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Tagesklinische Behandlung in der Psychiatrie
Abstract
Day hospitals provide an organizational framework for complex psychiatric and psychotherapeutic treatments. They have been developed regarding treatment and in number, perhaps surprisingly, to fit existing standards in almost all domains of psychiatry. Similarities exist in the emphasis on acute treatment, in the orientation towards social inclusion, and particularly in the ability to connect with previous treatment settings. Day treatment guidelines exist only in basic form. In general the complex outpatient treatment is led by psychiatrists; the treatment is planned and pre-defined regarding time and goal orientation. It is directed exclusively at patients with severe mental health disorders and practiced by a multi-professional team. A structured treatment milieu is likely to be the main ingredient which includes all somatic-biological and many psychotherapeutic methods. Special options that for the most part have been empirically validated are available for the treatment of post-acute patients, prevention of social exclusion from families and work, detoxification of addicts and psychotherapy of personality disorders. The rapid increase of facilities is expected to persist for some time. Scientific evidence is relatively strong. Given proper indication, financial resources are used with a high degree of efficiency.
... Since the 1970s, psychiatric day hospitals have become increasingly common (1)(2)(3). In the meantime, a large number of different psychiatric day hospitals exists. ...
... Its indication range therefore includes patients whose need for treatment and support is on the one hand to great for a purely outpatient setting and who on the other hand are not necessarily dependent on inpatient treatment (e.g. due to a pronounced deficit in selfcare caused by illness or due to acute suicidal tendencies) (2,5). In direct comparison to full inpatient treatment, advantages can be expected for day hospital treatment on two levels: ...
For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or waiting time and is open every day of the week. In addition, it was examined whether and to what extent there are cost advantages for day hospital treatment. Patients who were admitted to the hospital with a referral to an inpatient admission were treated randomly either fully inpatient or in the acute day hospital. As a pilot study, 44 patients were admitted to the study. Evidence of efficacy could be provided for both treatment settings based on significant reduction in psychopathological symptoms and improvement in functional level in the course of treatment. There were no significant differences between the two settings in terms of external assessment of symptoms, subjective symptom burden, functional level, quality of life, treatment satisfaction, and number of treatment days. Treatment in the day hospital was about 45% cheaper compared to inpatient treatment. The results show that acutely ill psychiatric patients of different symptom severity can be treated just as well in an acute day hospital instead of being admitted to the hospital. In addition, when direct treatment costs are considered, there are clear cost advantages for day hospital treatment.
... [11] Für Eikelmann ergeben sich die Einschränkungen der Indikation nicht bei den Diagnosen, sondern in einem bestimmten Schweregrad der Störung, in der Suizidalität, in bestimmten Formen der sozialen Funktionsstörungen und anderen eher praktischen Komponenten wie Anreise über 30 Min., Alter, fehlende Sprachkompetenz etc. 18 [12] Therapien im tagesklinischen Setting umfassen meist ein multimodales Programm, eine allgemeingültige Definition des tagesklinischen Behandlungssettings findet sich nicht. ...
Der Artikel gibt einen Überblick über die Rolle der sogenannten teilstationären Versorgungsangebote bzw. Tageskliniken in der Versorgung und Behandlung von psychisch kranken Rechtsbrecher:innen. Dabei skizziert der Artikel in einer auf juristische Leser:innen zugeschnittenen Darstellungsweise, was in der Psychiatrie unter Tageskliniken verstanden wird, welche Erfahrungen bezüglich der Wirksamkeit gemacht wurden, wo sich derartige Angebote in der forensischen Psychiatrie einordnen könnten und welche Kriterien erfüllt sein müssen, damit von einem tagesklinischen Angebot gesprochen werden kann.
... alliance, expectations (Wampold, 2015) Patients return home in the evening and on the weekends -therefore, daily and social life is not or only partially interrupted and change of setting can be practiced, which enhances transfer effects (e.g. Eikelmann, 2010;Wietersheim et al., 2005) When inpatient treatment is not necessary (anymore) ...
... Tageskliniken spielen bisher nur eine geringe Rolle bei der Behandlung der BPS [Kallert et al., 2003], obwohl diese als Baustein zwischen ambulanter und stationärer Therapie alltagsnäher und mit weniger Regression und Hospitalismus behaftet sind sowie seltener ein Herausfallen aus sozialen Netzen zur Folge haben [Eikelmann, 2010]. ...
b> Einleitung: Die dialektisch-behaviorale Therapie (DBT) für Patienten mit Borderline-Persönlichkeitsstörung (BPS) ist evidenzbasiert. Es gibt jedoch nur eine kleine Anzahl von Studien, die die Frage einer möglichen anhaltenden Wirkung von DBT untersuchen. Über Prädiktoren dieser Nachhaltigkeit ist wenig bekannt. Methode: Am Beispiel eines zertifizierten tagesklinischen Settings wird der posttherapeutische Verlauf untersucht. Mögliche Prädiktoren einer Verschlechterung nach Therapieende sollen erkannt werden. Hierzu wurden Patienten der DBT-Tagesklinik, deren Daten schon in eine prospektive, naturalistische, offene und nicht kontrollierte Vorstudie eingingen, erneut retrospektiv befragt. Somit konnten die Scores der Borderline-Symptomliste 95 (BSL-95) und des Beck-Depressions-Inventars (BDI) zu 3 verschiedenen Zeitpunkten (Z1 = Start, Z2 = Therapieende, Z3 = Katamnesezeitpunkt) verglichen werden. Der Fragebogen zu «Nebenwirkungen stationärer Psychotherapien» (NESTAP) lieferte weitere mögliche Prädiktoren. Ergebnisse: Der Katamnesezeitraum betrug 3-51 Monate. 82 Patienten wurden angeschrieben, es antworteten 41. Anhand des BDI und der BSL-95 (Differenz Z1 zu Z3, p < 0,05) ist eine Symptombesserung in dieser Gruppe auch weit über das Therapieende feststellbar. In einem linearen Regressionsmodell mit einer Effektstärke von 1,04 (Cohen) zeigt eine Subgruppe (25%), gekennzeichnet durch hohe Werte des Prädiktors «Dysphorie» im BSL-95 (Z2 zu Z1) eine geringe anhaltende Wirkung der DBT (Differenz der BSL-95- und BDI-Scores zu Z2 und Z3). Schlussfolgerungen: Es konnten Hinweise für ein tagesklinisches DBT-Programm zur anhaltenden Symptombesserung bis 51 Monate nach Therapieende dargestellt werden. Für 50% der Patienten ist hierfür keine Aussage möglich. Auch gab es keine Kontrollgruppe. Die Veränderung von «Dysphorie» während der Therapiephase scheint diese therapeutische Wirkung über diesen Katamnesezeitraum zu beeinflussen. Weitere Studien sollten folgen, um die Daten zu prüfen oder andere Prädiktoren zu finden.
