-GP) was developed. The results of the first trial are described in this article., Methods: In this prospective study all in-patients who were treated in the last quarter of 2006 were included. The BRAS-GP was applied on discharge to patients who were treated involuntarily. In a 1-year follow-up all patients who had been readmitted were analyzed to assess if any aggressive incident had occurred to confirm or refute the prognoses., Results: On evaluation of the readmissions data, we calculated sensitivity of 0.72 and specificity of 0.71 as well as an "area under the curve" of 0.74. Especially during the first months after discharge readmissions linked with aggressive behavior were observed., Conclusion: The BRAS-GP is a useful prognostic instrument with high predictive validity. It can be easily applied in general psychiatric wards to help identify risk patients. After detecting risk patients special treatment strategies can then be offered.

Aims: Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary)., Methods: Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge., Results: Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes., Conclusions: Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.

Background: Since 1991 the German psychiatry personnel regulation act (PsychPV) defines the number and tasks of medical doctors and nursing staff on a psychiatric ward. However, there is the suspicion that there are differences, especially with regard to an increased proportion of activities not involving patients, such as documentation and administrative work., Methods: To detect differences between requirements from the PsychPV and the actual amount of time spent on different activities, a task analysis was performed on a general psychiatric and a gerontological psychiatric ward. In this study the proportions of working time spent on five different types of activities with time that should have been spent according to the PsychPV were compared., Results: Discrepancies were found on both psychiatric wards and for medical doctors as well as for nursing staff. Tasks of documentation and administrative work took significantly higher proportions of working time than required in the PsychPV. On the other hand psychiatric personnel spent less time for treatment or nursing in direct contact with the patients., Conclusion: The results of this study confirmed the suspicion that shifting tasks on psychiatric wards has led to changed treatment settings.

Child- and adolescent psychiatry is a good field for the application of creative and playful therapies. Bibliotherapy and expressive writing are two examples of them. The effectiveness of both, for different types of disorders, has been proved in many studies. Up until today it was unknown just how prevalent these therapies are within child and adolescent psychiatry in the german speaking countries. The following article summarizes the results of a survey conducted in 122 child and adolescence psychiatric clinics in Germany, Austria and Switzerland to gain more information about their use. The survey takes into account the frequency of application of bibliotherapy and expressive writing therapies depending on age and type of disorder, preferences amongst patient groups, as well as specific approaches. More than half of the surveyed child and adolescent psychiatries are using at least one of the two therapies. They are used on an irregular and non-systematic basis and rather symptom- than diagnosis-orientated. Bibliotherapy and expressive writing are dynamic therapies which can be used in manifold ways. Reading and writing are two of the main pillars of our educational system and can be utilized within a therapeutic setting. Provided that the patient is not suffering from severe cognitive or mental limitations, the spoken and written word can leave deep imprints within the patient's, but also the therapist's, soul.

We assessed data concerning demographic, criminological and psychiatric characteristics of all patients with disorders of the schizophrenic spectrum, who were detained in the forensic psychiatric departments of Mecklenburg-West Pomerania, a federal state of Germany, in 2007. Of the 202 patients of both clinics, 45 suffer from a disorder of the schizophrenic spectrum assessed in ICD-10: F20-F29, which corresponds to 22%. This level is markedly lower than in other regions of Germany. But similarly to results assessed in other federal states of Germany and in Austria there is a high rate of pre-treatment in general psychiatric institutions. It remains a relevant task for general psychiatry to establish adequate interventions for hostile and violent psychotic patients, especially for those with a double diagnosis, history of delinquency and social decline.

Medical records of 50 consecutive psychogeriatric inpatients with moderate or severe dementia were retrospectively analyzed. Comorbid general medical disorders were diagnosed in 88% of the patients (202 disorders; mean: 4.6/patient). At least one general medical intervention was initiated during hospital treatment in 78% of patients (82 interventions in 39 patients with a mean length of stay of 38.8 days). Interventions were most frequently related to respiratory and urinary tract infections, followed by cardiovascular diseases and metabolic disorders, respectively. In conclusion, psychogeriatric patients with advanced dementia are in need of a substantial amount of general medical care.

