Martin Heinze | Georg-August-Universität Göttingen (original) (raw)
Papers by Martin Heinze
Hintergrund/Fragestellung/Problem: Im Rahmen einer systematischen Evaluation des Innovationsfonds... more Hintergrund/Fragestellung/Problem: Im Rahmen einer systematischen Evaluation des Innovationsfonds beim Gemeinsamen Bundesausschuss (G-BA) wurden die über 400 Förderprojekte aus den Bereichen "Neue Versorgungsformen" und "Versorgungsforschung" hinsichtlich [zum vollständigen Text gelangen Sie über die oben angegebene URL]
Frontiers in Psychiatry
Background: The past decade has witnessed the establishment of flexible and integrative treatment... more Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural an...
Frontiers in Psychiatry
Background: New cross-sectoral mental health care models have been initiated in Germany to overco... more Background: New cross-sectoral mental health care models have been initiated in Germany to overcome the fragmentation of the German health care system. Starting in 2013, flexible and integrative psychiatric care model projects according to §64b SGB V German Social Law (FIT64b) have been implemented. The study “PsychCare” combines quantitative and qualitative primary data with routine health insurance data for the evaluation of these models. Effects, costs and cost-effectiveness from the perspectives of patients, relatives and care providers are compared with standard care. Additionally, quality indicators for a modern, flexible and integrated care are developed. This article describes the rationale, design and methods of the project.Methods: “PsychCare” is built on a multiperspective and multimethod design. A controlled prospective multicenter cohort study is conducted with three data collection points (baseline assessment, follow-up after 9 and 15 months). A total of 18 hospitals (...
Das Gesundheitswesen
ZusammenfassungVersorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutu... more ZusammenfassungVersorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegründete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und für dieses Feld besondere Themenstellungen vorgestellt und diskutiert.
Psychiatrische Praxis, 2020
OBJECTIVE The obstacles to implementation of a German variation of psychiatric Home-Treatment (HT... more OBJECTIVE The obstacles to implementation of a German variation of psychiatric Home-Treatment (HT), called "Inpatient Equivalent Home-Treatment" (IEHT) are examined. METHOD 43 employees from 11 psychiatric hospitals in the federal states of Berlin and Brandenburg were questioned using interviews and focus groups. A thematic analysis was conducted using the socio-institutional theoretical model. RESULTS At system-level, implementation is hampered by an inadequate service definition, staff shortages, as well as performance assessments by health insurances. This leads to reluctant implementation at hospital-level with insufficient staffing of the teams. Other barriers include a lack of mobile devices for documentation and team communication. At the level of employees, poor information, and cooperation as well as unclear assignment of tasks are impeding factors. CONCLUSION For a more needs-oriented, flexible, and nationwide introduction of HT according to IEHT, improvements to...
ArXiv, 2020
The use of information and communication technologies (ICT) to support long-term care is gaining ... more The use of information and communication technologies (ICT) to support long-term care is gaining attention, also in the light of population ageing. Known in Scandinavian countries under the term of welfare technology, it aims to increase the quality of life and independence of people with physical, psychological or social impairments. In Germany, a new form of psychiatric home treatment, inpatient equivalent treatment (IET), is offered since 2018. It should allow service users with severe mental health issues to stay in their familiar environment during crisis, while being treated in the same complexity and flexibility like in an inpatient unit. However, this change in delivering healthcare services leads to socio-technical challenges, such as coordination of work, integration into existing healthcare workflows and ensuring continuity of care. Hence, the objective of this exploratory study is to examine how information and communication technologies (ICT) interact in the new setting...
Psychiatrische Praxis, 2006
BMC Psychiatry
Background Over the last decades, many high-income countries have successfully implemented assert... more Background Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user’s home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. Methods/design The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders’ exp...
International Journal of Environmental Research and Public Health
The global COVID-19 pandemic has led to drastic changes in the management of patients with rheuma... more The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendati...
