BackgroundSchizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia) data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS). This approach is different from and complementary to the genome-wide association studies (GWAS) on schizophrenia.MethodsFor this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected.ResultsThe corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail.ConclusionsThe GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.
Objective: To describe the ongoing process of German psychiatric reform and the structure and functioning of mental health services.
Method: Information sources used include official reports describing mental health services, relevant publications related to organization and functioning of services.
Results: There has been far‐reaching change in mental health care since the late 1960s: psychiatric hospitals have lost about 50% of their beds and one psychiatric hospital has been closed. One hundred and sixty‐five general hospital psychiatric units have been built up. Out‐patient, community and residential services have been developed. There is a lack of diversified residential and rehabilitation services, particularly for the most severely ill. Co‐ordination of care is not always ensured, transfer of patients to remote nursing homes has occurred in some places. Carers and service users articulate their views to an increasing degree.
Conclusion: Political and professional enthusiasm have been important in implementation of the German reform. Evolving it further will require major efforts.
A mental hospital and a psychiatric department of a general hospital in the region of Kassel have jointly analysed their basic documentation to produce an overview of hospital treatment of psychiatric patients in the region. Patients from the urban population occupy twice as many beds as those from the rural population which is a hint that standard bed-ratios per population are inadequate. Instead of the unsuitable official definition of duration of stay in hospital we used "days in hospital per person per year". Making allowance for groups of diagnoses this made possible interesting comparisons about the contributions of the two hospitals to the treatment of the psychiatric patients in the region. The two hospitals are not similar and the results show how the patients make use of the possibility of choosing the various specialities of the two hospitals.
This study examines the quality of residential care in non-psychiatric nursing homes and psychiatric group homes for a representative epidemiologically-based sample of patients discharged from a psychiatric hospital in West Germany. There were twice as many chronically ill patients in sheltered accommodation as in hospital, 85% of them in nursing homes, which scored badly on all measures of therapeutic environment. This poverty of social environment was correlated with severity of symptoms for schizophrenics, especially with flatness of affect and poverty of speech. Nursing homes were just as likely as hospitals to promote chronic illness and hinder rehabilitation.
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