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BackgroundPsychiatric inpatient treatment is increasingly performed in settings with locked doors. However, locked wards have well-known disadvantages and are ethically problematic. In addition, recent data challenges the hypothesis that locked wards provide improved safety over open-door settings regarding suicide, absconding and aggression. Furthermore, there is evidence that the introduction of an open-door policy may lead to short-term reductions in involuntary measures. The aim of this study was to assess if the introduction of an open-door policy is associated with a long-term reduction of the frequency of seclusion and forced medication.MethodIn this 6-year, hospital-wide, longitudinal, observational study, we examined the frequency of seclusion and forced medication in 17,359 inpatient cases admitted to the Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Switzerland. In an approach to enable a less restrictive policy, six previously closed psychiatric wards were permanently opened beginning from August 2011. During this process, a systematic change towards a more patient-centered and recovery-oriented care was applied. Statistical analysis consisted of generalized estimating equations (GEE) models.ResultsIn multivariate analyses controlling for potential confounders, the implementation of an open-door policy was associated with a continuous reduction of seclusion (from 8.2 to 3.5%; ηp2 = 0.82; odds ratio: 0.88) and forced medication (from 2.4 to 1.2%; ηp2 = 0.70; odds ratio: 0.90).ConclusionThis underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.

Ziel der Studie: Validierung der deutschsprachigen Version der Checkliste zur Erfassung neuropsychiatrischer Symptome bei der Parkinsonerkrankung (CENS-PE) von Martinez-Martin et al. (2012). Methodik: Die CENS-PE wurde an insgesamt 96 Patienten mit Parkinsonerkrankung (PE) (Alter: 65,3 Jahre ± 9,6, 29 Frauen) evaluiert. Die Checkliste umfasst 12 Items, die in die drei Domanen psychotische Symptome, Stimmung/Apathie und Storung der Impulskontrolle unterteilt sind. In mehreren statistischen Analysen wurde die Item- und Reliabilitatsanalyse durchgefuhrt und die Validitat uberpruft. Ergebnisse: Die untersuchten Patienten mit PE wiesen leichte neuropsychiatrische Symptome auf. Die drei Domanen konnten mit der Hauptkomponentenanalyse identifiziert werden. Die Items der Stimmung/Apathie-Domane erwiesen sich als homogen und trennscharf, die interne Konsistenz war akzeptabel. Fur die Domanen psychotische Symptome und Storung der Impulskontrolle waren die Kennwerte nur teilweise ausreichend. Die Checkliste erwies sich als konvergenz-, diskriminanz- und konstruktvalide. Schlussfolgerung: Die deutsche Ubersetzung der CENS-PE ist gesamthaft hinreichend reliabel und valide, um im deutschen Sprachraum eingesetzt zu werden. Die Domanen psychotische Symptome und Storung der Impulskontrolle konnen aufgrund der geringen Anzahl gemessener Symptome in diesem Bereich nur limitiert beurteilt werden.

Nichtmotorische Symptome bei Patienten mit Morbus Parkinson (MP) stosen zunehmend auf das Interesse der Forschung. Insbesondere psychische Erkrankungen wie Angst und Depression bei Patienten mit MP beziehen Fachleute oft nicht ins Diagnoseverfahren mit ein, obwohl die Pravalenzrate hoch ist. Fur eine umfassende Behandlung des Gesundheitszustands dieser Patientengruppe sind eine adaquate Diagnose und eine entsprechende Therapie notwendig. Die Kognitive Verhaltenstherapie (KVT) hat sich bislang als eines der effizientesten Therapieverfahren zur Behandlung von Angst und Depression erwiesen. Sowohl im Einzel- als auch im Gruppensetting hat sich die KVT bewahrt. In dieser Ubersicht werden zehn Studien einander gegenubergestellt und diskutiert, die die KVT bei Parkinsonpatienten mit Angst und Depression untersucht haben. In acht Studien fand eine Einzeltherapie statt. Darin enthalten sind drei Einzelfallstudien, drei Studien ohne Kontrollgruppe und zwei kontrollierte randomisierte Studien. Zwei Interventionen fanden ausschlieslich am Telefon statt. In zwei Studien wurde eine Gruppentherapie durchgefuhrt. Eine davon erfolgte mit einer Kontrollgruppe. Es gibt Hinweise, dass sowohl die depressiven Symptome der Patienten mit MP nach einer KVT abnahmen als auch die Angst. Kontrollierte randomisierte Designs zu dieser Frage sind selten. Die Wirksamkeit der Gruppentherapie sollte besser erforscht werden, um eine effiziente Behandlung anbieten zu konnen, die die speziellen Umstande von Parkinsonpatienten berucksichtigt.

