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ABSTRACT: Objective: Process evaluation of a needs-oriented discharge planning and monitoring (NODPAM) intervention for patients with severe mental illness with high utilisation of inpatient psychiatric care (within a RCT showing lack of evidence of superiority over treatment as usual).Methods: Analysis of intervention drop-outs vs. intervention group patients participating in the intervention; analysis of the impact of intervention characteristics on unmet needs over time.Results: Patients with more severe forms of illness were more likely to be among intervention drop-outs, a relatively high proportion of unmet needs persisted in patients participating in the intervention. Good intervention implementation and high patient satisfaction with the intervention were associated with a reduction of unmet needs.Conclusions: The NODPAM intervention failed to reach patients with high service use and more severe forms of illness; quality of intervention implementation might have contributed to the lack of superiority over treatment as usual. The intervention might not have been well integrated in routine treatment and was therefore experienced as extraneous to routine care.
Psychiatrische Praxis 03/2013; · 1.64 Impact Factor
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Sabine Steffen,
Rana Kalkan,
Kathleen Völker, Harald Freyberger,
Birgit Janssen,
Meike Ramacher,
Helmfried E Klein,
Katja Sohla,
Jan Bergk,
Julia Grempler,
Thomas Becker,
Bernd Puschner
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ABSTRACT: To evaluate feasibility of a structured discharge planning intervention for high utilisers of mental health care developed in a multicentre RCT.
Data of N = 241 participants (discharge and 3-month follow-up) allocated to the intervention group are analysed with regard to the intervention's quality of implementation, acceptance, and changes in needs.
The intervention was well accepted among patients and staff. However, a subgroup of participants showed manual violations. Total and unmet needs could be reduced between baseline and follow-up. Amount and change of needs substantially varied by centre and there was a trend towards variation by dose.
The intervention was feasible. Further analyses are needed to explore differential efficacy.
Psychiatrische Praxis 02/2011; 38(2):69-76. · 1.64 Impact Factor
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ABSTRACT: Abstract Background As in other countries worldwide, the prevalence of mental disorders in Germany is high. Although numerically a dense network of in- and outpatient psychiatric health services exists, the availability in rural and remote regions is insufficient. In rural regions, telemedical concepts can be a chance to unburden and complement the existing healthcare system. Telemedical concepts consisting of video or telephone consulting show first positive results, but there are only a few studies with a randomized controlled design. To improve the treatment of patients with mental disorders in rural regions, we developed a telemedical care concept based on telephone contacts and text-messages. The primary objective of this study is to evaluate the effects of the telemedical interventions on psychopathological outcomes, e. g. anxiety, depressive symptoms, and somatisation. Secondary objective of the study is the analysis of intervention effects on the frequency of medical contacts with healthcare services. Furthermore, the frequency of patients' crises and the frequency and kind of interventions, initiated by the project nurses will be evaluated. We will also evaluate the acceptance of the telemedical care concept by the patients. Methods/Design In this paper we describe a three-armed, randomized, controlled study. All participants are recruited from psychiatric day hospitals. The inclusion criteria are a specialist-diagnosed depression, anxiety disorder, adjustment disorder or a somatoform disorder and eligibility to participate in the study. Exclusion criteria are ongoing outpatient psychotherapy, planned interval treatment at the day clinic and expected recurrent suicidality and self-injuring behaviour. The interventions consist of regular patient-individual telephone consultations or telephone consultations with complementing text-messages on the patients' mobile phone. The interventions will be conducted during a time period of 6 months. Trial registration This study is registered in the German Clinical Trials Register (DRKS00000662).
BMC Psychiatry. 01/2011;
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ABSTRACT: The aim of the study was to determine the prevalence of mental disorders among prisoners with a short prison term.
We investigated 102 participants with the Structured Clinical Interview for DSM Disorders (SCID I and II) and the Symptom Check List (SCL-90).
We found a lifetime-prevalence of mental disorders (axis I) of 83 %. 80 % of the participants showed at least one personality disorder.
These results indicate that short-term prisoners are a population which is highly troubled in a psychiatric sense and shows a need of treatment in prison.
