Psychiatrische Praxis最新文献

Background: The predicted prevalence of people with dementia (PWD) in Germany has risen to 1.8 million since 2010. In the near future, we will see the approval of antibody therapies. The study aims to demonstrate the recent anti-dementia medication prescriptions and diagnosis prevalence.

Methods: Data from 357 general practitioner (GP) and 71 specialist practices (SP) (1.1 Mio. patients) were analyzed to demonstrate the prevalence of dementia diagnoses and anti-dementia drug prescriptions between 2010 and 2021.

Results: The diagnosis prevalence of PWD (Alzheimer's dementia) remained relatively constant in GP practices at 1.0-1.3% (0.19-0.21%). Among SP, the prevalence increased from 4.9% (2.8%) to 5.9% (3.6%). The anti-dementia prescription rate decreased in GP (from 0.14% to 0.10%) and increased in SP practices (from 2.1% to 2.4%).

Discussion: The diagnosis and prescription rate, especially in GP practices, remained below the prevalence forecasts and the expected prescriptions.

Aim: Inpatient-Equivalent Home Treatment (IEHT) for mental health is new in Germany and therefore requires quality development. A best practice model (BPM) for IEHT is being developed from a service user perspective.

Methods: 1. Collection and organization of evidence (literature review; n=55 interviews with service users), 2. qualitative analysis and formulation of criteria; 3. consensus and grouping of criteria (Delphi process).

Results: 58 Best practice criteria were developed in 8 groups: 1. Information, access and crisis management; 2. Treatment framework, end of treatment and continuity; 3. Scheduling, organization of contacts and flexibility; 4. Practical support and activation; 5. Treatment and therapy services; 6. Treatment team and staff; 7. Relatives, caregivers and community; and 8. Privacy and behavior in the home environment.

Conclusion: The BPM provides initial guidance for a user-centered assessment of the implementation of IEHT.

Aim: Different access routes to inpatient-equivalent home treatment (IEHT) were examined.

Methods: Baseline differences were examined using exploratory group comparisons, treatment effects by type of admission using regression analysis.

Results: Of 200 StäB users, 144 (72%) were admitted directly to IEHT, while 56 (28%) were transferred. Direct admissions showed a higher prevalence of affective disorders, while transfers more often had schizophrenia. There were no relevant differences in terms of treatment effects.

Conclusion: Access to IEHT treatment is used flexibly, treatment outcomes do not differ significantly. Outreach services should be designed even more flexible.

Aim of the study: To determine the circumstances of involuntary treatment under the German Civil Code (BGB) in psychiatric hospitals serving a catchment area.

Method: Medical directors of psychiatric hospitals in Germany, including psychiatric departments at general hospitals and university clinics, were interviewed by means of an online survey.

Results: The response rate among the N=397 institutions addressed was 43%. Coercive treatment according to the German Civil Code (BGB), which must be requested by a guardian and approved by a court, is relatively rare and mainly involves the forced administration of psychotropic drugs. 90% of the responding institutions had carried out such coercive treatment within the last five years. Involvement in involuntary treatment carried out in somatic hospitals was rarely reported. For the most part, it is not systematically recorded.

Conclusion: Taking into account the lack of data, there is a need for a national register of such intervention, including involuntary treatment in somatic hospitals.

Objective: The current systematic review summarizes reviews on effects of formalized peer support work in clinical psychiatric settings in order to obtain an up-to-date picture of the current state of evidence.

Methods: Search in five electronic databases for relevant literature reviews regarding effects of peer support work in psychiatric settings. Database searches were complemented by a hand search.

Results: 16 reviews were found. They evaluate effects of peer support on clinical or psychosocial outcomes. No consistent effects are found for clinical outcomes. Small positive tendencies occur for psychosocial outcomes.

Conclusions: The authors of the reviews consistently mentioned the low quality of the primary studies. Therefore, the present results can rather be interpreted as a preliminary tendency. Further studies are necessary for evaluation of peer support in a more differentiated way.

Peer support is recommended for improving acute psychiatric care, but research is lacking. This qualitative study examines the impact, particularly on coercive measures, through semi-structured interviews with four peers, four patients, and twelve (non-peer) staff members from two acute psychiatric wards. Analysis shows that peers experience unique opportunities and challenges in this context. Their effects include mediating between patients and the team, normalizing daily activities on the wards, promoting social interactions, fostering understanding and trust through shared experiences, as well as instilling hope and self-efficacy. Other staff members benefit from the exchange of patient information, task delegation, increased awareness of stigmatization, and promotion of a recovery-oriented mindset. While peers do not directly influence coercive measures, they contribute to de-escalation. Specific framework conditions are necessary.

Aim of the study: This study examines the extent to which a structured implementation of guidelines for the prevention of coercion leads to an improvement in guideline-compliant work and the reduction of coercion in routine clinical practice.

Methods: This is a secondary analysis of the shift of outcomes in the PreVCo study, which was conducted on 55 psychiatric wards throughout Germany.

Results: The number of coercive measures decreased significantly during the observation period. The degree of implementation of the guidelines increased significantly. This was achieved without an increase in aggressive assaults.

Conclusion: The structured implementation of guideline-compliant work is possible in routine operations on psychiatric wards.

Objective: People with mental illness should live independently in the community. This study analyzed the housing situation and the use and need of psychiatric housing facilities of people with severe mental illness.

Methods: Data from a cross-sectional study with 397 people with severe mental illness from two Bavarian districts were used and analyzed descriptively.

Results: 70% of the patients live independently. 6% use supported housing or residential care. 25% of the participants have housing needs, but 39% of them do not receive adequate help. Most of the patients are familiar with supported housing or residential care and find these helpful.

Conclusion: Most patients live in a housing situation that meets the social norm. However, some patients have an unresolved housing problem. The use of supported housing or residential care is helpful, but is rarely used.

Objective: Day centres for people with mental disabilities are widespread. Nevertheless, there are only a few studies on their utilisation and effectiveness. This study examines what an ideal day centre should look like from the perspective of the users.

Methods: Six guided focus groups were conducted with 4-8 users each. The discussions were transcribed verbatim and analysed using qualitative content analysis.

Results: 36 participants (67% women, aged 20-62 years). The day centres fulfilled 5 functions: Improving mental health, experiencing community, maintaining daily structure, meaningful occupation and building up workability. The results revealed important aspects of organisation, current and desired activities and support.

Conclusion: Day centres are seen as an elementary component of intermediate mental health care. Users have clear ideas about how day centres can support their social and occupational rehabilitation.