Cranial irradiation in prepubertal children with leukemia or brain tumors can lead to precocious or in high doses to late puberty. To unravel the underlying mechanisms, we developed a rat model with selective cranial Co60-irradiation technique. Infantile (12-16 d old) or juvenile (21-23 d old) female Sprague-Dawley rats received a single dose of 4, 5, 6, 9 or 2 x 9 Gy (at days 21 and 23). Each group consisted of 7-20 animals. High radiation doses (9 Gy and more) caused retardation of sexual development, whereas low radiation doses (5 or 6 Gy) led to accelerated onset of puberty in 20% of infantile irradiated rats animals as determined by vaginal opening. Interestingly, at peripubertal age (postnatal day 32-34), 5 or 6 Gy infantile irradiated rats had significantly higher serum LH levels stimulated by GnRH and estradiol levels (p < 0.05). 2 x 9 Gy irradiated rats had at the age of 3 mo a marked growth retardation and significantly lower GH levels than the controls (p < 0.05) whereas prolactin, FSH, TSH, T4, and corticosterone levels were comparable with controls. These studies demonstrate that the GnRH-pulse generator is very radiosensitive as precocious activation occurred after low dose irradiation (5 or 6 Gy) of infantile rats without any other endocrine disorder. High radiation doses (9 or 2 x 9 Gy) induced retardation of sexual maturation and later on growth hormone deficiency. Moreover this model of cranial irradiation seems to be suitable to study the molecular mechanisms of radiation induced pubertal changes.

Background Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both – HT and PS – to provide further evidence for a recovery-oriented treatment of psychiatric patients. Methods In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. Discussion This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients’ recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. Trial registration The trial is registered with ClinicalTrials.gov: NCT04336527, April 7, 2020.

Zusammenfassung Ziel der Studie Bisherige gesetzliche Grundlagen zur Förderung aufsuchender Behandlung schwer psychisch Erkrankter bringen Einschränkungen in der Umsetzung mit sich. Mit ‚Bremen ambulant vor Ort (BravO)‘ wurde ein Konzept zur aufsuchenden Behandlung auf Grundlage der Bundespflegesatzverordnung geschaffen. Methodik Rahmenbedingungen und Konzept von BravO werden dargestellt, Behandlungskennzahlen wurden für den Zeitraum 01.10.2019–30.09.2021 ausgewertet. Ergebnisse 20 vollstationäre Behandlungsplätze wurden aufgegeben und die finanziellen sowie personellen Ressourcen äquivalent BravO zur Verfügung gestellt. Es wurden 298 Patienten bzw. 392 Fälle durch BravO behandelt. Die Behandlungsdauer lag bei 36 Tagen (Median), die Anzahl der Tage mit Leistungserbringung bei 21 Tagen (Median). 74,7 % wiesen eine Diagnose aus den Gruppen F2 und F3 auf. Schlussfolgerung Die Implementierung von BravO in die Routineversorgung konnte erfolgreich umgesetzt werden. BravO ermöglicht eine flexible Behandlung psychisch schwer Erkrankter im häuslichen Umfeld abseits bisheriger Modelle.

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