Depression is a common psychiatric disorder in older people. It is often accompanied by comorbid somatic conditions, and affected patients become frequent users of the health care system. Due to its relevance not only for the individual but also for society, reflection on the current health care service and optimization possibilities for the depressed elderly seems important and necessary. Mostly, the general practitioner is not only the first point of contact, but is also responsible for the entire treatment of depression. Due to the limited possibilities of primary care, for several years, there have been collaborative care programs in the USA that provide an optimized networking and collaboration between different health care providers and use specially trained care managers to support the usual primary health care service with short behavioral interventions. In Germany, there are also new approaches and models to improve the health care service for the depressed elderly, but these require further evaluation.Depression ist eine der häufigsten psychischen Erkrankungen im höheren Lebensalter. Oft geht sie mit komorbiden somatischen Erkrankungen einher und Betroffene werden zu Vielnutzern des Gesundheitssystems. Aufgrund der nicht nur individuellen, sondern auch gesellschaftlichen Relevanz, ist ein Blick auf die aktuelle Versorgung und Optimierungsmöglichkeiten von älteren Menschen mit Depression wichtig und notwendig. Der Hausarzt stellt meist nicht nur die erste Anlaufstelle dar, sondern übernimmt oft die gesamte Depressionsbehandlung. Aufgrund limitierter Möglichkeiten in der hausärztlichen Versorgung, gibt es in den USA schon seit einigen Jahren kollaborative Programme, die eine optimierte Vernetzung und Zusammenarbeit zwischen unterschiedlichen Behandlern vorsieht und speziell geschulte Case Manager einsetzt, um die übliche hausärztliche Behandlung mit kurzen verhaltenstherapeutischen Interventionen zu unterstützen. In Deutschland gibt es ebenfalls bereits neue Ansätze und Modelle um die Versorgung älterer depressiver Menschen zu verbessern, die aber noch weiterer Überprüfungen bedürfen.

The aim of the present study was to validate and provide a German version of the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's disease (SEND-PD) of Martínez-Martín et al. (2012).The German version of the SEND-PD was evaluated in a sample consisting of 96 patients with Parkinson's disease (PD) (mean age: 65.3 years ± 9.6, 29 female). This scale includes 12 items, representing the domains psychotic symptoms, mood/apathy and impulse control disorders. Reliability and validity analyses were conducted.The examined patients presented a few neuropsychiatric symptoms. Explorative factor analyses identified the proposed three dimensions solution. The items of the mood/apathy domain were homogenous and selective, and the domain showed acceptable internal consistency. For the other two domains, the values were only partially acceptable. Convergent, discriminate and construct validity were shown.The German version of the SEND-PD is sufficiently reliable and valid to be adopted in German speaking countries. However, since patients showed only a few symptoms in the dimensions of psychotic symptoms and impulse control disorders, these two domains can be evaluated only to a limited extent.

Non-motor symptoms in patients with Parkinson's disease (PD) are gaining more and more interest. Diagnosis of mental disorders in particular, such as anxiety and depression, are often not a part of the professional's diagnostic procedure in spite of the high prevalence rate. To provide these patients with comprehensive treatment, proper diagnosis and appropriate therapy are required. Cognitive Behavioral Therapy (CBT) has been one of the most efficient therapies for anxiety and depression, also in a group setting. This review compares studies that examined patients with PD diagnosed with anxiety disorders and/or depression. In eight studies, CBT in an individual setting was assessed. Three of these had a single case study design, three did not have a control group and two were randomized controlled trials. Two interventions were telephone-based and two were in a group therapy setting. Several results indicate that there is a decline in depressive symptoms as well as anxiety after CBT. There are very few randomized controlled studies on this issue. The efficacy of group treatment needs to be investigated better in order to offer patients effective treatment, keeping in kind their special circumstances.

