Pilot study of Experience Focused Counselling by nurses with people who hear voices: Evaluation of the implementation of the study protocol Abstract: Background: Hearing voices and the treatment and support of people who hear voices and are distressed by the experience are defined differently in psychiatry. In contrast to the medical approach to define and treat voices as symptoms of a disease, the EFC counselling approach developed with voice-hearers focuses on non-pathologizing acceptance and a constructive relationship to voices. Mental health nurses with their focus on everyday life are predestined for the dissemination and application of alternative therapeutic approaches in practice. Aim: The aim was to evaluate the study protocol as part of a pilot study regarding its suitability for a larger trial. Method: The multi centre pilot study had a single-blind randomised controlled design. The intervention consisted of EFC counselling by nurses with people who hear voices. The control group received Treatment As Usual (TAU). The suitability of the study design was evaluated in terms of recruitment, burden on study participants, suitability of assessment tools, the application of EFC counselling and the use of study nurses. Results: As planned 21 participants could be included in the study within fifteen months across the two study sites. Overall, the participants rated the study as not very burdensome and the intervention as helpful. The application of EFC by the nurses as well as the use of study nurses was assessed as good and suitable respectively. Discussion: The evaluation of the study protocol shows that with minor adjustments it is suitable for conducting a larger study.

The Self and Interpersonal Functioning Scale (SIFS) is a 24-item self-report questionnaire assessing personality functioning according to the alternative DSM-5 model for personality disorders. We evaluated the German SIFS version in a total sample of 886 participants from Germany and Switzerland. Its factor structure was investigated with confirmatory factor analysis comparing bifactor models with two specific factors (self- and interpersonal functioning) and four specific factors (identity, self-direction, empathy, and intimacy). The SIFS sum and domain scores were tested for reliability and convergent validity with self-report questionnaires and interviews for personality functioning, -organization, -traits, -disorder categories, and well-being. None of the bifactor models yielded good model fit, even after excluding two items with low factor loadings and including a method factor for reverse-keyed items. Based on a shortened 22-item SIFS version, models suggested that the g-factor explained 52.9–59.6% of the common variance and that the SIFS sum score measured the g-factor with a reliability of .68–.81. Even though the SIFS sum score showed large test-retest reliability and correlated strongly with well-established self-report questionnaires and interviews, the lack of structural validity appears to be a serious disadvantage of the SIFS compared to existing self-reports questionnaires of personality functioning.

ZusammenfassungHintergrundDie Gesundheitsförderung und präventive Krisenprophylaxe sind fundamentaler Bestandteil derzeitiger Mental-Health-Strukturen. Recovery-Colleges, als Institutionen zur Förderung seelischer Gesundheit, leisten in Deutschland bereits einen wesentlichen Beitrag zur mentalen Gesundheitsförderung und individuellen Recovery. Mittlerweile hat sich aus einzelnen Projektstrukturen ein deutschlandweites Netzwerk gebildet.ZielsetzungDie vorliegende Übersichtsarbeit beschäftigt sich mit dem bisher noch nicht abgebildeten, aktuellen Umsetzungsstand der Etablierung und primären Verortung von Recovery-College-Strukturen (RC/EC) im deutschsprachigen Raum. Es werden grundlegende Aspekte, Inhalte und Strukturen zum Recovery-College-Konzept und dessen Herkunft aufgezeigt. Dabei werden unterschiedliche Projektmodelle, deren Ausprägungen und Besonderheiten betrachtet.Material und MethodenAufbauend auf eine Literaturrecherche über die Plattform PubMed zum Thema Recovery-Colleges konnten mittels Online-Befragung über das deutsche RC-Netzwerk (RCN) 11 verschiedene College-Einrichtungen rekrutiert und befragt werden.ErgebnisseDie Auswertung zeigt, dass die College-Einrichtungen nach gleichen Prinzipien strukturiert sind, aber sich z. B. in ihrem Standort, ihrer Refinanzierung und in ihrem Leistungsspektrum an Kursangeboten unterscheiden können. Des Weiteren stehen College-Einrichtungen oft in direkter oder indirekter Verbindung zu professionellen Akteuren des Gesundheitswesens, haben aber auch Anbindungen zu gemeindenahen Einrichtungen, Lehreinrichtungen und Selbsthilfegruppen.SchlussfolgerungLetztlich bedarf es einer verstärkten Aufmerksamkeit, einer kontinuierlichen finanziellen Rahmensubventionierung und weiterer Erforschung, um eine recovery-orientierte Praxis mit dem College-Konzept in Deutschland zu etablieren.

The quasi-experimental AKtiV study investigates the effects inpatient-equivalent home treatment (IEHT). This paper describes the study population based on demographic and clinical parameters at baseline and compares the index treatment. Over a period of 12 months 200 IEHT users were included in the intervention group (IG) and 200 inpatients were included in the control group (CG). The comparability of the two groups was ensured by propensity score matching (PSM). In addition to the PSM variables, IG and CG did not differ significantly from each other variables at study inclusion. The duration of the index treatment was significantly longer in the IG (M=37.2 days) compared to the CG (M=27.9 days; p<0.001). The similarity of the two groups enables comparisons over 12 months, investigating IEHT effects on long-term outcomes.

