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1. Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction

Author

O. Karasch, M. Schmitz-Buhl, R. Mennicken, J. Zielasek, and E. Gouzoulis-Mayfrank

Subjects
Mental health act, Involuntary admission, Machine learning, Decision-tree analysis, Environmental socioeconomic data, Urbanization, Psychiatry, RC435-571
Abstract

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

Published
2020
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2. EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

Author

W. Gaebel, A. Kerst, B. Janssen, T. Becker, M. Musalek, W. Rössler, M. Ruggeri, G. Thornicroft, J. Zielasek, and J. Stricker

Subjects
Care coordination, integrated care, mental health, quality, Psychiatry, RC435-571
Abstract

AbstractBackground.The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.Methods.We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.Results.We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.Conclusions.Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.

Published
2020
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3. [Joint crisis plans in mental health hospitals-Real practice in an association of psychiatric hospitals]

Author

A, Weide, J, Vrinssen, O, Karasch, T, Blumenröder, A, Staninska, S, Engemann, M, Banger, M, Grümmer, R, Marggraf, J, Muysers, S, Rinckens, N, Scherbaum, T, Supprian, A, Tönnesen-Schlack, R, Mennicken, J, Zielasek, and E, Gouzoulis-Mayfrank

Abstract

Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them.To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of a JCP.We carried out a retrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of a JCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24 months before index admission.Out of a total of 117,662 inpatients 467 (0.4%) had completed a JCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with a JCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with a JCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24 months preceding the first documentation of a JCP.Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of a JCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail.HINTERGRUND: Behandlungsvereinbarungen (BehV) werden an vielen psychiatrischen Kliniken angeboten, aber sie werden wenig in Anspruch genommen.Untersucht wurden die Quoten von BehV unter stationären Patient*innen und die klinischen Charakteristika der Patient*innen, die eine BehV abschließen.Retrospektive Analyse von Routinedaten aus der einheitlichen Statistikdatenbank/Basisdokumentation des LVR-Klinikverbunds mit neun psychiatrischen Fachkrankenhäusern. Es wurden alle voll- und teilstationär aufgenommenen Fälle der Jahre 2016 bis 2020 berücksichtigt. Erfasst wurden das Vorhandensein einer BehV, Alter, Geschlecht und Hauptdiagnose bei Entlassung sowie Voraufenthalte, Unterbringungen nach dem PsychKG NRW (Psychisch-Kranken-Gesetz Nordrhein-Westfalen) und Erfahrungen mit Zwangsmaßnahmen (Isolierung/Fixierung) in den 24 Monaten vor der Indexaufnahme.Insgesamt 467 von 117.662 Patient*innen (0,4 %) hatten eine BehV abgeschlossen. Patient*innen mit BehV litten häufiger an einer Schizophrenie, einer bipolaren affektiven Störung oder an einer emotional-instabilen Persönlichkeitsstörung. In der Vorgeschichte hatten sie mehr stationäre Voraufenthalte und häufiger Erfahrungen mit Zwangsunterbringungen und Zwangsmaßnahmen. Allerdings hatten 50 % der Patient*innen mit BehV andere Diagnosen und der überwiegende Teil dieser Patient*innen hatte in den vergangenen 24 Monaten keine unfreiwilligen Unterbringungen und keine Zwangsmaßnahmen aufgewiesen.Behandlungsvereinbarungen werden insgesamt selten abgeschlossen. Das Angebot erreicht die gewünschte Zielgruppe der Patient*innen mit schweren psychischen Erkrankungen und Vorerfahrungen mit unfreiwilligen Unterbringungen und Zwangsmaßnahmen, aber auch andere Patient*innen. Ergänzende qualitative Untersuchungen sind erforderlich, um Inhalte und Zielsetzungen von BehV näher zu analysieren.

Published
2022

4. Bedarfsgerechte Versorgung von Brustkrebspatientinnen mit Behinderung – CAre appropriate to the Needs of breast cancer patients with DisabilitY (CANDY) – Erste Ergebnisse

Author

H Gröber, E Gouzoulis-Mayfrank, J Zielasek, SE Groß, S Lee, and A Groß-Kunkel

Subjects
medicine.medical_specialty, Breast cancer, ddc: 610, Obstetrics, business.industry, medicine, 610 Medical sciences, Medicine, medicine.disease, business
Abstract

Hintergrund: Trotz der hohen Prävalenz von Krebs in Deutschland und der steigenden Lebenserwartung von Menschen mit Behinderungen sind die gesundheitliche Versorgung sowie die Bedarfe und Bedürfnisse von Krebspatienten mit Behinderungen in der Gesundheitsforschung unterrepräsentiert. [zum vollständigen Text gelangen Sie über die oben angegebene URL], 18. Deutscher Kongress für Versorgungsforschung (DKVF)

Published
2019
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5. Mental healthcare for refugees

Author

J. Zielasek, W. Gaebel, P. Falkai, and N. Sartorius

Subjects
Mental healthcare, Psychiatry and Mental health, medicine.medical_specialty, Nursing, business.industry, Refugee, Health care, medicine, Psychiatry, business, Healthcare system
Abstract

Summary Introduction: The current refugee situation in Europa also leads to an increasing number of people with mental disorders. Which measures need to be taken to ascertain adequate mental healthcare for refugees during and after fleeing from their home countries? Methods: Review of the current tasks, areas of action and future challenges of refugee mental healthcare. Results: Refugee healthcare poses new challenges for the receiving and the transit countries. Besides dealing with the acute refugee situation, long term aspects of mental and general healthcare for refugees need to be considered. This will also include the reconstruction of the healthcare systems in the countries of origin of refugees.

Published
2016
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6. How to evaluate mental healthcare models

Author

I. Großimlinghaus, J. Zielasek, W. Gaebel, S. Kowitz, A. Kerst, and M. Otten

Subjects
Teamwork, Knowledge management, business.industry, media_common.quotation_subject, Context (language use), Mental healthcare, Psychiatry and Mental health, Risk analysis (engineering), Intervention (counseling), Health care, Medicine, Relevance (information retrieval), Quality (business), business, media_common
Abstract

Summary Background: One of the main measures of improving the quality of mental healthcare in Europe is to promote the implementation of effective healthcare services. The evaluation of such health-care models is needed to assess their effectiveness and efficiency. Objectives: The article points out the main methodological challenges of demonstrating the effectiveness and efficiency of mental healthcare models. Results: Implementing healthcare models is complex and includes several components and a high number of confounding variables. This makes it difficult to identify the “active ingredients”. The range of evaluation criteria is wide. Therefore, it is crucial to define the main aim of the intervention clearly and to choose evaluation assessments with relevance for these aims. Conclusion: Addressing the question how to evaluate mental healthcare models, evaluation studies have to provide information not only about the chosen evaluation criteria but also about the context, in which a healthcare model works.

Published
2016
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8. Psychotic Disorders in ICD-11

Author

P. Falkai, J. Zielasek, and W. Gaebel

Subjects
Final version, Psychiatry and Mental health, medicine.medical_specialty, Delusional disorder, Schizophrenia, business.industry, medicine, Schizoaffective disorder, medicine.disease, Psychiatry, business, World health, DSM-5
Abstract

SummaryFor the development of ICD-11, the World Health Organization (WHO) has inaugurated a Working Group on the Classification of Psychotic Disorders (WGPD). A range of changes of the classification of primary psychotic disorders was developed by this group. While DSM-5 was published in 2013, the ICD-11 proposals are currently undergoing internet-based and clinical field trials and the final version is due in 2017. Among the major changes suggested by the WGPD for ICD-11 are the chapter titles, the replacement of the current schizophrenia subtypes by a number of symptom specifiers, a new set of course specifiers harmonized with DSM-5, transsectional diagnostic criteria for schizoaffective disorder, and a reorganization of the acute and transient psychotic disorders and delusional disorders.