Psychiatrische Praxis 05/2009; 36(5):219-24. · 1.64 Impact Factor
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ABSTRACT: The aim of the study was to determine the quality of life and the sense of coherence in a sample of former German child soldiers of World War II.
103 participants were recruited by the press, then administered a Short-Form-Health-Survey (SF-12), a sense-of-coherence scale (SOC) and 2 qualitative questions on possible resources in the combat situation.
The quality of life was not lowered compared to a comparison group of the same age. The sense of coherence was significantly higher than that of the comparison group.
The participants belonged to a comparably unobtrusive group of veterans. A possible protective variable might be the high sense of coherence.
Psychiatrische Praxis 09/2008; 35(8):399-403. · 1.64 Impact Factor
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ABSTRACT: Because of the presence of pronounced impulsiveness and affective dysregulation in subjects with Borderline Personality Disorder (BPD) executive dysfunctions have been suspected. Previous studies in this area revealed inconsistent results. However, most of these studies did not control for comorbidity (e. g. impulsiveness, depression) and current medication of participants. The aim of this study was, therefore, to investigate executive (dys)functions in patients with BPD and healthy controls controlling for impulsivity. Furthermore, a second control group with depression was included to test the specificity of the results.
24 unmedicated, female BPD patients as well as 24 healthy controls were matched for age, sex, and intelligence. Additionally, 22 female subjects with a life-time diagnosis of depression were included. All subjects completed a neuropsychological test battery assessing executive functions.
No significant differences in executive functioning were found between the three groups. BPD patients showed, however, a decreased ability to delay a gratification compared with controls.
These results implicate that BPD patients have deficits in motivational areas while other executive functions are not or only marginally involved.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 08/2008; 59(7):264-72. · 1.02 Impact Factor
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ABSTRACT: Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.
This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points. The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session. Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.
If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.
ISRCTN59603527.
BMC Health Services Research 01/2008; 8:152. · 1.66 Impact Factor
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ABSTRACT: Abstract
Background
Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.
Methods
This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.
The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.
Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.
Discussion
If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.
Trial Registration
ISRCTN59603527
BMC Health Services Research. 01/2008;
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ABSTRACT: We studied traumatic childhood experiences, comorbid posttraumatic stress disorders (PTSD), dissociation and self-destructive behavior in 30 inpatients with a borderline personality disorder. A standardized interview for the assessment of PTSD, the Dissociative Experience Scale and the Symptom-checklist were administered. Results were compared to a control of inpatients with neurotic disorders matched for gender and age. Borderline patients showed significantly more childhood sexual and physical abuse as well as emotional neglect than the control patients. Of the borderline patients, 67% met criteria for PTSD and only 13% of the control group. Dissociative symptoms were significantly more frequent in borderline patients and predicted in combination with PTSD symptoms and self-destructive behavior. We discuss our findings with respect to their etiological and clinical significance and propose a model for self-destruction in borderline patients which focusses on dissociation and trauma.
Zeitschrift fur Psychosomatische Medizin und Psychotherapie 02/2000; 46(3):273-285. · 1.30 Impact Factor
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ABSTRACT: Though the use of elaborated and standardized behavioral therapy strategies has been successful in treatment evaluation and in areas of neurobiological research, numerous psychoanalytically orientated therapists will exhibit fear and avoidance behavior while facing terms like "standardization", "treatment evaluation studies" and "neurobiology". In our comment, we aim to initiate a successful therapeutic process by intensified reality testing and repeated exposure therapy.
Zeitschrift fur Psychosomatische Medizin und Psychotherapie 02/1999; 45(1):39-42. · 1.30 Impact Factor
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ABSTRACT: This review summarizes from biological research in obsessive-compulsive disorder. In particular, functional brain imaging studies investigating the effects of symptom provocation, of behavioral and pharmacological treatment on brain activity and findings from neurochemical studies are presented with regard to the serotonergic system. We discuss a neurobiological model integrating the findings from brain imaging, functional anatomy and behavioral concepts which favors a functional imbalance within the orbitofrontal - basal ganglia - thalamus circuit and focus on hypothesis for further research.
Zeitschrift fur Psychosomatische Medizin und Psychotherapie 02/1999; 45(1):18-30. · 1.30 Impact Factor
