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Biomedical subjects

G Längle

Publications and source records attributed to G Längle.

16 recordsLinked to original sources
PubMed2003

Indicators of quality of in-patient psychiatric treatment: the patients' view.

OBJECTIVES: The object of this study was to find out from psychiatric in-patients which aspects of care and treatment they considered important and how satisfied they were with these. DESIGN: One hundred and ninety-four in-patients were asked to rate the importance of, and their satisfaction with, 22 different aspects of in-patient care and treatment. The questionnaire, developed for the purpose of the study after a pilot phase including professional care givers and patients, contained 92 items and was returned by 52% of all discharged patients from the Psychiatric university hospital during a 3-month period. RESULTS: Patients made a clear distinction between aspects of treatment they considered important and aspects they were satisfied with. Ranked of highest importance were various therapeutic relationships, and respect for their rights and privileges. They were satisfied with their relationships with clinical staff but dissatisfied with medication. CONCLUSION: A well differentiated assessment of importance and satisfaction has implications for the evaluation of the quality of psychiatric care, for specific methods of treatment, and for the improvement of in-patient psychiatric care.

Health Services Research↗
PubMed2003

Psychiatric commitment: patients' perspectives.

OBJECTIVE: The literature pertaining to patients' perceptions of commitment and its consequences is limited. The object of this study was to learn more about these experiences from the patient's perspective. MATERIAL AND METHODS: 108 court-committed patients (78% of whom were schizophrenic) were identified for inclusion in a retrospective follow-up study. After an interval varying from one to 4.5 years from time of commitment to follow-up, 76 patients could be contacted, of whom 47 were included in the follow-up. RESULTS: The majority of patients felt that their court commitment had not been justified and could have been avoided. Events and circumstances identified as particularly stressful about commitment were confinement in a locked ward, side effects of medication, feelings of helplessness, and certain staffbehaviors. Adverse psychological, somatic, and social consequences were common. Coercive measures during hospitalization were strongly associated with negative feelings about the effect of commitment on mental health and about subsequent treatment. The majority, however, also remained in treatment after commitment was terminated, said they would return to hospital in event of future crisis, and had pertinent comments about how commitment could have been avoided. CONCLUSIONS: Many patients who had been court-committed reported negative feelings about their experiences, but the great majority had continued in treatment, both at the termination of commitment and later. They also had ideas about how to reduce the negative impact of commitment that are worth including in future contingency plans.

Adult↗
PubMed2002

Heart-rate variability (HRV) in the ECG trace of routine EEGs: fast monitoring for the anticholinergic effects of clozapine and olanzapine?

Drug monitoring in psychiatry usually serves psychoactive drug plasma concentration measurement. Anticholinergic properties offer a faster approach to monitoring pharmacodynamic intraindividual effects of the drug by measuring their effects on heart rate variability (HRV), which is sympathetically and parasympathetically controlled via cholinergic synapses. The plasma concentrations of the atypical antipsychotics clozapine and olanzapine correlated with parameters of HRV in 59 patients suffering from schizophrenia or schizoaffective disorder. HRV during 4 minutes at rest was extracted from the ECG trace of a routine digital EEG registration in addition to blood sampling for plasma concentration measurement (HPLC method). We calculated sympathetically and parasympathetically controlled heart frequency bands (low, medium and high frequency) and other HRV parameters, coefficient of variation (CV), and root mean square of successive differences (RMSSD). All HRV parameters were significantly more impaired in clozapine patients (n = 33, mean clozapine plasma concentration 331 +/- 294 ng/ml) than in olanzapine patients (n = 26, mean olanzapine plasma concentration 42 +/- 32 ng/ml) and demonstrated 1.7 - 4.8 times the cardiac anticholinergic properties of clozapine in vivo. 14 out of 14 patients with a CV beyond 3.2 % had clozapine plasma concentrations below the proposed optimal therapeutic concentration of 350 ng/ml. All HRV parameters were inversely and significantly correlated with the clozapine plasma concentrations (such as lgCV: r = - 0.73, p < 0.001) and, to a lesser extent, with the olanzapine plasma concentrations (lgCV r = - 0.44, p < 0.05). These results underline the potential clinical value of HRV parameter extraction from routine ECGs in predicting plasma concentrations and objective individual neurocardiac effects of drugs with anticholinergic properties.

