[Health Care Organization - The New German S3-Guideline on Alcohol-Related Disorders and its Relevance for Health Care]. / Versorgungsorganisation ­ Die neue S3-Leitlinie Alkohol und ihre Bedeutung für die Versorgungspraxis.

BACKGROUND: Alcohol dependence is one of the most serious diseases of addiction in Germany. The new S3-guideline "Screening, Diagnostics and Treatment of Alcohol-Related Disorders" has been presented in 2015 and summarizes the present state of knowledge pertaining to the diagnosis and treatment of alcohol abuse and alcohol dependence. METHODS: This guideline was developed over four years within the framework of the Association of the Scientific Medical Societies in Germany (AWMF). The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the German Society for Research and Therapy in Addiction (DG-Sucht) took the lead in the organization. More than 50 professional societies and associations and health organizations as well as more than 60 acknowledged experts were involved, including networks of self-help groups and relatives. The working group on "health care organization", whose results are presented here, was one out of thirteen working groups, focusing on the task how to implement the guideline under the basic conditions of the German health care system with its sectors and interfaces. RESULTS: For the chapter on "health care organization" 27 recommendations have been consented. Many of these have been prepared by the respective working groups. These recommendations cover areas such as screening, diagnostics and short interventions, detoxification and withdrawal as well as pharmacotherapy, physical complications and psychic comorbidity, medical rehabilitation and other forms of post-acute treatment, primary care by general practitioners, as well as specific target groups such as children and adolescents, (pregnant) women and the elderly, and, in addition, self-help approaches. CONCLUSION: For needs-based diagnostics and treatment of alcohol-related disorders, guideline-based recommendations for health care organization offer a framework for the cooperation and coordination of all health sectors and occupational groups, especially with respect to their interfaces. This includes the cooperation between the medical and the psychosocial system and stretches from harm reduction to social inclusion of people concerned. Particularly the field of rehabilitation with its explicit aims for participation relies heavily on such a cooperation.

[Quality of life in relatives of mentally ill people]. / Zur Lebensqualität der Angehörigen psychisch Kranker.

OBJECTIVE: The effects of mental illness on the quality of life of relatives were assessed with the SF-36 (Short Form-36 Health Survey). METHODS: 304 relatives of 360 patients answered the SF-36 at hospital admission. The participant's data (age and gender) were randomizedly paired to data records of the German standard population. RESULTS: Relatives of mentally ill people judged their quality of life, especially their emotional well-being, significantly worse than the standard population. Female relatives estimated themselves as more burdened than male. CONCLUSIONS: By the means of SF-36 we could show that the quality of life in relatives of mentally ill people is clearly reduced especially in regard of social and psychical ranges.

[Chronic Alcoholics with Multiple Impairments] / Chronisch mehrfach beeinträchtigte Alkoholabhängige - Praxisnahe Evaluation eines Vorschlages zur operationalisierten Diagnostik und alternativer Modelle -

To improve reliability of diagnosis of a specific subgroup of chronic alcoholics with multiple impairments (CMA), operational criteria have been proposed. To evaluate usability and sensitivity vs. specifity, all in-patients fulfilling ICD-10 criteria of alcohol dependence were screened on two randomly chosen dates. Two clinically "extreme" groups were extracted: patients in a 8-week short-term residential treatment vs. patients in a residential program specifically designed for chronic alcoholics with severe somatic, psychic and/or social consequences. More quantitative operational criteria, such as "treatment experience" and "consumptive behaviour" revealed much lower discriminative power than more qualitative criteria, such as "comorbidity" and "social and legal status". Substantially revised and simplified operational criteria exhibited comparable sensitivity and specifity for the classification of chronic alcoholics with multiple impairments (CMA).

[What Expectations do Mental Disordered People have about the Treatment in an Psychiatric Hospital?] / Was erwarten psychisch Kranke von der Behandlung im psychiatrischen Krankenhaus?

Patiens are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develope itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61 %) of the patients were at admission ready for answering a self designed questionnaire. Only 4 % of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45 %), somatic illness (43 %) and mental health problem (42 %). A pharmacological therapy expected in totally 61 % of the patients. Mostly were expected drugs against depressive disorders (32 %), drugs against addiction (31 %) and tranquilizers (29 %). Only 10 % of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76 % of the patients. To have a speak with the doctor is with 69 % a first rank desire, followed by speaking with the psychologist (60 %), the nurses (58 %) and the patients comrades (56 %). Psychotherapy in a narrower sense expect only 40 % of the patients. Furthermore there are privacy and recreation throug promenades in front of the expectations (69 %), followed by relaxation (59 %), occupational therapy (55 %) and sports or acitive exercise therapy (54 %). 75 % of the patients want to be informed about the therapy. 69 % want to cooperate with planning of the therapy. Only 21 % commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.

[Chronic alcoholic patients with multiple comorbidity. Community outpatient evaluation of a recommendation for operationalized diagnosis and alternative models]. / Chronisch mehrfach beeinträchtigte Alkoholabhängige. Praxisnahe Evaluation eines Vorschlages zur operationalisierten Diagnostik und alternativer Modelle.

To improve reliability of diagnosis of a specific subgroup of chronic alcoholics with multiple impairments (CMA), operational criteria have been proposed. To evaluate usability and sensitivity vs. specificity, all in-patients fulfilling ICD-10 criteria of alcohol dependence were screened on two randomly chosen dates. Two clinically "extreme" groups were extracted: patients in a 8-week short-term residential treatment vs. patients in a residential program specifically designed for chronic alcoholics with severe somatic, psychic and/or social consequences. More quantitative operational criteria, such as "treatment experience" and "consumptive behaviour" revealed much lower discriminative power than more qualitative criteria, such as "comorbidity" and "social and legal status". Substantially revised and simplified operational criteria exhibited comparable sensitivity and specificity for the classification of chronic alcoholics with multiple impairments (CMA).

[What do psychiatric patients expect of inpatient psychiatric hospital treatment?]. / Was erwarten psychisch Kranke von der Behandlung im psychiatrischen Krankenhaus?

Patients are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develop itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61%) of the patients were at admission ready for answering a self designed questionnaire. Only 4% of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45%), somatic illness (43%) and mental health problem (42%). A pharmacological therapy expected in totally 61% of the patients. Mostly were expected drugs against depressive disorders (32%), drugs against addiction (31%) and tranquilizers (29%). Only 10% of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76% of the patients. To have a speak with the doctor is with 69% a first rank desire, followed by speaking with the psychologist (60%), the nurses (58%) and the patients comrades (56%). Psychotherapy in a narrower sense expect only 40% of the patients. Furthermore there are privacy and recreation through promenades in front of the expectations (69%), followed by relaxation (59%), occupational therapy (55%) and sports or active exercise therapy (54%). 75% of the patients want to be informed about the therapy. 69% want to cooperate with planning of the therapy. Only 21% commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.