Duration Of Inpatient Treatment Research Articles

Surveillance of Multidrug-resistant Gram-negative Pathogens in High-risk Neonates—Does it Make a Difference?

Surveillance of Multidrug-resistant Gram-negative Pathogens in High-risk Neonates—Does it Make a Difference?

One-year functional outcomes of naturalistically treated patients with schizophrenia

Against the background of the growing evidence that the patient's functioning significantly influences the course and outcome of schizophrenia, the aims of this analysis were to examine what proportion of patients achieve functional outcome criteria after 1 year, and to identify clinical and sociodemographic predictive factors for functional remission. Patients with the diagnosis of schizophrenia who were treated as inpatients at the beginning of the study were examined within a naturalistic follow-up trial. The present study reports on the time frame from admission to discharge of an inpatient treatment period and the 1-year follow-up assessment. The Global Assessment of Functioning (GAF) Scale and Social and Occupational Functioning Assessment Scale (SOFAS) were evaluated with respect to functional outcome, whereas Positive and Negative Syndrome Scale (PANSS) scores were rated as psychopathological outcome measures. Functional remission thresholds were defined according to a GAF score of ≥61 points and a SOFAS score ≥61 points. Symptomatic remission criteria were applied according to the remission criteria of the Schizophrenia Working Group. The Strauss–Carpenter Prognostic Scale (SCPS), the Phillips Premorbid Adjustment Scale, medical history, sociodemographic and psychopathologic parameters were evaluated in order to find valuable predictors for functional remission. One year after discharge from inpatient treatment, 211 out of 474 patients were available for analysis according to both rating scales used to assess functional remission (GAF and SOFAS). Forty-seven percent of patients fulfilled criteria for functional remission (GAF and SOFAS) at discharge and 51% of patients at the 1-year follow-up visit. With regard to symptomatic remission criteria, the corresponding remitter rates were 61% of patients at discharge and 54% at the 1-year follow-up visit. Forty-two percent of patients fulfilled both remission criteria at discharge and 37% at the 1-year follow-up visit. A significant association was found between functional and symptomatic remission at discharge and at the 1-year follow-up visit. The strongest predictors for functional remission at the 1-year follow-up visit were: a higher SCPS total score at admission, a lower number of previous hospitalizations, a status of employment, lower scores in all PANSS subscales at discharge, a better premorbid social adjustment, the occurrence of a first psychotic episode, a younger age, a lower PANSS negative subscore at admission, a status of being an early responder, a shorter duration of inpatient treatment, a later age of onset, and female gender.

The Potential Impact of Smoke-Free Facilities on Smoking Cessation in People with Mental Illness

The aim of this paper was to estimate the degree to which smoke-free facilities may facilitate smoking cessation in smokers with mental illness by estimating the proportion of smokers with mental illness who receive inpatient treatment, their smoking rates and average durations of stay. Smoking and hospitalization rates were estimated from the Australian National Survey of Mental Health and Wellbeing. Information on duration of inpatient treatment was calculated from the Western Australian Mental Health Information System. Of Australia's estimated 3,567,000 current adult smokers, 32.4% had a mental illness in the past 12 months, and 66.6% had a lifetime mental illness. However, only 1.4% of smokers were hospitalized for a mental health problem in the past 12 months, and 6.3% had ever been hospitalized for a mental health problem. Of those hospitalized for mental health treatment in the past 12 months, 61.2% were current smokers. In 2007 median duration of inpatient mental health admissions was 1 day, and 57% of admissions had duration of 2 days or less. The majority of smokers with mental illness are not treated in inpatient facilities, and where inpatient admissions occur they are generally of short duration. While smoking cessation is an important goal in treatment of smokers with mental illness, support after discharge from inpatient care is important for longer term cessation. Other strategies will be required to support smoking cessation efforts for the majority of smokers with mental illness not in contact with mental health services.

Cost-effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS).

BackgroundIntensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness of two intensive one-year inpatient treatments and usual care for severely obese children and adolescents.Methods/DesignParticipants are 40 children aged 8-13 and 40 adolescents aged 13-18 with severe obesity (SDS-BMI ≥ 3.0 or SDS-BMI ≥ 2.3 with obesity related co-morbidity). They will be randomized into two groups that will receive a comprehensive treatment program of 12 months that focuses on nutrition, physical activity and behavior change of the participant and their parents. The two programs are the same in total duration (12 months), but differ in inpatient treatment duration. Group A will participate in a 6 month intensive inpatient treatment program during weekdays, followed by six monthly return visits of 2 days. Group B will participate in a 2 month intensive inpatient treatment program during weekdays, followed by biweekly return visits of 2 days during the next four months, followed by six monthly return visits of 2 days. Several different health care professionals are involved, such as pediatricians, dieticians, psychologists, social workers, nurses and physiotherapists. Results will also be compared to a control group that receives usual care. The primary outcome is SDS-BMI. Secondary outcomes include quality of life using the EQ-5D and cardiovascular risk factors. Data will be collected at baseline and after 6, 12 and 24 months. An economic evaluation will be conducted alongside this study. Healthcare consumption will be based on actual resource use, using prospective data collection during 2 years through cost diaries. Quality Adjusted Life Years (QALYs) will be calculated using the EQ-5D.DiscussionThis study will provide useful information on the effectiveness and cost-effectiveness of inpatient treatment in severely obese children and adolescents. Valuable information on long term effects, after 2 years, is also included.Trial registrationNetherlands Trial Register (NTR): NTR1678

Erhebungsinstrumente zur Veränderungsmotivation von Patientinnen mit Anorexia nervosa im Vergleich

The study compares three instruments assessing the readiness to change in patients suffering from anorexia nervosa, and assesses their relationship to clinical data. Two of the instruments, the "Fragebogen zur Erfassung der eränderungsbereitschaft" (FEVER) and the "Anorexia Nervosa Stages of Change Questionnaire"(ANSOCQ), are questionnaires; the "Readiness and Motivation Interview"(RMI) is a semistructured interview. The sample consisted of 44 anorexia nervosa inpatients. The data of the three instruments correlate with each other to a medium high degree. Clinical variables such as BMI, bodyweight, and inpatient treatment duration show only a few, and mostly low, correlations. The therapeutic prognoses correlate with the motivation to change to a medium/high degree, whereas low motivation frequently correlates with negative predictions. The ambivalence of the anorexia nervosa patients shows up mostly on the RMI, which also displays the highest correlations to the clinical data and to the EDI-2 data.

Predictors of response and remission in the acute treatment of first-episode schizophrenia patients — Is it all about early response?

Background To evaluate the predictive validity of early response compared to other well-known predictor variables in acutely ill first-episode patients. Methods 112 patients were treated with a mean dosage of 4.14 mg (± 1.70) haloperidol and 112 patients with a mean dosage of 4.17 mg (± 1.55) risperidone for a mean inpatient treatment duration of 42.92 days (± 16.85) within a double-blind, randomized controlled trial. Early response was defined as a ≥ 30% improvement in the PANSS total score by week 2, response as a ≥ 50% reduction in the PANSS total score from admission to discharge and remission according to the consensus criteria. Univariate tests and logistic regression models were applied to identify significant predictors of response and remission. Results 52% of the patients were responders and 59% remitters at discharge. Non-remitters at discharge were hindered from becoming remitters mainly by the presence of negative symptoms. Univariate tests revealed several significant differences between responders/non-responders and remitters/non-remitters such as age, severity of baseline psychopathology as well as the frequency of early response. Both early response (p < 0.0001) and a higher PANSS positive subscore at admission (p = 0.0002) were identified as significant predictors of response at discharge, whereas a shorter duration of untreated psychosis (p = 0.0167), a lower PANSS general psychopathology subscore (p < 0.0001), and early treatment response (p = 0.0002) were identified as significant predictors of remission. Conclusion Together with the finding that early response is a significant predictor of response and remission, the relevance and predictive validity of negative and depressive symptoms for outcome is also highlighted.

Kindorientierte Frakturbehandlung

For child-oriented treatment of fractures it is important to consider healing processes specific to children. These healing processes necessitate early treatment and a primary definitive treatment concept in line with current standards. The parents or guardians of the child should be directly included while obtaining the anamnesis, for the diagnosis and when planning the treatment concept. Specifically, the potential of spontaneous correction of the growing bone and the necessity or avoidance of imaging procedures should be thoroughly discussed. For the treatment of shaft fractures of the long bones the method of elastic stable intramedullary nailing has found common acceptance as this method significantly reduces both the duration of inpatient treatment as well as the time of immobilization. The child-oriented treatment of fractures is still in development and demands specific knowledge of the orthopedic surgeon concerning the characteristics of the growing bones, the potential of spontaneous correction and the outcome of injuries to the growth plate on the growing skeleton.