BackgroundAlthough individuals vulnerable to psychosis show brain volumetric abnormalities, structural alterations underlying different probabilities for later transition are unknown. The present study addresses this issue by means of voxel-based morphometry (VBM).MethodWe investigated grey matter volume (GMV) abnormalities by comparing four neuroleptic-free groups: individuals with first episode of psychosis (FEP) and with at-risk mental state (ARMS), with either long-term (ARMS-LT) or short-term ARMS (ARMS-ST), compared to the healthy control (HC) group. Using three-dimensional (3D) magnetic resonance imaging (MRI), we examined 16 FEP, 31 ARMS, clinically followed up for on average 3 months (ARMS-ST, n=18) and 4.5 years (ARMS-LT, n=13), and 19 HC.ResultsThe ARMS-ST group showed less GMV in the right and left insula compared to the ARMS-LT (Cohen's d 1.67) and FEP groups (Cohen's d 1.81) respectively. These GMV differences were correlated positively with global functioning in the whole ARMS group. Insular alterations were associated with negative symptomatology in the whole ARMS group, and also with hallucinations in the ARMS-ST and ARMS-LT subgroups. We found a significant effect of previous antipsychotic medication use on GMV abnormalities in the FEP group.ConclusionsGMV abnormalities in subjects at high clinical risk for psychosis are associated with negative and positive psychotic symptoms, and global functioning. Alterations in the right insula are associated with a higher risk for transition to psychosis, and thus may be related to different transition probabilities.

Little is known about the risk profile and the further history of patients who attempted suicide by severe medicinal intoxication.All patients residing in Basel (n = 190) admitted to the intensive care unit between 01/01/1998 and 12/31/2001 because of a suicide attempt with legal drugs were investigated regarding psychopathology and sociodemographic features. Also, until the end of 2005, further suicide attempts as well as potential cases of death were followed up.All 190 patients had psychiatric disorders. Compared to the general population, female sex, single status, low educational level, unemployment and invalidity were found significantly more often. Until the end of 2005 almost half of 118 patients followed up in our outpatient department committed further suicide attempts. 28 patients died, 6 of these by suicide.These patients should preferably not be prescribed medication with a low therapeutic range and they should receive intensive follow-up care.

In the present study, the German-language version of the Stress Appraisal Measure (SAM) by Peacock and Wong was validated in a student population. SAM is a relatively short questionnaire (28 items) that evaluates a current, stress-triggering event. The theoretical background is provided by the stress model of Lazarus and Folkman.85 students (age: 23; 59 female, 26 male) were exposed to two stress scenarios in order to test whether they were suited to provoke stress. A factor analysis was performed and the internal consistency of the seven SAM scales was determined. In addition, the convergent validity of SAM with State and Trait Anxiety Inventory (STAI), Coping Inventory for Stressful Situations (CISS) and specific emotion scales was investigated via Pearson's product-moment correlation.The two stress scenarios were suited to evoke stress. The factor structure and the internal consistency of the individual scales, as well as the convergent validity of SAM were replicated with minor limitations in the present German version. Some items (especially from the fifth factor) were only replicated partially.SAM can also be employed in the German language version.

At the University of Basel (Switzerland), a multidisciplinary team was established for pre-operative selection and treatment of patients with gender dysphoria. As a result, the indications for surgical gender reassignment could be judged with considerably greater accuracy than previously possible. In the 9-year period of this prospective study only 14 of 57 patients with gender dysphoria were selected for surgical treatment. At the time of this survey, six patients are still under psychiatric preoperative evaluation, and six further male-to-female transsexuals are under hormonal treatment awaiting surgery. Following the operation, only one of nine male-to-female patients is socially unstable and that patient’s quality of life is worse than prior to gender reassignment. Of the female-to-male transsexuals, all four are stable in their professional and family relations. In conclusion, a comprehensive evaluation of patients with gender dysphoria and the conclusive indications established within the team considerably improved the postoperative outcome of gender reassignment.

Objective: Our study aims to establish a scientific basis for the very early detection of patients at risk for schizophrenia during the nonspecific prodromal phase of the disorder and to predict its outbreak. Method: A multidomain approach is used. After screening, approved psychopathological, neurophysiological, neuropsychological and neuroradiological investigations are used to assess a sample of individuals suspected to be at risk for schizophrenia. Results: Neuropsychological and fine motor functioning tests as well as eye movement measurements showed statistically significant differences (P

The importance of single symptoms in the diagnostic process has not been adequately studied, mainly because of the complexity of the information involved. The aim of the present study is to investigate the interconnection between psychopathological assessment and diagnostic classification, with the aid of a nonparametric, inductive pattern recognition method. Using the concept of inductive logic and a theory of inductive knowledge acquisition, a model has been developed to describe psychopathological assessment and diagnostic classification. Based on a comprehensive psychopathological assessment in 837 patients with 14 different diagnoses, classification values were calculated for specific symptoms in different diagnostic groups. Furthermore, nonparametric statistical procedures have advantages over discriminant analytic approaches: more information is utilized in differentiating the groups and differentiations can be made between more groups, whereby the rate of correctly classified cases is comparable with discriminant analytic approaches. The pattern recognition method appears to illustrate the multidimensional, medical decision-making in a comprehensible way.