Published
2015
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9. Konzept eines modularen, sektorübergreifenden Versorgungs- und Vergütungsmodells für die bedarfsorientierte Behandlung psychischer Erkrankungen als Alternative zu PEPP

Author

J. Zielasek, S. Thewes, M. Wenzel-Jankowski, B. Janssen, W. Gaebel, D. Hionsek, M. von Brederode, and E. Gouzoulis-Mayfrank

Subjects
Psychiatry and Mental health
Abstract

Zusammenfassung Ausgangslage: Für den Bereich der psychischen Störungen wird ein innovatives Versorgungsmodell zur bedarfsorientierten Behandlung psychischer Erkrankungen (BBPE) vorgestellt, das aus den Kernelementen eines die Versorgung steuernden und koordinierenden Fall-managements, einem die stationäre und ambulante Versorgung integrierenden Community Mental Health Center und leitlinienorientierten Diagnostik- und Behandlungsmodulen besteht. Damit stellt dieses Versorgungsmodell auch eine mögliche Alternative zum derzeit in Entwicklung befindlichen neuen Entgeltsystem für die psychiatrisch-psychosomatisch-psychotherapeutische (PEPP) Versorgung dar. Methodik: Der Gesetzgeber hat über den § 64b SGB V die Voraussetzungen geschaffen, solche innovativen Ansätze im geschützten Rahmen eines Modellvorhabens zwischen Leistungsanbieter und Kostenträger im „Echtbetrieb“ erproben zu können. Innerhalb eines solchen Modellvorhabens bietet es sich an, in einer ersten Entwicklungsstufe die stationären, tagesklinischen und ambulanten Tätigkeiten einer psychiatrischen Klinik in einem Versorgungsbudget zusammenzufassen und die Leistungserbringung und Abrechnung über Behandlungsmodule abzubilden. Diese sind beispielhaft leitlinienbasiert für von einer Schizophrenie Betroffene entwickelt. Ziel: Ziel ist es, die Ergebnisse wissenschaftlich zu evaluieren, um die Grundlagen für eine Ausweitung des Modells auf andere psychische Störungen und eine Implementierung in anderen Regionen zu legen

Published
2015
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10. The EPA Guidance Project: Guidance for Mental Healthcare in Europe

Author

I. Großimlinghaus, Wolfgang Gaebel, and J. Zielasek

Subjects
medicine.medical_specialty, Medical education, business.industry, media_common.quotation_subject, Stakeholder, Guideline, Mental health, Mental healthcare, Psychiatry and Mental health, Promotion (rank), Action plan, Family medicine, medicine, Quality (business), business, Quality assurance, media_common
Abstract

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

Published
2015
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11. Psychotic Disorders in ICD-11

Author

H.-R. Cleveland, J. Zielasek, and W. Gaebel

Subjects
Psychiatry and Mental health
Abstract

SummaryWithin the efforts to revise ICD-10, the World Health Organization (WHO) has appointed a disorder-specific Working Group on the Classification of Psychotic Disorders (WGPD). The WGPD has proposed several changes to the classification criteria of schizophrenia and other primary psychotic disorders in order to increase the clinical utility, reliability and validity of the diagnostic classification. The main proposals include changes to the chapter title, the replacement of existing schizophrenia subtypes with symptom specifiers, stricter diagnostic criteria for schizoaffective disorder, a reorganization of the delusional disorders and the acute and transient psychotic disorders, as well as the revision of course specifiers. These proposed revisions are subject to field trials with the aim of studying whether they will lead to an improvement of the classification system in comparison to its previous version. The proposals are compared with revisions of the according DSM-5 chapter. The impact of novel results from neuroscience and genetics on the current proposals is discussed, also with respect to future classification strategies such as the Research Domain Criteria (RDoC) project.

Published
2013
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12. [Utilization of outpatient psychotherapeutic treatment : A secondary data analysis]

Author

W, Gaebel, J, Zielasek, and S, Kowitz

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Mind-Body Therapies, Mental Disorders, Middle Aged, Psychotherapy, Young Adult, Germany, Utilization Review, Ambulatory Care, Prevalence, Humans, Female, Referral and Consultation, Aged
Abstract

In spite of a well-developed and complex mental healthcare system in Germany, problems remain in the capacity of psychotherapeutic care with an undersupply and long waiting times for provision of outpatient psychotherapeutic care.The analyses address the current level of psychotherapeutic care and the role of individual medical specialties in outpatient psychotherapeutic care in Germany.The analyses are based on secondary data from three statutory health insurance companies and the German pension funds for the years 2005-2007. Anonymized treatment data from 3.3 million insured persons with a diagnosis of a mental disorder (ICD-10 groups F0-F5) were analyzed.In outpatient treatment 9,670,588 psychotherapeutic accounting codes were analyzed of which 33 % were psychiatric, psychosomatic or psychotherapeutic consultations that are not covered by the scope of psychotherapy according to the standard regulations (psychotherapy guidelines). The most frequently used psychotherapeutic services were verbal interventions (accounting codes 35.100 and 31.110) and psychiatric consultations (accounting codes 14.220, 21.220 and 21.221), independent of the mental disorder. Of the patients 5.9 % received directive psychotherapy. The provider-specific analysis showed a great variation in the kind of accounting codes, which were brought into account by the different providers.With regard to the reform efforts in psychotherapeutic care, longitudinal trends in the utilization and quality of psychotherapeutic care in the individual fields of treatment should be analyzed in follow-up studies.

Published
2016

13. Immunologische Aspekte psychischer Störungen bei rheumatischen Erkrankungen

Author

R. H. Straub and J. Zielasek

Subjects
Psychiatry and Mental health
Abstract

ZusammenfassungEs gibt vielfältige Wechselwirkungen zwischen entzündlichen Erkrankungen und psychischen Störungen. Nicht nur sind post- oder periinfektiöse Depressionen oder „Fatigue“- Symptome sehr häufig, zunehmend wird auch entschlüsselt, auf welche Weise Immunsystem und Psyche einander beeinflussen. Auf der Grundlage solcher Erkenntnisfortschritte ergeben sich neue therapeutische Möglichkeiten, die erst ansatzweise untersucht sind. In diesem Übersichtsartikel werden zunächst die grundlegenden Mechanismen der Interaktionen zwischen psychischen Störungen beschrieben. Am Beispiel der rheumatologischen Erkrankungen werden diese konkretisiert und die therapeutischen Erfahrungen mit psychischen Störungen bei entzündlichen Erkrankungen im Allgemeinen thematisiert.

Published
2012
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14. Bedeutung der studentischen Lehre für die Attraktivität des Faches Psychiatrie und Psychotherapie: Was müssen wir ändern, damit wir mehr Nachwuchs bekommen?

Author

M. Wündrich, J. Zielasek, and U. Voderholzer

Subjects
Psychiatry and Mental health
Abstract

ZusammenfassungDas Fach Psychiatrie und Psychotherapie wird wie viele andere medizinische Fächer in den kommenden Jahren von einem Nachwuchsmangel bedroht werden. Es müssen daher besondere Anstrengungen unternommen werden, um Studenten frühzeitig für dieses Fach zu begeistern. Hierzu sollte in der Lehre stärker das Thema Entstigmatisierung aufgegriffen werden, und es sollten die neurowissenschaftlichen Erkenntnisse sowie die Fortschritte in der evidenzbasierten Therapie psychischer Erkrankungen stärker herausgestellt werden. Angesichts der zunehmenden soziökonomischen Bedeutung psychischer Erkrankungen sollte die Lehre im Fach Psychiatrie insgesamt ausgeweitet werden, wobei sich am besten drei- bis vierwöchige ganztägige Praktika empfehlen, am besten mit Integration neuer Lehrmethoden wie Simulationspatienten und auch OSCE-Prüfungen. Auch die praktischen Vorteile einer Tätigkeit im Bereich der Psychiatrie und Psychotherapie im Vergleich mit anderen Fächern sollten bereits in der Ausbildung stärker vermittelt werden. Eine Qualitätssicherung durch systematische Lehr-Evaluation ist unerlässlich.

Published
2012
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15. Die Rolle von Qualitätsindikatoren in der psychiatrischen Qualitätssicherung und aktueller Stand der Entwicklung von Qualitätsindikatoren

Author

D. Reich-Erkelenz, T. Wobrock, M. Riesbeck, J. Zielasek, B. Janssen, I. Großimlinghaus, W. Gaebel, and P. Falkai

Subjects
Psychiatry and Mental health
Abstract

ZusammenfassungDie Entwicklung von sektorenübergreifenden Qualitätsindikatoren für die Versorgung von Menschen mit psychischen Störungen wurde durch den Gemeinsamen Bundesausschuss auf den Weg gebracht. Wir beschreiben diese aktuelle Entwicklung und informieren über den Stand des Projektes zur Entwicklung von Qualitätsindikatoren durch die DGPPN für vier häufige psychische Störungen: Schizophrenie, Demenzen, Alkoholabhängigkeit und unipolare Depressionen.