Objective: This psychological autopsy study investigates suicide risk factors of schizophrenic and depressive inpatients., Methods: 67 potential risk factors of inpatient suicide were identified by means of literature research and caregiver interviews of schizophrenic and depressive suicidents (1995-2004). The medical records of the suicidents (n = 20) were analysed in respect to the identified risk factors and compared to their respective control group of non-suicidents (n = 20) which was matched by diagnosis, gender, age, year / month of admission and ward. Univariate and multivariate statistical analyses were performed., Results: In comparison to their respective control group schizophrenic (n = 11) and depressive suicidents (n = 9) differed clearly by their risk profile. Suffering from side effects of medication was found to be a predictor of suicide for schizophrenic inpatients., Conclusions: Psychological autopsy studies are indispensable for the construction of diagnosis-specific risk profiles. Reduction of side effects of medication seems to play a larger role in suicide prevention for schizophrenic inpatients than previously assumed., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

Background: Over recent decades, institutional psychiatric care has shifted its focus from traditional inpatient treatment to a variety of more advanced outpatient services. Within this context, a new "crisis home" programme (CHP) was launched in Zurich on 1 January 2005. With this programme, mentally ill patients can avoid hospitalization by living with a host family for a certain time period while receiving standard outpatient care. In this study we addressed the question of whether the quite substantial financial advantages of the Zurich CHP over traditional inpatient care are achieved at the expense of a reduced quality of care., Sample and Methods: Between 1 January 2005 and 30 June 2007, a total of 33 patients enrolled in the Zurich CHP with an average stay of 19 days at host families. The vast majority of the patients (85%) were moderately to severely ill at study entry. Of these patients data were collected in a standardized way on the basis of five rating instruments. The statistical data analysis included cross-comparisons with corresponding inpatient data., Results: Results showed that (1) the CHP works well in a routine setting and provides cost-efficient interventions for patients in acute crises; (2) the financial advantages of the Zurich host family programme over traditional inpatient care do not lead to a reduced quality in patient care; (3) patients suffering from severe mental illnesses clearly benefit from this programme, thus avoiding hospitalization., Conclusions: The Zurich CHP is a cost-efficient alternative to traditional inpatient treatment. Specifically, our results suggest that this type of acute crisis intervention should be established as a standard psychiatric care service.

The aim of this study is to compare psychiatric patients' satisfaction with their treatment in Munich and in South Tirol. For this purpose, besides clinical and social-demographic factors, for each sample-group of patients, their general satisfaction, their valuation of the different aspects of hospital treatment and life quality were considered and compared. The relevance of these elements in the global satisfaction was examined with linear multiple regression models. The results of the research show a rather high level of global satisfaction in both sample-groups, even if statistically relevant differences occur in evaluations of several aspects of the treatment. In Munich's sample-group a higher rate of satisfaction emerged in relation with the treatment: the attitude of the medical staff, the psycho-pharmacological treatments, the clinic's image and the conduct of the nursing staff. In both groups the most relevant factor for patients' satisfaction, besides the positive results of the treatment, was the attitude of the doctor, and in particular way his empathy with the patient. In regard to the age, the diagnosis and the duration of the hospitalization, it was not possible to demonstrate, in both sample-groups, any statistically relevant connection with the general satisfaction rate, while a high rate of trust in the doctors and in the medicines was found to be, in each group, a significant condition for a positive evaluation of the treatment. The influence of the personal life-quality was proven statistically relevant but weak. Altogether, regardless of the medical structure that was examined, the results underline the predominant importance of the curing doctor's social and emotional skills for patients' satisfaction.

Objective: This paper describes the frequency of remission in former inpatients with schizophrenia as well as its relations with sociodemographic and other relevant variables., Methods: The characteristics of 88 schizophrenia patients (ICD-10 F20.x) were examined in an extensive quality-monitoring-project at the Ev. Krankenhaus Bethanien Greifswald, Germany, encompassing a one-year follow-up., Results: 10.2 % of the patients reached remission during the 12-months follow-up. The rate of readmissions was 42.1 %., Conclusions: The frequency of remission in our sample is considerably less than the approximated 38 % from previous studies. This might be attributed to selection-bias and lack of representation in previous follow-up studies with schizophrenia inpatients.