Summary Background: Fatigue and a reduction in physical ability are common and often severe problems of cancer patients regardless of disease stage and modality of treatment. However, while physical performance can be assessed objectively with laboratory tests, fatigue is a subjective phenomenon whose perception is influenced by past experience and expectations for the future. Patients and methods: To evaluate the correlation between fatigue and physical impairment, we assessed maximal physical performance with a treadmill test, and mental state with two questionnaires, the Profile of Mood States (POMS) and the Symptom Check List (SCL-90-R), in a successive series of 78 cancer, patients with solid tumors or hematological malignancies. Results: A weak association between fatigue and maximal physical performance was found (r = -0.30; P < 0.01). However, intensity of fatigue showed a strong correlation with several indicators of psychological distress such as depression (r = 0.68), somatization (r - 0.64) and anxiety (r = 0.63; P for all < 0.001). Furthermore, patients with lower levels of physical performance had significantly higher scores for depression {P - 0.005), somatization (P = 0.03) and anxiety (P = 0.08), and significantly lower scores for vigor {P - 0.05) than their counterparts whose physical performance was higher. Conclusions: We conclude that fatigue in cancer patients may be related to mood disturbance but appears to be independent of physical performance. Moreover, low physical performance can be viewed as an independent predictor of mental distress in cancer patients.

BACKGROUND AND HYPOTHESES: Domestic violence is common and can lead to severe physical and psychological problems. Thus, we have investigated the frequency of occurrence, forms and risk factors of domestic violence against female patients on a crisis intervention ward.115 women were screened with the "screening spouse violence" (SPG) and the "index of spouse abuse" (ISA).The life time prevalence concerning spouse violence was 70 %. Out of 74 women who were currently living in a relationship 28 (38 % )were victims of violence in the last 12 months prior to their admission. Women who experienced violence had a significantly lower level of education.Screening for domestic violence in female patients in the field of crisis intervention and psychiatry should become a standard of "good clinical practice".

The multiaxial system (MAS) of ICD-10, chapter V (F) consists of three axes: axis I, clinical syndromes (psychiatric disorders including personality disorders and somatic diseases); axis II, disabilities; axis III, environmental/circumstantial and personal life-style/life management factors. Results of a multicentric field trial evaluating a preliminary draft of the MAS are presented. 45 raters in seven German centers made 488 ratings on 12 written case histories. With a mean kappa of 0.50 for 3-character diagnoses interrater reliability for axis I was moderate although lower than expected from previous field trials. On axis II the WHO Disability Diagnostic Scale (WHO-DDS) was compared to the Global Assessment of Functioning (GAF) used in DSM-III-R and DSM-IV. For both scales the intraclass correlation coefficient showed a moderate interrater reliability (WHO-DDS = 0.62; GAF = 0.65). On axis III the number of relevant psychosocial circumstances coded by the different raters varied greatly. Interrater reliability was very poor with kappa values ranging from 0.03 to 0.55 for the different categories and an overall kappa of 0.16.

The design of the international multicentric field trial on ICD-10, chapter V (F) "Mental and Behavioural Disorders (including disorders of psychological development): Diagnostic Criteria for Research' including some modifications for the study in German-speaking countries is described. The different stages of the study, the assessment instruments, and the database are presented.

There is little agreement about the methodology of clinical trials of antipsychotic drugs in patients with negative symptoms. A literature review revealed wide variation in experimental design, rating scales and study duration. This reflects differing views as to the definition and response to treatment of negative symptoms. Some degree of standardization would improve comparability of studies and aid the development of new compounds. Patients included in such studies should have displayed negative symptoms for at least 6 months. Depressive symptoms, positive schizophrenic symptoms and extrapyramidal signs may all influence or be confused with negative symptoms and may respond to treatment; they should be at a low level at baseline and should be measured during the study period. Studies should last at least 8 weeks. Several scales are available for measuring negative symptoms and are reviewed; a global impression score should be used additionally.

