[A telephone hotline as an easily accessible service for questions on schizophrenia]

Public relations activities of the German Research Network on Schizophrenia (GRNS) have shown that there is a demand for more information about schizophrenia disorder. This confirms international research findings that relatives of schizophrenia patients are particularly in need of information and support. In response, the GRNS has maintained a telephone hotline since 2001. The hotline is manned by clinical experts, psychiatrists, or psychologists once a week. The telephone calls are documented in a systematic manner. From 2001 to 2003, 3,909 calls were registered. This volume exceeds the limit of the hotline's resources. The telephone hotline is mainly used by relatives of psychotic patients. Most questions relate to the symptoms of schizophrenia and pharmaceutical treatment. The need for emotional support is also a high motivational factor for dialing the hotline number. The telephone hotline seems to be a worthwhile addition to the already existing crisis telephones and should be maintained even after public funding of the network expires.

[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.

[Trial employment: a provisional work setting for psychiatric patients]

OBJECTIVE

This study investigates the effects of probationary work for psychiatric patients in community-based small businesses during their inpatient or day care.

METHODS

Patients were evaluated for working capacity, psychopathology, motivation for work and patient satisfaction (n = 69).

RESULTS

The results confirm a high degree of acceptance of this approach as well as significant improvements on various clinical scales such as the Brief Psychiatric Rating Scale (BPRS), the Beck Depression Inventory (BDI), the Global Assessment of Functioning Scale (GAF), choice reaction time (Wiener Determinationsgerät, WDG), attention (Revisionstest) and self-rating of work-relevant skills.

CONCLUSIONS

This approach, with its complex demand characteristics, may be an effective alternative to occupational therapy, at least for small therapeutic units.

[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.