... The concept of day clinic treatment might be a feasible alternative to inpatient settings, as patients remain the major part of the day in familiar surroundings. However, although equivalency of treatment between day clinic and inpatient treatment has been reported in other areas of psychiatric work (Eikelmann, 2010), there is not yet evidence in the area of dementia care. So far, the number of empirical studies on psychiatric day clinics for PWD remains limited and it is discussed whether day clinic treatment is suitable for PWD (Weber et al., 2009). ...
Background
Caregiver burden is one of the most common reasons for hospitalization of patients with dementia. However, changes of location are not recommended for patients with dementia and associated with negative outcomes for patients with dementia. As there is yet a lack of outpatient treatment options, this study explores psychiatric day clinic treatment as option for patients with dementia by comparing characteristics of voluntarily treated patients with dementia and their respective informal caregivers between an inpatient and day clinic setting.
Methods
A total of 92 patients with dementia (56 inpatient, 36 day clinic) and their informal caregiver provided information on psychosocial and clinical characteristics (Mini-Mental-Status-Test, Neuropsychiatric Inventory, Bayer Activities of Daily Living, Barthel Index, Geriatric Depression Scale-30, Beck’s Depression Inventory-II, caregiver burden, Short Form Health Survey-36) at the beginning of treatment and at follow-up (n = 48 patient caregiver dyads) six months after discharge.
Results
Patients with dementia did not differ in disease severity, neuropsychiatric symptoms, and depression depending on treatment setting. However, the higher the Bayer activities of daily living score, the more likely treatment in day clinic was. Caregivers from patients with dementia in the inpatient setting were younger and reported more financial burden, whereas caregivers from patients with dementia in the day clinic reported lower physical health and more burden due to practical caring responsibilities. Longitudinal data indicated no differences in characteristics of patients with dementia and caregivers depending on treatment setting, despite caregivers from patients in the day clinic reporting more depressive symptoms after six months.
Conclusion
Day clinic treatment for voluntarily treated patients with dementia might be an alternative to inpatient settings. Patients with dementia do not substantially differ depending on treatment setting, rather characteristics of the caregivers were associated with placement in inpatient or day clinic setting. The needs of caregivers deserve special attention when considering treatment for patients with dementia.
... Psychosomatische, psychiatrische und psychotherapeutische Tageskliniken bieten gegenüber stationären Versorgungsangeboten einige therapeutische und ökonomische Vorteile: Sie eignen sich für ein breites Patientenspektrum, knüpfen an den Symptom auslösenden Alltagssituationen an, halten das soziale Umfeld aufrecht, lassen mehr Spielräume in der Nähe-und Distanzregulation und bieten eine geeignete Mischung aus Protektion und Konfrontation mit der Realität, was sich besonders bei Patienten mit Persönlichkeitsstörungen regressionshemmend auswirkt (Eikelmann, 2010;Eikelmann, Reker, Albers, 1999;Küchenhoff, 1998;Mattke, Zeeck, Strauß, 2012;Schultz-Venrath, 2011;Zeeck et al., 2009). Zudem repräsentieren psychosomatische und psychiatrische Tageskliniken Übergangsräume wie in den ersten Lebensjahren der Familie und dienen häufig als Übergangssetting von der Station über die Tagesklinik bis zur Rückkehr in Familie und Beruf (Richter u. ...
Comparing the group relationships in psychodynamic (PDGT) and mentalization-based group therapy (MBT-G) after each group session in a sample of 197 patients with heterogeneous, predominantly F3- or F4-diagnoses (ICD-10), treated in a day hospital, we analyzed more than 6,000 questionnaires of group climate (GCQ-S) by single case regression analysis on therapeutic outcome. In both groups, which were offered four times the week 90 minutes by two group leaders, seven selective progressive forms of group climate could be differentiated. Cohesion in both group therapies is comparable to closed groups. In MBT-G we found higher conflict-scores in the beginning of the group, in PDGT there is more avoidance during the course of therapy. The group conflicts of the most successful patients in PDGT undergo strong and ongoing fluctuations during their therapy process. In MBT-G the oscillations of the group relationships are much shorter and without a significant tendency. While in PDGT a part of the most successful patients show a significant decrease in cohesion, in MBT-G appears an increase of cohesion at the end of therapy. These results can be connected to the different therapeutic stances, goals and postulated change mechanisms of the treatment conditions. There is a need for validation by further prospective research.
... Psychosomatische, psychiatrische und psychotherapeutische Tageskliniken bieten gegenüber stationären Versorgungsangeboten einige therapeutische und ökonomische Vorteile: Sie eignen sich für ein breites Patientenspektrum, knüpfen an den Symptom auslösenden Alltagssituationen an, halten das soziale Umfeld aufrecht, lassen mehr Spielräume in der Nähe-und Distanzregulation und bieten eine geeignete Mischung aus Protektion und Konfrontation mit der Realität, was sich besonders bei Patienten mit Persönlichkeitsstörungen regressionshemmend auswirkt (Eikelmann, 2010;Eikelmann, Reker, Albers, 1999;Küchenhoff, 1998;Mattke, Zeeck, Strauß, 2012;Schultz-Venrath, 2011;Zeeck et al., 2009). Zudem repräsentieren psychosomatische und psychiatrische Tageskliniken Übergangsräume wie in den ersten Lebensjahren der Familie und dienen häufig als Übergangssetting von der Station über die Tagesklinik bis zur Rückkehr in Familie und Beruf (Richter u. ...
