[Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison]. / Leitlinienkonformität und Behandlungsergebnisse in der stationären Schizophreniebehandlung. Ein Klinikvergleich.

Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity.

A survey on psychiatric patients' use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction.

OBJECTIVES: We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers' professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. DESIGN: Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. RESULTS: About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable 'customer loyalty' towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient's well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. CONCLUSIONS: Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their 'psychotherapeutic' attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.

[Reform of psychiatry in Spain]. / Die Reform der Psychiatrie in Spanien.

Since the 1980's psychiatric care in Spain changed considerably (Reforma psiquiátrica española). In the course of this reform, many positive results were achieved. An extensive community network of mental health centres was build up which resulted in the majority of psychiatric patients being integrated in the Spanish general health care system and making a better organized mental health care structure possible. New legislation also improved the care and civil rights of patients. An analysis of the experiences of the Spanish psychiatric reform shows that the tendency to retain the old mental hospitals, alongside the other institutions still exists. The process of deinstitutionalization and the original aims of the psychiatric reform cannot only be satisfied by the closure of large psychiatric hospitals as during the reform new aspects and problems as well the great complexity of the task have become apparent. This article together with the details of the Spanish sources gives the German public a good overview of the developments in Spanish psychiatry.

[DEWIPA--a standardized questionnaire for assessing knowledge about symptoms, etiology and psychopharmacologic treatment in patients with depressive episodes]. / DEWIPA--Ein standardisiertes Verfahren zur Erfassung des Wissens über Symptome, Ursachen und psychopharmakologische Behandlung bei Patienten mit depressiven Episoden.

OBJECTIVE: The aim of this study was to develop a questionnaire for measuring depressed patients' knowledge of their disease. METHODS: 55 patients suffering from depressive episodes answered a 77-items questionnaire. RESULTS: Item analysis showed a discriminative power higher than 30 for 40 items, all of which applied to one factor. The items were arranged into two thematically similar 20 items forms. We added four additional items (discriminative power between 0.20 and 0.29) because future research may lead to different results concerning discriminative power. The questionnaires DEWIPA-A and DEWIPA-B consists of 24 items each. The average difficulty is equal for both DEWIPA forms and they both possess significant discriminative power. CONCLUSIONS: Our results support the hypothesis that DEWIPA is a valid and reliable instrument to determine patients' knowledge of symptoms, causes and the psychopharmacological treatment of depression.

[Is the anxiety about Ecstasy justified?]. / Ist die Angst vor Ecstasy berechtigt?

"Ecstasy", that is, MDMA and its analogues are derivatives of amphetamine. In consequence of its neurotoxicity, it can be acutely life-threatening, and can also have injurious long-term effects. A major role in its noxious effects is played by disorders in the serotonergic system and degeneration, in part irreversible, of serotonergic neurones (demonstrated in animals). Its, most youthful, users need to receive proper information that emphasizes rather than playing down its harmful effects.

[The alcoholic patient in general practice. From initial contact to implementing therapy]. / Der alkoholkranke Patient in der Praxis. Von der Kontaktphase zur Durchführung der Therapie.

General practitioners play an important role in the treatment of alcoholism. It is their task to come in contact with patients to assess the severity of their alcohol-related problems and to encourage them to stop drinking. As a rule, detoxification can be completed in less than two weeks. Slight withdrawal symptoms do not require drug treatment. However, alcoholics with heavy long-term continuous drinking need in-patient withdrawal treatment. After detoxification, out-patient treatment conditions are sufficient for highly motivated patients living under stable social conditions. In German facilities, short-term therapies of 4-6 weeks are adapted to the less disabled, long-term therapies of 2-6 months to physically and mentally more disabled patients. In Germany, in-patient treatment in specialized clinics is paid for under the pension insurance scheme. The results of alcoholism treatment are better than generally expected. Four years after treatment in specialized units, up to 61% of patients are abstinent.

[Long-term administration of benzodiazepines--disease follow-up, sequelae, treatment. A retrospective clinical record evaluation of 194 patients]. / Langzeiteinnahme von Benzodiazepinen--Krankheitsentwicklung, Folgeerscheinungen, Behandlung. Eine retrospektive Krankenblattauswertung bei 194 Patienten.

Clinical records of all patients treated from 1983 to 1991 in a university clinic for lang-term-use of benzodiazepines were examined. Daily intake of benzodiazepines began in 80% immediately after the first prescription. At the time of admission, 34% reported intake of more than 3 DDD, i.e. more than 30 mg of diazepam. In patients 70%, additional abuse of alcohol and/or other psychotropic substances was established. Benzodiazepines were the first substances abused in 49%. The diagnosis of abuse or dependency was made in 65% before admission. Symptoms of organic brain syndrome were described in 30% of all records. Symptom leading to first benzodiazepine intake were somatic complaints (40%), depressed mood (39%), insomnia (37% and anxiety (24%). Between first intake and admission, there was a significant increase in patients with somatic complaints, depressed mood and anxiety. After detocification, symptoms leading to admission improved in 80% of all patients.

[ERWIPA--a standardized inventory for assessment of illness-related insight in patients with schizophrenia]. / ERWIPA--ein standardisiertes Verfahren zur Erfassung des krankheitsbezogenen Wissens bei Patienten mit Schizophrenien.