Published
2012
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16. Nutzung von Routinedaten für die psychiatrische und psychosomatische Versorgungsforschung

Author

J. Zielasek, S. Kowitz, and W. Gaebel

Subjects
Psychiatry and Mental health, Psychology
Abstract

ZusammenfassungEs wird die Frage untersucht, ob und wie sich mit den bisher vorliegenden Routinedaten aus der stationären psychiatrischen und psychosomatischen Versorgung und deren – unter der Entwicklung eines neuen Entgeltsystems sich abzeichnenden – Erweiterungen sowie unter den gegenwärtigen gesetzlichen Voraussetzungen ihrer Nutzbarkeit eine aussagefähige Versorgungsforschung durchführen lässt. Es wird skizziert, welche Untersuchungen bereits mit den bisherigen Daten möglich waren und welche Untersuchungen bereits realisiert wurden. Ferner wird analysiert, inwieweit die künftigen Erweiterungen der Routinedatenerhebung darüber hinausgehen werden und welche zusätzlichen Daten realistischerweise wünschenswert zu inkludieren wären.

Published
2011
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17. Qualitätsindikatoren in der Psychiatrie

Author

P. Falkai, B. Janssen, T. Wobrock, K. Sommerlad, J. Zielasek, W. Gaebel, and D. Reich-Erkelenz

Subjects
Psychiatry and Mental health
Abstract

ZusammenfassungMit Einführung des neuen Entgeltsystems in Psychiatrie und Psychosomatik sowie der Einführung neuer Versorgungsmodelle stellt sich die Frage, wie sich diese Entgelt- und Versorgungsmodelle auf die Qualität der psychiatrisch-psychotherapeutischen sowie der psychosomatischpsychotherapeutischen Behandlung auswirken. Darum bedarf es begleitend zur gegenwärtigen Einführung eines neuen Entgeltsystems für die Bereiche Psychiatrie und Psychosomatik auch der Einführung von qualitätsorientierten Versorgungsanalysen, wobei als eine der wichtigsten Voraussetzungen für eine sektorenübergreifende Qualitätsmessung konsentierte und valide Qualitätsindikatoren zu entwickeln sind. Dabei spielen neben der Abbildung der Strukturqualität psychiatrischer und psychosomatischer Versorgungseinrichtungen insbesondere Indikatoren der Prozess- und Ergebnisqualität eine zentrale Rolle, die nach Möglichkeit mit den routinemäßig verfügbaren Daten gut messbar sind, eine hohe Aussagekraft besitzen und Aspekte der Qualität der Behandlung über den gesamten Krankheitsverlauf und, wenn möglich, über Grenzen der Versorgungssektoren ambulant vs. stationär hinweg darstellen können. Dabei ist darauf zu achten, dass es nicht zu einem übermäßigen Dokumentationsaufwand zu Lasten der Behandlungsqualität kommt. In dem vorliegenden Beitrag wird ein möglicher Entwicklungsprozess für Qualitätsindikatoren in der Psychiatrie skizziert. Weiterhin werden einige Beispiele für bereits vorgeschlagene Qualitätsindikatoren für die Diagnostik und Behandlung der Schizophrenie und Depression vorgestellt. Abschließend bleibt festzuhalten, dass die aus der Entwicklung der Leitlinien abgeleiteten Qualitätsindikatoren ihre Praxistauglichkeit erst unter Beweis stellen müssen, um sinnvolle Steuerungswirkungen entfalten zu können.

Published
2010
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18. [Assessment of quality indicators with routine data: Presentation of a feasibility test in ten specialist clinics for psychiatry and psychotherapy]

Author

I, Großimlinghaus, P, Falkai, W, Gaebel, A, Hasan, M, Jänner, B, Janssen, D, Reich-Erkelenz, L, Grüber, V, Böttcher, T, Wobrock, and J, Zielasek

Subjects
Adult, Male, Psychiatry, Quality Assurance, Health Care, Depression, Reproducibility of Results, Documentation, Middle Aged, Sensitivity and Specificity, Psychotherapy, Germany, Practice Guidelines as Topic, Schizophrenia, Electronic Health Records, Feasibility Studies, Humans, Female, Guideline Adherence, Quality Indicators, Health Care
Abstract

Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data.The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods.In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO.An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.

Published
2015

19. Die Aktualisierung der DGPPN S3-Leitlinie Schizophrenie: aktueller Stand

Author

D. Reich-Erkelenz, J. Zielasek, Alkomiet Hasan, I. Großimlinghaus, W. Gaebel, I. Kopp, T. Wobrock, P. Falkai, and B. Janssen

Subjects
Psychiatry and Mental health
Abstract

Zusammenfassung Ausgangslage: Es gibt seit 2006 in Deutschland eine Leitlinie für die Behandlung der Schizophrenie auf dem S3-Niveau der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Fragestellung: Die im Jahre 2006 von der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) publizierte S3-Leitlinie Schizophrenie befindet sich derzeit in einem umfangreichen Revisionsprozess. Die Notwendigkeit der Aktualisierung ergibt sich daraus, dass seit 2006 eine Vielzahl neuer klinischer Studien durchgeführt und publiziert worden sind, die eine neue Bewertung der Evidenzen für viele Bereiche erfordern. Daneben wurden viele methodisch hochwertige Meta-Analysen publiziert, die in verschiedenen Bereichen der Therapie eine Anpassung der Evidenzbewertung gebieten. Ziele: Es stehen zunehmend Fragen nach einer verbesserten Funktionsfähigkeit im Alltag, dem subjektiven Wohlbefinden und der Lebensqualität im Fokus der klinischen Praxis. Diese sehr relevanten klinischen Endpunkte sind in der letzten Version der S3-Leitlinie zwar erwähnt worden, besaßen aber noch nicht die heute gesellschaftlich und im Fach geforderte Relevanz.

Published
2015

20. [Mental healthcare in Germany--current situation and perspectives]

Author

S, Kowitz, J, Zielasek, and W, Gaebel

Subjects
Mental Health Services, Risk Factors, Germany, Mental Disorders, Utilization Review, Prevalence, Humans
Abstract

For several years, there has been a significant increase of the utilization of health care due to mental disorders in Germany. Epidemiologic studies dealing with the prevalence of mental disorders show that the prevalence of mental disorders haven't increased. In consideration of the relative stable prevalence, currently there are only speculations about the reasons for the increasing service utilization. The capacity of psychiatric-psychosomatic-psychotherapeutic health care services is increasing. Despite the fact that capacity is increasing, in the outpatient and inpatient sector it comes apparent that there is an increasing burden, indicating that the demand for mental health care is not met by the capacity of psychiatric-psychosomatic-psychotherapeutic health care services. Health care provision by general practitioners and somatic disciplines predominate, going along with low cross-disciplinary and coordinated cooperation. So far, cooperative, intersectoral care models for mental disorders have been realized only in individual projects. Valid data are lacking, which need to reveal the causes and especially the consequences of this situation of mental health care provision and provide reference standards for an optimized, need-based care planning. For this reason, it is imperative to advance quality management for the care of mental disorders. With a view to the high rates of somatic comorbidity, an expansion of cooperative forms of mental health care appears essential.

Published
2014

21. [Mental disorders in the general population : Study on the health of adults in Germany and the additional module mental health (DEGS1-MH)]

Author

F, Jacobi, M, Höfler, J, Strehle, S, Mack, A, Gerschler, L, Scholl, M A, Busch, U, Maske, U, Hapke, W, Gaebel, W, Maier, M, Wagner, J, Zielasek, and H-U, Wittchen

Subjects
Adult, Male, Adolescent, Psychometrics, Mental Disorders, Middle Aged, Young Adult, Age Distribution, Mental Health, Social Class, Germany, Surveys and Questionnaires, Activities of Daily Living, Prevalence, Humans, Female, Sex Distribution, Aged
Abstract

The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization.A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire.The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses).Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.