There is no evidence of efficacy of mentalization based group therapy (MBT-G) against widely distributed psychodynamic group therapy (PDGT). To prove if MBT-G is also a useful therapeutic concept for a heterogeneous patient group, we examined the efficacy of MBT-G in contrast to psychodynamic group therapy (PDGT) in a heterogeneous patient sample in a psychotherapeutic day clinic in a randomized process outcome study (N=211). The first results of completer analyses are shown. In sum in variance analysis there are high prepost- effects in symptom reduction (GSI/SCL) and interpersonal problems (IIP), middle effects in mentalization (LEAS, MASC), but no significant differences between the groups. Further analysis with depended t-tests show in scope of alexithymia (LEAS) middle effects in MBT-G and low effects in PDGT, whereas in social cognition (MASC) both have low treatment effects. The results can be interpreted that MBT-G in a heterogeneous population of a day clinic is not superior to PDGT, but supposedly tend to a higher improvement of mentalization of self (in contrast to other) as PDGT. In next step further analysis of diagnostic groups and mediator-moderator analysis of mentalization should enable to interpret the data in a differentiated way and to get more information for clinical use.
... Psychosomatische, psychiatrische und psychotherapeutische Tageskliniken bieten Patienten, Teammitgliedern und Trägern solcher Einrichtungen gegenüber stationären Versorgungsangeboten einige psychosoziale und ökonomische Vorteile. Sie eignen sich für ein breites Patientenspektrum, knüpfen -bei nicht zu langer Wartezeit bezüglich der Aufnahme -an den symptomauslösenden Alltagssituationen an, halten das soziale Umfeld aufrecht, lassen mehr Spielräume in der Nähe-und Distanzregulation und bieten eine geeignete Mischung aus Protektion und Konfrontation mit der Realität, was sich besonders bei Patienten mit Persönlichkeitsstörungen regressionshemmend auswirkt (Eikelmann, 2010;Eikelmann, Reker, Albers, 1999;Küchenhoff, 1998;Mattke, Zeeck, Strauß, 2012;Schultz-Venrath, 2011;Zeeck et al., 2009). Psychosomatische und psychiatrische Tageskliniken repräsentieren Übergangsräume wie in den ersten Lebensjahren der Familie. ...
Group psychotherapy research in a day treatment setting is confronted with a series of problems. At the same time group psychotherapy research offers great potential, based on the common outlook of clinicians and researchers, to conceptualize, to implement and to explore group psychotherapies. This will be demonstrated on a current research project, which compares mentalisation based (MGBT) and psychodynamic group psychotherapy (PDGT) in the same day hospital. Initially we shall focus on the problem of adherence to a hands-on approach in both group psychotherapies, with special reference to the differences of interventions in group sequences. After this we we will outline our concept of the study design.
... The present study aims to evaluate the feasibility and acceptability of adding a motivational intervention to the usual treatment for smoking cessation in a psychiatric day hospital. Day hospitals provide an organizational framework for complex psychiatric and psychotherapeutic treatments (Eikelmann, 2010), further offering the opportunity to address other comorbidities such as cigarette smoking. To study feasibility and acceptability, we collected information on the number of individuals who consented to participate in the motivational intervention, the number of motivational intervention meetings individuals attended, and whether participants in the motivational intervention made any changes in their smoking (either attained abstinence or decreased smoking) as compared to a cohort that received treatment as usual without the motivational intervention. ...
Objective:
Our main objective was to test the feasibility of adding motivational interviewing to the usual smoking cessation treatment for patients with psychiatric disorders attending a day hospital.
Methods:
A total of 44 patients participated in the study: a comparison group of 25 patients, all of whom received the usual smoking cessation treatment (nicotine replacement therapy, 1 hour of weekly group therapy, and daily individual advice), and an intervention group of 19 patients who received the usual smoking cessation treatment plus up to four motivational interviewing sessions. Data included sociodemographics, psychiatric diagnosis, cigarette use, and engagement in treatment. Descriptive analyses were conducted, along with logistic regression to test for differences on abstinence and daily smoking rates.
Results:
All 19 patients offered the motivational interviewing accepted it, and all of them completed at least one session (M = 2.53, SD = 0.234, Range = 1 to 4). At the end of treatment, four patients in the intervention group were abstinent (versus none in the comparison group), but this was not statistically significant. Both groups showed a mean daily reduction of eight cigarettes. After introducing all variables into the regression models, none reached significance.
Conclusions:
Adding motivational interviewing to usual smoking cessation treatment in a psychiatric day hospital seems feasible and acceptable. Further, more rigorous research is needed.
... Hier kann man zwischen gemeindenaher psychiatrischer Klinik, zuweilen gemeindenaher psychotherapeutischer Akutklinik, zwischen psychosomatischer Akutstation und im Grünen gelegener psychosomatischer Rehabilitationseinrichtung wählen. Nicht zu vergessen jene Tageskliniken, die sich der psychotherapeutischen Medizin oder Psychosomatik verschrieben haben [17]. Es ist nicht zuletzt die Konkurrenz um einzelne Patientengruppen, sondern die unterschiedliche Interpretation der Versorgungspflichten und diese organisatorische Redundanz, die die Integration der Psychiatrie / Psychotherapie in die somatische Medizin aufhalten. ...
