Metacognitive training in the acute psychiatric care setting: feasibility, acceptability, and safety

Patients on acute psychiatric wards desire more psychosocial treatment than they receive, according to recent studies, but evidence-based interventions tailored to this setting are currently lacking. Metacognitive Training for psychosis (MCT) is a flexible, easy-to-administer group therapy that has been adapted to meet this demand (MCT-Acute). Thirty-seven patients with severe mental illness took part in MCT-Acute twice a week during their stay on a locked acute ward and were interviewed before, during, and after the intervention period regarding subjective utility, subjective adverse events, and symptom severity; attendance rates and reasons for absence were recorded. In addition, staff rated adverse events, symptom severity, and functioning (German Clinical Trial Register ID: DRKS00020551). Overall, most patients evaluated MCT-Acute positively and reported symptom stabilization. Staff also reported improvement in functioning. No clinician-rated adverse events related to participation in MCT-Acute were reported. Conducting MCT-Acute is feasible and safe and may contribute to meeting patients’, practitioners’, and researchers’ demands for more evidence-based psychotherapeutic interventions for the acute psychiatric care setting.Clinical Trial RegistrationID: DRKS00020551, https://drks.de/search/de/trial/DRKS0002055

Service users’ perceptions of relevant and helpful components of an integrated care concept (ACCESS) for psychosis

IntroductionPsychotic disorders have a significant impact on patients’ lives and their families, and long-term treatment with individually tailored multimodal combinations of therapies is often required. Integrated care (IC) concepts such as the “Hamburg Model (ACCESS)” with a focus on psychotic disorders, includes different (therapeutic) components with pharmaco- and psychotherapy, family involvement, home treatment and the option of using a 24/7 crisis hotline. All components are offered by a therapeutically-oriented assertive community treatment (TACT) team in a need-adapted manner. So far, however, little is known about which specific components are regarded as especially relevant and helpful by the users of IC.MethodsPatients currently participating in IC completed a questionnaire as part of the continuous quality assurance study (ACCESS II) in which they were asked to rate the different components of treatment according to their relevance and helpfulness, considering the individual’s unique experiences with IC and needs in mental health care. Furthermore, they were asked to make suggestions regarding additional helpful components of treatment.ResultsFifty patients participated in this survey (23% of the patients currently participating in the IC concept). For participants, the most helpful and important factors were having the same therapist in the long-term and the 24/7 crisis telephone. Additional components suggested by patients included more addiction-specific therapies and increased focus on vocational rehabilitation and integration.ConclusionFrom the perspective of the users of IC, long-term care from a trusted therapist with whom there is a therapeutic relationship and the possibility to reach someone they already know from the TACT team 24/7 serves as the best basis for effective care, fostering trust, understanding, and open communication. In contrast, home treatment remains a relevant aspect of evidence-based care for people with severe mental illness, but perhaps surprisingly, is not viewed as the most important issue

Health-related quality of life in family caregivers of autistic adults

IntroductionFamily members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers’ HRQoL.MethodsN = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers’ HRQoL.ResultsFamily caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen’s d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen’s d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05).DiscussionFindings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers’ HRQoL

Stronger Neural Modulation by Visual Motion Intensity in Autism Spectrum Disorders

Theories of autism spectrum disorders (ASD) have focused on altered perceptual integration of sensory features as a possible core deficit. Yet, there is little understanding of the neuronal processing of elementary sensory features in ASD. For typically developed individuals, we previously established a direct link between frequency-specific neural activity and the intensity of a specific sensory feature: Gamma-band activity in the visual cortex increased approximately linearly with the strength of visual motion. Using magnetoencephalography (MEG), we investigated whether in individuals with ASD neural activity reflect the coherence, and thus intensity, of visual motion in a similar fashion. Thirteen adult participants with ASD and 14 control participants performed a motion direction discrimination task with increasing levels of motion coherence. A polynomial regression analysis revealed that gamma-band power increased significantly stronger with motion coherence in ASD compared to controls, suggesting excessive visual activation with increasing stimulus intensity originating from motion-responsive visual areas V3, V6 and hMT/V5. Enhanced neural responses with increasing stimulus intensity suggest an enhanced response gain in ASD. Response gain is controlled by excitatory-inhibitory interactions, which also drive high-frequency oscillations in the gamma-band. Thus, our data suggest that a disturbed excitatoryinhibitory balance underlies enhanced neural responses to coherent motion in ASD