Published
2014

24. [National and international schizophrenia guidelines. Update 2013 regarding recommendations about antipsychotic pharmacotherapy]

Author

A, Hasan, T, Wobrock, W, Gaebel, B, Janssen, J, Zielasek, and P, Falkai

Subjects
Psychotherapy, Evidence-Based Medicine, Internationality, Psychopharmacology, Germany, Practice Guidelines as Topic, Schizophrenia, Humans, Antipsychotic Agents
Abstract

Treatment guidelines provide evidence-based recommendations for diagnosis and treatment to assist clinicians, care givers and patients in finding an optimized treatment option in given clinical situations. Specific treatment guidelines for schizophrenia issued by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and published under the auspices of the Working Group for Scientific Medical Specialist Societies (AWMF) (i.e. fulfilling the highest quality standards at the S3 level) have been available in Germany since 2006. Currently, a comprehensive revision process is ongoing to update these guidelines with the aim to publish the revision before 2014. However, since publication of the German treatment guidelines many clinical trials and meta-analyses have been published which appear to make a new evaluation of antipsychotic drug treatment necessary. Currently available national and international guidelines, such as the WFSBP, PORT and NICE guidelines, place less emphasis on the general superiority of atypical antipsychotic medication but support the idea to evaluate antipsychotic drugs based on the side effect profiles. The present overview discusses the recent guidelines development processes regarding schizophrenia and compares the available German treatment guidelines with recently published international guidelines. Current developments and issues for discussion are described in detail to provide possible implications for changes in treatment recommendations.

Published
2013

25. [Developmental process of DGPPN quality indicators]

Author

I, Großimlinghaus, P, Falkai, W, Gaebel, B, Janssen, D, Reich-Erkelenz, T, Wobrock, and J, Zielasek

Subjects
Psychiatry, Psychotherapy, Neurology, Germany, Mental Disorders, Practice Guidelines as Topic, Humans
Abstract

Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia).The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators.Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed.It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.

Published
2013

26. Circulating forms of ICAM-3 (cICAM-3). Elevated levels in autoimmune diseases and lack of association with cICAM-1

Author

S Martin, P Rieckmann, I Melchers, R Wagner, J Bertrams, A E Voskuyl, B O Roep, J Zielasek, E Heidenthal, and I Weichselbraun

Subjects
Immunology, Immunology and Allergy
Abstract

The intercellular adhesion molecule-3 (ICAM-3) has been identified as the third LFA-1 ligand in addition to ICAM-1 and ICAM-2. In this report we have identified circulating forms of ICAM-3 (cICAM-3) in human serum. Using a sandwich ELISA with two monoclonal anti-ICAM-3 Abs, we detected cICAM-3 in concentrations between 40 and 360 ng/ml in all of 112 healthy controls. An analysis of patient sera from 10 different immune-mediated diseases revealed a distinct pattern of expression. Significantly elevated cICAM-3 levels were found in rheumatoid arthritis, systemic lupus erythematosus, Guillain-Barré syndrome, and multiple sclerosis, but not in type I diabetes, Grave's disease, chronic autoimmune thyroiditis, ulcerative colitis, or Crohn's disease. cICAM-3 levels were significantly higher in systemic lupus erythematosus patients with active compared with nonactive disease. Despite their binding to the same integrin receptor, serum levels of cICAM-3 did not correlate with cICAM-1 concentrations in either normal persons or in patients. The majority of patients had either elevated cICAM-3 or cICAM-1 levels but not both. In conclusion, a circulating form of ICAM-3 is present in human sera. cICAM-3 expression is elevated in certain immune-mediated diseases but occurs independently of cICAM-1.

