Outcome management has been suggested as a promising strategy to improve quality of mental health care. However, there is a lack of evidence on the efficacy of feedback of treatment outcome to people with severe mental disorder and their clinicians. Thus, the study "Outcome monitoring and outcome management in inpatient psychiatric care" (EMM) aims to to ascertain the short- and mid-term effect of outcome management in inpatient psychiatric care.

This cluster-randmised trial started in June 2005. 294 participants who gave informed consent have been recruited among patients admitted to a large psychiatric hospital in rural Bavaria. These were asked to provide information on treatment outcome on the Outcome Questionnaire 45 via weekly computerised assessments. Patients and clinicians in the intervention group received continuous feedback of outcome.

Patients were willing and able to provide outcome data on a regular basis. Patients highly valued feedback of outcome while clinician acceptance was moderate. At discharge, there were no differences between the feedback and no-feedback groups on patient-rated outcome. However, as compared to the no-feedback group, length of stay of patients with good outcome who received feedback was shorter while it was longer for those with unfavorable outcome. Further findings on the mid-term effect of feedback at follow-up and on the cost-effectiveness of the intervention will be reported.

Implications of these results for further improving the effectiveness of outcome management in mental health services and thus contributing to an adaptive allocation of treatment resources will be discussed.

There have been concerns about the risk benefit ratio of treatment with antidepressants and antipsychotics in the light of recent evidence pointing to a risk of suicide induction during the course of treatment with antidepressants. These concerns have led to a series of recent studies exploring national rates of suicide and correlating these with data on antidepressant consumption, which apparently showed reductions in suicides since the advent of the SSRIs.

The data from controlled trials on antidepressants and antipsychotics however point to increased suicide and suicide attempt rates. Against this background we have looked at suicide rates in schizophrenia in North Wales from the pre- and post-antipsychotic eras and have compared suicide rates in the Nordic countries with autopsy and ill-defined death rates, and antidepressant sales, during the period 1961 through to 2003.

There has been a 10-fold rise in suicide rates in schizophrenia since the introduction of the antipsychotics. In the Nordic countries, there is no relationship between antidepressant consumption and suicide rates but a close correlation between suicide rates and both autopsy and ill-defined death rates, which appear to need further clarification.

Combined these datasets suggest efforts to reduce suicide rates, in particular efforts that rely on psychotropic drug use may be quixotic.

Major mood disorders are quite prevalent, but frequently underreferred, underdiagnosed and undertreated illnesses. The early recognition and appropriate treatment of unipolar and bipolar mood disorders is particularly important, since untreated mood disorders carry extremely high risk of both attempted and committed suicide. Recent studies clearly show that suicidal behaviour in patients with major mood disorders is state and severity dependent and this means that suicidality markedly decreases or vanishes after clinical recovery from major depressive episode or from dysphoric mania. However, since the majority of mood disorder patients never committ and more than half of them never attempt suicide, special clinical characteristics of the illness as well as some familial and psycho-social factors should also play a contributory role in this self-destructive behavuour.

Considering the clinically explorable suicide risk factors in patients with mood disorders (family and/or personal history of suicidal behaviour, early onset of the disorder, severe depressive episode/hopelessness, agitated/mixed depression, bipolar II diagnosis, comorbid Axis I and Axis II disorders, adverse life situations, lack of social and medical support), in the majority of the cases, suicidal behaviour is predictable with a good chance. There are also several evidences that (succesfull) long-term treatment of unipolar depressives (with antidepressants and/or lithium) and bipolar patients (with mood stabilizers and with antidepressants/antipsychotics) substantially reduces the risk of attempted and completed suicide, even in this high-risk population. Most recent studies also show that supplementary psycho-social interventions (psychoeducation, and targeted psychotherapies) further improve the results.

International suicide rate in developed countries averages 13.3 x 100.000 population, a rate increased from 1955 to 2001 by 3.3% which has decreased from 1990 to 2001 by 11.7%. This decline may be associated with an improved health care, including medical interventions, with the most relevant role is attributed to treatments with antidepressants. Most of the studies showing an inverse correlation between increased usage of antidepressants and decreased suicide rates are based on ecological designs which do not provide information on the individual level.