Differenzierung dementieller Erkrankungen durch Kombination verschiedener Parameter im Liquor

Die Proteine des cerebrospinalen Liquors können die neuropathologischen Veränderungen des Gehirns widerspiegeln und zur Diagnostik dementieller Erkrankungen verwendet werden. Die vorliegende Arbeit hatte zum Ziel, erstens, die Sensitivität und Spezifität der Biomarker im Liquor bei der Alzheimer Demenz und den anderen differentialdiagnostisch in Betracht kommenden Erkrankungsgruppen in der Einzelparameteranalyse zu messen und zweitens, diese mit den Ergebnissen der Kombination der verschiedenen Parameter zu vergleichen um eine mögliche Verbesserung der Ergebnisse herauszufinden. Die Parameter wurden mit der multivariaten Diskriminanzanalyse kombiniert und so die aussagekräftigsten Biomarker herausgefunden. Sowohl in der Einzelparameteranalyse, wie auch bei der Kombination der Parameter, wurden die Gruppenvergleiche durch Vergleich einer Patientengruppe versus alle anderen Gruppen (also demente und nichtdemente Patienten, zusammengefasst in einer Vergleichsgruppe) durchgeführt um ein möglichst realitätsnahes Vorgehen zu bewirken. Hierbei wurden wichtige differentialdiagnostisch in Frage kommende Erkrankungen, wie MCI, vaskuläre und gemischte Demenzen, sowie Depressionen ausgewählt. Zusätzlich wurde eine Kontrollgruppe mit Patienten, die nichtdementielle neurologische Erkrankungen hatten, miteinbezogen. Es zeigte sich eine Verbesserung der differentialdiagnostischen Zuordnung durch Kombination der oben ausgewählten Parameter. Die geringen Fallgrößen und der aufgrund der mangelnden Liquorvolumenproben notwendig gewordene Ausschluss der Depressionsgruppe und des Phospho-Taus in der Diskriminanzanalyse lassen jedoch nur eine tendentielle Aussage zu. Die Ergebnisse geben jedoch einen hoffnungsvollen und richtungsweisenden Ansatz in der Verbesserung der differentialdiagnostischen Möglichkeiten dementieller Erkrankungen, um mit einer größeren Fallzahl an Patienten genauere Aussagen treffen zu können

Sexualität bei Menschen mit Autismus-Spektrum-Störung und ihre Bedeutung für die forensische Psychiatrie und Psychotherapie

Menschen mit einer Autismus-Spektrum-Störung zeigen die gesamte Vielfalt sexueller Fantasien und sexuellen Verhaltens ebenso wie ihre nichtbetroffenen Peers. Dennoch finden sich auch einige Besonderheiten in sexuellem Erleben und Verhalten bei Menschen mit einer Autismus-Spektrum-Störung, die größtenteils auf die störungsspezifischen Symptome zurückzuführen sind. Hierzu zählen eine höhere Diversität bezüglich der eigenen sexuellen Orientierung sowie des eigenen Geschlechtsrollenverständnisses, aber auch Probleme im Hinblick auf das Eingehen von festen Partnerschaften oder im Hinblick auf die eigene sexuelle Funktionsfähigkeit. Darüber hinaus finden sich bei manchen Personen mit einer Autismus-Spektrum-Störung (insbesondere bei Männern) Hinweise auf das Vorliegen hypersexueller Verhaltensweisen sowie paraphiler sexueller Fantasien und Verhaltensweisen. Bisher existieren keine empirischen Befunde, die nahelegen, dass eine Autismus-Spektrum-Störung einen Risikofaktor für allgemeine oder sexuelle Straffälligkeit darstellt. Basierend auf Fallstudien wurden jedoch einige Erklärungsansätze publiziert, die beschreiben, wie in einigen wenigen Fällen die autismusspezifische Symptomatik mit zu der Begehung einer Straftat beigetragen haben könnte, was auch bei der Schuldfähigkeitsbegutachtung Berücksichtigung finden könnte. Hierzu zählen eine fehlende Opferempathie, das Vorliegen kognitiver Verzerrungen oder defizitäre Kommunikations- und Interaktionsfertigkeiten. Straftäter mit einer Autismus-Spektrum-Störung sollten individuell auf sie zugeschnittenen psycho- und pharmakotherapeutischen Interventionen zugeführt werden, um eine erneute Straffälligkeit im besten Falle zu verhindern