Zusammenfassung
Ziel der Studie Die stationsäquivalente Behandlung (StäB) stellt eine Alternative zur stationären Krankenhausbehandlung dar. Im StäB München wird etwa die Hälfte der Patienten direkt aufgenommen und die andere Hälfte von Stationen zuverlegt. Bislang fehlen Daten, wie sich diese beiden Gruppen unterscheiden.
Methodik Auswertung der Daten aller Patienten der ersten 13 Monate der Münchener StäB (N = 169).
Ergebnisse Direktaufnahmen hatten häufiger affektive Erkrankungen, waren weniger schwer krank, zeigten seltener eine Sprachbarriere und gingen öfter einer Erwerbstätigkeit nach. Bei 66 % der Verlegungen war bei stationärer Aufnahme mindestens ein Ausschlusskriterium für eine StäB dokumentiert. Die Dauer der StäB-Behandlung unterschied sich für die beiden Gruppen nicht relevant.
Schlussfolgerung StäB stellt auch für Patienten, die zunächst die StäB-Einschlusskriterien nicht erfüllen, eine Möglichkeit der Behandlung im Anschluss an eine gewisse Stabilisierung dar.
The German mental health system has several peculiarities compared to its international counterparts. It shows a surprising amount of heterogeneity, as a variety of payers and care providers interact on the basis of a broad set of legal standards. This narrative review presents the historical background, current organizational aspects, several open questions, and future perspectives. It assumes that there is a need for future care concepts that overcome sector borders, observe the need for coordination and quality indicators, take into account the need for trialogic concepts (users, family, and professionals), reflect on human rights and ethical principles, and consider the need for prevention. © 2018, Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.
Im Herbst 2015 ist die Psychiatrie-Enquete 40 Jahre alt geworden, die umfassende Verbesserungen bei der Versorgung psychisch Kranker hervorbrachte. Heute blicken wir auf eine breit gefächerte psychiatrische Versorgungslandschaft, getragen durch umfängliche ambulante Dienste, teilstationäre und stationäre Einrichtungen darunter zahlreiche psychiatrische Abteilungen an Allgemeinkrankenhäusern als auch Angebote für die Bereiche Wohnen, Arbeit und Freizeit. Die psychiatrische Versorgung ist ein wichtiger Teil der gesamten gesundheitlichen Versorgung. Eine wichtige Brückenfunktion in die somatische Medizin hat die Konsiliarpsychiatrie inne: schwere körperliche Krankheiten gehen regelhaft mit psychischen Reaktionen einher, die Domäne des Konsiliarpsychiaters ist deren Abklärung und Therapie. Obgleich sich die Prävalenz psychischer Erkrankungen in Deutschland im Verlaufe der letzten Jahre nicht verändert hat, ist die bevölkerungsmedizinische Relevanz in verschiedenen Bereichen deutlicher geworden. Psychische Störungen bilden mittlerweile die zweitwichtigste Krankheitsgruppe bei der Arbeitsunfähigkeit. Im Bereich der beruflichen Teilhabe zeigt sich dies v. a. durch den steigenden Anteil an Frühberentungen aufgrund psychischer Erkrankungen. Gerade für Menschen mit chronischen psychischen Erkrankungen hat das Versorgungssystem spezielle Dienste z B. im Bereich des Wohnens oder der beruflichen Teilhabe hervorgebracht. Dennoch partizipieren die Betroffenen nicht immer in ausreichendem Maße am wissenschaftlichen Erkenntnisfortschritt. International gut evaluierte Modelle der mobilen ambulanten multiprofessionellen Versorgung als auch der beruflichen Rehabilitation bedürfen verstärkter Implementierung. Die UN-Behindertenrechtskonvention von 2006 fordert die volle und wirksame Teilnahme („participation“) und Teilhabe („inclusion“) von psychisch Kranken und Behinderten an allen Bereichen des gesellschaftlichen Lebens und unterstreicht die Zielvorgabe des vor 40 Jahren begonnenen Veränderungsprozess.
Psychiatrische Rehabilitation hat Teilhabe und Partizipation in der Gesellschaft als Ziel. Dazu gehören die Verbesserung psychischer Beeinträchtigungen und deren Auswirkungen auf das persönliche und gesellschaftliche Leben von Menschen mit psychischen Erkrankungen. Zudem geht es um die Förderung von Kompetenzen, um die Überwindung von Defizitorientierung hin zu einem Selbstverständnis der „Selbstbefähigung“ (Empowerment). Dies gelingt insbesondere in einem multidimensionalen, integrativen Konzept, welches Menschen mit psychischen Störungen die Partizipation an allen Bereichen öffentlichen Lebens ermöglicht (Bundesarbeitsgemeinschaft für Rehabilitation [BAR] RPK-Empfehlungsvereinbarung und Handlungsvereinbarungen für die praktische Umsetzung, 2011). In der personenzentrierten Perspektive können dabei medizinische, soziale und berufliche Rehabilitationsanteile weder zeitlich noch konzeptionell voneinander getrennt werden (Jäckel D, Hoffmann H, Weig W Praxisleitlinien Rehabilitation für Menschen mit psychischen Störungen. Psychiatrie-Verlag, Bonn, 2010), was sich aber leider bislang in Deutschland zu wenig in den sozialrechtlichen Realitäten widerspiegelt Stengler K, Brieger P, Weig W Psychiatr Prax 37: 206–207, 2010). Rehabilitative Überlegungen im Sinne der Teilhabeplanung sollten bei schweren psychischen Erkrankungen bereits in der Akutbehandlung beginnen und sind grundsätzlich als Teil jeder Behandlungsplanung zu fordern. Daraus folgt die Notwendigkeit eines psychiatrisch-psychotherapeutischen Versorgungskontinuums, das präventive, kurative und rehabilitative Elemente vereint.