Der Artikel gibt einen Uberblick uber verhaltenstherapeutische Strategien, die gegenwartig zur Behandlung persistierender schizophrener Produktivsymptomatik (Wahn, Halluzinationen) eingesetzt werden.

Little is known about the risk profile and the further history of patients who attempted suicide by severe medicinal intoxication.All patients residing in Basel (n = 190) admitted to the intensive care unit between 01/01/1998 and 12/31/2001 because of a suicide attempt with legal drugs were investigated regarding psychopathology and sociodemographic features. Also, until the end of 2005, further suicide attempts as well as potential cases of death were followed up.All 190 patients had psychiatric disorders. Compared to the general population, female sex, single status, low educational level, unemployment and invalidity were found significantly more often. Until the end of 2005 almost half of 118 patients followed up in our outpatient department committed further suicide attempts. 28 patients died, 6 of these by suicide.These patients should preferably not be prescribed medication with a low therapeutic range and they should receive intensive follow-up care.

In the past years, the significance of early detection of psychoses has been increasingly recognized. Screening for the onset of disorders should focus on individuals seeking treatment in an outpatient setting and should preferably operate stepwise. Within a prospective study for the early detection of psychoses (FePsy = Früh Erkennung von PSYchosen) the self-rating instrument "Self-screen Prodrome" was developed to differentiate between healthy individuals, individuals with psychosis or an at-risk mental state for psychosis and patients with other ICD-10 diagnoses.The "Self-screen Prodrome" was developed by taking established risk factors and early signs of disease into account. In particular, prodromes and pre-psychotic symptoms were captured. A total score and a subscale were analyzed with regard to validity and reliability.The total score "Self-screen Prodrome" distinguished between outpatients with a mental disorder and healthy individuals (Cut-offor = 6; sensitivity: 85 % specificity: 91 %). Additionally the subscale distinguished between psychosis-(risk)-individuals and outpatients with other ICD-10 psychiatric diagnoses (Cut-offor = 2; sensitivity: 85 % specificity: 39 %).The "Self-screen Prodrome" is a useful instrument that a) separates mentally ill patients from healthy individuals and b) filters individuals with a risk of developing psychoses from patients with other ICD-10 diagnoses for further screening. The next step in the early detection of psychoses for identified individuals should be a detailed psychiatric exploration by experts.

The author shows that the splitting of identity is reversible if the object relations are strong enough (example: Rahel Varnhagen). The schizophrenic subject escapes into another manner of being in a desperate effort to survive (example: Gregor Samsa in the novel of Kafka). A borderline patient recovers her identity by overcoming a symbiotic relationship with her psychotic mother.

Many reliable and valid instruments for screening, assessment of severity of depressive disorders and classification according to ICD-10 or DSM-IV criteria are available. Most instruments are available as self-, as well as observer-based rating questionnaires and interviews. The aim of this overview is to give a comprehensive review of well-established instruments in German speaking countries.

We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. We present basic psychometric data of the Wender-Reimherr Interview (WRI). Internal consistency was determined as 0.82 (alpha). The inter-rater reliability was 1.0 (kappa coefficient) regarding ADHD diagnoses, and the ICC was 0.98 referring to the WRI total scores. The convergent validity with the ADHD-SR was 0.65 (Spearman coefficient). In 126 of 168 patients an ADHD diagnosis was made according to at least one of the three systems. The DSM-IV diagnostic set led to 119 ADHD diagnoses. As compared with the two other systems, this is about the minimum level for an ADHD diagnosis. All of the 87 ADHD diagnoses according to ICD-10 were covered by DSM-IV. The ICD-10 had no independent psychopathological items and therefore offered no additional points for the diagnostic procedure than the DSM-IV. The situation regarding Utah criteria is different. These criteria contain seven psychopathological domains: inattention, hyperactivity, disorganisation, impulsivity, affective lability, overreactivity, and hot temper. They can be assessed by use of the WRI. Ninety-three of 168 patients were diagnosed as having ADHD according to the Utah concept, which is much lower than with the DSM-IV. The particular definition of the disorder by the Utah criteria resulted in seven patients having only a Utah diagnosis but no DSM-IV diagnosis. Thus we are in a position to say that the Utah criteria have a relatively high level for making an ADHD diagnosis but in certain cases move beyond the DSM-IV. Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.