Adolescent↗
PubMed2001

[Community-based rehabilitation for severely ill psychiatric patients?].

A central aim of reformatory efforts, as a consequence of the "Psychiatrieenquete" 1975 (a fundamental report of the situation of psychiatry in Germany), had been dehospitalisation of patients with chronic mental illness and their reintegration into the community. Despite a meanwhile well-developed range of community-based services, patients with severe mental illness only rarely get adequate care by these services. This holds especially true for patients with an unfavourable course of disease such as schizophrenia, severe personality disorder, skid-row alcoholism with multiple problems or for patients with double diagnosis. The reasons are barriers set up by the various services and their underlying concepts as well as structural problems in the health care system. Adapted to the special needs for help of these patients, we present a model for the community-based care of this group, combining elements of community psychiatry, addiction treatment and help for the homeless.

Alcoholism↗
PubMed2001

[Short- and medium-term outcome of outpatient treatment of alcohol dependent patients. A 6-, 18- and 36-month follow-up].

The aim of this study was to investigate the short- and medium-term outcome of alcohol dependent patients in Germany after a one-year outpatient treatment. For this purpose, a 6-, 18- and 36-month follow-up of 97 socially well adapted alcohol dependent patients treated between 1992 and 1997 at three "psychosocial advice center" run by the Diakonie Württemberg, Germany, was carried out. Based on the time period between treatment and follow-up, all 97 patients could be followed up for 6 months, 71 for 18 months, and 33 for 36 months. 83% of patients could be interviewed at 6 months, 80% at 18 months, and 78% at 36 months. The statistical analyses were based on the "intention to treat" model. All patients treated between 1992 and 1997 were included. Patients for whom no information was available were classified as relapsers. 6 months after the outpatient treatment 59% of patients were abstinent, 4% had lapsed and 37% were relapsers. At the 18- and 36-month follow-ups 61% of patients had been abstinent in the 6 months before the interview. 53% and 39% of patients respectively were continuously abstinent over the entire follow-up period of 18 and 36 months. Prognostic criteria for a relapse were regular completion of treatment (p < 0.001) and no prior detoxification or abstinence oriented treatment (p < 0.01). Patients without a partner showed a tendency towards higher relapse rates (p < 0.10). The results of this study indicate that an outpatient treatment program can be as effective as inpatient or combined inpatient/outpatient treatments, at least for some patients with good social integration.

Adult↗
PubMed2000

[Community psychiatric management of severely ill schizophrenic patients. An exemplary case study].

Psychiatric care for chronic schizophrenic patients has improved in recent years, but for severely ill patients, often with multiple comorbid psychiatric conditions and in great need of care, the situation remains unsatisfactory. Community-based psychiatric care is limited and psychiatric hospitals are now cutting back on inpatient care. The quality of care that chronically mentally ill patients receive at independent psychiatric nursing homes removed from population centers is undetermined, and many patients end up in asylums or homeless shelters unable to provide for their psychiatric needs. Neither a reliable way to assess the needs of these complicated patients nor a scientific basis for therapeutic intervention exists yet. The case study presented here illustrates an interdisciplinary approach to the care and treatment of a chronic schizophrenic patient with several comorbid conditions. Based on the individual needs of the patient and developed over the last 4 years, this approach had positive effects on the course and outcome of treatment and resulted in an impressive reduction of costs. The average annual number of days of hospitalization over a 3-year period was reduced from 206 to two and the total cost of care was reduced from US$70,000 annually to $8000. The results from this single case study are promising. Further investigation of the development and evaluation of highly individualized treatment plans for severely disturbed schizophrenic patients is warranted.

Case Management↗
PubMed2000

Chronic psychiatric patients without psychiatric care: a pilot study.

