The appropriateness of the treatment setting for the inpatient post-acute treatment of alcohol dependence disorders in Switzerland

<p>Abstract</p> <p>Background</p> <p>In Switzerland, a total of 1'000 patients a year are treated for alcohol-dependence in specialized institutions. Though the current literature suggests favoring outpatient treatment, whether outpatient or inpatient treatment is more efficient cannot be answered generally. For Germany, "AWMF"-treatment guidelines were formulated in order to treat patients with substance use disorders in the appropriate treatment settings. The aim of the present study was to test the hypothesis that the majority of patients treated in the largest specialized institution for alcohol abuse treatment in Switzerland were treated in the appropriate setting.</p> <p>Methods</p> <p>All completed treatments conducted in the Forel-Hospital – the largest clinic of its kind in Switzerland – between the 1st of January 2004 and the 20th of December 2006 were included in the investigation (n = 915). Patient and treatment characteristics were gathered using the information from the PSYREC and act-info questionnaire. The AWMF criteria were operationalized on the basis of the questionnaire.</p> <p>Results</p> <p>Applying the AWMF criteria resulted in the emergence of three groups: 73.7% of the study sample could clearly be assigned to the inpatient treatment group, and for 7.5% there was evidence supporting the allocation to an outpatient treatment setting. In 18.8% of the cases, however, the AWMF criteria did not allow an assignment to either of the treatment settings. Of the total sample, 18.5% of all patients apparently did not profit from the inpatient treatment setting, whereas for the vast majority (81.5%), a therapeutic progress was documented. In those patients who, according to the AWMF guidelines, did not need an inpatient setting, a larger proportion improved than in the group of the patients who needed an inpatient treatment in a specialized hospital. Furthermore, the logistic regression analyses revealed that the less severe the clinical state of a patient upon admittance, the higher the odds of improvement during the hospital stay.</p> <p>Conclusion</p> <p>The results serve as evidence that for at least three out of four patients treated in the investigated specialized institution, an inpatient treatment was appropriate. The principal reason for the necessity of an inpatient treatment setting was that this hospital population showed severe psychiatric, somatic or social irregularities. Only a very limited number of patients hospitalized in a specialized institution for the treatment of alcohol-related disorders can be treated in an outpatient setting.</p

Stabilität und Prädiktion von Prüfungsangst bei Studierenden

Theoretischer Hintergrund: Obwohl Prüfungsangst ein häufiges Anliegen in psychologischen Beratungsstellen ist, wissen wir wenig über ihren zeitlichen Verlauf sowie über Risikofaktoren für hohe Prüfungsangst kurz vor den Prüfungen. Fragestellung: Diese Studie untersucht, ob sich die Intensität von Prüfungsangst während eines Semesters verändert und wie Personen mit hoher Belastung kurz vor der Prüfung früh identifiziert werden können. Methodik: Zu Beginn und kurz vor den Prüfungen des Wintersemesters 2014/15 wurden Prüfungsangst, Depressivität und Prokrastination bei 427 Studierenden (88.3 % Erstsemester; 68.4 % weiblich; Altersdurchschnitt 20.0 Jahre) erfasst. Ergebnisse: Die Analyse auf Einzelfallebene zeigte, dass sich die Prüfungsangst bei den meisten Studierenden nicht signifikant veränderte. Bei der Vorhersage der Prüfungsangst zum Semesterende stellten Prüfungsangst und Depressivität zu Semesterbeginn signifikante Prädiktoren dar. Diese wurden anhand von 80 % der Gesamtstichprobe ermittelt und an den anderen 20 % validiert. Schlussfolgerungen: Erhöhte Prüfungsangst und Depressivität zu Semesterbeginn können die frühe Identifikation von Studierenden mit bedeutsamer Prüfungsangst kurz vor Prüfungen ermöglichen.Peer Reviewe

A brief intervention to improve exercising in patients with schizophrenia: a controlled pilot study with mental contrasting and implementation intentions (MCII)

BackgroundRegular exercise can have positive effects on both the physical and mental health of individuals with schizophrenia. However, deficits in cognition, perception, affect, and volition make it especially difficult for people with schizophrenia to plan and follow through with their exercising intentions, as indicated by poor attendance and high drop-out rates in prior studies. Mental Contrasting and Implementation Intentions (MCII) is a well-established strategy to support the enactment of intended actions. This pilot study tests whether MCII helps people with schizophrenia in highly structured or autonomy-focused clinical hospital settings to translate their exercising intentions into action.MethodsThirty-six inpatients (eleven women) with a mean age of 30.89 years (SD = 11.41) diagnosed with schizophrenia spectrum disorders from specialized highly structured or autonomy-focused wards were randomly assigned to two intervention groups. In the equal contact goal intention control condition, patients read an informative text about physical activity; they then set and wrote down the goal to attend jogging sessions. In the MCII experimental condition, patients read the same informative text and then worked through the MCII strategy. We hypothesized that MCII would increase attendance and persistence relative to the control condition over the course of four weeks and this will be especially be the case when applied in an autonomy-focused setting compared to when applied in a highly structured setting.ResultsWhen applied in autonomy-focused settings, MCII increased attendance and persistence in jogging group sessions relative to the control condition. In the highly structured setting, no differences between conditions were found, most likely due to a ceiling effect. These results remained even when adjusting for group differences in the pre-intervention scores for the control variables depression (BDI), physical activity (IPAQ), weight (BMI), age, and education. Whereas commitment and physical activity apart from the jogging sessions remained stable over the course of the treatment, depression and negative symptoms were reduced. There were no differences in pre-post treatment changes between intervention groups.ConclusionsThe intervention in the present study provides initial support for the hypothesis that MCII helps patients to translate their exercising intentions into real-life behavior even in autonomously-focused settings without social control.publishe