The results of the ICD-10 field trial in German-speaking countries relevant to sections F4 (neurotic, stress-related and somatoform disorders) and F5 (physiological dysfunction associated with mental or behavioural factors) show a comparatively low level of acceptance. Interrater-reliability in various diagnostic categories is not always adequate. In particular the allocation of some of the "old" diagnostic entities of ICD-9 to various sections of ICD-10, and in part unsatisfactory classificatory distinctions gave rise to certain problems.

Domestic violence is frequent. But up to now there is no screening instrument available in German which would allow a simple assessment. In this article a short screening interview is published that allows the identification of women who became victims of domestic violence. Such a screening interview has not been published in German speaking countries until now. A screening interview originally developed in English speaking countries called "Partner Violence Screen" (PVS) was translated, modified and validated in a population of female patients of a crisis intervention ward. The original version of the PVS consisted of 3 items which have been extended by two items, so that the modified version of the PVS is composed of 5 items now. In a validation study this instrument was compared to a much more detailed, 30 item self rating scale "Index of Spouse Abuse" (ISA). In addition to the validation of the PVS a life-time version of the PVS was developed which refers to the entire life period since the 18th birthday. The original version of the PVS showed a sensitivity of 0.79 and a specificity of 0.70. In the modified version "Screening Partner Violence" the sensitivity was 0.80 and the specificity 0.78. This screening instrument, which was translated and further developed by the authors, proved to be helpful for identifying domestic violence. With this instrument a screening interview is available for the first time in German speaking countries that can be accomplished with women in different institutions without losing much time.

Objective: To assess the prevalence of radiological magnetic resonance imaging (MRI) findings in individuals at high risk of schizophrenia. Methods: MRI scans from individuals at high risk of schizophrenia (HR; n = 37) were assessed by a radiologist blind to group status and compared with scans from patients with first episode psychosis (FE; n = 30), depressive controls (DC; n = 17), and healthy controls (HC; n = 26). Results: There was a significantly higher proportion of radiological findings in individuals at high risk of schizophrenia (35%) and patients with first-episode psychosis (40%) than in patients with depression (18%) or healthy controls (12%). These differences were specific to findings regarded as potentially clinically significant as opposed to normal variants; however, there was no indication for medical treatment. Conclusions: The results suggest that a large proportion of those at high risk of psychosis have radiological findings on MRI scanning, and that the prevalence of radiological findings in this group is similar to that in patients with first episode psychosis.

Mit kurzen Screening-Fragebogen lasst sich der Verdacht auf generalisierte Angststorung (GAD) oder Panikstorung bei Erwachsenen offenbar zuverlassig untermauern.

Schizophrenic disorders are a relatively common and severe psychiatric disorder. Extensive research efforts during the last two decades could show that the course and outcome of the disorder will be determined by a number of biological, psychological and social factors. The vulnerability-stress-coping-competence-model as a tentative heuristic framework integrates the different factors which contribute to the understanding of the disorder. In this model psychological factors play an important role. Some of these factors are subject of this paper: expressed emotions and the cognitive understanding and treatment of delusions and hallucinations.

We report on the development of a German self-rating behaviour questionnaire (ADHD-SR) and diagnostic checklist (ADHD-DC) for the diagnosis of attention-deficit/hyperactivity disorder in adults according to DSM IV and ICD 10 research criteria. When comparing self-rating with expert rating, we found good concordance measured by intraclass coefficients on the level of single symptoms and syndrome scores. High retest reliability of the ADHD-SR demonstrated the ability to assess time-stable behaviour traits. Evaluation of the psychometric properties revealed good internal consistency and adequate convergent and divergent validity measured by the "big five" derived from the NEO-FFI and the constructs impulsivity, venturesomeness, and empathy of Eysenck's impulsiveness questionnaire. We detected a remarkable correlation with the Wender Utah Rating Scale, which targets the detection of childhood ADHD symptoms. Diagnostic sensitivity for different cutoff points was calculated by ROC analysis at 65--88%. Specificity was 67% to 92%.

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.

