Fabian Friedrich

Summary: Reforms of psychiatric care systems in Western countries have been guided by several principles such as de-institutionalization, mental healthcare close to the community, and integration into general healthcare. This paper reflects the achievements, shortfalls, and problems of selected aspects of mental health reforms. Despite major improvements, there have also been some setbacks. We consider such analyses to be essential for future care planning.

EA is defined by a maladaptive preoccupation with exercise despite negative consequences. It shares the hallmarks of other addictions, namely salience, tolerance, withdrawal, craving and conflict, with additional features such as exercising against medical advice and guilt when unable to train.4 Unlike substance use or gambling, EA is socially reinforced through messages such as “no pain, no gain”, which valorise perseverance even when harmful. This social endorsement delays recognition, both for those affected and for those around them.

Purpose: This study aimed to examine the most important problems and needs caregivers of adult inpatients with eating disorders (EDs) are confronted with in their everyday lives. A further aim was to investigate the associations between problems, needs, involvement, and depression in carers. Methods: Fifty-five caregivers of inpatients with EDs (26 anorexia nervosa, 29 bulimia nervosa) completed the Carers' Needs Assessment, Beck Depression Inventory, and the Involvement Evaluation Questionnaire. The relationships between variables were tested via multiple linear regressions and mediation analyses. Results: The most frequent problem reported by caregivers was a lack of information about the course and treatment of the illness and consequent disappointment, whereas their most frequently reported needs were different forms of information and counselling. Problems, unmet needs, and worrying were especially high in parents compared to other caregivers. Involvement mediated significantly between problems (b = 0.26, BCa CI [0.03, 0.49]) as well as unmet needs (b = 0.32, BCa CI [0.03, 0.59]) of caregivers and their depressive symptoms. Conclusion: Our findings underline the importance of including the problems and needs of caregivers of adult eating disorder patients in the planning of family and community interventions, to support their mental health. Level of evidence: Level III: Evidence obtained from cohort or case–control analytic studies.

Introduction: People with epilepsy (PWE) have a higher prevalence of psychiatric disorders. Some individuals with drug-resistant epilepsy might benefit from surgical interventions. The aim of this study was to perform an assessment of psychiatric comorbidities with a follow-up period of 12 months in patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not.Material and methods: We assessed psychiatric comorbidities at baseline, after 4 months and after 12 months. Psychiatric symptoms and diagnoses were assessed using SCID-Interview, Hamilton Rating Scale for Depression, Beck-Depression Inventory, Hamilton Anxiety Rating Scale, Prodromal-Questionnaire and the Global Assessment of Functioning Scale.Results: Twenty-five patients were included in the study, 12 underwent surgery, 11 were esteemed as being neurologically unqualified for surgery and two refused surgery. Patients in the no-surgery group were significantly older, reported more substance use, had significantly higher levels of anxiety and were more often diagnosed with a personality disorder. Age and levels of anxiety were significant predictors of being in the surgery or the no-surgery group. The described differences between surgery and no-surgery patients did not change significantly over the follow-up period.Discussion: These data point toward a higher expression of baseline psychiatric symptoms in drug-resistant PWE without surgery. Further studies are warranted to further elucidate these findings and to clarify potential psychotropic effects of epilepsy itself, drug-resistant epilepsy and of epilepsy surgery and their impact on psychopathology. Clinically, it seems highly relevant to include psychiatrists in an interdisciplinary state-of-the-art perioperative management of drug-resistant PWE.

The influence of personality on health-related quality of life in patients with multiple sclerosis has been the focus of previous studies showing that introversion and neuroticism were related with reduced health related quality of life. However, no data exist on the impact of temperament on quality of life in this patient group. Between April 2014 and March 2016 139 multiple sclerosis patients were recruited from a specialized outpatient clinic of the general hospital of Vienna. Health-related quality of life was measured by “The Multiple Sclerosis International Quality of Life Questionnaire (MusiQol)”, temperament by “Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Questionnaire – Münster version” (briefTEMPS-M), and disability by the “Expanded disability status scale”. All patients underwent a diagnostic psychiatric semi-structured interview (MINI). Known predictors (like disease duration, EDSS, psychiatric co-morbidities, immunomodulatory treatments) explain the proportion of variation in the outcome of MusiQol global index score in 30.9% in multi-variable linear regression analysis. It increased respectively to 40.3, 42.5, and 45.8% if adding the depressive, cyclothymic, or hyperthymic temperament to the list of variables. An increase of depressive and cyclothymic temperament scores significantly reduced global index score of MusiQol (p = 0.005, p = 0.002, respectively), while the hyperthymic temperament significantly raised it (p < 0.001). In MS patients, the depressive and cyclothymic temperament predict a lower and hyperthymic temperament an increased health-related quality of life, independent of current disability status, immunomodulatory treatments, and affective co-morbidities.

