[show abstract][hide abstract] ABSTRACT: Der folgende Artikel berichtet über einen beziehungsorientierten psychotherapeutischen Behandlungsansatz im Anschluss an die Haftstrafe. Die Wirkung der Therapie auf die Rückfallrate von entlassenen Straftätern wird dargestellt. Die Ergebnisse zeigen, dass die Therapie auch unter Berücksichtigung des unterschiedlichen Basisrisikos zu einer Abnahme der Rückfallwahrscheinlichkeit führt. Am besten wirksam zeigt sich die Methode betreffend der Verhinderung gewalttätiger Rückfälle, die Ergebnisse hinsichtlich der Rückfallprävention von Sexualstraftaten sind zwar im unmittelbaren Gruppenvergleich deutlich, nach Korrektur des unterschiedlichen Basisrisikos jedoch schwach. In der Folge werden die Resultate vor dem Hintergrund der möglichen Wirksamkeit eines beziehungsori-entierten psychotherapeutischen Ansatzes bei einer forensischen Klientel diskutiert. Ebenso werden die Umstände, die das Gelingen einer derartigen offenbar wirksamen Form der Rückfallprävention ermöglichen, beleuchtet. Interaction-based psychotherapy with released offenders and a group of sex-offenders – 7 year follow-up This article reports on the effectiveness of a psychodynamic community based outpatient treatment program for general and sexual offenders after release from prison. The treatment program was found to be highly effective in preventing violent and general recidivism in a general offender population. Also, sexual offender recidivism was seen to be significantly lower in the treatment group, although effects were more substantial for preventing violent recidivism even in this group. Findings are discussed emphasizing the need for cooperation between courts and treatment providers.
[show abstract][hide abstract] ABSTRACT: Psychiatric services increasingly use internet technologies to enhance and support usual therapies, which are based on direct personal contact.
An anonymous e-mail-request of a young girl obviously requiring psychiatric support and treatment is illustrated, characterized by the intention of the service to establish personal contact.
Chances and limitations of psychiatric interventions using the internet are discussed.
[show abstract][hide abstract] ABSTRACT: Within the European Alliance Against Depression (EAAD), community mental health services inform in their service region in Lower Austria (pop. 1.600.000) about symptoms of depression, about treatment options and service characteristics. Social distance can be overcome preferably by public mental health projects involving users and relatives. Therefore, community mental health services in Lower Austria routinely inform the public about depression, treatment options and services together with service users and relatives. This paper presents an evaluation of workshops for police officers.
During the year 2010, 38 workshops for the police were conducted. All officers were asked to fill in the Gotland Scale of Male Depression, and to rate social distance and stereotypes regarding a case vignette of a fictitious depressive person. One week after the workshop, social distance and stereotypes were again rated.
852 police officers took part in the workshops, 703 were screened by the Gotland Scale of Male Depression. 9 % showed depressive symptoms. The officers were content with the workshops, they felt better informed afterwards and thought they could better help affected persons. The interpretation of the case vignette was more often "mentally ill" or "insane".
Personal experience with depression was more strongly related to present depressive symptoms than age or years on duty. Personal contact with a person that had been affected by depression before, and the slogan "depression can affect anybody" may have increased feelings of anxiety in officers that had taken part in the workshops.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 01/2011; 25(4):183-91. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: Community mental health teams (CMHT) provide support for severely disabled, chronic mentally ill patients. In this study, referrals to CMHT by a psychiatric hospital in Lower Austria were analysed, as were the first few weeks of care for referred patients.
Referrals to CMHT of a catchment area (pop 250.000) were analysed for 2002- 2006.
In the first 6 months of each year, 124 to 189 patients were referred to CMHT. Between 2002 and 2006, the percentage of affective disorders (ICD-10: F3: 40.0 %), and substance use disorders (F1: 38.9 %) within the referrals diminished, as compared to patients suffering from schizophrenia (F2 initially 25.4 % of referrals vs. 49.7 %) and personality disorders (F6 initially 6.4 % of referrals vs. 22.4 %). In 30.7 % vs. 56.6 % of patients, CMHT workers managed to establish contact to patients after discharge from hospital. They actively sought contact with 39.9 to 74.6 % of referred patients (by means of telephone calls, letters, home visits, etc.). In 26.5 to 46.9 % of the referrals, continuous care was planned.
This study emphasizes the advantage of specific referrals to CMHT, if care for severely disabled individuals is needed and should be provided. Furthermore, a description of outreach activities, which are intended to maintain contact with patients characterized by poor compliance, is presented. These activities are not yet part of routine care in German speaking countries.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 01/2010; 24(3):195-9. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: The "Viennese Instrument for Suicidality in Correctional Institutions" (VISCI) presented here is based on the results of a large case-control study and on research on literature examining suicide prevention in general and in the prison population in particular. The aim of this study was to validate the properties of the VISCI to differentiate between suicides and nonsuicides. The sensitivity and specificity of the VISCI was tested in the files of 55 correctional suicides, and 110 controls. VISCI differentiated well between suicides and nonsuicides. The routine administration of the VISCI may help to direct the existing professional attention to inmates with the highest need.