The diagnosis of adult attention deficit/hyperactivity disorder (ADHD) requires the retrospective assessment of ADHD symptoms in childhood. The Wender Utah Rating Scale (WURS) is helpful in detecting ADHD-associated symptomatology in childhood. A German short version (WURS-k) of this instrument has been made available recently. In the present study, we investigated the validity of the WURS-k. In a population of 63 adult ADHD patients (according to ICD-10 and DSM-IV criteria) and 1,303 male controls, ROC analysis indicated a sensitivity of 85% and specificity of 76% at a cutoff of 30 points. In ADHD patients, seven individual factors explained 70.3% of the variance. The highest diagnostic precision was demonstrated using the WURS-k total score. The seven extracted factors of the WURS-k did not differ in diagnostic value. Significant correlations were found between impulsivity according to Eysenck's Impulsivity Questionnaire (EIQ) and excitability, aggression, emotional lability, and satisfaction on the Freiburg Personality Inventory (FPI-R) in ADHD patients. Concerning a 30-50% persistence of ADHD symptomatology in adults, these correlations underline the diagnostic validity of the WURS-k. The scale manifested excellent internal consistency (alpha=0.91) and a split-half correlation of r(12)=0.85.

Although depression occurs frequently during early motherhood, specific psychotherapy relevant to the needs of mothers of small children is still rare. Therefore, a group therapy programme for depressive mothers with children from pregnancy up to preschool age was developed and implemented. This manualised group therapy consisted of 12 group sessions and one session with each couple. The main therapeutic method was cognitive behavioural therapy. In addition, educational and systemic therapy components were used. Five consecutive treatment groups with 31 participants were evaluated by using Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), and several other scales. Depressive symptom decrease was significant in all groups, and mother-child interaction improved as perceived by the mothers. This newly conceptualised group therapy proved to be effective and well accepted by the participants. Further investigations such as comparing group therapy with standard therapy are necessary to confirm these preliminary results.

Our study aims to establish a scientific basis for the very early detection of patients at risk for schizophrenia during the nonspecific prodromal phase of the disorder and to predict its outbreak.A multidomain approach is used. After screening, approved psychopathological, neurophysiological, neuropsychological and neuroradiological investigations are used to assess a sample of individuals suspected to be at risk for schizophrenia.Neuropsychological and fine motor functioning tests as well as eye movement measurements showed statistically significant differences (P0.01) between individuals suspected to be at risk for schizophrenia and healthy controls.Individuals suspected to be at risk for schizophrenia show specific impairments in various investigations including neuropsychological and fine motor functioning tests as well as eye movement measurements. A set of methods sensitive to even subtle changes in normal functioning may prove useful in predicting the subsequent outbreak of schizophrenia.

Diagnostische Fragen gewinnen seit einigen Jahren in Psychiatric und Psychotherapie, in Forschung wie Praxis wieder zunehmend an Bedeutung. Zur Systematisierung der verschiedenen Aktivitaten bietet sich eine Differenzierung hinsichtlich der Ebenen Symptom, Syndrom und Diagnose an. Einige wichtige Meilensteine der Entwicklung in diesen Bereichen bis heute seien zunachst kurz erwahnt. Auf der Symptomebene sind im deutschsprachigen Raum vor allem Aktivitaten der Arbeitsgemeinschaft fur Methodik und Dokumentation in der Psychiatric (AMDP) seit Anfang der 60er Jahre zu nennen mit dem Ziel der Vereinheitlichung der psychopathologischen Befunderhebung, deren wichtigstes Ergebnis die Herausgabe des AMDP-Systems [vgl. 1, 16] war. Parallel dazu waren Entwicklungen zu erkennen, auf solchen Symptombeschreibungen aufbauend Skalen zu entwickeln, um die in den 50er und 60er Jahren des 20. Jahrhunderts neu entwickelten Psychopharmaka wie Psychotherapieverfahren zu evaluieren. Solchen Verfahren auf der Syndromebene kommt bis heute grose Bedeutung zu, da neben der Therapieevaluation vor allem auch Therapieentscheidungen meist auf Syndrombewertungen basieren [vgl. 18]. Als Verfahren der „ersten Stunde“ zu nennen sind hier die Hamilton-Depressions-Skala (HAMD) als Fremdbeur- teilungsverfahren und das Beck-Depressions-Inventar (BDI) als Selbstbeurtei-lungsverfahren, beides Verfahren, die bis zum heutigen Tag eine zentrale Rolle in Forschung und Praxis spielen. Es existiert z.B. kaum eine relevante Depressionsstudie, in der nicht mindestens eine der beiden Skalen eingesetzt wurde.