[Religious and spiritual attitudes of patients with schizophrenic or affective disorders]. / Religiöse und spirituelle Einstellungen psychiatrischer Patienten.

OBJECTIVE: In psychiatry and psychotherapy religion and spirituality were for a long time mainly considered as a pathological and neurotic phenomenon. Nowadays they are increasingly accepted as an independent dimension and resource. METHODS: By means of a questionnaire, inpatients of 3 hospitals with schizophrenic (F2) or affective (F3) disorders were interviewed shortly before discharge about their religious and spiritual attitude with regard to therapy, coping with psychiatric disorder and hospital based pastoral care. General religiousness of the participants was measured using the centrality scale of the Structure of Religiosity Test. RESULTS: Of the 216 participants 25% rated themselves as not religious, 61% as religious, and 14% as highly religious. Diagnosis, education, sex, duration of illness and self-evaluation of current mental health status had no significant statistical impact on the importance of religion. Higher age and importance of religion were positively correlated. Hospital based pastoral services were perceived as very helpful. Results indicate positive effects of religiousness on coping with the psychiatric disorder. CONCLUSIONS: For three of four patients religion and spirituality play a more or less important role in their life. In a clinical as well as in a scientific context this dimension should be paid more regard in psychiatry and psychotherapy.

Adherence to guidelines for treatment of depression in in-patients.

BACKGROUND: Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment. AIMS: To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines. METHOD: We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge. RESULTS: The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy. CONCLUSIONS: The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.

Insufficient depression treatment in outpatient settings.

BACKGROUND: The present status of outpatient treatment of depression in Germany was evaluated with respect to the adherence of general practitioners (GPs) and specialists of psychiatry to clinical practice guidelines. METHODS: In total, 488 depressed patients' psychopathology, diagnostic assessment, therapeutic measures and referral frequency were documented at inclusion into study by 43 general practitioners and 23 specialists of psychiatry in three regions of Germany. The investigation of change in depressive symptoms after six to eight weeks by means of self-assessment could be evaluated for 165 patients. RESULTS: The results of diagnostic assessment demonstrated that diagnoses of depression were not always based on the diagnostic criteria for depression (ICD-10): 33% of GPs' and 17% of specialists' patients were included as depressed patients into the study despite not fulfilling the ICD-10 criteria in the standardized documentation. Therapeutic undertreatment was more often found in the group of GPs. Referrals were found not to be oriented towards guidelines. After six to eight weeks, one half of patients reported a reduction in depressed symptoms, the other half of patients reported a stagnation or even a progression. CONCLUSIONS: The study has shown that physicians in outpatient settings still fail to orient themselves towards guideline recommendations. This reflects the need for physicians to receive guideline training, with the aim of improving the quality of care for depression. A quality management intervention program consisting of guideline training and an interdisciplinary quality circle to improve depression treatment and networking was supported by the authors and is currently being evaluated.

[Cost optimization of the outpatient management of depression]. / Kostenoptimierung ambulanter Depressionsbehandlung.

Against the background of the important role of depressive disorders in health policy, outpatient management still seems to have some optimisation potential. In particular, improvement can be expected from a stricter adherence to diagnostic and therapeutic guidelines. The article discusses potential elements of a quality-orientated, guideline-based reimbursement system as a component of a comprehensive strategy for implementing available guidelines. This includes focussing on target areas typical of depression as well as improving outcome by controlling process elements during treatment.

[Guideline-oriented patient information on depression--an example contributing to the provision of sound professional health information for patients and relatives]. / Leitlinienorientierte Patienteninformationen zur Depression--ein Beitrag zur Bereitstellung fachlich fundierter Gesundheitsinformationen für Betroffene und Angehörige.

It is a prerequisite of sound professional information on the various courses of the disease and available treatment options in order to guarantee that persons affected are actively involved in their individual treatment course or preventive measures. In the following article, guideline-oriented patient information on depression will be presented, which--as a result of a co-operation between AQuMed and the Department of Quality Assurance of the DGPPN--emerged from a series of lay information on psychiatric diseases.