Glasgow Coma Scale and laboratory markers are superior to COHb in predicting CO intoxication severity

Carbon monoxide (CO) intoxications can affect several organ systems and lead to coma or death in severe cases. To date, COHb is routinely used as a marker for detecting CO intoxication. In this retrospective study, we investigated 173 patients admitted with CO intoxication to our intensive care unit (ICU) over a period of 8 years. Standardised blood tests, chest X-ray and neurological status evaluation were performed on admission and throughout the inpatient treatment. The duration of inpatient treatment was considered to be an indication of the severity of CO-related illness. Interestingly, the data did not reveal a significant correlation between initial COHb level and the duration of inpatient treatment. Instead, a significant inverse correlation was found between the initial Glasgow Coma Scale and the duration of inpatient treatment. Furthermore, significant correlations were found between the duration of inpatient treatment and the occurrence of elevated leucocyte numbers, elevated C-reactive protein (CRP) serum concentrations and the presence of lung infiltrates. In conclusion, we postulate that clinical parameters, such as the Glasgow Coma Scale and the laboratory markers CRP and leucocyte count are adequate supportive tools for evaluating the severity of CO-related illness, and further, that the measurement of COHb alone is insufficient for this purpose.

Time course of antipsychotic treatment response in schizophrenia: Results from a naturalistic study in 280 patients

ObjectiveTo describe the course of positive and negative symptoms during inpatient treatment and examine remission and response rates under routine clinical care conditions. MethodsTwo hundred and eighty inpatients with schizophrenia (DSM-IV criteria) were assessed with the Positive and Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the symptom–severity component of the consensus criteria (Remission in Schizophrenia Working Group) as a rating of three or less in the relevant PANSS items at discharge, and response as a reduction of at least 20% in the PANSS total score from admission to discharge. ResultsThe mean duration of inpatient treatment was 54.8days. Of the total sample, 78.5% achieved the criteria for response and 44.6% those for remission. Mean PANSS total scores decreased from 72.4 at admission to 52.5 at discharge (p<0.001). A reduction in PANSS total scores was found from visit to visit, up to week 8. The most pronounced decline was observed within the first two weeks of treatment. ConclusionResponse rates were comparable to those found in efficacy studies, and remission rates were slightly higher. This may be explained by differences in the selection and the treatment of patients. Nevertheless, the findings might indicate that a complex naturalistic treatment approach is beneficial in terms of effectiveness.

Outcomes of 1014 naturalistically treated inpatients with major depressive episode

Due to strict exclusion criteria the generalizability of randomized controlled trials appears to be limited. Therefore, outcomes of naturalistically treated depressive inpatients with respect to depression mean scores, response and remission rates were evaluated. This was a multicenter trial, conducted in 12 psychiatric hospitals in Germany with a follow-up period of 4years. Patients were assessed biweekly from admission to discharge with diverse psychopathological rating scales. All patients (n=1014) met DSM-IV criteria for major depressive episode. Results are presented only for the acute inpatient treatment period. Mean inpatient treatment duration was 53.6+/-47.5days. Reduction on depression scales was evident as soon as week 2 and remained significant. Mean HAMD-17 total score decreased from 22.3 to 8.8. A total of 68.9% were classified as responders (> or =50% reduction of the initial HAMD-17 score), whereas 51.9% achieved remission (HAMD-17 total score < or =7). Of those who ultimately achieved response more than 40% did so within the first 2weeks. An individualized naturalistic inpatient treatment approach appears to be beneficial in terms of effectiveness.

Long-term observation of patients successfully switched to risperidone long-acting injectable: A retrospective, naturalistic 18-month mirror-image study of hospitalization rates and therapy costs

Objective. The aim of the present 18-month retrospective study was to assess the association between a continuous long-term treatment with risperidone long-acting injectable (RLAI) of at least 12 months and in-patient care of patients suffering of schizophrenia or schizoaffective disorder. Furthermore we wanted to assess the cost-effectiveness of a long-term treatment with RLAI. Methods. In a mirror-image design, data of 119 patients with schizophrenia and schizoaffective disorder who were switched to RLAI treatment were analyzed retrospectively. Hospitalization rates, the duration of inpatient treatment and the overall treatment costs were assessed 12 and 18 months after switching to RLAI and compared to the equivalent time preceding the switch. Results. After 12 and 18 months of RLAI treatment, the mean reduction of inpatient care was 27.4 and 38.4 days per patient, respectively, compared to the equivalent time period prior to switching to RLAI (Wilcoxon P < 0.001). The overall savings in drug and institutional-care costs were 21.1 and 21.9%, respectively. Conclusions. Patients receiving RLAI for at least 12 months showed a reduction in inpatient days and lower overall treatment costs.

