[Psychosocial therapy in psychiatry : Update of the DGPPN-S3 guidelines "Psychosocial therapies for severe mental illnesses"]. / Psychosoziale Therapien in der Psychiatrie : Update der DGPPN-S3-Leitlinie "Psychosoziale Therapien bei schweren psychischen Erkrankungen".

BACKGROUND: Severe mental illnesses are often associated with substantial impairments of psychosocial functioning and a high risk of social exclusion. Along with somatic and psychotherapeutic treatment approaches, psychosocial interventions are an integral component of treatment. Psychosocial therapies aim to improve participation and enable patients to live self-determined lives as far as possible. OBJECTIVE: This paper provides an overview of the structure and recommendations of the German S3 guidelines "Psychosocial therapies for severe mental illnesses" of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). MATERIAL AND METHODS: In the DGPPN S3 guidelines psychosocial therapies are systematically described for the first time and recommendations are formulated on the basis of a systematic processing of scientific evidence and a formalized consensus process. RESULTS: The evidence-based and consensus-based guidelines formulate a total of 33 recommendations and 12 statements. For many psychosocial interventions there is a broad evidence base. In the field of individual interventions psychoeducation, social skills training and health-promoting interventions have been given the highest recommendation strength (A). In the field of system level interventions, team-based, multiprofessional community psychiatric approaches, supported employment and self-determined housing with mobile support (supported housing) are given A level recommendations. For other interventions, the current evidence base is less robust. CONCLUSION: The successful implementation of guidelines depends not only on the quality but also on the dissemination. Therefore, in addition to the treatment guidelines a short version, a patient version and a waiting room version were developed.

[Innovative patient-centered care systems: International perspectives]. / Innovative patientenzentrierte Versorgungssysteme : Internationale Perspektiven.

BACKGROUND: The "Psychiatrie-Enquete" (German Report on the State of Psychiatry) is 40 years old this year. It has always been inspirational; also internationally. OBJECTIVE: Which innovative elements of community mental health services can be found in an international perspective? MATERIALS AND METHODS: Narrative review. RESULTS: Community mental health care is a lively field with much research and innovative practice. With assertive community treatment (ACT) and home treatment (HT), internationally well-evaluated forms of community mental health care are available. CONCLUSION: Recovery-based and peer-to-peer approaches hold promise for the future. In terms of mid- and long-term perspectives, an increase in patient-centering via individualization of mental health care and a better implementation of community mental health interventions would be desirable in Germany.

[Need for guideline recommendations on treatment of late-life depression from the perspective of experts]. / Der Bedarf an Leitlinienempfehlungen für die Behandlung depressiver Menschen im höheren Lebensalter aus Expertensicht.

Using a qualitative study approach (expert interview/focus group) the present work explores the question of the necessity of guideline recommendations for the treatment of depression in old age from the experts' perspective. In addition to positive aspects such as signal effect, pooling of knowledge and standardisation of treatment, also many doubts and obstacles are identified and place the practical feasibility of such a treatment recommendation in question. Different factors, such as content- or creative-related aspects (e. g., brevity and clarity) and development-related aspects (e. g. participation of all relevant professional societies) need to be taken into account in the development of guideline recommendations.

[Collaborative and home based treatment for older adults with depression: a review of the literature]. / Kollaborative und aufsuchende Ansätze in der Behandlung depressiver alter Menschen : Ein Literaturüberblick.

BACKGROUND: Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge. OBJECTIVES: The article reviews effective approaches towards treatment of depression in the elderly. METHODS: A literature review of complex interventions improving depression care was carried out. RESULTS: Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective. CONCLUSION: Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified.

[Team-based community psychiatry: importance of context factors and transferability of evidence from studies]. / Teambasierte Gemeindepsychiatrie : Bedeutung von Kontextfaktoren und Übertragbarkeit der Studienevidenz.

The German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) guidelines on psychosocial interventions for people with severe mental illness appraise the transferability of results of trials evaluating community-based mental health services to the German situation. This assessment has to draw on research results on factors determining effectiveness. This must be seen against the background of a lack of high-quality trials in Germany. The article discusses system, context and setting factors related to the transfer of evidence on community-based service models from other countries. These issues are discussed on the basis of evidence concerning the models of case management, assertive community treatment and community mental health teams. International differences in study findings are highlighted and the importance of treatment-as-usual in influencing study results is emphasized. The more control services including elements of community-based care there are and the less the pressure to reduce inpatient treatment (threshold to inpatient care admission), the smaller the relative effect sizes of innovative care models will be.In the absence of direct evidence, careful examination of transferability is required before introducing health care models. Research has revealed solid evidence for several factors influencing the effects of innovative community mental health care. Among key factors in the care of people with severe mental illness, home visits and joint team responsibility for both psychiatric and social care were identified. This evidence can facilitate the adaptation of successful mental health care models in Germany.