Sexual Dysfunctions and Their Association with the Dual Control Model of Sexual Response in Men and Women with High-Functioning Autism

Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual Control Model of Sexual Response presents one approach that is frequently used to explain the emergence of sexual dysfunctions. The aim of the present study was to assess the extent of symptoms of sexual dysfunctions in men and women with ASD and to evaluate their association with the individual propensity of sexual excitation and inhibition as defined by the Dual Control Model. Both men and women with ASD were more likely to report about sexual dysfunctions than individuals from the control group. In men with ASD, sexual inhibition was significantly correlated with the emergence of sexual dysfunctions, while there was no association between sexual functioning and sexual excitation. In women, the opposite pattern was found. Especially the peculiarities in sensitive perception could be responsible for the observed problems with sexual functioning in individuals with ASD. The present findings highlight the great need for specialized treatment programs addressing the frequently observed sexuality-related problems in individuals with ASD. However, up to now such treatment programs are lacking

Initialising customer-orientated digital transformation in enterprises

Digitisation forms a part of Industrie 4.0 and is both threatening, but also providing an opportunity to transform business as we know it; and can make entire business models redundant. Although companies might realise the need to digitise, many are unsure of how to start this digital transformation. This paper addresses the problems and challenges faced in digitisation, and develops a model for initialising digital transformation in enterprises. The model is based on a continuous improvement cycle, and also includes triggers for innovative and digital thinking within the enterprise. The model was successfully validated in the German service sector

Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency

Purpose of review: Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. Recent findings: Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P = 0.001) and functioning (P = 0.01), quality of life (P = 0.01), adherence (P <0.05) and patient's satisfaction (P = 0.01), and reduction of caregiver's stress (P < 0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. Summary: There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions

Effectiveness of aripiprazole once-monthly in schizophrenia patients pretreated with oral aripiprazole: a 6-month, real-life non-interventional study

Abstract Background In this study, the treatment of schizophrenia patients with aripiprazole once-monthly (AOM) was evaluated under real-life conditions in a naturalistic setting. Methods This multicenter, prospective, non-interventional study included 242 patients (age = 43.1 ± 15.1 years, 55.0% male) who were monitored during 6 months of AOM treatment. Endpoints included measurements of psychopathology (Brief Psychiatric Rating Scale, BPRS) and severity of illness scales (Clinical Global Impressions-Severity, CGI-S, and -Improvement, CGI-I). Furthermore, treatment-related adverse events (TRAEs) were recorded. Results At baseline, the mean BPRS total score was 54.1 ± 15.6, the mean CGI-S was 4.8 ± 0.8 and the most frequent illness category was ‘markedly ill’ (41.7%). Patients had been pretreated with oral aripiprazole for a mean duration of 9.7 months (SD: 22.3) and 87.9% were deemed by their clinician as “clinically stable” and for a mean of 5.9 months. The difference in global BPRS after 6 months was − 13.8 (SD: 16.0; 95% CI: [− 15.9; − 11.7]; p < 0.001). The proportion of patients with high CGI-S scores decreased and the proportion of patients with low scores increased significantly (p < 0.001, respectively). BPRS scores improved numerically especially well in younger patients ≤35 years, CGI-S scores decreased significantly more in this population. TRAEs were rare, with low incidences of extrapyramidal symptoms (2.9%) or weight increase (0.4%). Conclusions Treatment with AOM showed satisfying effectiveness in outpatients with further improvement of psychopathology after oral aripiprazole treatment for a considerable duration and even after having achieved clinically judged “stability”. Our findings indicate a robust therapeutic effect of AOM and substantiate previous results from randomized controlled trials under real-world routine conditions