The aim of our study was to determine the development of the number of patients with schizophrenia in detention (section 63 German Penal Code) in North Rhine-Westphalia and the characterization of these patients. Patients with schizophrenia are examined, by using a standardized questionnaire answered by the attending psychiatrist or psychologist (n = 531). During the last 12 years the number of patients with schizophrenia in forensic-psychiatric hospitals has increased three times, whereas the number of patients with other diagnoses heightened only twofold. The patients with schizophrenia showed high rates of psychiatric comorbidities (substance disorders 73.9 %, personality disorders 17.2 %), previous inpatient treatments (78.3 % with a mean of 7.5 stays) and previous convictions (63.4 %). Almost half of these convictions (46.6 %) were violent offences (e. g. assault, homicide). Possible explanations for this development are discussed.

Objective: The study aimed at exploring prevalence and risk factors of inpatient suicides and attempted suicides in a psychiatric hospital., Method: Based on the German psychiatric basic documentation system, 20,543 patients with 40,451 episodes of inpatient care (1995-2004) in a psychiatric state hospital were included. Besides univariate analyses, multivariate logistic regression analyses and classification and regression tree analyses were performed., Results: Forty-one inpatient suicides were recorded. Risk of inpatient suicide is increased for patients with resistance to psychopharmacological treatment, previous suicide attempt, severe side effects and supportive psychotherapy before admission. Two hundred fourteen inpatient suicide attempts occurred during the 10-year period. Risk factors of inpatient suicide attempt are assault, personality disorder, previous suicide attempt, psychopharmacological treatment resistance, suicidal thoughts at admission, schizophrenia, depression, female sex and length of stay., Conclusion: The identified risk factors underline the need for a cautious investigation of previous suicide attempts as well as for giving special attention to patients who have problems with psychopharmacotherapy during hospitalization.

Objectives: Although music therapy is very common in child and adolescent psychiatry, no data are available that describe the working conditions for music therapists or the situation with regard to coverage of the patient population., Methods: A cross-sectional questionnaire study in all German hospitals of child and adolescent psychiatry with inpatient treatment programmes (n = 134) collected data on the structure and content of the respective music therapy treatment offered., Results: 63.4% of the hospitals provide music therapy as a method of inpatient psychotherapy (77.7% response rate). This article focuses on the duties, setting, and clientele in music therapy, the available equipment and instruments, and the formation and methodological spectrum of music therapists., Conclusions: In summary, we conclude that music therapists working in child and adolescent psychiatry are well trained and experienced. To strengthen the professional identity of music therapists and to evaluate the efficacy of music therapy further research is needed and professional representation and proofs of efficacy must be emphasized.

Empirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.

Objective: To describe and characterize the work of independent complaint offices for users of psychiatric services and of ombudsmen in psychiatric hospitals., Methods: Nationwide survey addressed to all independent complaint offices and to all psychiatric hospitals in Germany., Results: The authors were able to identify n = 37 independent complaint offices. About 50 % (n = 215) of the hospitals surveyed reported having a patient's advocate ("Patientenfürsprecher"). While complaint offices are regularly staffed by psychiatry-experienced, their relatives and professionals, patient's advocates are often retired employees of the respective hospitals. Among the most frequent complaints were complaints about the behaviour of psychiatric staff towards patients and complaints about the correctness or necessity of treatments and constraints. Ombudsmen were additionally faced with complaints about food and sanitation in hospitals., Conclusions: Patients' complaints can be used to improve psychiatric services. However, the existing complaint management system in German psychiatry should be improved with respect to publicity, user acceptance and accessibility.