Published
1995
Full Text
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28. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. Murray, M. Parent, M. Koepp, V. Dimova, D. De Leo, K. Jellinger, G. Salemi, S. Mientus, M. L. Hansen, F. Mazzucchelli, J. Vieth, M. Mauri, E. Bartels, L. Johannsen, C. Humphreys, J. Emile, D. N. Landon, E. Kansu, R. Sanchez-Pernaute, Rsj Frackowiak, M. Gonzalez Torres, L. Oller, C. Machedo, J. Kother, M. Billiard, H. Durak, T. Schindler, A. Frank, A. Uncini, A. Sbriccoli, C. Farinas, D. W. Paty, N. Fast, A. T. Zangaladze, A. Kerkhofs, J. M. Pino Garcia, I. De la Fuente, B. Marini, L. Gomez, I. Rubio, Alessandra Bardoni, C. Brodie, P. Acin, U. Sliwka, S. A. Hawkins, S. Tardieu, F. Vitullo, J. M. Pereira Monteino, R. Gagliardi, T. Jezewski, A. Cano, T. Lempert, F. Abad Alegria, G. Rotondo, D. Ince, C. Martinez Parra, Y. Huang, H. Luders, Y. Steinvil, F. G. A. Van Der Meche, R. Bianchi, A. Sanchez, T. Sevilla, J. M. Ketelslegers, A. Domzal-Stryga, M. Pandolfo, M. O. Josse, K. W. Neff, I. Blanco, G. W. Bruyn, O. W. Witte, J. L. Thibault, G. Andersen, J. Pariset, A. Marcone, R. J. M. Lane, A. Hofman, M. Verin, T. Matilla, P. Bedoucha, J. Roche, M. Lai, M. Collard, A. Ugarte, F. Gallecho, D. Silbersweig, C. Kennard, J. P. Azulay, T. W. Ho, P. L. I. Dellemijn, R. Girardello, F. Baas, B. Voss, F. Rozenberg, E. M. Brocker, V. Stanev, A. A. J. Soeterboek, A. Marra, A. Rey, E. Ertem, M. Sawradewicz-Rybak, J. De Keyser, P. Cavallari, F. Proust, Y. Chevalier, H. C. Hansen, D. Leys, C. A. Davie, K. Hoang-Xuan, C. Bairati, H. van Crevel, Thomas T. Warner, B. Bompais, A. Dobbeleir, T Campbell, C. Macko, C. J. M. Klijn, M. Dussallant, T. P. Berlit, W. Rozenbaum, M. J. van den Bent, W. A. Rocca, M. Muller, H. Hundemer, U. Zifko, M. Campera, F. Drislane, D. Ranoux, T. M. Kloss, Anil Kumar, I. Ruolt, C. Bargnani, B. Marescau, N. A. Losseff, S. Notermans, B. Kint, E. T. Burke, C. Aykut, J. Matias Guiu, P. Maquet, T. Drogendijk, M. Leone, K. von Ammon, M. Pepeliarska, C. Prados, L. DiGiamberardino, T. Logtenberg, G. Lenoir, I. Castaldo, Damhaut, M. Radionova, G. Sirabian, R. Navon, Giovanni Antonini, K. Al Moutaery, E. Chamas, R. Schönhuber, M. Giannini, B. Debilly, I. Labatut, H. Henon, J. A. Egido, M. Baudrimont, J. N. Lorenzo, J. E. C. Bromberg, R. Antonacci, J. J. Vilchez, T. Moulin, B. Rautenstrauss, Giovanni Meola, J. Noth, S Mammi, P. Laforet, F. Lopez, C. Gehring, S. Bort, G. Rancurel, D. Decamps, S. Kostadinova, Y. Shapira, B. Neundoerfer, D. Chavrot, M. Solimena, J. P. Salier, W. Deberdt, R. Hoff-Jörgensen, A. Messina, S. Meairs, G. Rosoklija, E. Nelis, I. Bertran, C. Ertekin, J. Lohmeyer, Mitermayer Galvao dos Reis, L. Calo, E. Maccagnano, A. P. Hays, J. Verlooy, M. G. Forno, T. Blanco, L. Bail, Gabriella Silvestri, J. Montero, F. Bertrand, R. T. Ghnassia, C. Besses, T. Sereghy, F. Shalit, G. Bogliun, S. Braghi, St. Baykouchev, C. Franke, A. Lasa, L. C. Archard, J. Kriebel, S. Shaunak, M. Nocito, Alexander Tsiskaridze, E. Manfredini, T. Seigal, David G. Gadian, M. Barlas, J. D. Degos, C. Seeber, J. Caemert, J. L. Mas, R. B. Pepinsky, M. G. D'Angelo, N. Baumann, S. Yorifuji, H. P. Endtz, M. A. Cassatella, R. A. C. Hughes, V. Golzi, A. Bittencourt, A. Ferreira, M. Sanson, C. Alper, M. Vermeulen, M. A. A. van Walderveen, E. Alexiou, C. H. Lucas, M. Fiorelli, Y. N. Debbink, R. Gil, S. Congia, T. Banerjee, J. M. Bouchard, A. N. Pinto, A. Ceballos-Baumann, G. Grollier, P. I. M. Schmitz, M. D. Catata, N. Lahat, N. S. Rao, P. Papathanasopoulos, J. Valls-Solé, D. Claus, G. Schroter, A. Castro, C. Videbaek, R. Martinez Dreke, A. D. Platts, M. Hermesl, A. C. PeÇanha-Martins, M. Cardoso Silva, P. Masnou, M. J. A. Tanner, Ch. Confavreux, B. Mishu, H. Rasmussen, L. Valenciano, Carlo Pozzilli, S. W. Li, V. Salzman, Y. Vashtang, Massimo Franceschi, M. Severo, G. Deuschl, S. Setien, G. Mariani, A. Protti, J. Castillo, M. J. B. Taphoorn, M. Frontali, I. Milonas, D. Decoq, J. A. Navarro, S. Castellvi-Pel, C. Ertikin, M. Urtasun, Y. Lajat, B. E. Kendall, E. Verdu, B. Gueguen, E. Boisen, R. Couderc, A Danek, JM Stevens, F. Nicoli, L. Feltri, M. L. Vazquez-Andre, J. A. Morgan-Hughes, L. D'Angelo, F. Y. Liew, L. F. Pascual, J. Patrignani Ochoa, Vittorio Martinelli, J. Cophignon, L. Zhang, S. Martin, J. F. Meder, H. C. Buschmann, L. Bertin, J. van Gijn, A. Barreiro, A. Cools, C. Leon, A. Berod, E. A. Anllo, E. Zanette, L. Petrov, R. Barona, B. Gallicchio, P. J. Cozzone, N. Diederich, G. Cancel, L. Schelosky, P. Orizaola, K. Yulug, S. Ozer, Valeria A. Sansone, B. Guiraud-Chaumeil, K. Voigt, P. Labauge, M. Eoli, J. Zhu, J. Aguirre, M. Ferrarini, B. Zyluk, E. Planas, A. Cadilha, C. Tortorella, H. Bismuth, C. E. Counsell, A. Laun, A. Ferlini, Rio J. Montalban, N. Biary, L. Becker, M. Fardeau, M. Poloni, V. M. S. de Bruin, C. Fornada, J. Barros, E. Ganzmann, E. Touze, D. Wallach, J. Peila, H. Fujimura, M. T. Iba-Zizen, G. Macchi, C. Villoslada, R. Gouider, Ph. Rondepierre, P. Grummich, P. Chiodi, C. Conte, M. Michels, P. Annunziata, G. Semana, C. Sommer, J. Vajsar, D. Zekin, J. Kulisevsky, David G. Munoz, B. Jacotot, M. Magoni, A. Luxen, T. Garcia-Silva, S. Di Cesare, Christophe Tzourio, M. Gomori, I. Picomell, L. Santoro, F. Villa, Giovanni Pennisi, T. Ribalta, J. M. Molto, L. Marzorati, P. Loiseau, F. Gemignani, A. Gironell, J. Wissel, A. Prusinski, F. Cailloux, P. Villanueva-Hemandez, P. Cozzone, T. Del Ser, J. Sans-Sabrafen, M. Zappia, P. W. A. Willems, G. Tchernia, D. Gardeur, R. Bauer, F. Palomo, H. Metz, S. Lamoureux, C. Chastang, I. Reinhard, A. Goldfarb, S. Harder, Jordi Río, C. Ozkara, E. Tekinsoy, P. Vontobell, J. De Recondo, M. Rabasa, L. Lacomblez, F. Boon, Dgt Thomas, V. Palma, Renato Mantegazza, A. Dervis, M. Nueckel, B. YalÇinerner, I. Duran, G. Dalla Volta, A. Zubimendi, J. Pinheiro, A. Marbini, Xavier Montalban, H. Wekerle, X. Pereira Monteino, F. Crespo, F. Koskas, N. Battistini, C. Ruiz, H. Offner, J. de Pommery, P. Kanovsky, J. Y. Barnett, J. Pardo, G. Tomei, R. Rene, H. M. Lokhorst, P. Thajeb, H. Bilgin, D. McGehee, R. Fahsold, L. Morgante, Katie Sidle, C. Delwaide, M. N. Diaye, P. H. Rice, A. Creange, C. Sabev, K. Stephan, K. WeilBenborn, G. Magnani, L. Grymonprez, F. Cardellach, M. Kaps, N. G. Meco, F. Vega, V. Bonifati, A. Desomer, M. Baldy-Moulinier, G. Kvale, F. J. Authier, B. Yegen, T. Ho, J. M. Rozet, E. A. Cabanis, L. Bruce, L. Ambrosoli, M. A. Petrella, M. Hernandez, P. Timmings, H. B. van der Worp, F. Mahieux, A. Urbano-Marquez, D. A. Krendel, A. A. Garcia, R. Divari, R. Michalowicz, M. R. Piedmonte, M. Bondavalli, M. Zanca, P. F. Ippel, Onofre Combarros, B. Tavitian, E. Hirsch, I. Anastasopoulos, A. Roses, A. Köhler, P. Vienna, V. Timmerman, P. Sergi, F. Cornelio, A. Di Pasquale, R. Verleger, S. Castellvirel, J. Proano, B. van Moll, F. Rubio, W. Hacke, I. Lavenu, L. Zetta, M. W. Tas, N. Bittmann, M. Bonamini, O. R. Hommes, V. Dousset, N. Afsar, S. Belal, R. R. Myers, J. Goes, Giuseppe Vita, E. Clementi, V. G. Karepov, M. Jueptner, A Vincent, P. Emmrich, Th. Heb, A. Caballo, J. Gallego, T. Mokrusch, C. Perla, L. Gebuhrer, O. 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C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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29. [From 'schizophrenia' to 'disturbance of the integrity of the self': causes and consequences of renaming schizophrenia in Japan in 2002]

Author

H, Umehara, H, Fangerau, W, Gaebel, Y, Kim, H, Schott, and J, Zielasek

Subjects
Diagnostic and Statistical Manual of Mental Disorders, Ego, Japan, Attitude of Health Personnel, International Classification of Diseases, Terminology as Topic, Social Stigma, Schizophrenia, Sick Role, Humans, Genetic Predisposition to Disease, Schizophrenic Psychology, Self Psychology
Abstract

In August 2002 the Japanese Society of Psychiatry and Neurology decided to rename the Japanese expression for schizophrenia from Sêshin Bunretsu Byô to Tôgô Shicchô Shô. Currently the psychiatric classification systems ICD-10 and DSM-IV are under revision. Against this background the Japanese process of renaming a psychiatric disorder is of high interest as far as the clinical, social and cultural implications of the new name are concerned.The authors give an overview of the Japanese process of renaming schizophrenia. Its background and realization are explained and the expectations of Japanese physicians, patients and their families related to the new name are analysed. Furthermore, its effects are evaluated. The aim of the paper is to clarify in how far the Japanese example may serve as a model for evaluating the possible implications that a renaming or nosological redefinition of schizophrenia might have in the course of the revision process of ICD 10 and DSM IV.