55 schizophrenic patients answered a 2 x 30 items questionnaire, Item analysis showed a low discriminative power, the initial forms differing with regard to degree of difficulty. Items with discriminative power over 0.30 were arranged into two thematically similar 13 item forms of equal difficulty. The questionnaires ERWIPA-A and ERWIPA-B consist of 2 x 20 items. The first item of each from had been answered correctly by all patients from our sample. We considered six additional items because future research may to different results as far as discriminative power is concerned. The average difficulty of both ERWIPA forms is equal for both the 2 x 13 items and the 2 x 20 items version.

Clinicians' information habits, patients' knowledge of diagnoses and etiological concepts in four different clinical samples.

A total of 230 psychiatric inpatients and their physicians in charge took part in semistandardized interviews. Patients suffering from schizophrenia received information less frequently and less comprehensively than other patients. The label of schizophrenia was often paraphrased or not communicated at all; patients knew their diagnosis less exactly than other subgroups. Asked to indicate the most important cause of their disorder, neurotics tended to name their living conditions (60%), and addicts preferred to blame themselves (73%). Only 26% of the patients with affective disorders or schizophrenia accepted the idea of their disorders as diseases in a medical sense, whereas the psychiatrists favored a biological concept in more than 90% of the cases. The findings stress the need to improve communication between patients and psychiatrists as regards information on illness and treatment.

[Self-administration of drugs in an open psychiatric unit]. / Selbstabholung von Medikamenten auf einer offenen psychiatrischen Station.

In 65% of the rehabilitation wards on Bavarian psychiatric hospitals, medication is not distributed by nurses but is collected by the patients in the nurses' room. For 159 patients, data on their reliability in this procedure were obtained. Patients generally come for their medication with considerable reliability. Patients suffering from schizophrenia were unreliable during the first week of treatment. During the last week of treatment, however, their reliability improved. The improvement of reliability was high for patients of higher education, productive psychotic symptoms at the beginning of the treatment, good response to neuroleptic medication, or first manifestation of the disease. The system of patients coming for their medication is a method of training self-responsible medication intake. The reliability of the patients' participation can be interpreted as a measure of their compliance.

[Patient education and information in psychiatry]. / Aufklärung und Information in der Psychiatrie.

All physicians are obliged to inform their patients about their disease and about course, purpose and risks of diagnostic and therapeutic procedures. Many physicians, however, try to avoid the dialogue with the patients particularly if disaggreable details are to be communicated. This is valid both for somatic medicine and for psychiatry. The openness of information in psychiatry depends on the patient's disease. Schizophrenic patients receive comprehensive information less frequently than patients suffering from mania, major depression, alcoholism and other dependencies. The label "schizophrenia" is generally paraphrased, the possibility of residual damage and the long-term side effects of neuroleptics are not mentioned by many physicians. Patients' knowledge about diagnosis and medical treatment does not depend on the duration of their illness and on the diagnosis but on individual factors: patients with secondary education and patients whose physicians regard comprehensive information to be favourable are better informed. Information about diagnosis and therapy can help the patients to understand their illness and to enhance compliance if the individual experience of the patients, their disease concept and their medical knowledge are taken into consideration. Information can be regarded as an important part of the relation between doctor and patient.

[Knowledge of the diagnosis and drug treatment of psychiatric patients]. / Kenntnis von Diagnose und medikamentöser Behandlung bei psychisch Kranken.

Among 117 patients of the psychiatric department of a university hospital, semistandardized interviews were conducted to examine their ideas about their diagnosis and psychopharmacological treatment. At the times of the interviews, 55.5% of the patients were fairly correct about their diagnosis, 49% could name more than half the drugs prescribed, 46.5% knew at least some of the side effects, and 32% had largely appropriate ideas about the desired drug effects. The level of knowledge about the diagnosis and psychopharmacological treatment was not related to the diagnosis or to the duration of disease. Patients who had had the benefit of further or higher education and patients whose physicians regard comprehensive patient information about diagnosis as favourable were better informed. Out-patients knew more about psychopharmacological treatment than in-patients. Information about diagnosis and therapy enables patients to understand their symptoms and to integrate them into their own disease concept, provided their existing medical knowledge and disease concepts are taken into consideration.

[Client-centered self-experience groups in male alcohol-dependent patients]. / Klientenzentrierte Selbsterfahrungsgruppen bei männlichen Alkoholabhängigen.

104 group sessions with 59 male alcoholics were classified under 9 themes. At the beginning of self-experience sessions, all patients looked back to their drinking history. 8 patients reported mere facts, whereas 51 patients expressed their emotional involvement. Drinking style and themes of self-experience could not be definitely correlated. There was a statistical tendency for alcoholics with loss of control (Gamma-alcoholics) to describe themselves as craving for adventure, as men who tend to live according to their momentary needs whenever possible. Alcoholics with inability to abstain (Delta-alcoholics) describe themselves more often than Gamma-alcoholics as passive hangers-on, as persons who tend to drink as others do, who do not worry much about their alcohol intake, who become aware, by somatic and social consequences, that they cannot go on living as before. These results were compared to results found in research literature. It is astonishing that so little work has been done to find out the themes presented by alcoholics in the course of self-experience.

Flicker fusion frequency and organic syndrome in alcoholics.

Flicker fusion frequencies of 48 healthy controls and of 35 alcoholics were measured to detect possible associations between flicker fusion and signs of nonspecific brain damage, the aim of the study. FFF was statistically significantly lower in patients addicted to alcohol than in healthy subjects. Lower flicker fusion frequencies were associated with the severeness of organic psychosis as rated psychopathologically. The hypothesis that addiction to alcohol is a sign of diffuse, nonspecific, organic brain damage was discussed.