Mangelnde Krankheitseinsicht bei Patienten mit einer schizophrenen Psychose aus der Perspektive der Angehörigen

Lack of insight into illness of patients with schizophrenia is often a big problem for relatives. Therefore, information was collected on how relatives assess the patients' insight into illness and their current treatment situation. This assessment was compared with the relatives' feelings of well-being. Questionnaire-assisted exploration of 84 relatives, who participated in an information session about lack of insight into illness. 73 % of patients had a lack of insight into illness according to their relatives. Of these, 79 % were male, the mean duration of inpatient treatment was 12 months, 56 % used an antipsychotic medication and 80 % were "quite/very ill". Of the patients with insight into illness, 45 % were male (p < 0.01), the duration of inpatient treatment was significantly longer (29 months; p < 0.05), 86 % used antipsychotics (p < 0.05) and only 42 % were judged as "quite/very ill" (p < 0.01). Only 49 % of relatives from the first group, but 67 % of relatives from the second group described their feelings of well-being as "very good / good" (p < 0.05). The lack of insight into illness requires greater scientific attention in order to develop better treatment options along with greater relief for relatives.

Thrombotic thrombocytopenic purpura is associated with a high relapse rate after plasma exchange: a single‐centre experience

Thrombotic thrombocytopenic purpura (TTP) is a rare condition characterized by microangiopathic haemolytic anaemia, thrombocytopenia, renal and/or neurological dysfunction secondary to microvascular or macrovascular thrombosis. Despite advances in treatment, TTP remains a serious condition with significant morbidity and mortality. We undertook an audit of patients with TTP over 14 years to assess remission, relapse, survival and factors predictive of outcome using current therapy based on plasma exchange with fresh-frozen plasma. Forty patients were identified between January 1992 and December 2005. Thirty-one (82%) achieved complete response (CR) to therapy using plasma exchange with fresh-frozen plasma (median 11 exchanges) and steroids. Twelve (37%) relapsed a median of 14 days following cessation of therapy, with multiple relapses occurring in two patients. TTP-related death occurred in four patients during their initial presentation and in two during subsequent relapse. Four patients were only partially responsive to first-line therapy. The absence of neurological features at presentation was the only factor predicting a sustained CR to first-line therapy (P = 0.027, log-rank analysis). The mean duration of inpatient treatment was 18 days (range 4-38 days) with 30% of patients requiring intensive care admission. Thirty-four per cent of patients acquired central venous line infection, with a median of two episodes of line sepsis per patient. Our results indicate the need for better treatments to reduce the high early relapse rate and significant mortality associated with current therapy.

Guided self-help for binge eating/purging anorexia nervosa before inpatient treatment

The goal of this study was to develop a cognitive–behavioral self-help manual for anorexia nervosa. Patients diagnosed with anorexia nervosa (N=102), binge eating/purging type (AN-B/P), were consecutively assigned to one of two conditions: 6-week manualized guided self-help or a wait-list control. All patients thereafter received inpatient treatment in a hospital for behavioral medicine. The primary outcome variable was the number of days in inpatient treatment. Secondary outcome variables were measures of psychopathology. Results showed that duration of inpatient treatment was significantly shorter (by 5.2 days) among participants receiving guided self-help. Body image, slimness ideal, general psychopathology, and some bulimic symptoms improved significantly during self-help. The authors conclude that, to increase effects of therapist-guided self-help in AN-B/P, additional variants of a self-help manual should be tried in different therapeutic settings.