In a representative nationwide survey, the Psychiatry and Migration Working Group of the German Federal Conference of Psychiatric Hospital Directors (Bundesdirektorenkonferenz) examined the use of inpatient psychiatric and psychotherapeutic services in Germany by patients of immigrant origin. Questionnaires were sent to a total of 350 general hospital psychiatric clinics throughout Germany, and 131 clinics responded. As shown by the 2005 Microcensus [22], almost one-fifth (18.6%) of the German population is of immigrant origin. In our study, persons of immigrant origin comprised 17% of patients in the responding facilities. This indicates that the percentage of inpatient psychiatric services used by patients of immigrant origin is almost proportionate to these patients' percentage of the general population. The largest group of immigrant patients in our study were those of Russian heritage, followed by patients of Turkish, Arabic, or other origin. Almost two-thirds of the immigrant patients were born in Germany, and a considerably larger percentage were German citizens (74%). Sixty-two per cent of all patients of immigrant origin spoke a language other than German (e.g. Russian, Turkish, Polish) at home. Patients of immigrant origin were significantly more likely to receive an ICD-10 F2 diagnosis, and it was precisely patients with this diagnosis who were observed to experience difficulties in communication with caregivers.

Objective: To show the treatment situation for severely depressed in-patients in German clinics for psychiatry and psychotherapy., Methods: A questionnaire was sent to all German "depression units" including questions about number of beds and admission, treatment strategies and diagnostic profile in the year 2005., Results: 65 of 71 clinics which are members of the "Working Group Depression Units" responded 52 reports could be used for the study. Treatment included antidepressants, psychotherapy, group therapies, psychoeducation, occupational and sport therapies, social work, cooperation with self help group for depressives and including relatives., Conclusion: German specialized depression units represent a high level of depression treatment.

Objective: The study aimed at investigation outpatient treatment of schizophrenic patients referred to a psychiatric hospital by general practitioners (GP) in comparison to psychiatrists in private practice (PP)., Methods: Data of the German psychiatric basic documentation system (BADO) of all schizophrenic inpatients admitted to a psychiatric hospital in 2003 were analysed (n = 578)., Results: Schizophrenic patients of GP and PP differed not regarding any sociodemographic or disease-related variable. Also concerning psychopharmacological pre-treatment, no significant differences between schizophrenics of GP and PP could be revealed. 84.1% of GP-patients and 90.6% of PP-patients had a psychopharmacological pretreatment. 81.2% of GP-patients with antipsychotics (PP: 77.7%). Conventional antipsychotics were prescribed to 49.3% of GP-patients (PP 50.9%), atypicals to 44.9% (PP: 39.6%). Antidepressants were given to 18.8% of GP-patients and 22.6% of PP-patients, tranquilizers to 4.3% of GP-patients and 9.4% of PP-patients, mood stabilizers to 18.8% of GP-patients and 17.0% of PP-patients., Conclusions: GP and PP treat the same population of schizophrenic patients, psychopharmacotherapy delivered by GP and PP differed only slightly (by number). Treatment of schizophrenics could be improved with respect to current treatment guidelines.

Objective: Against the background of the problematic interface between outpatient and inpatient care in the German psychiatric health care system, the role of psychiatrists in private practice concerning the pathways of psychiatric inpatients before and after their hospital stay should be evaluated., Methods: Based on data of the psychiatric basic documentation (DGPPN-BADO) of 4905 patients admitted to the psychiatric hospital in 2003, predictors of the type of referral as well as the outpatient aftercare were analysed by means of logistic regression analyses., Results: 9.8 % of patients were referred by psychiatrists in private practice. Patients sent by psychiatrists more seldom had an addiction disorder, more often were residents of sheltered homes, showed a present episode lasting more than three months and had a psychopharmacological pre-treatment with an atypical antipsychotic or SSRI. At discharge, outpatient aftercare by psychiatrists in private practice was recommended to 32.1 % of inpatients. Referral by a psychiatrist in private practice as well as the diagnosis of schizophrenia or affective disorder led more often to an outpatient aftercare by a psychiatrist., Conclusions: Due to the small number of patients referred by psychiatrists, the cooperation between psychiatric hospital and psychiatrists in private practice has to be focused by the quality management of the hospital.