Published
2011

30. Ätiopathogenetische Konzepte und Krankheitsmodelle

Author

W. Gaebel and J. Zielasek

Abstract

Psychische Krankheit ist kein Mythos, sondern – jenseits kultureller, politischer und weltanschaulicher Perspektiven – nachweisliche Realitat. In ihrem Ubergangsbereich sind psychische Krankheit und Gesundheit nicht scharf abgrenzbar, definitorisch sind sie aufeinander bezogen. Psychische Krankheit wird in ihren Erscheinungs- und Verlaufsformen, ihren Ursachen und Bedingungen mehrdimensional konzipiert und diagnostiziert. Pathobiologische, -psychologische und soziale Aspekte sind komplementar, objektive Indikatoren allerdings teilweise noch unzureichend entwickelt. Eindimensionale oder monokausale Theoriebildung ist uberholt; in der Forschung ist zwecks Hypothesenprufung oft ein reduktionistischer Ansatz, in der klinischen Praxis jedoch durchgehend eine integrative Sichtweise erforderlich. Grundsatzlich ist eine funktionale, auf normale Funktionsweisen und ihre Storungen ausgerichtete Betrachtungsweise anzustreben, die deskriptive Operationalisierungen moderner Klassifikationssysteme erganzt und rein nosologische Konzeptionen kontrastiert. Valide, empirisch geprufte oder prufbare atiopathogenetische Rahmenkonzepte und Krankheitsmodelle sind die Voraussetzung zur Entwicklung und Anwendung rationaler Therapie. Als allgemeines Modell zur integrativen Konzeptualisierung von Atiopathogenese , Disposition, auslosenden, aufrechterhaltenden und chronifizierenden sowie protektiven und therapeutischen Faktoren fur Krankheitsmanifestation und Verlauf kann heute das Vulnerabilitats-Stress-Coping-Modell gelten. Es besitzt heuristischen Wert fur die individuelle Psychoedukation und Therapieplanung wie fur die Ursachen-/Bedingungs- und Therapieforschung. Psychiatrische Forschung ist – in einem klar bestimmten begrifflichen Feld und unter Berucksichtigung strategischer wie methodischer Erfordernisse – multidisziplinar orientiert. Dies ruckt die Psychiatrie – im Kontext eines naturwissenschaftlich orientierten Weltbildes – naher an Psychologie, Sozialwissenschaften und Medizin; letzteres ist auch ein Beitrag zur immer noch unvollstandigen sozialen Gleichstellung von psychisch und somatisch Kranken.

Published
2011
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32. Untersuchungen zur Häufigkeit pathologischer Befunde im Routine-Elektroenzephalogramm einer psychiatrischen Universitätsklinik

Author

D. Gessner-Özokyay, R. Weierstall, J. Zielasek, and J. Brinkmeyer

Subjects
Physiology (medical), Neurology (clinical)
Abstract

Fragestellung: Durch die Einfuhrung der atypischen Neuroleptika und eine Zunahme alterer Patienten mit Demenzen hat sich das Potential fur pathologische Befunde in der Routine-Elektroenzephalographie (EEG) bei Patienten mit psychischen Storungen verandert. Wir untersuchten daher die Art und Haufigkeit von EEG-Veranderungen im Alltag des EEG-Labors einer psychiatrischen Universitatsklinik. Methoden: Analyse der Befunde von Routine-Wach-EEG-Untersuchungen im Laufe des Monats Oktober 2006 der Rheinischen Kliniken Dusseldorf. Die EEGs wurden von zwei verschiedenen Befundern getrennt voneinander untersucht, beide mit mehrjahriger Erfahrung in der EEG-Analyse. Unterschiedliche Befundinterpretationen wurden durch Diskussion der Graphoelemente entschieden. Ableitungsdauer 20 Minuten mit 24 Kopfhaut-Elektroden inklusive Elektrookulogramm und Elektrokardiogramm. Als Provokationsverfahren wurde die Hyperventilation eingesetzt. Ergebnisse: Im Oktober 2006 wurden 124 EEGs abgeleitet (45Manner, 79 Frauen). Die Mehrheit der Untersuchten befand sich in stationarer psychiatrischer Behandlung (97 stationar, 26 ambulant). Das Alter lag bei 9–89 Jahren (Median 43 Jahre). Es dominierten affektive Storungen (43%) und Erkrankungen aus dem schizophrenen Formenkreis (33%). Der Grundrhythmus lag bei 6–14/s (Median 10/s). In 90 Fallen wurden auffallige Befunde festgestellt (73%), am haufigsten waren das Einschlafen (47%), Medikamenten-Einflusse (36%), leichtere Vigilanzschwankungen (31%) und Zeichen mangelnder Entspannung (22%). Epilepsie-typische Graphoelemente kamen nur bei 7 Patienten (6%) zur Darstellung. Durchgehende Grundrhythmusverlangsamungen, die nicht auf Vigilanzschwankungen zuruckgefuhrt werden konnten, wurden nur in einem Fall gefunden. Die Hyperventilation erbrachte keine zusatzlichen Erkenntnisse. Schlussfolgerungen: Schwerwiegende pathologische Graphoelemente waren selten. Verlangsamungen des Grundrhythmus waren haufig, meist jedoch Ausdruck von Vigilanzschwankungen. Neben Vigilanzstorungen traten haufig Hinweise fur Medikamenten-Einflusse auf. Bei der Beurteilung des psychiatrischen Routine-EEGs ist daher besonders auf Vigilanzschwankungen zu achten. Auserdem sind genaue Angaben zur aktuellen Medikation in Anbetracht der Haufigkeit von wahrscheinlich durch die Medikation bedingten EEG-Veranderungen sehr wichtig.

Published
2007
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37. Nerve conduction abnormalities and neuromyotonia in genetically engineered mouse models of human hereditary neuropathies

Author

J, Zielasek and K V, Toyka

Subjects
Mice, Knockout, Mice, Mice, Neurologic Mutants, Genotype, Charcot-Marie-Tooth Disease, Neural Conduction, Animals, Humans, Muscle, Skeletal, Myelin P0 Protein, Axons, Myelin Proteins, Myelin Sheath
Abstract

We performed electrophysiological studies in myelin protein mutant mice in order to characterize nerve conduction changes. We performed neurographic studies on the facial and sciatic nerves and needle electromyography (EMG). Mice homozygously deficient for the peripheral myelin protein 22 gene (Pmp22-/-) exhibited increased motor latencies, reduced nerve conduction velocities, and polyphasia of the M-response, which are the typical electrophysiological signs of dysmyelination. PMP22 +/- mice developed only mild conduction slowing at an old age and a mild reduction of the M-amplitude, which indicates mild axonal dysfunction. Mice overexpressing Pmp22 developed severe electrophysiological signs of dysmyelination. In myelin protein zero-deficient mice (P0 -/-), we found alterations similar to those found in Pmp22 -/- mice, whereas P0 +/- mice developed mildly increased sciatic nerve F-wave latencies only late in life, which indicates only mild dysmyelination. Connexin 32-deficient mice showed electrophysiological evidence of mild axonal damage. By EMG, we found the clinical and electrophysiological signs of neuromyotonia, that is, continuous spontaneous motor unit discharges, often in rhythmic patterns (myokymia), in P0 -/-, Pmp22 -/-, Trembler, Trembler-J, and Pmp22-overexpressing mice. This indicates abnormal impulse generation in these dysmyelinated nerves. In summary, our studies demonstrate nerve conduction changes in mice with myelin protein gene defects that are similar to those found in patients with Charcot-Marie-Tooth disorders. In addition, we identified new mouse models of hereditary neuromyotonia.

Published
1999

38. Neuromuscular blockade by IgG antibodies from patients with Guillain-Barré syndrome: a macro-patch-clamp study

Author

B, Buchwald, K V, Toyka, J, Zielasek, A, Weishaupt, S, Schweiger, and J, Dudel

Subjects
Adult, Male, Nerve Endings, Mice, Inbred BALB C, Patch-Clamp Techniques, Neuromuscular Junction, Polyradiculoneuropathy, Middle Aged, Blood Physiological Phenomena, Synaptic Transmission, Antibodies, Electrophysiology, Mice, Immunoglobulin G, Synapses, Animals, Humans, Female, Neuromuscular Blocking Agents, Aged
Abstract

Guillain-Barré syndrome (GBS) is often associated with serum antibodies to glycoconjugates such as GM1 and GQ1b. The pathogenic role of these antibodies and other serum factors has not yet been clarified. We have investigated the effect of serum, plasma filtrate, and highly purified IgG and IgM from 10 patients with typical GBS on motor nerve terminals in the mouse hemidiaphragm. Quantal endplate currents were recorded by means of a perfused macro-patch-clamp electrode. The plasma filtrate of all GBS patients led to a 5- to 20-fold reduction of evoked quantal release within 7 to 15 minutes of continuous superfusion. In 4 patients, the amplitudes of single quanta were clearly reduced (by 10-66% of control values), indicating an additional postsynaptic action. Blocking effects could be reversed to a variable degree within 15 to 18 minutes after washout. Purified IgG was as effective as native serum, whereas a purified GBS IgM fraction did not block transmission. Sera from convalescent patients and IgG from healthy subjects were without blocking effect. The effects were complement independent and there was no link to the presence (in 6 patients) or absence (in 4 patients) of detectable antibodies to GM1 or GQ1b. In GBS, antibodies to an undetermined antigen depress the presynaptic transmitter release and, in some cases, the activation of postsynaptic channels. We suggest that weakness in the acute stage of GBS may be caused in part by circulating antibodies.

