Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial

Background Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Results Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance

現代語の終助詞「さ」の機能に関する考察

本稿では,長崎(1998)の追調査として,昭和初期から現代に至る終助詞「さ」の機能的変遷を観察した。長崎(1998)では,江戸語における終助詞「さ」の機能を調査し,その主たる機能は断定の働きであったこと,またこの働きが,明治から大正にかけて,現在のように情意表現を主体とした終助詞の機能に移行していく経過を報告した。本調査では,終助詞「さ」を,昭和前期(第二次大戦前),昭和後期(第二次大戦後),平成期に分けて,その機能的変遷を観察した。昭和前期には,終助詞「さ」の用法として,江戸語に見られた丁寧な会話にも使用される用例が見られた。特に江戸語の名残のある女性の言葉遣いの中心その用法が見られた。戦後は,終助詞「さ」の女性の用例は減少し,用言に接続する用例加増加し,「さ」は主に男性が使用する終助詞として定着した。平成に入ると,「さ」は終助詞としての使用より,間投助詞としての使用が目立つようになる。特に若い世代では終助詞「さ」は,男性にもあまり使用されなくなっている。この結果から,今後「さ」の終助詞としての機能は,衰退していくことが予想される

A variant of guanidine-IV riboswitches exhibits evidence of a distinct ligand specificity

Riboswitches are regulatory RNAs that specifically bind a small molecule or ion. Like metabolite-binding proteins, riboswitches can evolve new ligand specificities, and some examples of this phenomenon have been validated. As part of work based on comparative genomics to discover novel riboswitches, we encountered a candidate riboswitch with striking similarities to the recently identified guanidine-IV riboswitch. This candidate riboswitch, the Gd4v motif, is predicted in four distinct bacterial phyla, thus almost as widespread as the guanidine-IV riboswitch. Bioinformatic and experimental analysis suggest that the Gd4v motif is a riboswitch that binds a ligand other than guanidine. It is found associated with gene classes that differ from genes regulated by confirmed guanidine riboswitches. In inline-probing assays, we showed that free guanidine binds only weakly to one of the tested sequences of the variant. Further tested compounds did not show binding, attenuation of transcription termination, or activation of a genetic reporter construct. We characterized an N-acetyltransferase frequently associated with the Gd4v motif and compared its substrate preference to an N-acetyltransferase that occurs under control of guanidine-IV riboswitches. The substrates of this Gd4v-motif-associated enzyme did not show activity for Gd4v RNA binding or transcription termination. Hence, the ligand of the candidate riboswitch motif remains unidentified. The variant RNA motif is predominantly found in gut metagenome sequences, hinting at a ligand that is highly relevant in this environment. This finding is a first step to determining the identity of this unknown ligand, and understanding how guanidine-IV-riboswitch-like structures can evolve to bind different ligands.publishe

Patienten mit Migrationshintergrund in Psychiatrischen Institutsambulanzen – ein Vergleich zwischen Patienten mit türkischer und osteuropäischer Herkunft sowie Patienten ohne Migrationshintergrund

Schouler-Ocak M, Bretz H, Hauth I, et al. Patienten mit Migrationshintergrund in Psychiatrischen Institutsambulanzen – ein Vergleich zwischen Patienten mit türkischer und osteuropäischer Herkunft sowie Patienten ohne Migrationshintergrund. Psychiatrische Praxis. 2010;37(8):384-390.Anliegen Erhebung der Inanspruchnahme der Psychiatrischen Institutsambulanzen durch Patienten mit Migrationshintergrund. Methoden Am 27. Mai 2008 (Stichtag) wurden bundesweit in den Psychiatrischen Institutsambulanzen von 171 Kliniken für jeden fünften Patienten soziodemografische Daten, ICD-10-Diagnosen, Angaben zu Verständigungsproblemen, Dauer der Erkrankung und der Arbeitsunfähigkeit erhoben. Ergebnisse 32,5 % der Patienten hatten einen Migrationshintergrund. Patienten mit einem Migrationshintergrund wiesen signifikant häufiger eine Diagnose aus dem Bereich Neurotische, Belastungs- und somatoforme Störungen auf als deutsche Patienten. Patienten mit türkischem Migrationshintergrund erhielten im Vergleich zu deutschen und osteuropäischen Patienten signifikant häufiger eine Diagnose aus dem Bereich Affektive Störungen (F3). Patienten mit Migrationshintergrund befanden sich kürzer in psychiatrischer Behandlung und erhielten längere Arbeitsunfähigkeitsbescheinigungen ausgestellt. Bezüglich soziodemografischer Daten war auffällig, dass Patienten mit osteuropäischem Migrationshintergrund eine signifikant höhere Schulbildung verglichen mit Patienten mit türkischem Migrationshintergrund hatten. Patienten mit Migrationshintergrund waren durchschnittlich jünger und hatten signifikant mehr Kinder. Schlussfolgerungen Patienten mit Migrationshintergrund sind in Psychiatrischen Institutsambulanzen stärker repräsentiert und profitieren möglicherweise besonders von dem multiprofessionellem Setting und dem niedrigschwelligen Angebot

Online therapy: an added value for inpatient routine care? Perspectives from mental health care professionals

Internet-delivered interventions can be effective in treating mental disorders. However, their rate of use in German psychiatric inpatient routine care is low. The current study aimed to investigate the attitude of mental health care professionals working in inpatient care regarding internet-delivered interventions, including presumed benefits, barriers and facilitators. In total, 176 health professionals from ten inpatient psychiatric hospitals throughout Germany were surveyed on site. The professionals’ attitude towards internet-delivered interventions in inpatient care was assessed by an adapted version of the ‘Attitude toward Telemedicine in Psychiatry and Psychotherapy’ (ATTiP) questionnaire. To identify benefits, barriers and facilitators, we developed open-response questions that were based on the ‘Unified Theory of Acceptance and Use of Technology’ (UTAUT) and analyzed by a qualitative content analysis. Professionals reported little experience or knowledge about internet-delivered interventions. Their attitude towards internet-delivered interventions in psychiatric inpatient care was rather indifferent. The most frequently mentioned potential benefits were an optimised treatment structure and patient empowerment; the most frequently anticipated barriers were too severe symptoms of patients, the feared neglect of face-to-face contacts and insufficient technical equipment; and the most frequently mentioned facilitators were high usability of the internet-based intervention, a sufficient functional level of the patient and further education of staff. For successful implementation in the inpatient sector, internet-delivered interventions must be adapted to the special needs of severely mentally ill patients and to the hospital management systems and workflow. In addition, technical preconditions (internet access, devices) must be met. Last, further education of mental health care professionals is needed