Das 22q11.2-Mikrodeletionssyndrom (klinisch auch bekannt als velokardiofaziales Syndrom oder DiGeorge-Syndrom) gilt als das häufigste beim Menschen auftretende Mikrodeletionssyndrom und kann mit einer Vielzahl an klinischen Auffälligkeiten einhergehen. Wir berichten in diesem Artikel über den Fall eines 22 Jahre alten Patienten aus Österreich, bei dem im Rahmen einer psychotischen Erstmanifestation ein bis dahin unbekanntes 22q11.2-Mikrodeletionssyndrom diagnostiziert wurde, und diskutieren anhand dieses Falles die Implikationen dieser genetischen Erkrankung für die psychiatrische Praxis.

Anliegen: Der Bedarf der Angehörigen von Schizophreniekranken, die erstmals mit einer psychiatrischen Einrichtung in Kontakt kamen, sollte analysiert werden. Methode: 93 Angehörige Schizophreniekranker wurden mittels „Carers’ Needs Assessment for Schizophrenia“ (CNA-S) untersucht. Ergebnisse: Die häufigsten Probleme der Angehörigen von Kranken beim Erstkontakt waren zu wenig Information über die Krankheit und Sorgen bezüglich der Krankheit. Individuelle Psychoedukation wurde im Falle eines Erstkontakts signifikant gehäuft benötigt. Schlussfolgerungen: Beim ersten Kontakt werden einige Interventionen häufiger als im späteren Krankheitsverlauf benötigt. Objective: The purpose of the present study was to investigate the problems and needs for interventions among caregivers of patients with schizophrenia who were the first time in contact with psychiatric services. Methods: 93 family caregivers of schizophrenia patients during the first contact with services were investigated by means of the the “Carer’s Needs Assessment for Schizophrenia” (CNA-S). Results: The most frequent problems of caregivers of first contact patients with schizophrenia were insufficient information on mental illness and concerns about the patient’s future. Individual psychoeducation was needed significantly more often among caregivers of first contact patients than among those having been previously in contact with psychiatric services. Conclusion: Those being the first time in contact with psychiatric services need some specific interventions significantly more often than later.

Anliegen: Es sollte versucht werden, Prädiktoren für die Belastungen von Angehörigen Schizophreniekranker zu identifizieren. Methode: 135 Angehörige Schizophreniekranker wurden mittels „Carers’ Needs Assessment for Schizophrenia“ (CNA-S) und dem „Involvement Evaluation Questionnaire“ (IEQ) untersucht. Ergebnisse: Jene Angehörigen, die Hilfen benötigten, jedoch nicht ausreichend oder gar nicht erhielten, berichteten über erhöhte Sorgen und vermehrte Spannungen mit den Kranken. Schlussfolgerungen: Defizite im Versorgungsangebot haben eine negative Wirkung auf Angehörige. Objective: Relatives of persons with schizophrenia have an essential role in informal caregiving. This may result in a high level of burden. Aim of the study was to investigate, if the frequency of unmet needs among relatives caring for schizophrenia patients increases the risk for burden among these relatives. Methods: 135 relatives of patients with schizophrenia or schizoaffective disorder were investigated by means of the “Involvement Evaluation Questionnaire” (IEQ) and the “Carer’s Needs Assessment for Schizophrenia” (CNA-S). Results: Multiple linear regression analyses showed positive associations between the frequency of caregivers’ unmet needs and the IEQ-subscores “tension” and “worrying”. Further, the IEQ-subscore “worrying” was significantly lower among caregivers of outpatients than among caregivers of inpatients or day hospital patients. The IEQ-subscore “urging” was significantly associated with patient’s negative symptoms. Conclusion: Unmet needs among caring relatives have negative effects on their burden. Further, the patients’ type of treatment setting (inpatient, outpatient, day hospital) seems to predict caregivers’ burden.