Published
1998

39. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group

Author

R D, Hadden, D R, Cornblath, R A, Hughes, J, Zielasek, H P, Hartung, K V, Toyka, and A V, Swan

Subjects
Motor Neurons, Time Factors, Neural Conduction, Polyradiculoneuropathy, Immunoglobulins, Intravenous, G(M1) Ganglioside, Axons, Electrophysiology, Treatment Outcome, Humans, Peripheral Nerves, Autoantibodies, Demyelinating Diseases, Follow-Up Studies
Abstract

We performed electrophysiological and serological testing within 15 days of symptom onset on 369 patients with Guillain-Barré Syndrome (GBS) enrolled in a trial comparing plasma exchange, intravenous immunoglobulin, and both treatments. Patients were classified into five groups by motor nerve conduction criteria; 69% were demyelinating, 3% axonal, 3% inexcitable, 2% normal, and 23% equivocal. Six of 10 (60%) patients with axonal neurophysiology had had a preceding diarrheal illness compared with 71 of 359 (20%) in other groups. Antiganglioside GM1 antibodies were present in a higher proportion of patients with axonal physiology or inexcitable nerves than other patients. The number dead or unable to walk unaided at 48 weeks was greater in the group with initially inexcitable nerves (6 of 12, 50%) compared with the rest (52 of 357, 15%), but was not significantly different between the axonal (1 of 10, 10%) and demyelinating (44 of 254, 17%) groups. Sensory action potentials and clinical sensory examination were both normal in 53 of 342 (16%) patients, and these "pure motor GBS" patients were more likely than other GBS patients to have IgG antiganglioside GM1 antibodies and to have had preceding diarrhea but had a similar outcome. The axonal group was more likely than other groups to have normal sensory action potentials. The outcomes in response to the three treatments did not differ in any subgroup (including patients with pure motor GBS or preceding diarrhea) or any neurophysiological category.

Published
1998

41. Inhibition of cytokine-inducible nitric oxide synthase in rat microglia and murine macrophages by methyl-2,5-dihydroxycinnamate

Author

J, Zielasek, B, Müller, and H P, Hartung

Subjects
Macrophages, Neuropeptides, Down-Regulation, Protein-Tyrosine Kinases, Nitric Oxide, Cell Line, Rats, Mice, Animals, Newborn, Cinnamates, Rats, Inbred Lew, Enzyme Induction, Animals, Cytokines, Microglia, Nerve Growth Factors, Enzyme Inhibitors, Nitric Oxide Synthase
Abstract

Microglial cells are resident macrophages in the central nervous system (CNS) which serve specific functions in the defence of the CNS against microorganisms, the removal of tissue debris in neurodegenerative diseases or during normal development, and in autoimmune inflammatory disorders of the brain. Microglia express a cytokine-inducible isoform of nitric oxide synthase, which leads to the production of nitric oxide (NO). Since NO is highly toxic to neurons and oligodendrocytes, we were interested to test down-regulating neuropeptides and second messenger de-activators in order to identify novel antagonists of cytokine-induced NO production. We found that only the tyrosine kinase inhibitor methyl-2,5-dihydroxycinnamate suppressed cytokine-induced NO production by rat microglial cells and murine macrophages, while a range of other tyrosine kinase inhibitors, neuropeptides and growth factors was ineffective. Since NO production may play a role in the pathogenesis of experimental neuro-immunological disorders like experimental autoimmune encephalomyelitis and experimental autoimmune neuritis, our findings suggest a possible therapeutic role for tyrosine kinase inhibitors.

Published
1996

42. [Therapy of acute polyradiculoneuritis (Guillain-Barré syndrome)]

Author

H P, Hartung, R, Gold, J, Zielasek, J J, Archelos, and K V, Toyka

Subjects
Neurologic Examination, Critical Care, Dose-Response Relationship, Drug, Plasma Exchange, Adrenal Cortex Hormones, Immunization, Passive, Polyradiculoneuropathy, Humans
Abstract

The Guillain-Barre syndrome (GBS) is the most common cause of acute paralysis. It requires early institution of therapy to avoid life-threatening complications, to speed up recovery and minimize residual handicap. Advances in supportive care (treatment of infections, anticoagulation) and the introduction of intensive care (assisted ventilation, treatment of autonomic disturbances) have greatly improved the management of this disease and consequently its prognosis. A better understanding of the underlying immune mechanisms prompted pathogenetically oriented therapy. Plasma exchange and high dose intravenous immunoglobulin have been demonstrated in large controlled trials to hasten recovery in GBS. Problems of these studies are discussed and the presumed mode of action of these therapies is reviewed. Corticosteroids have shown no benefit. Ongoing trials are listed and future strategies for immunointervention are outlined.

Published
1994

43. Morphological And Electrophysiological Signs Of Dysmyelination In Transgenic Mice Expressing CMT1B ( MPZ DELSer34 ) or DSS ( MPZ Ser34Cys ) Mutations

Author

P Fratta, Ml. Feltri, K Toyka, Albee Messing, M D'antonio, G Dati, Angelo Quattrini, M Fasolini, J Zielasek, and Lawrence Wrabetz

Subjects
Genetically modified mouse, Genetics, medicine.medical_specialty, General Neuroscience, Mutant, Wild type, Stimulation, Biology, Phenotype, Myelin, Endocrinology, medicine.anatomical_structure, Internal medicine, medicine, Neurology (clinical), Sciatic nerve, Allele
Abstract

Charcot-Marie-Tooth 1B neuropathy (CMT1B), Dejerine-Sottas syndrome (DSS) and Congenital Hypomyelination are each associated with mutations in MPZ, encoding P0 glycoprotein, the major structural protein of peripheral nerve myelin. To explore whether new abnormal functions of mutant MPZ can explain this phenotypic diversity, we expressed either of two MPZ mutations: DELSer34 (causing CMT1B) or Ser34Cys (causing DSS) in addition to the two normal endogeneous copies of Mpz in transgenic mice. We have shown previously that overexpression of wild type Mpz causes dose-dependent dysmyelination. However, multiple lines of mice containing the MPZ mutants showed not only hypomyelination, but also abnormalities in myelin sheaths and onion bulbs that were never observed in Mpz overexpressor mice. To create a mouse model of CMT1B with no Mpz overexpression, one line of DELSer34 that expresses mutant Mpz at levels similar to one wildtype Mpz allele was crossed with heterozygous Mpz knock-out mice, to obtain the genotype Mpzwt/−/MpzDELSer34. These mice manifest progressive peripheral neuropathy with hypomyelination, and onion bulbs that appear around 6 months of age. As a first step towards longitudinal studies of phenotype, we performed detailed neurophysiological analyses at 12 months of age. We found signs of demyelination, with statistically significant increases of both motor latency after proximal stimulation and F-wave latencies, and decreases in both motor and mixed afferent nerve conduction velocities of sciatic nerve. The motor response was polyphasic and there was a trend towards reduced CMAP amplitudes. Thus, the clinical onset and progression, pathological features and neurophysiological findings provide a reasonable model of CMT1B. Longitudinal studies to correlate the onset and progression of morphological and electrophysiological abnormalities in these mice are ongoing.

Published
2001
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44. [Interleukin-2 modifies the development of insulin-dependent diabetes of BB rats]

Author

J, Zielasek, V, Burkart, and H, Kolb

Subjects
Diabetes Mellitus, Type 1, Dose-Response Relationship, Immunologic, Animals, Interleukin-2, Rats, Inbred BB, Injections, Intraperitoneal, Recombinant Proteins, Diabetes Mellitus, Experimental, Rats
Abstract

Intraperitoneal administration of human recombinant IL-2 led to a significant, dose-dependent increase and acceleration of diabetes development in BB rats, while we observed a suppression of diabetes development in animals with a high spontaneous disease incidence.