Das psychiatrische, gesundheitliche Versorgungssystem bietet gegenüber seinem somatischen Pendant Besonderheiten. Immerhin macht die psychiatrische Gesundheitsversorgung etwa 15% des gesamten gesundheitlichen Versorgungssystems aus. Obwohl es seit langem erklärtes Ziel der Politik ist, Psychiatrie und Psychotherapie in die allgemeine Medizin zu integrieren, ist das nur in gewissem Umfang gelungen; die »Psycho«-Fächer behalten ihre Eigenheiten bis hin zu den finanziellen Grundlagen. Praxen von Psychiaterinnen und Psychiatern finden sich zwar neben Praxen von Radiologen, Allgemeinmedizinern usw., ärztliche und psychologische Psychotherapeuten haben ihre Praxen ebenfalls in den Stadtvierteln. Etwa das Gleiche kann man von psychiatrischen Tageskliniken sagen, soweit sie nicht in Kliniken inte griert sind. Nach wie vor ist jedoch die Hälfte der (gemeinde-)psychiatrischen Betten in eigenen Fachkrankenhäusern aufgestellt, die nicht notwendigerweise vor Ort sind. Vor allem Kliniken mit dem Auftrag Psychotherapie und Psychosomatik, ob sie nun der Akutversorgung oder der Rehabilitation dienen, sind häufig in ländlichen Regionen lokalisiert, nicht selten in landschaftlich reizvollen Gegenden. Eine wichtige Brückenfunktion in die somatische Medizin hat die Konsiliarpsychiatrie inne: schwere körperliche Krankheiten gehen regelhaft mit psychischen Reaktionen einher, die Domäne des Konsiliarpsychiaters ist deren Abklärung und Therapie. Fachlich ist eine Trennung in Akuttherapie und Rehabilitation zum Teil diffizil, am besten gelingt sie anhand der Kostenträger. Gerade für Menschen mit chronischen und wiederkehrenden psychischen Erkrankungen hat das Versorgungssystem spezielle Dienste hervorgebracht. So gibt es tausende Plätze im Betreuten Wohnen, z. T. in Heimen, z. T. in beschützten Wohngruppen oder in betreuten Einzelwohnungen. Ferner existiert eine erhebliche Zahl an Einrichtungen, die der Aufgabe gewidmet ist, Menschen mit chronischen psychischen Erkrankungen in Arbeit zu vermitteln, sie in Arbeit zu halten oder ihnen Beschäftigungen anzubieten. Von hier aus lässt sich die Verbindung leicht zu Diensten herstellen, die der weiteren soziokulturellen Partizipation der Betroffenen dienen. Die UNBehindertenrechtskonvention von 2006 fordert auch für psychisch Kranke und Behinderte u. a. die volle und wirksame Teilnahme (»participation «) und Teilhabe (»inclusion«) am gesellschaftlichen Leben.
Anliegen: Evaluation und Zusammenfassung der neueren Evidenz sowie Beurteilung des Stellenwerts von Tageskliniken im Versorgungssystem.
Methode: Systematischer Review der Evidenz zur Wirksamkeit und Kosteneffektivität tagesklinischer Behandlung im Vergleich zu stationärer und ambulanter Behandlung.
Ergebnisse: Die Evidenzlage ist nach wie vor unzureichend und widersprüchlich.
Schlussfolgerung: Tageskliniken stellen als Bindeglied zwischen stationärer und ambulanter Behandlung nach wie vor ein wichtiges Element der gemeindepsychiatrischen Versorgung dar, jedoch ist die Evidenz zur Effektivität und Kosteneffektivität im Vergleich zur stationären und ambulanten Behandlung weiterhin unklar.
Gruppenpsychotherapieforschung in einer psychiatrisch-psychotherapeutischen Tagesklinik ist mit einer Reihe von Problemen konfrontiert. Zugleich bietet sie aufgrund des gemeinsamen Denkraums von Klinikern und Forschern ein großes Potenzial, Gruppenpsychotherapien für eine große Klientel von Patienten theoretisch zu konzeptualisieren, praktisch umzusetzen und zu erforschen. Dies soll an einem Forschungsprojekt veranschaulicht werden, das mentalisierungsbasierte und psychodynamische Gruppenpsychotherapie in ein und derselben Tagesklinik miteinander vergleicht. Zunächst richten wir den Schwerpunkt auf die Adhärenz des manualisierten Vorgehens in beiden Gruppenpsychotherapien. Dann wird die Studie, in die unsere klinischen Überlegungen eingebettet sind, skizziert.
Objective:
Investigation of the clinical effectiveness of dialectical behavioral therapy in a day clinic setting (DBT-DC) for borderline personality disorders (BPD), and impact of medication and daily costs.
Methods:
In a prospective, naturalistic, open and uncontrolled design BPD patients were enclosed in a 12-week DBT-DC. This DBT-program was certified by the German network of DBT. We collected data from the Symptom Checklist (SCL-90), the Beck Depression Inventory (BDI) and the Borderline Symptom List 95 (BSL-95) in the first and at the end of the 11th week. The concomitant medication and its changes were described.
Results:
31 cases were included (9 drop-outs: 29 %). The average age was 33.3 years (18 - 52, SD = 10.6). 21 females and one male completed the program. There was no relationship between changes of BDI, SCL-90 and BSL-95 scores (p < 0.001) and medication (and its alteration). The BDI scores improved by 50.8 % (p < 0.001), the SCL-90 by 42.9 % (p < 0.01) and the BSL-95 by 48.4 % (p < 0.001). The power was 0.99 (α = 0.05), the effect size was 1.41. In our setting the daily costs showed a reduction of about 6500 € per case compared to an inpatient DBT. Medications played no significant role for improvement.
Conclusions:
For the first time a partial remission for BPD patients after 12 weeks has been shown to be achieved in a DBT-DC setting. DBT-DC reduces the primary costs of BPD compared to a specific inpatient therapy.
AIMS AND METHOD
We conducted a postal questionnaire survey of all psychiatric day hospitals in England to identify the range of aims, organisational structure and content of service provision.
