Psychiatric Acute Day Hospital as an Alternative to Inpatient Treatment

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

Untersuchungen zur Rolle genetischer Veränderungen in der chromosomalen Region 11p15 bei der Entstehung des Silver-Russell-Syndroms

Silver-Russell-Syndrome (SRS) is a clinically heterogeneous syndrome, associated with pre- and postnatal growth retardation, cranial dysmorphisms, clinodactyly of the fifth finger, skeletal asymmetry and relative macrocephaly. The syndrome usually occurs sporadically, but in some cases a familial accumulation can be observed. 10% of the SRS-Patients show a maternal uniparental dysomie (UPD) of chromosome 10. Therefore different growth-regulating genes on chromosome 7 have been analysed. So far, however, no responsible gene could be determined. Kosaki et al. (2000) and Fisher et al. (2002) reported four patients with growth retardation and SRS-like features, which had a duplication of the maternal chromosomal region 11p15.5. Interestingly a paternal duplication of this region leads to the Beckwith-Wiedemann-syndrome (BWS), which is associated with overgrowth. Therefore it is possible that a duplication of the region 11p15.5 leads to growth retardation or overgrowth, due to decreased or increased expression of imprinted growth-regulating genes. Furthermore, some patients with BWS showed a paternal UPD 11 as well as changed imprinting patterns and mutations in the IGF2 and CDKN1C genes, which lie in the region 11p15.5. Owing to the discoveries of Kosaki et al. (2000) and Fisher et al. (2002) as well as the findings in BWS it is possible that a maternal duplication of the region 11p15.5, a maternal UPD11 as well as changed imprinting patterns and mutations in the growth regulating genes IGF2 and CDKN1C participate in the aetiology of SRS. In this thesis 46 Patients with SRS and their families were screened for maternal UPD11 and duplications of the region 11p15.5. Furthermore 40 patients were screened for mutations in the growth-regulating genes IGF2 and CDKN1C. The occurrence of variants in the IGF2-gene, which were previously associated with the body-mass-index (Gaunt et al. 2001) were compared to a collective of controls. Additionally, changes in the imprinting patterns of the IGF2 gene have been described in connection with BWS (Algar et al. 2002), so that variances in the methylation of the IGF2 gene were examined in this study. A summary of the results of this thesis shows that a maternal duplication of the region 11p15.5 can be found in approximately 5% of the SRS-patients. This leads to the assumption that imprinted genes of the region 11p15.5 are involved in the aetiology of the syndrome. A substantial involvement of the genes IGF2 and CDKN1C could be ruled out in this study. However, a correlation between known variants of the IGF2 gene and SRS could not be clarified completely, so that further studies on larger collectives of controls and SRS-patients are needed in the future. Furthermore changes in imprinting patterns as well as mutations of other growth-regulating genes in the region 11p15.5 should be analysed

Untersuchungen zur Rolle genetischer Veränderungen in der chromosomalen Region 11p15 bei der Entstehung des Silver-Russell-Syndroms

Silver-Russell-Syndrome (SRS) is a clinically heterogeneous syndrome, associated with pre- and postnatal growth retardation, cranial dysmorphisms, clinodactyly of the fifth finger, skeletal asymmetry and relative macrocephaly. The syndrome usually occurs sporadically, but in some cases a familial accumulation can be observed. 10% of the SRS-Patients show a maternal uniparental dysomie (UPD) of chromosome 10. Therefore different growth-regulating genes on chromosome 7 have been analysed. So far, however, no responsible gene could be determined. Kosaki et al. (2000) and Fisher et al. (2002) reported four patients with growth retardation and SRS-like features, which had a duplication of the maternal chromosomal region 11p15.5. Interestingly a paternal duplication of this region leads to the Beckwith-Wiedemann-syndrome (BWS), which is associated with overgrowth. Therefore it is possible that a duplication of the region 11p15.5 leads to growth retardation or overgrowth, due to decreased or increased expression of imprinted growth-regulating genes. Furthermore, some patients with BWS showed a paternal UPD 11 as well as changed imprinting patterns and mutations in the IGF2 and CDKN1C genes, which lie in the region 11p15.5. Owing to the discoveries of Kosaki et al. (2000) and Fisher et al. (2002) as well as the findings in BWS it is possible that a maternal duplication of the region 11p15.5, a maternal UPD11 as well as changed imprinting patterns and mutations in the growth regulating genes IGF2 and CDKN1C participate in the aetiology of SRS. In this thesis 46 Patients with SRS and their families were screened for maternal UPD11 and duplications of the region 11p15.5. Furthermore 40 patients were screened for mutations in the growth-regulating genes IGF2 and CDKN1C. The occurrence of variants in the IGF2-gene, which were previously associated with the body-mass-index (Gaunt et al. 2001) were compared to a collective of controls. Additionally, changes in the imprinting patterns of the IGF2 gene have been described in connection with BWS (Algar et al. 2002), so that variances in the methylation of the IGF2 gene were examined in this study. A summary of the results of this thesis shows that a maternal duplication of the region 11p15.5 can be found in approximately 5% of the SRS-patients. This leads to the assumption that imprinted genes of the region 11p15.5 are involved in the aetiology of the syndrome. A substantial involvement of the genes IGF2 and CDKN1C could be ruled out in this study. However, a correlation between known variants of the IGF2 gene and SRS could not be clarified completely, so that further studies on larger collectives of controls and SRS-patients are needed in the future. Furthermore changes in imprinting patterns as well as mutations of other growth-regulating genes in the region 11p15.5 should be analysed