Published
1990

45. Type I Diabetes as a 'Mendelian' and 'Regulated' Immune Process

Author

Ralph Ziegler, R. C. Nayak, David Bleich, R. D. Herskowitz, J. Zielasek, R. A. Jackson, R. J. Keller, G. S. Eisenbarth, E. Russo, Luis Castano, M. Hattori, Francesco Dotta, and Myra A. Lipes

Subjects
Lupus erythematosus, business.industry, Autoantibody, Nod, medicine.disease_cause, medicine.disease, Autoimmunity, symbols.namesake, Autoimmune Process, Diabetes mellitus, Immunology, Mendelian inheritance, symbols, medicine, business, NOD mice
Abstract

From studies of non-organ specific autoimmune diseases such as Lupus Erythematosus the concept has developed that autoimmunity is characterized by marked variation over time reflected by clinical remission and exacerbation. Our family studies of the development of Type I diabetes is providing us with a very different picture of the autoimmunity associated with Type I diabetes. In addition studies of NOD mice indicate that the Mendelian inheritance of a series of necessary but not sufficient diabetes associated alleles (H-2 NOD, theta linked, and the autosomal recessive gene determining anti-polar antibodies) create diabetes susceptibility. We will review our studies indicating that Type I diabetes is an autoimmune process in which there is remarkable quantitative stability of autoantibody levels amongst prediabetics (at times extending to more than a decade).

Published
1990
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46. Analysis of 22 immunomodulatory substances for efficacy in low-dose streptozotocin-induced diabetes

Author

H, Kolb, M, Oschilewski, U, Oschilewski, E, Schwab, C M, Moumé, B, Greulich, V, Burkart, J, Zielasek, and U, Kiesel

Subjects
Blood Glucose, Male, Pertussis Vaccine, Islets of Langerhans, Mice, Adjuvants, Immunologic, Azathioprine, Cell- and Tissue-Based Therapy, Animals, Mice, Inbred Strains, Cyclophosphamide, Immunosuppressive Agents, Diabetes Mellitus, Experimental
Abstract

Of 22 immunomodulatory substances screened 12 were effective in modulating the course of hyperglycemia following low dose streptozotocin treatment. In this animal model diabetes is induced by administration of low doses of streptozotocin (30-40 mg/kg) body weight to male C57BL/6J/Bom, C57BL/KsJ and C3H/He/Bom mice on 5 consecutive days. Conventional immunosuppressants (azathioprine, cyclophosphamide) largely protected from diabetes development. Partial suppression of hyperglycemia was also seen after administration of B. pertussis, fetal tissue extracts, FTS, inosine pranobex, metronidazole and ADA 202-718. The majority of these substances, when applied with another regimen, and TP5 caused enhancement of diabetes. In conclusion, several substances with a therapeutic potential in experimental diabetes have been identified. Those with little risk of side-effects may deserve further analysis.

Published
1987

47. The potentially simple mathematics of type I diabetes

Author

J. Zielasek, George S. Eisenbarth, and R.A. Jackson

Subjects
Immunology, Elisa assay, Biology, Models, Biological, Pathology and Forensic Medicine, Autoimmune Diseases, Diabetes Mellitus, Type 1, Simple (abstract algebra), Insulin dependent diabetes, Mathematics education, Immunology and Allergy, Type i diabetes, Humans, Disease Susceptibility
Published
1989

48. Therapy of post-stroke depression - A systematic review

Author

Wienke Wannagat, W. Gaebel, and J. Zielasek

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Neuropsychiatry, Placebo, Pharmacological treatment, Transcranial magnetic stimulation, Psychiatry and Mental health, Pharmacotherapy, Medicine, Post-stroke depression, Antidepressant, business, Intensive care medicine, Psychiatry, Depression (differential diagnoses)
Abstract

SummaryWe performed a systematic review of randomized placebo-controlled pharmacological and non-pharmacological trials for the therapy and prevention of post-stroke depression that have been published between 1980 and 2011. We initially identified 2 260 records of which 28 studies were finally included into this review. A meta-analytic approach was hampered by considerable differences regarding the kinds of therapeutic regimens and the study durations. Modest effects favoring treatment of post-stroke depression could be found for pharmacological treatment as well as repetitive transcranial magnetic stimulation. For the prevention of post-stroke depression, antidepressant pharmacotherapy showed promising results. However, large-scale studies with better standardized study populations, optimized placebo control procedures in non-pharmacological studies, and replication in larger follow-up studies are still necessary to find the optimal therapeutic regimens to prevent and treat post-stroke depression.

49. Implementation of an electronic patient portal in routine mental health care of hospitals in Germany - evaluation of attitudes of healthcare providers.

Author

Reinhardt I, Holsten R, Zielasek J, Kuhlmann L, and Gouzoulis-Mayfrank E

Subjects
Humans, Germany, Surveys and Questionnaires, Male, Female, Hospitals, Psychiatric, Electronic Health Records, Adult, Mental Health Services organization & administration, Middle Aged, Health Personnel psychology, Patient Portals statistics & numerical data, Attitude of Health Personnel
Abstract

Background: The use of digital tools such as electronic patient portals in different health care disciplines and settings has been increasing, but the rate of implementation in clinical practice still lags behind expectations. While studies have linked the use of electronic patient portals to positive health outcomes for patients, studies addressing the viewpoints of healthcare providers are rare., Methods: We performed an online survey of attitudes of healthcare providers towards an electronic patient portal for mental health hospitals. The portal was developed by five communal providers of mental health care in different regions in Germany. The survey was carried out during the early phase of implementation of the portal., Results: Twenty project leaders and 37 clinicians from five different mental health hospitals answered the questionnaire (response rate: 45% and 28%). Overall, acceptance of online applications among respondents was high. The healthcare providers mentioned perceived benefits (e.g. accessibility of new patient groups, use of therapy-free periods) as well as a number of technical, structural, organizational and staffing barriers for successful implementation in hospital settings (e.g. workload of healthcare providers and lack of staff, limited digital competences, unstable WLAN)., Conclusion: The perceived barriers and facilitators of the implementation of online applications and electronic patient portals in mental health hospitals identified by healthcare providers may be taken into account. Improving commitment of the healthcare providers to implementation and use of digital interventions may help foster digitalisation in mental health hospitals., (© 2024. The Author(s).)

Published
2024
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50. [Professionals' Views On Forensic-Psychiatric Patients With Intellectual Disability: Impact Of Structural, Systemic And Diagnosis-Related Aspects On Treatment And Release].

Author

Querengässer J, Reinhardt I, Zielasek J, Hufnagel S, and Gouzoulis-Mayfrank E

Subjects
Humans, Germany, Mental Disorders therapy, Mental Disorders diagnosis, Mental Disorders psychology, Male, Adult, Female, Middle Aged, Length of Stay statistics & numerical data, Patient Discharge, Intellectual Disability therapy, Intellectual Disability psychology, Intellectual Disability diagnosis, Forensic Psychiatry methods, Attitude of Health Personnel
Abstract

In forensic psychiatric clinics, patients who have committed a criminal offense on the basis of intellectual disability are also treated in according to Sect. 63 of the German Criminal Code. This group of patients has above-average lengths of stay and specific difficulties in treatment and in transition to aftercare systems are reported from practice. The present study is based on a content-analytical evaluation of ten structured interviews with practitioners of different professions who are familiar with the treatment of this patient group in forensic psychiatry. The aim was to identify treatment experiences and challenges of inpatient forensic care for this group as well as needs for change and suggestions for improvement. Respondents confirmed the specific treatment needs and person- and diagnosis-related challenges known from other studies, which were considered to be causally related to prolonged hospital stay and problems at discharge. Numerous structural and systemic barriers were also identified that impede the shortest possible forensic inpatient care and seamless transition to the non-forensic aftercare system. At the structural level, these included the need for human resources (both quantitative and qualitative) and adapted treatment concepts. Professional aftercare was considered very important for this group of patients. In this regard, the non-availability of suitable institutions, long waiting lists and reservations on the part of these institutions towards former forensic patients were identified as problems. The fact that patients with intellectual disability were less able to make their needs known than other patients and thus often received less attention from the treatment providers can be described as a systemic obstacle. This also applies to the rather high demands that the forensic system, with its goal of "improvement" through treatment, also places on people with intellectual disability. The findings of this study can contribute to improvement of the forensic inpatient care of people with intellectual disability at systemic and structural levels., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Published
2024
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