Suicide and Life-Threatening Behavior 08/2009; 39(4):376-85. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: In the last decades, long-time patients were systematically discharged from psychiatric hospitals in order to integrate this disadvantaged population into the community. This procedures where adequately evaluated and are regarded to be completed in the western world today. However, few evidence has been presented regarding the further course of integration following discharge from mental hospitals: was integration into community really successful or were patients permanently placed in sheltered housing staffed 24 hours 7 days a week. This review focuses on the question whether papers describing large de-institutionalisation projects mention the level of institutional support in the years following discharge from hospital. Furthermore we tried to find out which parameters are dealt with when describing successful community integration.
"Pubmed" was searched for studies on de-institutionalisation projects published between 1997 and 2007.
The discharge from the mental hospital wards was in all studies described as successful, positive effects like an increased quality of life were found. However, studies describing the years following discharge mentioned that patients continuously stayed in sheltered housing with care offered 24 hours a day.
Reviewing the available data about the level of support regarding accommodation of former long time patients, the danger of "trans-institutionalisation" has to be pointed out. Evidence is lacking concerning support models tailored to the individual needs of the patients. Similarly, possible side effects of long-term stays in sheltered housing staffed 24 hours a day have not yet been established. Therefore, we see a need for further evaluation of different models of supported housing for former long-term hospitalised patients, as well as for new chronic mentally ill patients.
[show abstract][hide abstract] ABSTRACT: Most studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients' mothers.
101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the "Carers' Needs Assessment for Schizophrenia".
Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers' problems was predicted by not living with a partner and by a shorter duration of the patients' illness. The number of mothers' needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients' illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.
Fathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work.
Social Psychiatry 07/2008; 43(12):968-74. · 2.05 Impact Factor
[show abstract][hide abstract] ABSTRACT: Unemployment has a strong negative impact on quality of life and on the further course of the disease of mentally disordered individuals. Therefore, vocational rehabilitation programmes are necessary to help people with mental disorders to obtain work. There is increasing scientific evidence concerning positive predictors for vocational integration. This paper intends to give an overview about established predictors for successful integration.
"Pubmed" was searched for studies on psychiatric vocational rehabilitation programmes published between 1997 and 2007, which had the focus on predictors of successful outcome.
Some of the most important predictors are a better history of work integration and better work performance measured during psychiatric vocational rehabilitation. Successful vocational integration is harder if negative symptoms or cognitive deficits are present. The impact of sociodemographic factors, diagnosis, motivation to work and social skills is discussed controversially.
Future research should be directed to design vocational rehabilitation programmes, which address the specific needs of psychiatric patients.
[show abstract][hide abstract] ABSTRACT: The assessment and estimation of suicidal risk constitutes a serious and difficult task for any mental health professional. If we add to this the challenges that may be presented by a specific population at higher risk with little possibilities for thorough psychiatric evaluation, the task appears even more complicated.
The "Viennese Instrument for Suicidality in Correctional Institutions" ("VISCI") presented here is based on the results of a case control study including all suicides in all Austrian jails and prisons between 1975 and 1999 and on research on literature examining suicide prevention in general and prison population in particular.
Sensitivity and specificity of VISCI are presented.
As suicide rates in custody are higher than in the general population, and these rates have been increasing within the last 20 years, the screening of offenders newly admitted to prison for their propensity to suicide is necessary to give a better estimation of the suicide risk and hopefully to stop further increase of suicide rates in jails and prisons.
[show abstract][hide abstract] ABSTRACT: Summary Community based psychiatric services have been established in Austria within the last decades, but differ from their mission
and their professional procedures and are differently staffed in different counties. We report about a mother with schizoaffective
disorder in Lower Austria, who presented with complex needs (including compulsory in-patient treatment and homelessness) and
had to be supported in a variety of aspects. The cooperation across services and across agencies – which usually is a complicated
procedure frequently failing – was managed by a young psychiatrist in an outreach manner. Finally, mother and baby were well,
had spent the first 2 years together, and the patient was ready to live independently with a low level of support, and to
make her own meaningful decisions without needing further in-patient treatment.
Psychiatrie und Psychotherapie 01/2008; 4(4):133-136.
