Are early post-discharge physician contacts associated with 30-day psychiatric re-hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias.

Objectives: Cost containment and quality of care considerations have increased research interest in the potential preventability of early re-hospitalisations. Various registry-based retrospective cohort studies on psychiatric re-hospitalisation have focused on the role of early post-discharge service contacts, but either did not consider their time-dependent nature ('immortal time bias') or evaded the issue by analysing late re-hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re-hospitalisations.

Late 'Early Intervention in Psychosis': A Family School for Learning How to Live with Schizophrenia.

The paper describes a family school for learning how to live with schizophrenia, which was founded in 1986 in Vienna, Austria, and is still running today. It was established in cooperation between professionals and the Austrian self-help association HPE of the relatives of persons with mental disorders. It addresses the needs of 10 families at a time, in cases where a son or a daughter was diagnosed with schizophrenia and had already experienced one or several episodes of the illness.

Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations.

Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out.

["But you know Mr. M., you won't get hospitalised" : A qualitative study on service users' experience of seeking psychiatric inpatient admission].

In a qualitative study using thematic analysis of focus group interviews with service users their perspectives and experiences concerning the process of seeking admission to psychiatric inpatient care in Austria were explored. The aim of the study was to better understand service users' motivation, decisions and actions in the process of seeking psychiatric hospitalisation. Results show that admission to psychiatric inpatient care was often sought directly without a referral from an outpatient service.

Psychiatry's contribution to the public stereotype of schizophrenia: Historical considerations.

The public stereotype of schizophrenia is characterized by craziness, a split personality, unpredictable and dangerous behaviour, and by the idea of a chronic brain disease. It is responsible for delays in help-seeking, encourages social distance and discrimination, and furthers self-stigmatization. This paper discusses the circumstances of the origins of the idea of a chronic brain disease (Emil Kraepelin, 1856-1926), of the split personality concept derived from the term "schizophrenia" (Eugen Bleuler, 1857-1939), and the craziness idea reflected in the "first rank symptoms", which are all hallucinations and delusions (Kurt Schneider, 1887-1967).

Modern medicine and the one-size-fits-all approach: A clinician's comment to Alexandra Pârvan's "Mind Electric" article.

As a clinician, I can easily agree with the author that a person's own reality of being healthy is independent of physical evidence or clinical categories and that this perspective should be considered to improve clinical care. However, I cannot follow the assumptions about the nature and working of modern medicine and psychiatry as typically using "black box" and one-size-fits-all treatments in daily practice. I outline several working contexts of doctors where this criticism does only marginally apply or not at all and wonder whether the author might wish, if possible at all from a philosophical viewpoint, to differentiate her concepts with regard to these different contexts.

The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment.

Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed "top-down" and "bottom-up" approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing.

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature.

Background: High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far.

[Pain Symptoms as Predictors of Depressive or Anxiety Disorders in Patients with Physical Illness].

Objective: The aim of this study was to investigate the frequency of pain symptoms reported by patients of non-psychiatric hospital departments and to explore their association with affective and anxiety disorders.

Methods: Patients of non-psychiatric hospital departments (n = 290) reported pain symptoms by filling in a self-rating questionnaire. Psychiatric examinations were performed by psychiatrists using a structured diagnostic interview.

Research priorities for public mental health in Europe: recommendations of the ROAMER project.

Background: The ROAdmap for MEntal health Research in Europe project aimed to create an integrated European roadmap for mental health research. Leading mental health research experts across Europe have formulated consensus-based recommendations for future research within the public mental health field.

Methods: Experts were invited to compile and discuss research priorities in a series of topic-based scientific workshops.

[Counselling customers with psychotropic vs. cardiovascular prescriptions: a survey among Austrian community pharmacists].

Background: Prescriptions for psychotropic drugs in general and their share of all prescriptions have substantially risen over the last decades. Thus, also counselling by pharmacists becomes more important in this area. This study focuses on how community pharmacists see their own role when counselling persons with prescriptions for psychotropic medication and how this differs from counselling persons with other types of prescriptions.

Development of the ITHACA Toolkit for monitoring human rights and general health care in psychiatric and social care institutions.

Background. Human rights violations are commonly experienced by people in psychiatric and social care institutions. States and private organizations providing such health and social services must comply with international human rights law.

No amygdala attenuation in schizophrenic patients treated with atypical antipsychotics.