In order to prevent suicidal behavior it is fundamental to know that: [a] 90% of all suicides are associated with a psychiatric disorder, especially mood disorders that account for more than a half of all completed suicides; [b] the ratio of attempts to suicide in the general population is about 20:1, whereas the same ratio is about 5:1 in Bipolar Disorder (BPD) patients, showing higher lethality of suicide attempts. Indeed, the Standardized Mortality Ratio reaches the highest value (20; normal value = 1) in mood disorder patients among all psychiatric disorders, with little differences between BPD I and II, and Major Depressive Disorder.

Early interventions are important since suicide occurs in patients with BPD in the first years after illness onset. From a medical point of view, the use of antidepressants has not been associated with reduction of suicidal behavior. In BPD, the only treatment showing a consistent reduction of suicidal behavior is the maintenance therapy with lithium salts.

To analyse GxE interactions assess non-shared environmental (E) risk factors for the development of AN specific for sisters discordant for an ED, polymorphisms in the serotonin transporter (G),.

We interviewed 128 sister pairs discordant for an eating disorder using the Oxford-RFI as part of the European "Healthy Eating" multicenter study at 3 university centres (Vienna, London, Barcelona) (AN-R: 58; AN-BP: 70; 128 sisters without ED). To examine association between AN, G and E, and G x E-interaction, conditional logistic regression was used with a Cox proportional hazards regression model using the exact method.

Genotype (GT) distributions did not differ between the sister groups. Significant main effects were found for disruptive events, interpersonal problems and family dieting behaviour. The risk for AN increased with higher levels in these variables independently of the genotype. Significant interactions were found for G x parental problems and G x burden by parental psychiatric disorder. The increase of risk for AN with increasing number of problems with parents is larger for the S/S genotype than for L/L. However, a higher burden by parental psychiatric illness (subjective E according to Turkheimer 2000) increased the risk for AN-this was larger for the L/L than for the S/S GT.

This study suggests that there is an interaction between stress (problems with parents) and the ss GT which increases the risk of developing AN.

The research on the aetiology of eating disorders (EDs) has implicated many apparently disparate risk factors, which include: biochemical, genetic, familial and psychological factors. In the environmental domain, the presence of particular traits such as perfectionism, comorbidity in the family, eating patterns during childhood and exposures to adverse events have been revealed to be implicated in the aetiology of EDs. Whereas, from a biological point of view some recent new findings have suggested the important role of genetic factors, in combination with share and non-share environmental factors, developmental factors seems to have also a crucial role in the development of EDs later in life.

In order to replicate these findings in a larger sample, we performed several combined population (case-control) and family-based studies of eight independently recruited samples from several European countries participating in the European Community Framework V “Factors in Healthy Eating” project. We analyzed as well genetic as environmental factors, but also developmental factors that might be implicated.

The findings of our studies agree with the growing body of research indicating that a variety of environmental and social factors are associated with unhealthy individual and family eating patterns during childhood and early adolescence, and which if not detected early could result in the development of a subsequent eating disorder.

Anorexia nervosa (AN) patients show remarkably rigid control over eating and exhibit persistent and obsessive temperament traits. Neuropsychological studies have shown minor impairments in cognitive flexibility in AN patients. The aim of the present study was to investigate alterations of the functional neuroanatomy in AN patients performing a cognitive flexibility task.

Thirteen female subjects aged 18 to 26 years with chronic AN (8 with the purging subtype) and 15 age-matched healthy female controls (HC) underwent functional magnetic resonance imaging while performing a reactive flexibility task. In an event related paradigm, participants had to respond with a different button press to infrequent target stimuli embedded in the prepotent presentation of standard stimuli. The performance to the task was quantified as reaction time and number of correct trials.

On behavioral level, AN patients and the HC group showed a similar performance (reaction times, number of correct trials) in the reactive flexibility task. During correct behavioral shifts, the AN patients compared to the HC group showed decreased activation of the bilateral thalamus, ventral anterior cingulate gyrus (ACC), ventral insula, dorsolateral prefrontal (DLPFC), premotor cortex, visual stream and cerebellum (p uncorr. < .001).