BACKGROUND: The study is based on the hypothesis that in any catchment area there are patients with chronic mental illness who are unknown to a comprehensive psychiatric/psychosocial care system. METHOD: A standardized questionnaire was sent to all general practitioners in a circumscribed catchment area in southwestern Germany in an attempt to identify such a group, to ascertain what the practitioners considered to be the needs of these patients, and to find out why the patients were not receiving specialized psychiatric care. RESULTS: Of 97 general practitioners contacted, 62 returned the questionnaire. Within a study period of 3 months, 89 patients were identified as having a significant psychiatric disorder, of whom 53% were older than 60 years and 15% were schizophrenic. General practitioners most frequently said that provision of specialized psychiatric care was the most pressing need of these patients, followed by a need for psychosocial services. They also said that the major reason patients did not participate in the mental health system was patient refusal of such services. CONCLUSIONS: Having identified the existence of a group of chronic psychiatric patients who are not receiving specialized psychiatric care, further in-depth field studies to pursue some of the issues raised in this pilot study will be necessary to determine whether further efforts to reach psychiatric patients without defined psychiatric care would be worthwhile. These issues include estimates of the prevalence of such patients in a defined population, patients' more specific reasons for refusal of psychiatric care, and the quality of psychiatric care they receive from general practitioners in comparison with patients who receive more conventional psychiatric care.

Adult↗
PubMed2000

[Role of the clinic in follow-up of schizophrenic illnesses].

Schizophrenics have the longest hospital stays and incur the greatest costs with respect to psychosocial care compared to other psychiatric patients. The present study focuses on the relevance of inpatient treatment during the course of schizophrenia with regard to specific symptom characteristics. In addition, the role of the hospital in partnership with local community health care facilities for the care of schizophrenic patients is described. Central aspects of hospitalisation, such as the circumstances of first admission, involuntary treatment, discharge planning, and provision for readmission are analysed and linked to our own data. Schizophrenic patients comprised the largest group of involuntarily treated patients and only 50% said they would return voluntarily to hospital if their symptoms recurred. On discharge from hospital, schizophrenic patients did not differ from other psychiatric patients with regard to their attitudes to hospitalisation. Improvement in both work and interpersonal skills was evident after first inpatient treatment. To provide better care for this group of patients, patient-oriented health provision services with individual attention, treatment and care planning are needed, in contrast to the more traditional hospital-oriented approaches that have been tending to give priority to institutional needs.

Case Management↗
PubMed2000

[Role of sports in treatment and rehabilitation of schizophrenic patients].

The literature on the role of sports in the treatment and rehabilitation of schizophrenic patients is meagre and no systematic interdisciplinary review of the subject exists. This article reviews the existing literature and summarizes the relevant research findings. It also discusses practical experiences derived from a model project designed to study the role of sports in the management of chronically ill psychiatric patients, which showed that social interaction as well as the ability to organize time and leisure activities improved as did self-esteem, body awareness, and overall physical activity. Sports activities as part of the care of chronically ill psychiatric patients are effective as well as cost-effective and should receive more attention in both practice and research.

Humans↗
PubMed2000

[Does modification of documentation result in a reduction of medication to involuntary patients?].

OBJECTIVE: The effects of modification of documentation on the administration of psychotropic medication to involuntary patients in hospital were investigated. METHODS: The charts of 414 inpatients on the acute-ward were reviewed two months before and two months after a new form for documentation of rationales for medication administration to involuntary patients was instituted. A follow-up was carried out for a two-month period a year later. RESULTS: The percentage of patients who received medication involuntarily, 70% of whom were schizophrenic, fell by over half, from 12% to 5%, after additional standardized documentation for the use of such medications was instituted. The number of medications administered to involuntary patients fell from 80 to 21, a reduction of 74%. The effects were stable over the course of one year. CONCLUSIONS: Modification of documentation seems to reduce the use of medication with involuntary patients.

Acute Disease↗
PubMed1999

[Effects of regional obligatory health care exemplified by a university clinic].