Borderline Personality Pathology in an At Risk Mental State Sample

Introduction: Transient psychotic symptoms in patients with borderline personality disorder seem to be similar to those in patients with psychotic disorders. Especially in the field of early detection of psychosis, this might lead to individuals with borderline personality disorder being wrongly classified as subjects at risk for developing a manifest psychosis. The aim of the present study was to investigate the occurrence of borderline symptoms in a sample of subjects at risk for psychosis as well as possible effects on the transition rate. Methods: Seventy help-seeking individuals of an early psychosis recognition center were additionally examined for borderline symptoms by the borderline symptom checklist. Results: We found a significant correlation between borderline symptomatology and positive symptoms assessed by the structured interview for prodromal symptoms. There were no associations between basic symptoms for psychosis and borderline symptoms. In addition, there was no influence of borderline symptomatology on the rate of transition into a manifest schizophrenic disease. Summary: In conclusion, borderline personality disorder should not be an exclusion criterion for the screening for psychosis or for an early intervention treatment. On the other hand, not every patient with borderline personality disorder, (especially those not suffering from hallucinations, unusual thought content, or persecutory ideas) should automatically be screened for the risk of developing a psychotic disorder

The effectiveness of individual placement and support for people with mental illness new on social benefits: a study protocol

Background In Switzerland, people with a severe mental illness and unable to work receive disability benefits (‘IV-pension’). Once they are granted these benefits, the chances to regain competitive employment are usually small. However, previous studies have shown that individual placement and support (IPS) supports a successful reintegration into competitive employment. This study focuses on the integration of newly appointed IV-pensioners, who have received an IV-pension for less than a year. Method/design The present pilot project ZHEPP (Zürcher Eingliederungs-Pilot Projekt; engl.: Zurich integration pilot project) is a randomized controlled trial (RCT). The 250 participants will be randomized to either the intervention or the control group. The intervention group receives support of a job coach according to the approach of IPS. Participants in the control group do not receive IPS support. Participation takes a total of two years for each participant. Each group is interviewed every six months (T0-T4). A two-factor analysis of variance will be conducted with the two factors group (intervention versus control group) and outcome (employment yes/no). The main criterion of the two-factor analysis will be the number of competitive employment contracts in each group. Discussion This study will focus on the impact of IPS on new IV-pensioners and aims to identify predictors for a successful integration. Furthermore, we will examine the effect of IPS on stigma variables and recovery orientation

Evaluation of trait adjectives and ego pathology in schizophrenia: An N400 study

The N400, an event-related brain potential (ERP), can be triggered by semantic or arithmetic violations in visual or auditory stimulus material. Schizophrenia patients exhibit an altered N400 presumably resulting from impaired semantic memory associative networks. The present study investigates, whether an altered N400 can also be found in semantic violations of the own self-concept. We use simple descriptive sentences to combine semantics with the self-concept in order to explore differences and possible deficits in schizophrenia patients. Schizophrenia patients and controls were shown trait adjectives in reference to themselves. Participants had to decide if the presented trait adjective was congruent or incongruent with their own self-concept. Only in controls, the N400 was significantly more negative in the incongruent compared to the congruent condition. Controls seemed to profit from a stable self-concept as they were faster in judging if a given trait was descriptive for the self than for someone else, which might result from processes related to the self-reference effect. Interestingly, in schizophrenia patients, the higher the scores for ego pathology were, the smaller the N400 effect turned out to be. The diminished N400 effect is probably associated with a disturbed self-concept in schizophrenia