Psychoanalysis and History
Nervenheilkunde
ZUSAMMENFASSUNGDie stationsäquivalente Behandlung (StäB) ist eine besondere Form des internationa... more ZUSAMMENFASSUNGDie stationsäquivalente Behandlung (StäB) ist eine besondere Form des international anerkannten und evidenzbasierten Home-Treatment. Als komplexe Intervention erfordert StäB im deutschen Kontext eine Evaluation auf unterschiedlichen Ebenen. Die quasi-experimentelle „AKtiV-Studie“ mit Propensity-Score-gematchter Kontrollgruppe entspricht dieser Forderung. Sie hat eine Laufzeit von 36 Monaten und wird vom Innovationsfonds des Gemeinsamen Bundesausschuss gefördert. In diesem Zeitraum werden neben der Untersuchung klassisch klinischer Endpunkte wie der stationären Wiederaufnahmerate, der Psychopathologie und Recovery-orientierten auch Fragen hinsichtlich der geeigneten Zielpopulationen, Implementierungsbedingungen, Behandlungsprozessen und Wirkfaktoren beantwortet. Dabei werden sowohl die Perspektiven von Patienten, Angehörigen und Mitarbeitenden als auch die Standpunkte und Erfahrungen von Akteuren aus Politik und Selbstverwaltung eruiert. Damit kann erwartet werden, das...
Oral presentations
Over the last decades, there has been a marked increase in diagnosed psychiatric disorders worldw... more Over the last decades, there has been a marked increase in diagnosed psychiatric disorders worldwide causing a growing burden for health-care systems and society. In the USA, a full half of the population is claimed to meet the criteria for a DSM-IV disorder over the course of their lives. Typical explanations are that advancing destigmatization of mental illness and psychiatric treatment may be uncovering the real number of mental disorders for the first time. Also, contemporary working and living conditions are held responsible for causing a massive increase in psychiatric morbidity. On the other hand, changes in epidemiology, inflation of psychiatric diagnoses and widespread overdiagnosis are criticized as having substantially contributed to this increase. Although all of these factors seem relevant, the question remains, if there could be a more general, higher-order process behind these developments, both connecting and explaining them. We identify this process as a progressing psychiatrization of society, which causes as well as reflects the rising diagnoses of mental disorders. Psychiatrization and its various sub-processes are increasingly relevant in the light of ongoing and profound social changes in countries of the Global North, which coincide with a reorientation of psychiatric services (e.g. through digitalization and gradual substitution of inpatient-care with outpatient services). Simultaneously, Western psychiatric concepts and mental health services are exported to the Global South widely unchallenged. In this context, there is an urgent need for a broad debate about psychiatrization and its numerous negative consequences: On an individual level, these are mainly related to overdiagnosis and overtreatment, e.g. medication adverse effects and harms from long term use. Through pathologization of minor disturbances of psychological wellbeing and various life issues, psychiatrization can also promote disempowering changes to subjectivity and sense of the self, co-produce avoidable patient careers and create dependencies on mental health services. On a societal level, psychiatrization predetermines preferences for ineffective and short-term medical interventions which require individuals to cope with social problems, instead of finding collective long-term solutions. These would be located rather in the political than the medical field. From a public health point of view, psychiatrization might stimulate a further adaptation of mental health services to the needs of the ‘worried well’ and borderline cases while the provision of care for the severely and chronically ill is reduced. Objectives Our aim is to stimulate debate and research about psychiatrization as a highly complex, diverse, globally effective process of great importance for society as a whole. Its effects can be harmful to individuals in many ways and detrimental to society and public healthcare systems. Empirical preliminary studies on psychiatrization processes and their effects are largely missing. Theoretical work on single aspects can be found essentially outside of psychiatric research itself, i.e. in the canon of antipsychiatric literature of the 1960s and 70 s or sociological studies on medicalization. Further studies will need to update theoretical understanding of psychiatrization and fill conceptual gaps in order to initiate a theory-led, transdisciplinary research program, which can empirically establish its various manifestations and consequences. Additionally, further research will have to acknowledge the vast body of experience of (anti-)psychiatric researchers and organizations through collaborative projects between professionals and service users.