The Consumption of Khat and Other Drugs in Somali Combatants: A Cross-Sectional Study

Having interviewed military personnel in Somali, Michael Odenwald and colleagues conclude that drug-related problems, mainly relating to the use of khat, have reached proportions formerly unknown to the country

ZO-1 interactions with F-actin and occludin direct epithelial polarization and single lumen specification in 3D culture

Epithelia within tubular organs form and expand lumens. Failure of these processes can result in serious developmental anomalies. Although tight junction assembly is crucial to epithelial polarization, the contribution of specific tight junction proteins to lumenogenesis is undefined. Here, we show that ZO-1 (also known as TJP1) is necessary for the formation of single lumens. Epithelia lacking this tight junction scaffolding protein form cysts with multiple lumens and are defective in the earliest phases of polarization, both in two and three dimensions. Expression of ZO-1 domain-deletion mutants demonstrated that the actin-binding region and U5-GuK domain are crucial to single lumen development. For actin-binding region, but not U5-GuK domain, mutants, this could be overcome by strong polarization cues from the extracellular matrix. Analysis of the U5-GuK binding partners shroom2, α-catenin and occludin showed that only occludin deletion led to multi-lumen cysts. Like ZO-1-deficiency, occludin deletion led to mitotic spindle orientation defects. Single lumen formation required the occludin OCEL domain, which binds to ZO-1. We conclude that ZO-1–occludin interactions regulate multiple phases of epithelial polarization by providing cell-intrinsic signals that are required for single lumen formation

Therapeutic success in relapse prevention in alcohol use disorder : the role of treatment motivation and drinking-related treatment goals

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Addictive Diseases on 5. Nov 2020, available online: http://www.tandfonline.com/10.1080/10550887.2020.1820810Background Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent. Objective The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder. Methods In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression. Results During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment. Conclusions This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored

Screening for Posttraumatic Stress Disorder among Somali ex-combatants: A validation study

In Somalia, a large number of active and former combatants are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD), that impairs their ability to re-integrate into civilian life. This study reports on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants.Waxaa Soomaaliya ka jira tiro badan oo askartii hore ah oo dhimirka wax ka gaaray, sida cudurka la yiraahdo "Posttraumatic Stress Disorder (PTSD)", kaaso isbeddel ku sameeyo qofka dad ladhaqankiisa. Darasaadkanina wuxuu horumarinayaa qalabka baaritaanka caafimaadka cudurka DPTS oo loo adeegsanayo Af-soomaaliga.In Somalia, un gran numero di soldati o ex-soldati sono affetti da problemi psicologici come il Disturbo Post-Traumatico da Stress (DPTS), che altera la capacità di re-integrarsi nella vita civile. Questo studio riporta sullo sviluppo di uno strumento di screening per il DPTS in lingua somala

Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study

Onyut LP, Neuner F, Ertl V, Schauer E, Odenwald M, Elbert T. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study. Conflict and Health. 2009;3(1):6.Background: The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003. Methods: The Posttraumatic Diagnostic Scale (PDS) and the Hopkins Symptom Checklist 25 were used to screen for posttraumatic stress disorder and depression. Results: Thirty two percent of the Rwandese and 48.1% of the Somali refugees were found to suffer from PTSD. The Somalis refugees had a mean of 11.95 (SD = 6.17) separate traumatic event types while the Rwandese had 8.86 (SD = 5.05). The Somalis scored a mean sum score of 21.17 (SD = 16.19) on the PDS while the Rwandese had a mean sum score of 10.05 (SD = 9.7). Conclusion: Mental health consequences of conflict remain long after the events are over, and therefore mental health intervention is as urgent for post-conflict migrant populations as physical health and other emergency interventions. A mental health outreach program was initiated based on this study

Khat use as risk factor for psychotic disorders: A cross-sectional and case-control study in Somalia

BACKGROUND: Little is known about the prevalence of khat-induced psychotic disorders in East African countries, where the chewing of khat leaves is common. Its main psycho-active component cathinone produces effects similar to those of amphetamine. We aimed to explore the prevalence of psychotic disorders among the general population and the association between khat use and psychotic symptoms. METHODS: In an epidemiological household assessment in the city of Hargeisa, North-West Somalia, trained local interviewers screened 4,854 randomly selected persons from among the general population for disability due to severe mental problems. The identified cases were interviewed based on a structured interview and compared to healthy matched controls. Psychotic symptoms were assessed using the items of the WHO Composite International Diagnostic Interview and quantified with the Positive and Negative Symptoms Scale. Statistical testing included Student's t-test and ANOVA. RESULTS: Local interviewers found that rates of severe disability due to mental disorders were 8.4% among males (above the age of 12) and differed according to war experiences (no war experience: 3.2%; civilian war survivors: 8.0%; ex-combatants: 15.9%). The clinical interview verified that in 83% of positive screening cases psychotic symptoms were the most prominent manifestations of psychiatric illness. On average, cases with psychotic symptoms had started to use khat earlier in life than matched controls and had been using khat 8.6 years before positive symptoms emerged. In most cases with psychotic symptoms, a pattern of binge use (> two 'bundles' per day) preceded the onset of psychotic symptoms, in contrast to controls of the same age. We found significant correlations between variables of khat consumption and clinical scales (0.35 to 0.50; p < 0.05), and between the age of onset of khat chewing and symptom onset (0.70; p <0.001). CONCLUSION: Evidence indicates a relationship between the consumption of khat and the onset of psychotic symptoms among the male population, whereby not the khat intake per se but rather early onset and excessive khat chewing seemed to be related to psychotic symptoms. The khat problem must be addressed by means other than prohibition, given the widespread use and its role in Somali culture