[Psychosocial interventions in severe mental illness: evidence and recommendations: psychoeducation, social skill training and exercise]. / Psychosoziale Interventionen bei schweren psychischen Störungen : Evidenz und Empfehlungen: Psychoedukation, Training sozialer Fertigkeiten, Sport und Bewegung.

This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.

[Arts therapies in severe mental illness: are they effective?]. / Künstlerische Therapien bei schweren psychischen Störungen : Sind sie wirksam?

Arts therapies are widely used treatment strategies for people with severe mental illness. Generally, only a few randomized trials are available, however, the studies show that additional use of arts therapies reduces the appearance of negative symptoms among people with schizophrenia. The most significant evidence can be seen with music therapy. The treatment of severe depression has shown that additional music therapy improves depression. The S3 guidelines on psychosocial therapies in severe mental illness of the Germany Society for Psychiatry, Psychotherapy and Neurology (DGPPN) recommended arts therapies are with recommendation level B.

Apolipoprotein E allele 4 is not a sufficient or a necessary predictor of the development of Mild Cognitive Impairment.

The presence of Mild Cognitive Impairment (MCI) and of an apolipoprotein E (apoE) varepsilon4 allele both predict the development of Alzheimer's disease. However, the extent to which this allele also predicts the development of MCI is unclear even though MCI is an early transitional stage in the development of Alzheimer's disease. The present study investigates the prevalence of the apoE varepsilon4 allele in incipient MCI. Participants were recruited from the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). All subjects who were initially cognitively healthy, i.e. did not meet MCI criteria described by Petersen [Petersen RC. Mild cognitive impairment. J Intern Med 2004; 256(3): 183-94], and whose apoE status could be determined were followed-up. After 4.5 years, 15.5% of the cognitively healthy target population had developed MCI. The frequencies of the apoE varepsilon4 genotype did not differ between individuals with incipient MCI (12.9%) and individuals who remained cognitively healthy during the study (18.4%, p>0.5). Consequently, the apoE varepsilon4 genotype is not a necessary or sufficient risk factor for MCI. Further studies need to investigate the influence of the whole range of genetic and environmental risk factors on the course of Alzheimer's disease including the initial development of MCI and the later conversion to Alzheimer's disease.

Mild cognitive impairment: long-term course of four clinical subtypes.

OBJECTIVE: To empirically validate the expanded concept of mild cognitive impairment (MCI), which differentiates between four clinical subtypes-amnestic MCI-single domain, amnestic MCI-multiple domains, nonamnestic MCI-single domain, and nonamnestic MCI-multiple domains-and to examine the prevalence, course, and outcome of these four clinical MCI subtypes. METHODS: We studied a community sample of 980 dementia-free individuals aged 75 years or older who participated in the Leipzig Longitudinal Study of the Aged (LEILA 75+). All participants were examined by neuropsychological testing based on 6 years of observation. The diagnoses of the four clinical MCI subtypes were made according to the original and to slightly modified criteria by Petersen et al. (2001) (both with a cutoff of 1.0 SD and with a cutoff of 1.5 SD). The complete range of outcome types (dementia, death, improvement, stable diagnosis, unstable diagnosis) was described for all subtypes. The relative predictive power of stable MCI for dementia onset was determined. RESULTS: MCI-single domain is more frequent than MCI-multiple domains, and the nonamnestic MCI type is as frequent as the amnestic MCI type. The "MCI modified, 1.0 SD" criteria have the highest relative predictive power for the development of dementia (sensitivity = 74%, specificity = 73%). Alzheimer disease (AD) was the most common type of dementia at follow-up in all but one MCI subtype. Participants with nonamnestic MCI-multiple domains were more likely to progress to a non-AD dementia. CONCLUSIONS: It has been assumed that each MCI subtype is associated with an increased risk for a particular type of dementia. We can only partially agree with this.

[A programme to assist close relatives and lifelong partners in caring for persons suffering from depressions or schizophrenic disorders]. / Ein Unterstützungsprogramm für Lebenspartner von Menschen mit depressiven oder schizophrenen Störungen.

OBJECTIVE: Lifelong partners or close relatives of persons suffering from mental disorders will naturally step in to help by assuming a great variety of tasks. By witnessing their relative's illness on a daily basis, they are exposed to many burdens with a negative impact on their own well-being. Hence, supporting the relatives of persons with mental disorders appears imperative. While there are various approaches to working with relatives, there are hardly any specific programmes for working with certain groups of relatives such as spouses, children or siblings. METHODS: Basing on a discussion of the various approaches to looking after relatives, development of a programme is described aimed at specifically supporting spouses of persons suffering from depression or schizophrenia. RESULTS: The concept of our programme is presented and results of its evaluation by participants are reported. CONCLUSION: The initial experiences with the support programme are quite promising. An evaluation of its effects, based on a case-control-design, is currently under way.