Auditing Clinical Outcomes after Introducing Off-Licence Prescribing of Atypical Antipsychotic Melperone for Patients with Treatment Refractory Schizophrenia

Aims and Method. To evaluate the practical utility of off-licence prescribing and clinical outcomes of treatment with atypical antipsychotic Melperone. Method: Prospective data collection on patient's clinical characteristics and outcomes. Results. 17 patients with a diagnosis of refractory schizophrenia were identified as suitable for off-license prescribing of Melperone and commenced treatment (13 were previously treated with Clozapine). Seven of those currently remain on Melperone (41%), and for six patents, the BPRS symptom scores reduced significantly over time (24–61%) additionally patients displayed improvements of their quality of life. Six patients were discontinued due to noncompliance and/or side effects. Melperone was ineffective in the other four patients. Clinical Implications. The example of a small group of patients responding well to a comparably safe and inexpensive atypical antipsychotic with favourable side effect profile should encourage clinicians to use this tool as third-line treatment and to conduct more systematic clinical research

Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia - a multi-centre randomised controlled trial

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Tierarten und Großpilze der Lebensraumtypen des Anhangs I der FFH-Richtlinie

Die Zusammenstellung der Liste der charakteristischen Tierarten erfolgte analog der vom LAU (2002) geschilderten Vorgehensweise. Inzwischen konnten durch die vom LAU in den FFH-LRT Sachsen-Anhalts durchgeführten intensiven faunistischen Untersuchungen ein besseres Bild der charakteristischen und regional typischen Artengemeinschaften vermittelt werden. Allerdings stehen für einige der neu aufgenommenen FFH-LRT solche Untersuchungen noch aus. Deshalb werden hier in naher Zukunft verstärkte Anstrengungen nötig sein, die Wissenslücken zu schließen

Methodik

Die vegetationskundliche und strukturelle Zuordnung der Lebensraumtypen erfolgt nach der vorrangig von Braun-Blanquet entwickelten Vegetationsklassifizierung, einer hierarchischen Gliederung der Vegetationstypen (Syntaxonomie), die die Ebenen der Assoziation, des Verbandes, der Ordnung und der Klasse umfasst. Hierbei ist die Assoziation die grundlegende Einheit, in der die Pflanzengesellschaften zusammengefasst werden, die sich durch gleiche charakteristische Arten(gruppen)kombinationen auszeichnen. Der Verband vereinigt ähnliche Assoziationen. Das sind bereits umfassendere, jedoch standörtlich noch recht einheitliche Vegetationseinheiten. In Ordnungen werden ähnliche Verbände zusammengefasst. Die Klasse vereinigt ähnliche Ordnungen

Le modèle théorique et les principes/mécanismes d’une psychothérapie intégrative axée sur le corps dans les cas de troubles somatoformes