This randomised controlled trial (RCT) assessed the effect of a 1-year, partially supervised, physical activity (PA) intervention on a cardiovascular disease (CVD) risk score in adult survivors of childhood cancer. We included childhood cancer survivors ≥16 y at enrolment, <16 y at diagnosis and ≥5 y in remission. The intervention group was asked to perform an additional ≥2.5 h of intense physical activity/week, controls continued exercise as usual; assessments were performed at baseline, 6 months (T6) and 12 months (T12). The primary endpoint was change in a CVD risk score (average z-score of waist circumference, blood pressure, fasting glucose, inverted high-density lipoprotein cholesterol, triglycerides, and inverted cardiorespiratory fitness) from baseline to T12. We performed intention-to-treat (ITT, primary) and 3 per protocol analyses. We randomised 151 survivors (44% females, 30.4 ± 8.6 years). We found a significant and robust reduction of the CVD risk score in the intervention compared to the control group at T6 and T12 across all analyses; with a difference in the reduction of the CVD risk z-score of -0.18 (95% confidence interval -0.29 to -0.06, P = 0.003) at T12 in favour of the intervention group (ITT analysis). This RCT showed that a long-term PA intervention can reduce CVD risk in long-term survivors of childhood cancer. Clinicaltrials.gov: NCT02730767.

"If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures. Abstract. Background: There is an urgent need to reduce coercive measures in psychiatric care. The interaction between patients, nursing staff and medical professionals influences the course of a coercive measure. Aim: The interaction before, during and after coercive measures will be described and compared from the perspectives of the parties involved in order to identify a potential for prevention and quality improvement. Methods: A multiple case study of three coercive measures was conducted, each consisting of interviews with three participants, case documentation, photos, and observation. The data material was analysed thematically with subsequent single-case and cross-case analysis. Results: The thematic analysis revealed three areas of tension: tension and relaxation, humaneness and dehumanisation, as well as safety and autonomy. The stage before coercion was characterised by interacting tensions and the influence of emotions and stress. In all cases, a verbal communication gap was present. During the coercive measure, the quality of interactions between patients and nurses determined their experience. After coercion, the impacts of the measure on the persons and their relationships as well as reflections were the focus. Conclusions: De-escalation techniques turn out to be a key issue, whereby special attention should be paid to emotional and nonverbal aspects in the future. The results underline the relevance of empathy and respect throughout the process for prevention as well as for quality of care. Debriefings of coercive measures should be conducted routinely.

Zusammenfassung Ziel der Studie Der psychiatrisch-psychotherapeutische und psychosoziale Hilfebedarf in der ambulanten Suchthilfe wurde im Rahmen eines integrierten Versorgungskonzepts mit Beteiligung von Einrichtungen der Suchtberatung und Suchtbehandlung ermittelt. Methodik Die prospektive Datenerhebung erfolgte zwischen dem 01.03.2020 und dem 30.04.2021 im Rahmen der erstmaligen Vorstellung in den beteiligten Einrichtungen der Suchtberatung und Suchtbehandlung. Die Erfassung der psychischen Belastung bei den teilnehmenden Personen, die sich in einer Suchtberatung vorstellten (N=234), erfolgte mit Hilfe der Brief-Symptom-Checklist (BSCL). Die psychosoziale Belastung bei den teilnehmenden Personen, die sich in einem suchtmedizinischen Ambulatorium vorstellten (N=198), wurde mit Hilfe des Kurzassessments zur Indikation der psychosozialen Suchtberatung erfasst. In beiden Versorgungsstrukturen wurden zudem soziodemografische und klinische Daten erhoben. Ergebnisse 1.) In den Einrichtungen der Suchtberatung zeigte sich bei etwa 55% der Klient:innen eine klinisch auffällige psychische Belastung. Diese Klient:innen hatten zudem häufiger Probleme mit mehreren Substanzen sowie häufiger psychische Begleiterkrankungen, insbesondere affektive Störungen. 2.) In den Einrichtungen der Suchtbehandlung wiesen etwa 52% der Patient:innen eine Unzufriedenheit bezüglich der finanziellen Situation und etwa 44% bezüglich der Beschäftigungs- und Alltagssituation auf. Die Unzufriedenheit mit der sozialen Situation und der Wohnsituation war mit jeweils etwa 25% geringer ausgeprägt. Schlussfolgerung Der psychiatrisch-psychotherapeutische und psychosoziale Hilfebedarf ist in beiden Versorgungsstrukturen hoch und erfordert ein integriertes Versorgungssystem mit dem routinemäßigen Einsatz standardisierter Assessments und einer koordinierten Zuweisungspraxis zwischen Suchtberatung und Suchtbehandlung.