Nervenarzt最新文献

Background: Young people in mental health crises have severely limited access to clinical care and show the lowest adherence to conventional clinical services. Low-threshold and integrated services (integrated youth mental health services, IYMHS) are recommended to overcome these barriers and provide early detection, early intervention and psychosocial care appropriate for young people.

Objective: The aim is to provide an overview of low-threshold IYMHS globally and in Germany and to report on international experiences with these services and evidence of their effectiveness.

Methods: The narrative review is based on research conducted in PubMed, including the use of published reviews.

Results: International developments show that IYMHS have become established as innovative models of care for young people in mental health crises. Australia is seen as a pioneer with its nationwide network of headspace centers. In Germany, soulspace is the first model project and another, ancora, is in the pipeline. Evaluations to date show that many young people who would not otherwise have sought help use these integrated services and predominantly experience symptomatic and functional improvements.

Conclusion: International experiences to date and pilot projects in Germany have demonstrated the potential of IYMHS to provide low-threshold support at an early disease stage to young people with first symptoms of mental health. For Germany, expanding an integrated, cross-sectoral care structure is recommended through pooling resources from statutory health insurances and public funding.

Background: Numerous studies have shown a high incidence and increase in stress-related symptoms and depression-like complaints among students. During teaching on mental disorders at our medical faculty, students repeatedly reported emotionally stressful situations and expressed a desire for support services. The aim of the present study was to objectify the level of stress and the need for such support services.

Material and methods: A total of 118 students in the 9th semester (winter semester 2022/2023) were surveyed using a questionnaire on their emotional stress. The online questionnaire was conducted via LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) and contained a total of 18 items formulated as statements as well as other items. The students rated the individual items on 11-point numerical scales with external anchor ratings.

Results: The respondents rated their own stress as increased compared to other modules, particularly for the subject of psychiatry (> 5 out of 10). Bedside teaching was estimated as being the most stressful, followed by seminars and lectures (all pairwise comparisons p < 0.001). The contents on depression predominantly caused the most stress. Approximately half of the students would like to be offered support services and most frequently a consultation session (78.0%) and defined contact persons (70.7%).

Conclusion: The emotional stress of students in the context of teaching on mental disorders is particularly high in psychiatry and higher with increasing patient contact; offers of support services are needed. Teachers should be sensitized to this and create offers such as open consultation sessions and the provision of defined contact persons.

Background: To overcome fragmented care provision in Germany, flexible, integrated psychiatric care (FIT) model projects according to § 64b of the German Social Code Book (SGB) V were implemented.

Objectives: The results of the prospective cross-model, controlled, multiperspective/multimethod study PsychCare are presented and discussed along with data from statutory health insurance (SHI)-based research.

Materials and methods: PsychCare applied a multi- and mixed-method design. Primary data were acquired in 18 psychiatric hospitals (n = 10 FIT; n = 8 matched treatment as usual-TAU) at study start (M-I) and 15 months later (M-II). Main outcomes were treatment satisfaction and health-related quality of life. Secondary outcomes included recovery, clinical decision-making, symptom severity, healthcare utilization and costs, needs and experiences with care, and caregiver burden. Participatory process evaluation assessed process-, structure-, and experience-related components.

Results: Patients in FIT (n = 595) had significantly higher treatment satisfaction (ZUF-8: 26.3 ± 4.36 vs. 24.9 ± 4.70; p < 0.001) and recovery (RAS‑R total: 134 ± 35.8 vs. 119 ± 54.3; p < 0.001) at M‑I compared to TAU patients (n = 555), despite comparable symptom severity. About 50% of patients reported high satisfaction with clinical decision-making (p > 0.05); FIT caregivers were numerically more satisfied. Direct medical costs were significantly lower in FIT both at M‑I and M‑II. Type of care was associated with the degree of implementation of FIT components. Linking primary and SHI data was feasible.

Conclusion: PsychCare showed that FIT was superior in cross-sectional treatment satisfaction, recovery, and caregiver satisfaction with suggested cost-effectiveness. Long-term FIT success compared to standard care needs further assessment.

Background: Clinical studies with psilocybin in combination with psychotherapy show promising results for the treatment of various mental disorders; however, there still exists a lack of knowledge, rejection and prejudice towards this new form of therapy among doctors, psychotherapists and patients. The aim of this study was to gain a representative impression, as far as possible, of the level of information and attitudes towards the implementation of psilocybin-assisted therapy (PAT) among mental health experts, patients and the general population.

Methods: An online survey was used to collect information on the attitudes and knowledge of 1456 participants and to test the effect of a brief intervention. Results were determined using analyses of variance and regression models.

Results: Regression analyses showed that a higher knowledge score and self-assessed level of knowledge, own treatment experience and also own experience with psychedelics predicted more positive attitudes towards the introduction of PAT, F(8, 1447) = 154.646, p < 0.001, R² = 0.39. Providing information about the potential of PAT only led to higher acceptance when combined with information about its risks.

Conclusion: The results indicate that participants are optimistic about the implementation of PAT. The relationship between knowledge and acceptance was confirmed. The fact that receiving balanced information leads to higher acceptance should be taken into account when educating and reporting on PAT.

The current article addresses, from different perspectives, the question of the optimal number of psychiatric hospital beds required. It summarizes reviews of expert opinions and estimates of optimal bed numbers, considers the balance between inpatient care and other institutions and services for people with mental disorders, addresses associated issues such as the length of stay, and outlines the importance of the local context. Furthermore, it presents the different objectives of bed provision and concludes by presenting a way forward, utilizing data on populations, patients, services, and treatments at a local level.

Background: The psychosocial burden of the population is increasing and psychosocial crisis intervention teams already play an important supportive role in the care in some regions in Germany. A comprehensive description of existing psychosocial crisis services in Germany is lacking.

Objective: Description of the experiences of selected psychosocial crisis services in Germany and development of a concept for the implementation of new psychosocial crisis services.

Material and methods: A narrative synthesis of the experiences of established psychosocial crisis intervention services in Germany was carried out based on searches in the scientific literature, perusal of information available on the internet regarding the activities of existing services and conversations with their representatives. We developed an experience-based concept for psychosocial crisis services in Germany.

Results: The search for scientific evidence in the literature showed only limited evidence for the efficacy of psychosocial crisis intervention services. There is a broad diversity of types of services and models of financing. Barriers and facilitators of the implementation of psychosocial crisis services could be identified. These were included in a modular, experience-based transsectoral concept for psychosocial crisis intervention services in Germany.

Conclusion: An experience-based modular concept for the implementation of a mental health crisis intervention service was developed. The modularity facilitates the adaptation to local and regional needs and resources and can promote a broader implementation.