RESULTS
Of 102 identified day hospitals, 77% responded to the questionnaire. The findings confirmed that there is great heterogeneity in English day hospital service provision. The function or aim with the highest mean rating was ‘ providing an alternative to in-patient care’, with 66% of day hospitals giving this a rating of great or greatest importance. However, the majority of respondents prioritised multiple roles, with many day hospitals aiming to provide acute and chronic care concurrently.
CLINICAL IMPLICATIONS
The label ‘day hospital’ covers a considerable range of community psychiatric services. The heterogeneity of service provision in existing day hospitals could lead to difficulties in generalising research findings on day hospital efficacy.
Fifty psychiatric patients attending a day hospital were asked at the beginning of their attendance what their expectations of treatment were. The same patients were asked how they saw their own treatment on discharge from the day hospital. A high degree of patient satisfaction was found and implications were discussed.
The authors reviewed published research that compared partial and full hospitalization as alternative programs for the care of mentally ill adults, with the goal of both systematizing the knowledge base and providing directions for future research.
Studies published since 1950 were obtained through manual and electronic searches. Results were stratified by outcome domain, type of measure used to report between-group differences (global, partial, or rate-based), and time of assessment. Effect sizes were computed and combined within a random-effects framework.
Eighteen investigations published between 1957 and 1997 were systematically reviewed. Over half of eligible patients were excluded a priori; diagnostic severity of enrollees varied widely. On measures of psychopathology, social functioning, family burden, and service utilization, the authors found no evidence of differential outcome in the selected patient population admitted to the studies reviewed. Rates of satisfaction with services suggested an advantage for partial hospitalization within 1 year of discharge, with the gap being largest at 7-12 months.
Although partial hospitalization is not an option for all patients requiring intensive services, outcomes of partial hospitalization patients in these studies were no different from those of inpatients. Further, patients and families were more satisfied with partial hospitalization in the short term. Weaknesses of the studies limited the scope of our inquiry and the generalizability of findings. Positive findings require replication under the present circumstances of mental health care, and more research is needed to identify predictors of differential outcome and successful partial hospitalization. A clearer definition of partial hospitalization will help consolidate its role in the continuum of mental health services.
This paper describes a day treatment program that provides predominantly cognitive-behavioral therapy for a heterogeneous group of patients. Preliminary results of the program are also presented. Assessment tools included the Beck Depression Inventory, the Symptom Checklist, and a questionnaire on changes in social life. Instruments were administered at admission, at discharge, and six months after discharge. The patients showed significant improvement in scores on all instruments at discharge. Improvements were stable after six months for all diagnostic categories-depression, eating disorders, and personality disorders. The program shows promise as an effective treatment approach for patients with various psychiatric diagnoses.
As the use of "day hospitals" increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e.g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care.
Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001--2002.
Response rates varied from 52 to 91 %. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital's statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries.
Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.
Zusammenfassung
Die Inanspruchnahme psychiatrischer und psychotherapeutischer Leistungen hat in der letzten Dekade erheblich zugenommen, am besten zu erkennen an der früher aus der Sicht der Patienten hoch problematischen Leistung „stationär psychiatrische Behandlung”. Im Jahr 2001 wurden mehr als 800 000 Patienten stationär behandelt, das entspricht gegenüber 1980 etwa einer Verdoppelung. Die Besonderheit des deutschen Systems wird durch eine hohe Bettenmessziffer von mehr als einem Bett pro 1 000 Einwohner dokumentiert, ferner durch die Redundanz aus stationärer Akutpsychiatrie, stationärer psychotherapeutischer Akutmedizin einerseits und stationärer psychiatrischer bzw. psychosomatischer Rehabilitation andererseits, während gleichzeitig ein gemeindenahes psychiatrisches Verbundsystem aus komplementären Einrichtungen und Diensten im Betreuten Wohnen, in bestimmten Tageskliniken, psychiatrischen Institutsambulanzen, Selbsthilfe- und anderen Firmen und sozialpsychiatrischen Diensten unabhängig davon geschaffen wurde. Ähnlich verhält es sich mit den ambulanten Leistungen, die als Standardversorgung, als Psychotherapie und als Komplexleistungen sich zumindest teilweise überlappen und redundant vorgehalten werden.
Anliegen: Bislang sind zur akutpsychiatrischen Tagesklinikbehandlung weltweit nur fünf Studien in einem randomisierten kontrollierten Design vorgelegt worden, die in Gegenüberstellung zur vollstationären Behandlung einen Vergleich direkter Versorgungskosten vornehmen. Für den deutschen Sprachraum soll diese Forschungslücke durch die vorliegende Arbeit geschlossen werden. Methode: An der Psychiatrischen Universitätsklinik Dresden konnten 191 Patienten in eine weitere solche Studie eingeschlossen werden. Die Inanspruchnahme von Versorgungsleistungen wurde zu drei Untersuchungszeitpunkten (Aufnahme, Entlassung, drei Monate nach Entlassung) mit dem Client Service Receipt Inventory erfasst. Basierend auf den in einem gesonderten regionalen Kostenkalkulationsprojekt ermittelten Daten, konnten individuelle „Versorgungspakete” berechnet werden. In die Intention-to-treat-Analyse wurden 144 Patienten (Tagesklinik: n = 75, Station: n = 69) mit vollständigen Daten zu allen Untersuchungszeitpunkten einbezogen. Berechnet wurden Kostenmittelwerte (in Euro umgewandelte DM-Angaben aus dem Jahr 2000), die im Gruppenvergleich mittels t-Test und Bootstrapverfahren analysiert wurden. Zudem erfolgten eine Missing-Analyse sowie eine Sensitivitätsanalyse der ermittelten durchschnittlichen Kostensätze für einzelne Versorgungsleistungen. Ergebnisse: Patienten im tagesklinischen Setting führten mit durchschnittlich 12 401 € pro Person im untersuchten Gesamtzeitraum um 22,1 % geringere Kosten herbei als vollstationär behandelte Patienten (15 924 €). Selektionseffekte durch die nicht zu allen Zeitpunkten erfassten Studienteilnehmer fanden sich nicht. Als die sensitivsten Größen für die Aufrechterhaltung der Signifikanz der Mittelwertsunterschiede erwiesen sich die Kosten für die stationäre und tagesklinische Behandlung. Schlussfolgerung: Die Studie belegt, dass akutpsychiatrische tagesklinische Behandlung - bei vergleichbarer klinischer Effektivität - kostengünstiger ist als die vollstationäre Versorgung.
