Risikomanagement bei Antipsychotika – Klinische Versorgungsrealität

Angesichts der anhaltenden Kontroverse über Nutzen und Risiken in der Behandlung mit Antipsychotika erscheint es zweckmäßig, auch Daten aus der klinischen Routineversorgung zu berücksichtigen. Die Mortalität stationär-psychiatrischer Patienten ohne Suizid betrifft überwiegend Patienten über 60 Jahre mit der Diagnose einer Demenz. Trotz methodischer Einschränkungen gibt es Hinweise für einen Rückgang von unerwünschten Arzneimittelwirkungen, wobei nach wie vor extrapyramidalmotorische Störungen (Akathisie, Frühdyskinesien, Parkinsonoid), Gewichtszunahme, Unruhe/Erregung, sexuelle Funktionsstörungen und Leberwerterhöhungen auch in der klinischen Routine am häufigsten erfasst werden. Die Kenntnis der Antipsychotika assoziierten Nebenwirkungen, Anwendungsbeschränkungen und Kontraindikationen sowie eine gute Dokumentation sind für ein erfolgreiches Risikomanagement erforderlich.&nbsp

Model-based position and reflectivity estimation of fiber bragg grating sensor arrays

We propose an efficient model-based signal processing approach for optical fiber sensing with fiber Bragg grating (FBG) arrays. A position estimation based on an estimation of distribution algorithm (EDA) and a reflectivity estimation method using a parametric transfer matrix model (TMM) are outlined in detail. The estimation algorithms are evaluated with Monte Carlo simulations and measurement data from an incoherent optical frequency domain reflectometer (iOFDR). The model-based approach outperforms conventional Fourier transform processing, especially near the spatial resolution limit, saving electrical bandwidth and measurement time. The models provide great flexibility and can be easily expanded in complexity to meet different topologies and to include prior knowledge of the sensors. Systematic errors due to crosstalk between gratings caused by multiple reflections and spectral shadowing could be further considered with the TMM to improve the performance of large-scale FBG array sensor systems

Automatisierte präferenzoptimierte Dienstplangenerierung für Ärzte

Die Generierung von Dienstplänen für Personal ist in der Informatik eine klassische Optimierungsaufgabe mit zahlreichen bewährten wie innovativen Antworten.  Allerdings gelten traditionelle Problemstellungen nur für Schichtarbeit oder vergleichbare Modelle und weisen daher Prämissen auf, die auf ärztliche Bereitschaftsdienste nicht übertragbar sind.  Die als Folge daraus häufig rein manuell erstellten Dienstpläne vergeben Optimierungschancen und berücksichtigen individuelle Wünsche nicht immer in vollem Umfang. Gerade in Zeiten zunehmender Ressourcenverknappung ist für die Aufrechterhaltung der psychiatrischen Versorgung eine optimierte Planung von hoher Relevanz. Die vorliegende Arbeit stellt ein Verfahren vor, mit dem Dienstpläne nach den individuellen Vorlieben der beteiligten Ä;rzte automatisiert erstellt werden

Evaluating Depressive Symptoms in Schizophrenia: A Psychometric Comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale

Background: The aim of this study was to compare two measures of depression in patients with schizophrenia and schizophrenia spectrum disorder, including patients with delusional and schizoaffective disorder, to conclude implications for their application. Sampling and Methods: A total of 278 patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS) and the Hamilton Depression Rating Scale (HAMD-17). The Positive and Negative Syndrome Scale (PANSS) was also applied. At admission and discharge, a principal component analysis was performed with each depression scale. The two depression rating scales were furthermore compared using correlation and regression analyses. Results: Three factors were revealed for the CDSS and HAMD-17 factor component analysis. A very similar item loading was found for the CDSS at admission and discharge, whereas results of the loadings of the HAMD-17 items were less stable. The first two factors of the CDSS revealed correlations with positive, negative and general psychopathology. In contrast, multiple significant correlations were found for the HAMD-17 factors and the PANSS sub-scores. Multiple regression analyses demonstrated that the HAMD-17 accounted more for the positive and negative symptom domains than the CDSS. Conclusions:The present results suggest that compared to the HAMD-17, the CDSS is a more specific instrument to measure depressive symptoms in schizophrenia and schizophrenia spectrum disorder, especially in acutely ill patients. Copyright (c) 2012 S. Karger AG, Base

What are residual symptoms in schizophrenia spectrum disorder? Clinical description and 1-year persistence within a naturalistic trial

The aim of this study was to evaluate residual symptoms in patients achieving remission according to the consensus criteria and to analyze their potential influence on the patient's outcome one year after discharge. In total, 399 patients suffering from a schizophrenia spectrum disorder were evaluated within a naturalistic study. Remission status was examined using the consensus criteria. Residual symptoms were defined as any symptom present at the time-point of remission following analogous analyses performed in depressed patients. Therefore, a PANSS item with a symptom severity of > 1 (= at least borderline mentally ill) was defined to be a residual symptom. Remitters with and without residual symptoms were compared regarding psychopathology, functioning and side effects. In total, 236 patients (59 %) were remitters at discharge with 94 % of them suffering from at least one residual symptom. The most common residual symptoms were blunted affect (49 %), conceptual disorganization (42 %) and social withdrawal (40 %). A significant association was found between the presence of residual symptoms and the severity of side effects (p < 0.0001) and functioning (p = 0.0003) at discharge as well as between residual symptoms and the risk of relapse and chance of remission one year after discharge. Residual symptoms were highly prevalent in remitted schizophrenia inpatients following the suggested definition. Most residual symptoms were persistent baseline symptoms suggesting an ongoing illness severity. Also, the necessity to re-evaluate the consensus criteria questioning the status of remission in these patients is also pointed out

Influencing factors and predictors of early improvement in the acute treatment of schizophrenia and schizophrenia spectrum disorder

Background: To examine the influencing factors and predictors of early improvement in schizophrenia patients. Methods: 370 patients suffering from a schizophrenia spectrum disorder were examined within a naturalistic multicenter study. Early improvement was defined as a >= 30% PANSS total score reduction within the first two treatment weeks, response as a >= 50% improvement of the PANSS total score from admission to discharge and remission according to the consensus, remission criteria. Baseline and course-related variables such as positive, negative and depressive symptoms, side effects, functioning and subjective well-being were examined regarding their explanatory value for early improvement. Results: 46% of the patients were identified to be early improvers. Of these, 77% became treatment responder at discharge and 74% achieved the consensus remission criteria. Amongst others, early improvers were significantly more often first-episode patients (p = 0.009), with a significantly shorter duration of current episode (p = 0.024) and a shorter duration of the illness (p = 0.0094). A higher PANSS positive subscore (p = 0.0089), a higher score in the Strauss-Carpenter-Prognostic Scale (SCPS) (p < 0.0001), less extrapyramidal side effects (p = 0.0004) at admission and the development of less extrapyramidal side effects within the first two treatment weeks (p = 0.0013) as well as a duration of current episode of <= 6 months (p = 0.0373) were identified to be significant predictors of early improvement. Conclusion: Early improvement is associated with less illness chronicity and seems to be independent of the type of antipsychotic and the antipsychotic dosage applied. The SCPS was found to be a valuable tool to detect early improvers already at the initiation of antipsychotic treatment. (C) 2011 Elsevier Ltd. All rights reserved

Mobility behaviour and driving status of patients with mental disorders – an exploratory study

<p><b>Background</b> Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. <b>Method</b> Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. <b>Results</b> 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. <b>Conclusion</b> Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.</p