Effects of gatekeeper trainings from the Austrian national suicide prevention program.

Background: The development and implementation of gatekeeper trainings were first goals in the national suicide prevention strategy "Suicide Prevention Austria" (SUPRA). The current study aims to assess the short- and longer-term effects of the SUPRA gatekeeper trainings in comparison with established gatekeeper trainings. Methods: We evaluated 28 gatekeeper trainings including 427 participants by assessing improvement of knowledge (facts about suicide and suicide prevention), gatekeeper self-efficacy and attitudes, and gatekeeper behavior (e.g., asking depressed people about suicide). Assessments were immediately before and after the gatekeeper trainings, with an additional follow-up 6 months later. Effects were compared with benchmark effects of established gatekeeper trainings. Results: There were substantial improvements in knowledge, self-efficacy and attitudes immediately after the training, comparable or larger than known from evaluations of established gatekeeper trainings. Most of these changes were upheld in the follow-up assessment, with effects comparable to other gatekeeper trainings. There was only a small increase of self-reported gatekeeper behavior, in line with results from other gatekeeper trainings. Conclusion: The SUPRA gatekeeper training had some beneficial effects in the short- and longterm, with effect sizes comparable to established gatekeeper trainings.

[Crisis intervention - Professional first aid in acute crisis].

Crisis Intervention is a professional method to help people suffering from acute psychosocial crisis. The basis of effective crisis intervention is a collaborative relationship facilitated by genuineness, respect and acceptance. A thorough assessment of possible endangerment including self harm and suicidal ideations or danger of being a target of violence or even being harmful to others must be established. A facing dialogue offering the possibilities to express and communicate difficult emotional feelings, helping to restore emotional stability and to restore adaptive functioning is an essential basis and might in addition be complemented by medical and/or legal support.

Typical neuroleptics vs. atypical antipsychotics in the treatment of acute mania in a natural setting.

The present retrospective chart review documents the treatment practice of in-patients suffering from acute manic or hypomanic episodes, at the Department of General Psychiatry, Medical University of Vienna between 1997 and 2001. The aim of the study was to compare the efficacy of typical neuroleptics and atypical antipsychotics as add-on therapy to mood stabilizers. A total of 119 episodes of consecutively admitted patients with ICD-10-defined acute mania (n=106) or hypomania (n=13) were included in a retrospective analysis. Two subgroups were separated out of the whole patient sample according to the medication used: (a) mood stabilizer+typical neuroleptic (n=27) and (b) mood stabilizer+atypical antipsychotic (n=39). The treatment patterns of both subgroups during the first 14 d of in-patient treatment were evaluated. The therapeutic effect was measured by the Clinical Global Impression Scale (CGI). Both patient groups showed no differences on CGI at admission. Patients treated with atypical antipsychotics showed a significantly greater clinical improvement after 14 d (p<0.005) and on discharge (p<0.05) than patients treated with typical neuroleptics. Furthermore, patients treated with atypical antipsychotics developed significantly less extrapyramidal side-effects (p<0.01) and were significantly treated less often with benzodiazepines (p<0.05) during the first 14 d compared to the group receiving typical neuroleptics. Based on our evaluation and the data available in the literature atypical antipsychotics can be considered as first choice for the treatment of acute mania as add-on therapy to mood stabilizers because of their better efficacy and side-effect profile compared to typical neuroleptics.