Functional magnetic resonance (fMRI) imaging was used to measure amygdala activation in an emotional valence discrimination task in clinically stable patients with schizophrenia treated with atypical antipsychotics and healthy controls. No difference was detected between patients with schizophrenia and controls.

Mental health care for irregular migrants in Europe: barriers and how they are overcome.

Background: Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.

Supporting decision-making processes for evidence-based mental health promotion.

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

Monitoring service utilization of persons with mental disorders--a case for mapping pathways of care.

Routinely collected and reported indicators for health service utilization have traditionally been event/episode related and hospital centered. This is also the case for service utilization by persons with mental disorders, for whom national and international databases usually report rates of hospital discharges, mean length of stay for hospital episode and the like. Such event/episode-related indicators are of limited use for planning and improving services for persons with mental disorders.

ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital.

Objective: To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients.

Method: 290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version).

Results: 63 patients suffered from a current depressive episode according to the CIDI.

Are psychiatrists an endangered species? Observations on internal and external challenges to the profession.

Based on recently voiced concerns about a crisis in psychiatry, six challenges to our profession are identified and discussed. As we approach the revisions of ICD-10 and DSM-IV, the validity of psychiatry's diagnostic definitions and classification systems is increasingly questioned also from inside psychiatry. In addition, confidence in the results of therapeutic intervention studies is waning.

Patients' perspectives on what works in psychoeducational groups for schizophrenia: a qualitative study.

Background: Psychoeducational groups are a common component of interventions in schizophrenia.

Aims: To explore patients' views about wanted and unwanted effects of group psychoeducation.

Method: Subjective feedback of 103 participants of a psychoeducational intervention as well as data from two specific focus groups-one with "enthusiastic" and one with "critical" participants-were analyzed by means of qualitative content analysis.

[Bipolar disorder and manic-depressive disorder on the Internet].

Objective: The internet is an important source of information and exchange for patients and can exert considerable influence on their health-related behaviours and decisions. This makes the quality of information on the internet an important factor. The present study analyzes the quality of German-language internet information on "bipolar disorder" and "manic-depressive disorder".

Patterns of social distance towards people suffering from schizophrenia in Austria: a comparison between the general public, relatives and mental health staff.

Objective: The aims of this study were to identify the different aspects of the attitudes towards people suffering from schizophrenia and to find factors influencing these attitudes -- especially the willingness to contact people suffering from schizophrenia -- as well as to obtain information on how to reduce stigma and discrimination.

Method: We conducted a study to investigate these attitudes in Austria. A representative sample of the general public, different professional groups working in the field and relatives of mentally ill people were interviewed.

Learning by doing: a novel approach to improving general practitioners' diagnostic skills for common mental disorders.

Introduction: Two strategies have been proposed to increase the rather low recognition rate of common mental disorders in primary care: (1) the use of screening instruments and (2) extensive psychiatric training for general practitioners. We have chosen a "middle-of-the-road" approach to teach general practitioners by means of a time-saving psychiatric training programme how to make their own psychiatric diagnoses. This pilot study aimed at assessing the acceptance of this programme, its impact on general practitioners' knowledge of 12 ICD-10 disorders - depressive, anxiety and alcohol-related disorders - and the short-term persistence of the knowledge acquired.

[Cost of disorders of the brain in Austria in the year 2004].

Objectives: The costs of twelve selected neurological, neuro-surgical and psychiatric disorders in Austria in the year 2004 will be presented. The present paper is part of the "Cost of Disorders of the Brain in Europe" study.

Methods: The data for the present calculations are based on systematic reviews of epidemiological and health-economic studies.

One-year outcome of low-intensity booster sessions versus care as usual in psychosis patients after a short-term psychoeducational intervention.

Objective: In this study we aimed to evaluate long-term effects of a community-based, quality of life oriented psychoeducational intervention for schizophrenia with and without booster sessions.

Method: One hundred and three outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a 9-week psychoeducational programme. At the end of the programme groups were block-randomised to either an extension programme comprising monthly booster sessions for a further nine months (booster condition) or routine clinical care with no further group meetings (non-booster condition).

Quality of life in mental disorders: challenges for research and clinical practice.

The term quality of life (Qol) has become a rallying cry for all those who strive to integrate patients' subjective experience of their life during illness into clinical care. With its intuitive appeal, Qol seems to be understood by everyone involved in managing health and disease. However, when examining the ever increasing research literature, it becomes clear that many methodological questions still beset this field, since neither a commonly accepted definition nor a gold standard for measuring Qol exist.