Journal of Clinical Psychopharmacology
BACKGROUND Impaired subjective well-being in schizophrenia patients treated with antipsychotics h... more BACKGROUND Impaired subjective well-being in schizophrenia patients treated with antipsychotics has often been linked inter alia to the antidopaminergic effects of medication. Thus, it is important to capture the association between striatal dopamine D2 receptor occupancy (D2-RO) and global subjective well-being. We examined this association using data from our multicenter, randomized, double-blind Neuroleptic Strategy Study (NeSSy). METHODS An innovative double randomization process was used for allocation of patients to the specific treatment groups. Plasma drug concentrations were measured after 6 and 24 weeks of treatment to obtain the estimated D2-RO (eD2-RO) relative to literature values. We made an exploratory analysis of associations between eD2-RO and subjective well-being scores. One hundred two blood samples from 69 patients were available for the analysis. Because of the lack of a satisfactory occupancy model for quetiapine, only haloperidol, flupentixol, and olanzapine treatment groups were pooled, whereas aripiprazole data were analyzed separately, because of its partial agonistic properties. RESULTS In the pooled antagonist group, eD2-RO correlated negatively with the summarized well-being score. In a more detailed analysis, this association could be confirmed for all first-generation antipsychotic-treated patients, but not for the separate second-generation antipsychotic groups. In the aripiprazole group, higher eD2-RO was associated with impaired physical well-being, but had no association with mental well-being. CONCLUSIONS Our results suggest that high plasma levels and consequently high occupancy at D2 receptors are disadvantageous for subjective well-being, as distinct from the objective extrapyramidal side effects. To minimize patients' malaise, which disfavors adherence, implementation of therapeutic drug monitoring in the clinical routine may be useful.
European Archives of Psychiatry and Clinical Neuroscience
Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress facto... more Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000–2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis “adjustment disorder” is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie
Zusammenfassung Ziel Untersuchung des Implementierungsstands und der Erfahrungen der Stakeholder ... more Zusammenfassung Ziel Untersuchung des Implementierungsstands und der Erfahrungen der Stakeholder mit der Zuhause-Behandlung (=ZHB) in der Modellversorgung nach §64b SGB V (=MV). Methodik Standardisierte Befragung von 381 Patienten aus 8 Kliniken der MV und inhaltsanalytische Auswertung von Fokusgruppen und Interviews mit Patienten, Angehörigen und Mitarbeitern (n=37). Struktur-, prozess- und leistungsbezogene Daten wurden ergänzend abgefragt. Ergebnisse Die ZHB der MV ist äußerst heterogen implementiert, insbesondere zwischen ländlichen und städtischen Regionen. Aus Sicht der Stakeholder wird eine längerfristige, flexible und settingübergreifende Versorgung geboten, die alltagsintegrativ wirkt und häufig erst mit zunehmender Inanspruchnahme als hilfreich bewertet wird. Schlussfolgerung Eine starke Orientierung an den Bedürfnissen der Patienten und regionalen Besonderheiten zeichnet die ZHB aus. Es lassen sich Implikationen zur Weiterentwicklung von stationsäquivalenter Behandlung ab...
Psychiatrische Praxis
Zusammenfassung Ziel der Studie Psychopharmaka werden in Pflegeheimen oft verordnet und stellen z... more Zusammenfassung Ziel der Studie Psychopharmaka werden in Pflegeheimen oft verordnet und stellen zusammen mit allgemeiner Polypharmazie ein Risiko für unerwünschte Wirkungen und Arzneimittelwechselwirkungen dar. Methodik Medikationsdaten (n = 398) wurden erhoben und Leitfadeninterviews bzw. Fokusgruppen durchgeführt. Ergebnisse Etwa 70 % der Bewohner bekommen Psychopharmaka. Einfluss haben Arbeitsbelastung der Pflegenden, soziodemografische Entwicklung und Facharztmangel. Schlussfolgerung Es muss ein Bewusstsein für Risiken durch Psychopharmaka geschaffen und gleichzeitig deren Reduktion angestrebt werden.
International Journal of Geriatric Psychiatry
Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementa... more Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects.
BMC Psychiatry
Background: Flexible and integrative treatment (FIT) models are rather novel in German mental hea... more Background: Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. Methods: A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach's α coefficient. Results: Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. Conclusions: The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.