Zusammenfassung Ausgehend von den in phänomenologischer Hinsicht zu beschreibenden spezifischen Störungen des Körpererlebens und Körperbezugs bei Patienten mit sog. somatoformen Störungen wird eine manualisierte, körperpsychotherapeutische Gruppentherapie entwickelt (KPT). Die KPT bietet einen störungs-spezifischen, syndromorientierten Zugang und fokussiert zunächst auf das Erklärungsmodell der Patienten eines “dysfunktionalen Körpers”. Der Therapeut versucht nicht, das Erklärungsmodell des Patienten zu ersetzen, sondern dieses mit zusätzlicher, neuer, teils auch widersprüchlicher Evidenz anzureichern, zu erweitern und komplettieren; erreicht wird dies durch ein Navigieren fort von einem einseitig auf den symptomatischen Körper ausgerichteten Wahrnehmungs-Fokus hin zu einem bio-psycho-sozialen Modell psychosomatischer Erkrankung. Die Grundzüge und Prinzipien der KPT-Interventionsstrategie werden vorgestellt.Schlüsselwörter Somatoforme Störung, medizinisch nicht erklärbare Symptomatik, KörperpsychotherapieAbstract Based upon phenomenological findings regarding a range of disturbed body experiences in somatoform disorder, a manualised body oriented psychological group therapy (BPT) was developed specifically for patients with medically unexplained symptoms. BPT offers a novel disorder specific and syndromatic intervention strategy for these patients, focusing initially on the explanatory model of „dysfunctional bodies“. The therapist works towards enriching and complementing this model, adding new and at times even contradictory evidence from a range of body related observations, perceptions and feelings. This is achieved through careful steering away the attentional focus from monocausal attribution of worrying somatic clues to a more complex bio-psycho-social model of psychosomatic disease. Theoretical and practical principles of BPT for the treatment of somatoform disorders are presented. Keywords Somatoform disorder, medically unexplained symptoms, body psychotherapyZusammenfassung Ausgehend von den in phänomenologischer Hinsicht zu beschreibenden spezifischen Störungen des Körpererlebens und Körperbezugs bei Patienten mit sog. somatoformen Störungen wird eine manualisierte, körperpsychotherapeutische Gruppentherapie entwickelt (KPT). Die KPT bietet einen störungs-spezifischen, syndromorientierten Zugang und fokussiert zunächst auf das Erklärungsmodell der Patienten eines “dysfunktionalen Körpers”. Der Therapeut versucht nicht, das Erklärungsmodell des Patienten zu ersetzen, sondern dieses mit zusätzlicher, neuer, teils auch widersprüchlicher Evidenz anzureichern, zu erweitern und komplettieren; erreicht wird dies durch ein Navigieren fort von einem einseitig auf den symptomatischen Körper ausgerichteten Wahrnehmungs-Fokus hin zu einem bio-psycho-sozialen Modell psychosomatischer Erkrankung. Die Grundzüge und Prinzipien der KPT-Interventionsstrategie werden vorgestellt.Schlüsselwörter Somatoforme Störung, medizinisch nicht erklärbare Symptomatik, KörperpsychotherapieAbstract Based upon phenomenological findings regarding a range of disturbed body experiences in somatoform disorder, a manualised body oriented psychological group therapy (BPT) was developed specifically for patients with medically unexplained symptoms. BPT offers a novel disorder specific and syndromatic intervention strategy for these patients, focusing initially on the explanatory model of „dysfunctional bodies“. The therapist works towards enriching and complementing this model, adding new and at times even contradictory evidence from a range of body related observations, perceptions and feelings. This is achieved through careful steering away the attentional focus from monocausal attribution of worrying somatic clues to a more complex bio-psycho-social model of psychosomatic disease. Theoretical and practical principles of BPT for the treatment of somatoform disorders are presented. Keywords Somatoform disorder, medically unexplained symptoms, body psychotherap

Novel primary care treatment package for patients with medically unexplained symptoms: a cohort intervention study

Background: Existing care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes. Aim: To explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation. Design & setting: Prospective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service Method: The care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed. Results: In total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs. Conclusion: The primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package

Group body psychotherapy for the treatment of somatoform disorder - a partly randomised-controlled feasibility pilot study

Abstract Background Clinical outcomes for patients with heterogeneous somatoform disorder (bodily distress disorder, including medically unexplained symptoms) are suboptimal, new treatments are required to improve acceptance. Body-oriented psychological therapy approaches have been identified as potentially beneficial additions to the portfolio of treatments. This study was aiming to assess the acceptability, the potential benefits, and associated change processes of manualised group body psychotherapy (BPT) for outpatients with Somatoform Disorder. Methods A randomized controlled feasibility trial was carried out with follow-up at 6 months after baseline assessments using the Primary Health Questionnaire (PHQ), Somatic Symptom Screening Scale (SOMS-7), quality of life ratings (Short-Form Health Survey-36; SF-36) and body image measures (Dresden Body Image Questionnaire). Acceptance was assessed with the Helping Alliance Scale (HAS). Results A total of 24 patients were recruited to participate. Sixteen patients were randomly assigned to receive either manualised BPT or TAU, eight patients were directly assigned to BPT. Drop-out rates were acceptable, patients reported to be highly satisfied with the group intervention. Somatic symptom levels reduced significantly in the BPT group. Additionally, a significant effect on self-acceptance and the mental component of quality of life was observed. Conclusion Group body psychotherapy is a feasible and acceptable treatment for patients with somatoform disorder and a larger trial studying the effectiveness of BPT in these patients should be conducted. Trial registration Retrospectively registered SRCTN12277345; Trial Registraton Date: 27/03/2019