AIMS: The present study aimed to evaluate whether individual counselling for alcohol-dependent patients in three sessions is as effective as a 2-week group treatment programme as part of an in-patient stay in a psychiatric hospital which was to foster motivation to seek further help and to strengthen the motivation to stay sober. Of particular importance was the external validity of the results, i.e. a 'normal' intake load of in-patients in detoxification and a wide variety of motivation to stop drinking were to be investigated. METHODS: Subjects eligible for the study were all patients with alcohol problems admitted to a psychiatric hospital, but without psychosis, as the main diagnosis, and with a maximum of 10 detoxification treatments in the past. A randomized-controlled trial was conducted with 161 alcohol-dependent in-patients who received three individual counselling sessions on their ward in addition to detoxification treatment and 161 in-patients who received 2 weeks of in-patient treatment and four out-patient group sessions in addition to detoxification. Both interventions followed the principles and strategies of motivational interviewing. RESULTS: Six months after intervention, group-treatment patients showed a higher rate of participation in self-help groups; however, this difference had disappeared 12 months after treatment. The abstinence rate among the former patients did not differ between the two intervention groups. CONCLUSION: Group treatment may lead to a higher rate of participation in self-help groups, but does not increase the abstinence rate 6 months after treatment.

Alcoholism↗

PubMedDate not supplied

Use of the ICD-10 classification in psychiatry: an international survey.

On the background of some years of experience with ICD-10 psychiatric diagnoses in many countries of the world, an international comparison was performed to evaluate the frequency and use of the ICD-10 psychiatric diagnoses. For future revision of the ICD-10, it is important to know which diagnostic categories are either not used or are used possibly in an unspecific manner. Nineteen departments of psychiatry in 10 different countries took part in the study, presenting data on 33,857 treatment cases leading to a total of 25,470 ICD-10 main diagnoses. The analysis of data reveals that on a four-character level (Fxx.x), the 10 most often used diagnostic categories represent 40% of all main diagnoses, and 70% on a three-character level (Fxx.-). There are 32 specific diagnostic categories on a four-character level which are not used at all and 121 which are used less frequently than 0.1% in inpatient and outpatient treatment. The study shows that the ICD-10 classification is in use in a variety of treatment settings worldwide. Further results and limitations of this study are discussed against the background of transcultural differences.

Aged↗

PubMedDate not supplied

Evaluation of the multiaxial system of ICD-10 (preliminary praft): correlations between multiaxial assessment and clinical judgements of aetiology, treatment indication and prognosis.

Forty-five raters in 7 German centres took part in a multicentric field trial of the multiaxial system of ICD-10, delivering a total of 488 multiaxial assessments of 12 written case summaries. In addition to the multi-axial ratings (including main and subsidiary psychiatry diagnoses, level of social dysfunctioning and psychosocial stressors), assessments were made by the raters of the aetiology, treatment indications and prognosis of the main psychiatric disorder. There were significant correlations between these judgements and the measures of the multiaxial ratings: 62% of the cases diagnosed as endogenous were assessed as having a high level of social dysfunctioning (the proportion for all cases being 50.4%) and 63.4% as having a low number of stressors (vs. 52.8% in all cases). In contrast, cases diagnosed as reactive were assessed as having a lower level of social dysfunctioning and more social stressors. Cases whose prognosis was poor showed a higher rate of comorbidity and a high level of social dysfunctioning. The results demonstrate that the multiaxial approach reflects factors important to the process of clinical treatment and decision making and delivers preliminary evidence of this system's treatment and prognostic validity.

Adult↗

PubMedDate not supplied

Comparison of psychiatric ICD-10 diagnoses in Denmark and Germany.

A dataset of psychiatric ICD-10 diagnoses from the Danish case register concerning psychiatric hospitals was compared with a sample of psychiatric diagnoses from 27 psychiatric hospitals in Germany. The comparison shows a higher proportion of F1 diagnoses in the German dataset and a difference in the coding of alcohol dependence and harmful use. Some further differences in the groups F0-F6 are demonstrated and some of them are discussed. The most frequent diagnoses found in both datasets but in different sequence are alcohol dependence syndrome and paranoid schizophrenia and, in third place, adjustment disorder. Various aspects of the problem of rarely used diagnoses are discussed.

Adjustment Disorders↗

PubMedDate not supplied

The multiaxial system of ICD-10: evaluation of a preliminary draft in a multicentric field trial.

The multiaxial system (MAS) of ICD-10, chapter V (F) consists of three axes: axis I, clinical syndromes (psychiatric disorders including personality disorders and somatic diseases); axis II, disabilities; axis III, environmental/circumstantial and personal life-style/life management factors. Results of a multicentric field trial evaluating a preliminary draft of the MAS are presented. 45 raters in seven German centers made 488 ratings on 12 written case histories. With a mean kappa of 0.50 for 3-character diagnoses interrater reliability for axis I was moderate although lower than expected from previous field trials. On axis II the WHO Disability Diagnostic Scale (WHO-DDS) was compared to the Global Assessment of Functioning (GAF) used in DSM-III-R and DSM-IV. For both scales the intraclass correlation coefficient showed a moderate interrater reliability (WHO-DDS = 0.62; GAF = 0.65). On axis III the number of relevant psychosocial circumstances coded by the different raters varied greatly. Interrater reliability was very poor with kappa values ranging from 0.03 to 0.55 for the different categories and an overall kappa of 0.16.

Adult↗

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[Speech and intelligence performance in relation to social class and family status].

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

[Psychiatric patients treated in a district of Bavaria].

Following a WHO study, the psychiatric care of a district in Bavaria was surveyed. At first the various institutions, psychiatrists in practice and psychiatric hospitals, were analysed as to their patients, then all psychiatric patients receiving treatment were referred to a region of 442 000 inhabitants. The incidence rate amounted to 0,4% the prevalence rate to 0,9% relative to a period of six months. We estimated a yearly incidence rate of 0,8% and a yearly prevalence rate of 1,5% relative to all age-groups. In our study psychiatric patients were described according to different variables, particularly of diagnostic classification. --The last part of the study contains some proposals of improving the psychiatric care in the area referred to.

Germany, West↗

PubMedDate not supplied

[Psychotherapy in general practice of physicians and psychologists].

This study tries to reveal the epidemiology of outpatient psychotherapy in practices in a defined northern area of Germany (Schleswig-Holstein, 2.66 Mill. inhabitants) by a postal questioning of all medical (n = 242) and psychological (n = 45) psychotherapists registered. Psychotherapy was defined as enclosing at least 10 meetings. 54.7% of the questionnaires were returned to us. An analysis on this database showed that 8310 adult patients were psychotherapeutically treated within one year (0.3% of the population). On the base of different epidemiological studies the treatment prevalence widely differed from 3.9 to 31.9%. The majority of diagnoses were reactive disorders or neuroses (52.8%) and psychosomatic disorders (24.3%). Patients out of middle and upper social classes, with higher educational levels, and from urban areas (> 100 000 inhabitants) were more likely to be treated than others. This trend was significantly more apparent in psychologists than in physicians.

Adult↗