Hintergrund/Fragestellung/Problem: Im Rahmen einer systematischen Evaluation des Innovationsfonds... more Hintergrund/Fragestellung/Problem: Im Rahmen einer systematischen Evaluation des Innovationsfonds beim Gemeinsamen Bundesausschuss (G-BA) wurden die über 400 Förderprojekte aus den Bereichen "Neue Versorgungsformen" und "Versorgungsforschung" hinsichtlich [zum vollständigen Text gelangen Sie über die oben angegebene URL]
Frontiers in Psychiatry
Background: The past decade has witnessed the establishment of flexible and integrative treatment... more Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural an...
Frontiers in Psychiatry
Background: New cross-sectoral mental health care models have been initiated in Germany to overco... more Background: New cross-sectoral mental health care models have been initiated in Germany to overcome the fragmentation of the German health care system. Starting in 2013, flexible and integrative psychiatric care model projects according to §64b SGB V German Social Law (FIT64b) have been implemented. The study “PsychCare” combines quantitative and qualitative primary data with routine health insurance data for the evaluation of these models. Effects, costs and cost-effectiveness from the perspectives of patients, relatives and care providers are compared with standard care. Additionally, quality indicators for a modern, flexible and integrated care are developed. This article describes the rationale, design and methods of the project.Methods: “PsychCare” is built on a multiperspective and multimethod design. A controlled prospective multicenter cohort study is conducted with three data collection points (baseline assessment, follow-up after 9 and 15 months). A total of 18 hospitals (...
Das Gesundheitswesen
ZusammenfassungVersorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutu... more ZusammenfassungVersorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegründete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und für dieses Feld besondere Themenstellungen vorgestellt und diskutiert.
Psychiatrische Praxis, 2020
OBJECTIVE The obstacles to implementation of a German variation of psychiatric Home-Treatment (HT... more OBJECTIVE The obstacles to implementation of a German variation of psychiatric Home-Treatment (HT), called "Inpatient Equivalent Home-Treatment" (IEHT) are examined. METHOD 43 employees from 11 psychiatric hospitals in the federal states of Berlin and Brandenburg were questioned using interviews and focus groups. A thematic analysis was conducted using the socio-institutional theoretical model. RESULTS At system-level, implementation is hampered by an inadequate service definition, staff shortages, as well as performance assessments by health insurances. This leads to reluctant implementation at hospital-level with insufficient staffing of the teams. Other barriers include a lack of mobile devices for documentation and team communication. At the level of employees, poor information, and cooperation as well as unclear assignment of tasks are impeding factors. CONCLUSION For a more needs-oriented, flexible, and nationwide introduction of HT according to IEHT, improvements to...
ArXiv, 2020
The use of information and communication technologies (ICT) to support long-term care is gaining ... more The use of information and communication technologies (ICT) to support long-term care is gaining attention, also in the light of population ageing. Known in Scandinavian countries under the term of welfare technology, it aims to increase the quality of life and independence of people with physical, psychological or social impairments. In Germany, a new form of psychiatric home treatment, inpatient equivalent treatment (IET), is offered since 2018. It should allow service users with severe mental health issues to stay in their familiar environment during crisis, while being treated in the same complexity and flexibility like in an inpatient unit. However, this change in delivering healthcare services leads to socio-technical challenges, such as coordination of work, integration into existing healthcare workflows and ensuring continuity of care. Hence, the objective of this exploratory study is to examine how information and communication technologies (ICT) interact in the new setting...
Psychiatrische Praxis, 2006
BMC Psychiatry
Background Over the last decades, many high-income countries have successfully implemented assert... more Background Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user’s home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. Methods/design The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders’ exp...
International Journal of Environmental Research and Public Health
The global COVID-19 pandemic has led to drastic changes in the management of patients with rheuma... more The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendati...