[show abstract][hide abstract] ABSTRACT: In letzter Zeit werden vermehrt Fachärzte für Psychiatrie schwerpunktmäßig in "psychosozialen Einrichtungen" tätig. Diese
Tätigkeit ist im Vergleich zur Arbeit in Krankenhäusern oder Ordinationen bisher wenig bekannt und schlecht beschrieben. Dem
soll durch dieses Papier abgeholfen werden. Gemeindepsychiatrische fachärztliche Tätigkeit wird als sinnvolle und fachlich
notwendige Ergänzung zur stationären bzw. Zur Tätigkeit in Ordinationen erklärt und positioniert. Beispielhaft werden drei
wesentliche Einsatzgebiete detailliert erfasst und beschrieben: 1) Umfassende Hilfsangebotsplanung und Durchführung für Menschen
mit komplexem psychiatrischem Hilfebedarf, 2) Abklärung und Clearing, 3) Gesundheitsförderung und Prävention. Auf die Notwendigkeit
regionaler Anpassungen wird hingewiesen. Zu diesem Thema wird die erforderliche fachärztliche Expertise dargelegt. Weiters
werden Anforderungen, die sich von Erfordernissen anderer Bereiche unterscheiden, deutlich gemacht.
An increasing number of psychiatrists have the focus of their work in extramural psychosocial institutions. Job descriptions
in this type of workplace are usually much less well defined then those in hospital or private practice. In this manuscript
we describe the tasks of community based psychiatrists in detail and explain their role in complementing hospital and private
practice based care. Three important work areas serve as examples: Firstly comprehensive planning and implementation of support
for people with complex psychiatric needs, secondly differential diagnosis and clearing, thirdly the perspective of health
promotion and preventional medicine. We also emphasise that these concepts need to be adapted to meet regional needs. The
importance of specialized training and the demands which distinguish the psychiatrists in such institutions is underscored
Psychiatrie und Psychotherapie 11/2007; 3(4):169-173.
[show abstract][hide abstract] ABSTRACT: The decision whether admitted inmates should be placed in solitary cells or shared cells has to take place immediately after intake. This decision can have major impact on the occurrence of suicide in custody. The ‘Viennese Instrument for Suicidality in Correctional Institutions’ presented here is based on the results of a case-control study examining suicide prevention in general and within the prison population in particular. The administration of this instrument helps the officers to decide about the accommodation without an immediate psychiatric or psychological assessment. The screening of newly admitted offenders to prison for suicidality is necessary to better estimate the suicide risk.
International Journal of Prisoner Health 09/2007; 3(3):225-232.
[show abstract][hide abstract] ABSTRACT: The subject of religion and spirituality has attracted little attention in psychiatric research so far. The aim of the study was to give an overview of the attitudes of patients as well as psychiatrists towards regarding the importance of religion and spirituality in the treatment of mental illness. Furthermore we tried to give a description of established ideas involving both dimensions into the treatment of psychiatric patients.
We performed a search for relevant literature using the electronic databases Medline, PubMed, Psyndex and Embase. In addition we used the internet search engines Scopus and Google Scholar.
Patients mention religion twice as often as an important factor in their lives as compared to psychiatrists. Consecutively, particular emphasis should be paid to the integration of both dimensions into clinical treatment. Additionally, the education of mental health professionals, consultation and the enrollment of religious or spiritual needs of patients when taking their medical history are essential factors. Religious coping and positive and negative components in matters of mental health are highlighted.
More attention should be paid to the "religiosity gap" between patients and their psychiatrists. The entirety of a human being includes a physical, emotional, social as well as a spiritual dimension. Mental health professionals ignoring one of these aspects may delay recovery.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 02/2007; 21(4):239-47. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: International surveys found an increase of mentally disordered individuals in correctional institutions. As a consequence, suicides and suicide rates in jails and prisons are increasing. Mental health services and criminal justice authorities have identified this problem, but there is a lack of knowledge concerning risk factors for inmate suicides and practicable prevention.
A literature research was conducted through "medline" searching for studies addressing the problem of jail and/or prison suicide. Subsequently, results of relevant surveys were compared and depicted in several tables.
Suicide rates in correctional facilities significantly exceed those in the general male population. Suicide rates in custody have been increasing within the last decades. Pre-trial prisoners have the highest suicide risk within the total prison population. Long-term sentences, single-cell use, mental illness, substance abuse and a history of suicidality are associated with an increased suicide risk.
The impact of suicide prevention strategies and future directions of research in this high-risk setting are highlighted.
[show abstract][hide abstract] ABSTRACT: Objective: International surveys found an increase of mentally disordered individuals in correctional institutions. As a conse- quence, suicides and suicide rates in jails and prisons are increas- ing. Mental health services and criminal justice authorities have identified this problem, but there is a lack of know ledge concern- ing risk factors for inmate suicides and practicable prevention. Method: A literature resear ch was conducted through πmedline" searching for studies addressing the problem of jail and/or prison suicide. Subsequently, res ults of relevant surve ys were compared and depicted in several tables. Results: Suicide rates in correctio- nal facilities significantly ex ceed those in the gener al male popu- lation. Suicide rates in custody have been increasing within the last decades. Pre-trial prisoners have the highest suicide risk within the total prison population. Long-term sentences, single- cell use, mental illness, substance abuse and a history of suicida- lity are associated with an increased suicide risk. Discussion: The impact of suicide pre vention strategies and future directions of research in this high-risk setting are highlighted.