Outpatient Antipsychotic Treatment and Inpatient Costs of Schizophrenia

Objective: To estimate the proportions of acute care inpatient admissions and hospital days for schizophrenia patients in the Medicaid program that are attributable to gaps in outpatient antipsychotic treatment and to calculate the corresponding total health care costs of this care. Methods: A series of multivariate regressions were performed with statewide 2001–2003 California Medicaid data to estimate the fraction of acute care hospital admissions and hospital days for schizophrenia attributable to gaps in antipsychotic medication treatment. This fraction was then applied to national estimates of the number and costs of inpatient treatment episodes for patients with schizophrenia in the national Medicaid program. Results: In the United States, there are roughly 87 000 annual acute care inpatient admissions of Medicaid patients for the treatment of schizophrenia. These admissions include a total of approximately 930 000 hospital days at a total cost of $806 million. Improving adherence to eliminate gaps in antipsychotic medication treatment could lower the number of acute care admissions by approximately 12.3% (95% confidence interval [CI]: 11.7%–12.6%) and reduce the number of inpatient treatment days by approximately 13.1% (CI: 9.8%–16.5%) resulting in a savings of approximately $106 million (95% CI: $79.0 million–$133.0 million) in inpatient care costs for the national Medicaid system. Conclusions: Nonadherence to antipsychotic medication treatment accounts for a considerable proportion of inpatient treatment costs of Medicaid patients with schizophrenia. Improving continuity of antipsychotic medications could lead to savings by reducing the frequency and duration of inpatient treatment.

Neue Versorgungsmodelle in der Psychosebehandlung

It is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex and, together with financing by the different social insurance providers, may lead to a rather problematic fragmentation of health service supply. Schizophrenia is considered the most expensive mental illness in Germany. It is estimated that indirect costs (expressed in financial terms) are five times higher than the direct costs of treatment and care. Innovative concepts of psychosocial intervention show that case management and assertive community treatment reduce the hospitalisation rate and duration of inpatient treatment, enhance social integration, and find the approval of most patients. However, there is no empirical evidence supporting this "psychiatry with no beds". Consideration should be given to psychosocial interventions as an alternative to inpatient hospital treatment such as day hospital care, crisis houses, or acute home treatment.

Twelve‐year course and outcome predictors of anorexia nervosa

The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.

Affective disorders in older inpatients.

After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990-1998. The clinical diagnoses were made according to the ICD-10 criteria. 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3-31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70-79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (< 65 years) and the older inpatients (>/= 65 years). In particular, no higher frequency of psychotic symptoms with increasing age could be found. The length of inpatient treatment did not significantly differ between both age groups. The elder patients showed less suicidal attempts prior to admission and less psychiatric comorbidity, but a significantly higher rate of concurrent physical illness. In 923 inpatients a psychiatrist was consulted by the other medical departments because of a co-occurrence of physical with affective disorders, making up 8.6% of the total seen by the psychiatric consultation service. Here again, the proportion of depressive episodes increased with age. The pattern of the depressive episodes in these patients did not differ from that seen in the psychiatric inpatients. Only clinical diagnoses made by experienced psychiatrists were evaluated. According to our results older depressive inpatients differ from younger ones only with regard to concurrent comorbidity but not with respect to the duration of inpatient treatment or the pattern or severity of depressive symptoms. They more frequently suffered from physical illness but less often showed concurrent psychiatric comorbidity.

The consequences of non-cognitive symptoms of dementia in medical hospital departments.

To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes. The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used. Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables. Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Predicting long-term outcome of in-patient psychosomatic treatment

Abstract. The outcome of in-patient psychosomatic treatment was evaluated by longitudinal assessment at hospital admission, discharge, and 1-year-follow-up. Out of n = 1829 patients, n = 712 responded (38.9 %). Response rates co-varied with duration of in-patient treatment. Responder-analyses characterise the sample as fairly representative. Outcome criteria included standardised measures of complaints, mood quality, global quality of life, life satisfaction, everyday functioning, and social integration. Disease-related parameters (duration of illness, medical certification, number of doctors consulted, number of somatic resp. psychosocial diagnoses) and generalised outcome expectancies (self-efficacy, optimism, pessimism) were included as predictors. Patients' retrospective estimations at follow-up as well as longitudinal assessments show a successful and mostly stable therapy outcome. Negative moods and complaints show a new increase at follow-up, though, still remaining below the level at hospital admission. Although there is much accordance among the diagnostic groups, patients with anxiety disorders (ICD-10: F40/41) and patients with adaptation disorders (F43) show distinctly varying courses. Regression analyses yield specific correlations between disease-related parameters and long-term outcome: Duration of treatment does not predict treatment outcome. The number of somatic diagnoses is a predictor of complaints, the number of psychosocial diagnoses a predictor of negative moods at follow-up. Pessimism and - to a lesser degree - self-efficacy prove to significantly predict numerous outcome criteria. Generalised expectancies should be considered in the process of prognosis and differential indication.