Psychoanalysis and History
Nervenheilkunde
ZUSAMMENFASSUNGDie stationsäquivalente Behandlung (StäB) ist eine besondere Form des internationa... more ZUSAMMENFASSUNGDie stationsäquivalente Behandlung (StäB) ist eine besondere Form des international anerkannten und evidenzbasierten Home-Treatment. Als komplexe Intervention erfordert StäB im deutschen Kontext eine Evaluation auf unterschiedlichen Ebenen. Die quasi-experimentelle „AKtiV-Studie“ mit Propensity-Score-gematchter Kontrollgruppe entspricht dieser Forderung. Sie hat eine Laufzeit von 36 Monaten und wird vom Innovationsfonds des Gemeinsamen Bundesausschuss gefördert. In diesem Zeitraum werden neben der Untersuchung klassisch klinischer Endpunkte wie der stationären Wiederaufnahmerate, der Psychopathologie und Recovery-orientierten auch Fragen hinsichtlich der geeigneten Zielpopulationen, Implementierungsbedingungen, Behandlungsprozessen und Wirkfaktoren beantwortet. Dabei werden sowohl die Perspektiven von Patienten, Angehörigen und Mitarbeitenden als auch die Standpunkte und Erfahrungen von Akteuren aus Politik und Selbstverwaltung eruiert. Damit kann erwartet werden, das...
Oral presentations
Over the last decades, there has been a marked increase in diagnosed psychiatric disorders worldw... more Over the last decades, there has been a marked increase in diagnosed psychiatric disorders worldwide causing a growing burden for health-care systems and society. In the USA, a full half of the population is claimed to meet the criteria for a DSM-IV disorder over the course of their lives. Typical explanations are that advancing destigmatization of mental illness and psychiatric treatment may be uncovering the real number of mental disorders for the first time. Also, contemporary working and living conditions are held responsible for causing a massive increase in psychiatric morbidity. On the other hand, changes in epidemiology, inflation of psychiatric diagnoses and widespread overdiagnosis are criticized as having substantially contributed to this increase. Although all of these factors seem relevant, the question remains, if there could be a more general, higher-order process behind these developments, both connecting and explaining them. We identify this process as a progressing psychiatrization of society, which causes as well as reflects the rising diagnoses of mental disorders. Psychiatrization and its various sub-processes are increasingly relevant in the light of ongoing and profound social changes in countries of the Global North, which coincide with a reorientation of psychiatric services (e.g. through digitalization and gradual substitution of inpatient-care with outpatient services). Simultaneously, Western psychiatric concepts and mental health services are exported to the Global South widely unchallenged. In this context, there is an urgent need for a broad debate about psychiatrization and its numerous negative consequences: On an individual level, these are mainly related to overdiagnosis and overtreatment, e.g. medication adverse effects and harms from long term use. Through pathologization of minor disturbances of psychological wellbeing and various life issues, psychiatrization can also promote disempowering changes to subjectivity and sense of the self, co-produce avoidable patient careers and create dependencies on mental health services. On a societal level, psychiatrization predetermines preferences for ineffective and short-term medical interventions which require individuals to cope with social problems, instead of finding collective long-term solutions. These would be located rather in the political than the medical field. From a public health point of view, psychiatrization might stimulate a further adaptation of mental health services to the needs of the ‘worried well’ and borderline cases while the provision of care for the severely and chronically ill is reduced. Objectives Our aim is to stimulate debate and research about psychiatrization as a highly complex, diverse, globally effective process of great importance for society as a whole. Its effects can be harmful to individuals in many ways and detrimental to society and public healthcare systems. Empirical preliminary studies on psychiatrization processes and their effects are largely missing. Theoretical work on single aspects can be found essentially outside of psychiatric research itself, i.e. in the canon of antipsychiatric literature of the 1960s and 70 s or sociological studies on medicalization. Further studies will need to update theoretical understanding of psychiatrization and fill conceptual gaps in order to initiate a theory-led, transdisciplinary research program, which can empirically establish its various manifestations and consequences. Additionally, further research will have to acknowledge the vast body of experience of (anti-)psychiatric researchers and organizations through collaborative projects between professionals and service users.