OBJECTIVE: Local care provision for the chronically mentally ill entails responsibility to be taken by all institutions involved in the care system of their respective area. In the clinical sphere regional responsibility is implement-ed to a large extent apart from a few university clinics. The University Psychiatry and Psychotherapy Clinic Tuebingen look after an area with obligatory provision of care consisting of 140,000 inhabitants in 1995. RESULTS: The comparative evaluation of the basic documentation showed minimal overall changes but an increase of older patients, of patients who are frequently hospitalised, and of addicts. The number of emergencies remained unchanged. The concomitant questioning of colleagues indicated delayed acceptance of the change. According to experiences made to date, the conditions for research and teaching have improved in certain areas thanks to the obligatory provision of care.

Adolescent↗
PubMed1998

[Cooperation guidelines--a contribution to the development of process quality in psychiatric community management].

Cooperation in the provision of care to individuals with chronic psychiatric illnesses represents a significant criterion for quality. In the Tuebingen administrative district, guidelines for cooperation in the handover of patients to facilities providing follow-up care and in parallel care of patients have been developed. Elements of the guidelines include handover standards, case conferences and case management. The results of accompanying research are encouraging, while indicating the necessity of continued discussion in the individual facilities and in the relevant authorities: The acceptance of the guidelines is high and they are considered useful in concrete practice, but implementation is sometimes hesitant and the instrument provided for documentation is barely used due to time limitations. Only by means of compulsory basic documentation will it be possible to evaluate the guidelines and secure the criteria for quality on a long-term basis. As with other models, integration of neurologists and psychiatrists in private practice into the cooperation with inpatient and outpatient facilities is a problem that must yet be resolved.

Case Management↗
PubMed1998

[The Community Psychiatry Organization in Baden-Württemberg].

While as a result of the report of the German Federal Government's Inquiry Commission a nationwide programme for further development of the provision of care to the mentally ill was launched, Baden-Wuerttemberg went it's own ways with its "Programme for the Development of Outpatient Psychiatric Care 1982-1986". In 1994 Baden-Wuerttemberg's concept of a "Communal Psychiatric Combine" ("Gemeindepsychiatrischer Verbund", GPV) was worked out; this concept increases in some respects the existing differences from other states. Apart from an improvement in coordination and cooperation, the GPV is intended to secure comprehensive local care provision for the chronically mentally ill. Furthermore, care provision appropriate to requirements should be made possible and quality assurance realised on all levels. In the following, Baden-Wuerttemberg's understanding of a "Communal Psychiatric Combine" is contrasted with the combine concept of the expert commission. The potential effects of the reginal care situation as well as the chances of implementation are discussed with reference to earlier experiences.

Ambulatory Care↗
PubMed1996

[Management of psychiatric patients in the community--developments up to now, current problems and future perspectives exemplified by the Tübingen district].

The development of the care of mentally ill persons in the last 25 years is shown by the example of the district of Tübingen with about 200,000 inhabitants, a district that did not take part in the model program of the Government. Considering the current care situation, the problems of cooperation and coordination as well as the ensuring of quality, which are actually most important, are discussed; approaches for solutions are outlined. We try a view on the coming 25 years.

Activities of Daily Living↗
PubMed1993

The reversibility of alcoholic brain damage is not due to rehydration: a CT study.

Alcoholic brain damage is reversible when the patients are continually abstinent. An increase of brain water content was the putative explanation for this phenomenon. We tested the rehydration hypothesis using CT density measurements in 29 alcohol-dependent male inpatients. During a 5-week period of controlled abstinence, CT density measures did not decrease in any of the investigated regions of the brain as one would expect with an increase in brain water. Although the volumetry of the ventricular system and the subarachnoidal spaces revealed a significant reduction of CSF volume, we found a slight increase in CT density measures. Thus, our results are in contradiction to the rehydration hypothesis. Under discussion is whether neuronal plasticity might be the explanation of the reversibility of alcoholic brain damage in abstinent patients.

Adult↗