Posttraumatische Störungen bei Patienten mit Erkrankungen aus dem schizophrenen Formenkreis

Background. The findings of internation- al studies suggest high rates of interperson- al violence and posttraumatic stress disorder (PTSD) among patients with schizophrenia spectrum disorders. Only few studies, how- ever, have so far been conducted in the Ger- man-speaking countries. Objectives. The aim of our study was to determine the prevalence of lifetime experi- ences of interpersonal violence and comor- bid PTSD among inpatients in a German uni- versity hospital. Method. In N=145 consecutively admitted patients with schizophrenia spectrum disor- ders (67% male) the structured trauma in- terview (STI) was used to assess experiences of interpersonal violence and the structured clinical interview for DSM-IV (SCID) to assess comorbid PTSD. Results. Sexual violence under the age of 16 years was reported by 17% of the patients (women 27%, men 12%). Approximately one third (32%) reported physical violence by pa- rental figures (women 38%, men 29%). At least one form of early violence (sexual or physical) was reported by half of the women (48%) and one third of the men (34%). Neg- ative sexual experiences later in life were re- ported by 17%, physical violence by 38% and at least one of these forms by 48% of the pa- tients. In total two thirds of all patients (66%) reported experiences of violence during their lifetime. The prevalence of acute PTSD was 12%. Another 9% of patients had a subsyn- dromal PTSD. Conclusion. The present study confirmed the high rates of experiences of interperson- al violence and comorbid PTSD in a German sample of patients with schizophrenia spec- trum disorders. Violence and it's consequenc- es should therefore be routinely assessed and the full spectrum of trauma-specific therapies should be integrated into the treatment of this group of patients

Modification of 40X13 steel at high-intensity nitrogen ion implantation

This paper presents the results of the formation of deep modified layers in 40X13 steel using a high-intensity repetitively pulsed nitrogen ion beam with a current density up to 0.25 A/cm2. An arc generator with a hot cathode provided the DC nitrogen plasma flow. A plasma immersion approach was used for high-frequency, short-pulse very intense nitrogen ion beam formation. A grid hemisphere with radii of 7.5 cm was immersed in the plasma. Negative bias pulses with an amplitude of 1.2 kV, a pulse duration of 4 µs, and a pulse repetition rate of 105 pulses per second were applied to the grid. The substrates were implanted at the temperature of 500 °C and various processing times ranging from 20 to 120 minutes with 1.2 keV nitrogen ions using a very-high current density up to 0.25 A/cm2 ion beams. The work explores the surface morphology, elemental composition, and mechanical properties of deep-layer modified 40X13 steel after low ion energy, very-high-intensity nitrogen ion beam implantation

Themenheft 41 "Psychotherapeutische Versorgung"

Die Bundesrepublik Deutschland verfügt im internationalen Vergleich sowohl im stationären (Krankenhäuser, Kliniken), als auch im teilstationären (Tageskliniken) und ambulanten Bereich (Praxen, Ambulanzen, Beratungsstellen) über ein dicht ausgebautes System der psychotherapeutischen Versorgung, das weitestgehend durch die gesetzlichen Sozialversicherungssysteme finanziert wird. Seit dem Inkrafttreten des Psychotherapeutengesetzes im Jahr 1999 wird die ambulante Versorgung psychisch Erkrankter hauptsächlich durch niedergelassene ärztliche und psychologische Psychotherapeutinnen und -therapeuten geleistet

Klinikvergleiche als Instrument der Qualitätssicherung in der Rehabilitation von Patienten mit psychischen/psychosomatischen Störungen: Bedeutung von Risikoadjustierung

Zusammenfassung Für Leistungserbringer im Gesundheitswesen wird es zunehmend relevanter, sich auch an einrichtungsübergreifenden, externen Qualitätssicherungsmaßnahmen zu beteiligen. Im Bereich der Versorgung von Patienten mit psychischen Störungen finden sich hierzu erst in jüngerer Zeit einige systematische Ansätze, die auch die Ergebnisqualität einbeziehen und einen Vergleich von Einrichtungen beinhalten. Dabei stellt eine Schlüsselfragestellung die angemessene Berücksichtigung von Confoundern dar, d.h. von ungleich verteilten Patientenmerkmalen, die mit dem Behandlungsergebnis in Zusammenhang stehen. Wir haben exemplarisch an einer Stichprobe von konsekutiven Patienten aus vier Rehabilitationsfachkliniken die Bedeutung der Confounder für den Vergleich der Einrichtungen hinsichtlich des kurzfristigen Outcomes untersucht. Die Ergebnisse zeigen, dass eine Adjustierung grundsätzlich geboten und in der Regel mit einer Reduktion der Unterschiedlichkeit der Behandlungsergebnisse verbunden ist. Diskutiert wird, dass die Verwendung von Regressionsgewichten, die an unabhängigen, repräsentativen Stichproben ermittelt wurden, eine validere Risikoadjustierung erlaubt. Schließlich wird auf die Relevanz der Berücksichtigung variierender Ressourceneinsätze bei der Bewertung der risikoadjustierten Einrichtungsvergleiche hingewiesen. -------- Abstract It is becoming increasingly more relevant for health care providers to also participate in external quality assurance measures. A few systematic approaches that also integrate outcome quality and include a comparison of different clinics have only recently been developed for the area of the treatment of patients with mental disorders. In this context, a key issue is the appropriate consideration of confounders, i.e., of unevenly distributed patient characteristics that are causally related to the treatment results. Using a sample of consecutive patients from four psychotherapeutic clinics, we exemplarily examined the significance of the confounders for the comparison of the clinics with regard to short-term outcome. The results show that an adjustment is principally advisable and is generally associated with a reduction of the differences in treatment results. The discussion asserts that the use of regression weights, which were ascertained using an independent, representative sample, allows for a more valid risk adjustment. Finally, reference will be made to the relevance of giving consideration to varying resource usage in the assessment of the risk-adjusted clinic comparisons

Posttraumatische Störungen bei Patienten mit Erkrankungen aus dem schizophrenen Formenkreis

Background. The findings of internation- al studies suggest high rates of interperson- al violence and posttraumatic stress disorder (PTSD) among patients with schizophrenia spectrum disorders. Only few studies, how- ever, have so far been conducted in the Ger- man-speaking countries. Objectives. The aim of our study was to determine the prevalence of lifetime experi- ences of interpersonal violence and comor- bid PTSD among inpatients in a German uni- versity hospital. Method. In N=145 consecutively admitted patients with schizophrenia spectrum disor- ders (67% male) the structured trauma in- terview (STI) was used to assess experiences of interpersonal violence and the structured clinical interview for DSM-IV (SCID) to assess comorbid PTSD. Results. Sexual violence under the age of 16 years was reported by 17% of the patients (women 27%, men 12%). Approximately one third (32%) reported physical violence by pa- rental figures (women 38%, men 29%). At least one form of early violence (sexual or physical) was reported by half of the women (48%) and one third of the men (34%). Neg- ative sexual experiences later in life were re- ported by 17%, physical violence by 38% and at least one of these forms by 48% of the pa- tients. In total two thirds of all patients (66%) reported experiences of violence during their lifetime. The prevalence of acute PTSD was 12%. Another 9% of patients had a subsyn- dromal PTSD. Conclusion. The present study confirmed the high rates of experiences of interperson- al violence and comorbid PTSD in a German sample of patients with schizophrenia spec- trum disorders. Violence and it's consequenc- es should therefore be routinely assessed and the full spectrum of trauma-specific therapies should be integrated into the treatment of this group of patients