Introduction: This study examines the prevalence of off-label prescriptions in a large German psychiatric hospital. The influence of a 2002 decision by the Federal Social Court regarding reimbursement issues is investigated., Methods: Two random samples ( N(1)=125; N(2)=126) of all patients treated in the years 2001-2002 and 2003-2004, respectively, were examined. All prescriptions of psychotropic drugs were evaluated and categorized as CLEARLY OFF-LABEL, PROBABLY OFF-LABEL, or ON-LABEL. Label status for each product was judged according to the information stated in the officially authorized Summary of Product Characteristics., Results: In 2001-2002 20% of all prescriptions of psychotropic drugs were clearly off-label, and 19% were probably off-label. In 2003-2004 the numbers were 21% and 26%, respectively. There was a significant increase in probable and combined probable and clear off-label use. There was no significant influence of sex and patients' age on off-label prescribing, but treatment duration showed a significant positive correlation with off-label use. Drugs prescribed on discharge were significantly more often prescribed off-label than drugs prescribed during the whole duration of treatment., Discussion: Prevalence of psychiatric off-label use in Germany is high. These results are in accordance with international surveys. The restrictive interpretation of the legal reimbursement provisions applied by the German Federal Social Court has not caused a decrease in off-label use. Although measures have been taken to solve the legal problems arising from off-label-use, further solutions are needed to ensure both patient and prescriber safety.

Introduction: Psychoeducation can reduce rehospitalization rates and mental health costs in schizophrenia. The aims of this study were to investigate the percentage of patients and family members participating in psychoeducation in the year 2003 and to evaluate how psychoeducation was conducted., Methods: Part I of a 2-part postal survey was sent to the heads of all psychiatric institutions in Germany, Austria, and Switzerland; part II was sent directly to the moderators of psychoeducational groups. Responses were analyzed using descriptive statistics., Results: Psychoeducation was offered in 86% of the responding institutions and in 84% of these for schizophrenia (response quotas: part I, 54%; part II, 55%). A mean of 21% of the patients with schizophrenia and 2% of their family members had taken part in psychoeducation in the responding institutions in the year 2003., Discussion: Many readmissions and thus significant costs to the health system and substantial human suffering could be avoided if more patients and their family members participated in psychoeducation. New approaches to offering more psychoeducation would consist in integration of the entire psychiatric team into psychoeducation and peer-to-peer strategies.

The objective of this study was to compare the prevalence of mental disorders among sexual offenders in forensic psychiatry (SF) with the prevalence of such disorders among sexual offenders in prison (SP) and violent offenders in prison (VP). In a cross-sectional study, 40 of 47 SF detained in forensic psychiatry in Baden-Wuerttemberg, Germany, could be included. They were compared with 30 SP and 26 VP. All study participants were interviewed by means of SCID I and SCID II and assessments of functioning (GAF, BSS). There was a high prevalence of mental disorders (DSM-IV: Axis I) in all three groups (SF: 80%, SP: 63%, VP: 73%). Among SP and VP, this was attributed mainly to substance use disorders. The prevalence and comorbidity of personality disorders was significantly higher in the group of the SF (prevalence: SF: 85%, SP: 27%, VP: 39%). In a psychopathological view, SP were all together more similar to the imprisoned non-sexual delinquent VP than to the SF.

A retrospective survey on drug prescription over a 5-year period (1998 to 2003) in 1,540 inpatients in a psychiatric university hospital in Germany was carried out. The aim was to establish a basis for a monitoring of prescription habits and for pharmacoeconomic considerations. It was established that there was only a slight increase in polyvalent drug use between 1998 and 2003. The results are presented in more detail in relation to the diagnosis of organic mental disorders, drug abuse disorders, schizophrenia, mood disorders and personality disorders. Newer atypical antipsychotics, SSRIs and mood stabilizers were increased across diagnoses while lithium and clozapine were prescribed less frequently. The rare occurrence of monotherapy in general might reflect a common trend in psychiatry fostering polydrug use. Studies of this type are biased by the fact that local habits of prescription do not allow generalisation of the findings. Such surveys should be carried out more frequently and simultaneously in different centers. Critical comparisons could help to optimize treatment.

The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.

Background: Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management., Methods: In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment., Results: According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious., Conclusions: Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.