In this study, the author employs observations from a psychiatric day unit in an analysis of regularly occurring forms of ‘professional talk’. Considerable staff time is scheduled for such talk, which must be considered as part of the health professional's work. Much of the talk which occurs may be analysed as having ‘technical’ significance in programming staff to behave appropriately towards different patients, so as to maximize the effectiveness of hospital treatment. Very much more time than is technically necessary, however, is devoted to talking about patients. Rather than seeing this ‘superfluity’ of talk as an indication of inefficiency within the system, the author examines its functions in maintaining the social structure of the unit and meeting the personal needs of the staff. This appears to be of particular importance against the background (common to many psychiatric settings) of staff-patient and interdisciplinary role ambiguity, high patient chronicity, and the absence of many of the structural and symbolic ‘props’ of a conventional hospital. This ‘excess talk’ is expensive in terms of professional time, and takes time away from direct patient contact. None the less, it may be a necessary cost if staff are to continue to pursue therapeutic goals within a deliberately ‘informal’ psychiatric setting.
Electronic absorption spectra have been measured by diffuse reflectance for MgUO4−x, MgU3O9, CaUo)4−x, Ca2UO5, Ca3UO6, Ca2U3O11, CaU2O7, CaU4O12, SrUO3, SrUO4, SrUO3.67, Sr2U3O11, SrU4O12.8, Sr2UO5, Sr3UO6, BaUO4, Ba3UO6, BaU2O7, Ba2U2O7 and Ba2U3O11.
Measurements in the near i.r. region of the spectrum have identified transitions arising within the manifold of the 5f electronic levels which indicate the presence of uranium(V) in certain compounds. The portion of the spectrum between 20 000 and 30 000 cm−1 is shown to contain charge-transfer transitions and, in certain instances, vibrational progressions which are characteristic of the symmetry of the UO6 octahedron in the solid state structure.
This study examined the ability of seven patient characteristics to predict success (remaining, benefiting) in a day treatment program for psychiatric outpatients. The sample consisted of 165 patients, most with affective and personality disorders, who participated in an intensive psychodynamically and group-oriented program within a controlled clinical trial. Two patient personality characteristics (psychological mindedness, quality of object relations) emerged as the strongest predictors. Other variables that contributed to the predictions, either singly or in an interaction with quality of object relations, were age, marriage, presence of a personality disorder, and previous psychiatric hospitalization. The patient's initial level of symptomatic disturbance was not a significant predictor. The advantage of using predictors that are relevant to the theoretical and technical orientation of a program is emphasized.
The outcome of a day treatment program for psychiatric outpatients with affective and personality disorders was evaluated. The program was dynamically oriented, intensive, group focused, and time limited (18 weeks).
The prospective trial used a randomized treatment-versus-control (delayed-treatment) design to examine 17 outcome variables covering five areas: interpersonal functioning, symptomatology, self-esteem, life satisfaction, and defensive functioning. Those variables, plus individualized treatment objectives, were monitored before and after the treatment and control periods and at follow-up an average of eight months later.
Treated patients showed significantly better outcome than control patients for seven of the 17 outcome variables: social dysfunction, family dysfunction, interpersonal behavior, mood level, life satisfaction, self-esteem, and severity of disturbance associated with individual goals of treatment as rated by an independent assessor. The findings could not be accounted for by diagnosis or use of medication. Benefits were maintained over the follow-up period. The average treatment-versus-control effect size for all 17 variables was .71.
The study supports the efficacy of an intensive day treatment program for patients who manifest significant difficulties associated with affective and personality disorders.
The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program.
The patients (N = 197) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient, day hospital, and outpatient services provided by the CMHC.
On average, the day hospital/crisis respite program cost less than inpatient hospitalization. The average saving per patient was +7,100, or roughly 20% of the total direct costs. There were no significant differences between programs in service utilization or costs during the follow-up phase. Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorders, and dual diagnoses; psychotic patients had the highest costs in both programs. The two programs had roughly equal direct service staff and capital costs but significantly different operating costs (day hospital/crisis respite operating costs were 51% of inpatient hospital costs).
The programs were equally effective, but day hospital/crisis respite treatment was less expensive for some patients. Potential cost savings are higher for nonpsychotic patients. Cost differences between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service staff costs in the two programs may be an important clue for understanding why these programs provided equally effective acute care.
This paper describes a successful day treatment program that provides four months of intensive psychodynamic group-oriented milieu treatment for patients with long-standing personality disorders, who commonly experience recurrent major depression, dysthymia, and excessive anxiety. The authors outline three factors that have contributed to the success of the program--optimal treatment-patientmatching, judicious use of authority in milieu therapy, and careful attention to maintaining close working relationships with referral sources. They provide an overview of the historical evolution of day treatment programs from earlier day hospital model to show day programs' neglect of these factors may have led to treatment failures. Such failures may have spurred recent suggestions that psychiatric day treatment programs should be replaced entirely by assertive community treatment. The authors argue that such a move could amount to abdication of psychiatry's responsibility to provide intensive milieu treatment that can be effectively offered only on a day treatment basis.
This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder.
Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend.
Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced inpatient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months.
Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.
The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period.
Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment.
Patients who completed the partial hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period.
The superiority of psychoanalytically oriented partial hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.