Journal of Clinical Psychopharmacology
BACKGROUND Impaired subjective well-being in schizophrenia patients treated with antipsychotics h... more BACKGROUND Impaired subjective well-being in schizophrenia patients treated with antipsychotics has often been linked inter alia to the antidopaminergic effects of medication. Thus, it is important to capture the association between striatal dopamine D2 receptor occupancy (D2-RO) and global subjective well-being. We examined this association using data from our multicenter, randomized, double-blind Neuroleptic Strategy Study (NeSSy). METHODS An innovative double randomization process was used for allocation of patients to the specific treatment groups. Plasma drug concentrations were measured after 6 and 24 weeks of treatment to obtain the estimated D2-RO (eD2-RO) relative to literature values. We made an exploratory analysis of associations between eD2-RO and subjective well-being scores. One hundred two blood samples from 69 patients were available for the analysis. Because of the lack of a satisfactory occupancy model for quetiapine, only haloperidol, flupentixol, and olanzapine treatment groups were pooled, whereas aripiprazole data were analyzed separately, because of its partial agonistic properties. RESULTS In the pooled antagonist group, eD2-RO correlated negatively with the summarized well-being score. In a more detailed analysis, this association could be confirmed for all first-generation antipsychotic-treated patients, but not for the separate second-generation antipsychotic groups. In the aripiprazole group, higher eD2-RO was associated with impaired physical well-being, but had no association with mental well-being. CONCLUSIONS Our results suggest that high plasma levels and consequently high occupancy at D2 receptors are disadvantageous for subjective well-being, as distinct from the objective extrapyramidal side effects. To minimize patients' malaise, which disfavors adherence, implementation of therapeutic drug monitoring in the clinical routine may be useful.
European Archives of Psychiatry and Clinical Neuroscience
Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress facto... more Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000–2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis “adjustment disorder” is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie
Zusammenfassung Ziel Untersuchung des Implementierungsstands und der Erfahrungen der Stakeholder ... more Zusammenfassung Ziel Untersuchung des Implementierungsstands und der Erfahrungen der Stakeholder mit der Zuhause-Behandlung (=ZHB) in der Modellversorgung nach §64b SGB V (=MV). Methodik Standardisierte Befragung von 381 Patienten aus 8 Kliniken der MV und inhaltsanalytische Auswertung von Fokusgruppen und Interviews mit Patienten, Angehörigen und Mitarbeitern (n=37). Struktur-, prozess- und leistungsbezogene Daten wurden ergänzend abgefragt. Ergebnisse Die ZHB der MV ist äußerst heterogen implementiert, insbesondere zwischen ländlichen und städtischen Regionen. Aus Sicht der Stakeholder wird eine längerfristige, flexible und settingübergreifende Versorgung geboten, die alltagsintegrativ wirkt und häufig erst mit zunehmender Inanspruchnahme als hilfreich bewertet wird. Schlussfolgerung Eine starke Orientierung an den Bedürfnissen der Patienten und regionalen Besonderheiten zeichnet die ZHB aus. Es lassen sich Implikationen zur Weiterentwicklung von stationsäquivalenter Behandlung ab...
Psychiatrische Praxis
Zusammenfassung Ziel der Studie Psychopharmaka werden in Pflegeheimen oft verordnet und stellen z... more Zusammenfassung Ziel der Studie Psychopharmaka werden in Pflegeheimen oft verordnet und stellen zusammen mit allgemeiner Polypharmazie ein Risiko für unerwünschte Wirkungen und Arzneimittelwechselwirkungen dar. Methodik Medikationsdaten (n = 398) wurden erhoben und Leitfadeninterviews bzw. Fokusgruppen durchgeführt. Ergebnisse Etwa 70 % der Bewohner bekommen Psychopharmaka. Einfluss haben Arbeitsbelastung der Pflegenden, soziodemografische Entwicklung und Facharztmangel. Schlussfolgerung Es muss ein Bewusstsein für Risiken durch Psychopharmaka geschaffen und gleichzeitig deren Reduktion angestrebt werden.
International Journal of Geriatric Psychiatry
Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementa... more Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects.
BMC Psychiatry
Background: Flexible and integrative treatment (FIT) models are rather novel in German mental hea... more Background: Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. Methods: A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach's α coefficient. Results: Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. Conclusions: The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.