Day treatment, a form of partial hospitalization, may have unique advantages in the care of patients with personality disorders. It appears to offer a favorable level of intensiveness and containment, thus facilitating treatment of the chronic emotional and behavioral difficulties experienced by these individuals. Although several authors have written about the appropriateness of day treatment for personality disorder patients, empirical support has been slow to accumulate. More recently, greater research attention has been focused on this question. This review examines the current research. The findings suggest that day treatment is effective for this difficult patient population and that it is more effective than standard treatment (i.e., medication and support). Preliminary evidence indicates that day treatment may lead to a reduction in future health-services costs. Some findings also show that day treatment may be particularly beneficial for certain patients-for example, those who are more psychologically minded. Implications of these findings for clinical practice are considered. Limitations in our current approach to research in this area are highlighted, and recommendations for future study are provided.
Psychiatric day hospitals offer care that is less restrictive than in-patient care but more intense than out-patient care. Day hospitals can be used to provide more intense/specialised care to treatment-resistant out-patients (day treatment programmes) or to long-term patients (day care centres). They can also bridge the gap between in-patient and out-patient care (transitional day hospitals). This review compared day hospital care (in day treatment programmes, day care centres and transitional day hospitals) to out-patient care. Overall there was insufficient evidence to determine whether any of the three types of day hospital care had substantial advantages over out-patient care.
Day hospitals are a less restrictive alternative to inpatient admission for people who are acutely and severely mentally ill. This review compares acute day hospital care to inpatient care. It was found that at least one in five patients currently admitted to inpatient care could feasibly be cared for in an acute day hospital. The psychiatric symptoms of inpatients deemed suitable for acute day care appeared to improve more quickly than if the person had been cared for as an inpatient. Day hospital care was also less expensive than inpatient care.
Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care.
This study focuses on a 4 1/2-year prospective assessment of normative needs for care in a cohort (initially N = 115) living in the Dresden care region (Germany). At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS).
The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of "unmeetable needs" increased. Consistently, 70-80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities. Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 4 1/2-year community treatment.
The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.
So far only five randomized controlled trials on acute day hospital care have assessed direct health care costs and compared these with costs of conventional inpatient treatment. This paper aims to close this research gap for German speaking countries.
Another trial was conducted at the Department of Psychiatry and Psychotherapy, Dresden University of Technology. Using the Client Service Receipt Inventory interviews with patients at three time-points (admission, discharge, three months after discharge) assessed their utilization of health care services. Based on the results of a separate regional cost-calculation project, costs of individual care packages could be calculated. 144 patients (day care: n = 75, inpatient care: n = 69) with complete data sets for all time-points of assessment were included in the intention-to-treat-analysis. Means of direct costs (given in Euro and referred to Deutsche Mark prices in 2000) were computed, and t-tests and bootstrap-procedures were used for group comparison. Furthermore, missing and sensitivity analyses were conducted.
Patients in the acute day hospital caused mean direct health care costs of 12 401 per person within the entire period assessed. Thus, their cost level falls below the mean costs of inpatient care (15,924 euro per person) by 22.1 %. Missing analyses showed no selection effects on cost results caused by patients who could not be assessed at all defined time-points. Costs for inpatient and day care services were the most sensitive parameters for maintaining the statistically significant differences of cost means demonstrated between the two study groups.
For German-speaking countries, this study shows for the first time that acute day care -- which has been demonstrated to be clinically at least as effective as inpatient care - is the less expensive option if these two settings are comparatively assessed.
Acute psychiatric day care has been proposed as an alternative to conventional inpatient care, yet the evidence of its effectiveness is inconsistent and based only on single-site studies in 3 countries. The aim of this multicenter randomized controlled trial was to establish the effectiveness of acute day hospital care in a large sample across a range of mental health care systems.
The trial was conducted from December 2000 to September 2003 in 5 European countries, with a sample of 1117 voluntarily admitted patients. Immediately before or very shortly after admission to the participating psychiatric facilities, patients were randomly allocated to treatment in a day hospital or an inpatient ward. Psychopathology, treatment satisfaction, subjective quality of life, and social disabilities were assessed at admission, at discharge, and 3 and 12 months after discharge. An intention-to-treat analysis was conducted using fixed-effects linear models with structured error covariance matrices and covariates.
Day hospital care was as effective as conventional inpatient care with respect to psychopathologic symptoms, treatment satisfaction, and quality of life. It was more effective on social functioning at discharge and at the 3- and 12-month follow-up assessments.
This study, which has more than doubled the existing evidence base, has shown that day hospital care is as effective on clinical outcomes as conventional inpatient care and more effective on social outcomes.
ClinicalTrials.gov identifier NCT00153959.
This study evaluated the effect of mentalization-based treatment by partial hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete.
Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data.
Five years after discharge from mentalization-based treatment, the mentalization-based treatment by partial hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of medication (0.02 versus 1.90 years taking three or more medications), global function above 60 (45% versus 10%), and vocational status (employed or in education 3.2 years versus 1.2 years).
Patients with 18 months of mentalization-based treatment by partial hospitalization followed by 18 months of maintenance mentalizing group therapy remain better than those receiving treatment as usual, but their general social function remains impaired.
Aspekte einer aktuellen Bestandsaufnahme psychiatrisch-tagesklinischer Arbeit in Deutschland
- E Diebels
- V Tschuschke
- C Benz
Aktuelle Probleme bei der Begutachtung tagesklinischer Behandlung aus Sicht des MDK Nordrhein. 5. Jahrestagung der Deutschen Arbeitsgemeinschaft Tageskliniken PsychiatriePsychotherapiePsychosomatik am 15.03.07 in Weimar
- B Treeck
- Van
Psychiatrie und Psychotherapie in der Tagesklinik
- B Eikelmann
- T Reker
Direct costs of acute day hospital care: results from a randomized controlled trial
- T W Kallert
- R Schönherr
- S Schnippa
- Kallert
Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial
- F Creed
- P Mbaya
- S Lancashire
- Creed