AN patients show an impaired activation in thalamo-(striato)-cortical loops involved in response selection and behavioral shift. These findings support from a neurobiological perspective a more generalized cognitive rigidity in AN, that is not restricted to food, weight and shape.

Complex psychiatric disorders develop from interactions between genetic and environmental factors. Offspring of women with a history of an eating disorder (ED) are a high risk group due to a combination of both genetic vulnerability and rearing/environmental factors.

The aim of this study is to examine the clinical features and also the experiences of mother-daughter dyads where both mother and daughter have had an eating disorder in order to explore factors that may impact on risk for and outcome in eating disorders.

Mother-daughter ED dyads participated in a study that used a combination of quantitative and qualitative methodologies.

the quantitative assessment found marked differences distinguishing ED mothers from control mothers (with no ED history), particularly in areas such as caregiving, eating attitudes and personality traits. The qualitative assessment identified an important phenomenological interaction between the mothers’ and daughters’ experiences of an eating disorder.

These results shed light on the significant role and impact of a mother's eating disorder when her offspring develops the same illness. The study's findings highlight the need to take these possible transmission factors and the impact of maternal ED into account in clinical practice.

To describe the characteristics of psychiatric research and their changes within one decade by analysing the publications in three high impact general psychiatric journals.

All articles published in the “American Journal of Psychiatry“, “British Journal of Psychiatry” and “Archives of General Psychiatry” in 1994 and 2004 were considered for analysis. The publications were classified as “research” or “non-research” articles and further categorised according to a range of variables including “methodology”, “research area”, “subject matter”; “number of participants” and “statement on funding”. Data were analysed descriptively.

In 2004 the overall percentage of non-research articles was 6,8% higher than in 1994. The use of different research methods remained fairly stable, with the exception of case-control studies, which accounted for a slightly higher percentage of all publications in 2004 compared to 1994. Further relevant developments included the tremendous increase in published studies involving neuro imaging techniques from 1994 to 2004. An increase in publications was also found for genetic and cross-cultural studies, while the number publications in most other research areas remained relatively stable. Moreover, the percentage of papers reporting funding also increased significantly from 1994 to 2004.

The systematic analysis of journal content can be used to assess the state of psychiatric knowledge and practice. Highlighting advancements and changes over time it may reflect research trends and policies.

Qualitative research has been met with growing interest in recent years. Several trends in medical and psychiatric practice, including patient orientation, the recovery movement and the search for evidence-based psychotherapeutic interventions, have propelled scientific inquiry into subjective perspectives on experiencing mental health problems, their consequences, and psychiatric services. While initially largely criticised as lacking scientific rigour, the value of qualitative research has increasingly been recognised, following a certain disenchantment with genetic research, the acknowledgement of methodological limitations in measuring subjective constructs such as needs, quality of life or stigma with standardised tools, and the definition of clear quality criteria for qualitative studies.

Multiple databases (Ovid Medline, PsycINFO, PsychLit, Cochrane Reviews) were scanned for relevant publications in the period from 1990 to 2007.

A proliferation of qualitative literature could be noted, especially from 2000 onward. Published research focuses on patients’ and caregivers’ experiences of mental health problems (subjective illness models, stigma, help-seeking motivations) and of using mental health services (expectations, empowerment, service evaluation). Among mental health professionals, experiences of service provision (service development, job motivation, stress & burnout) were studied.

Qualitative methods are becoming an integral part of the methodological canon of psychiatric research. This presentation gives an overview of publication trends regarding topics covered, journals featuring qualitative papers, and methodological quality criteria. It further focuses on fields of application for qualitative vs. quantitative methods and discusses specific requirements on scientific writing in publishing qualitative data.

The Danish National Schizophrenia project for persons with a first episode psychosis within the schizophrenia spectrum (F20-29) has initially collected data for 562 persons, included consecutively in a 2 years period (1997-1999). The investigation covers 45% of the Danish population.

To present a prospectively investigation of three types of treatment: Psychodynamic Psychotherapy, Integrated Treatment and Treatment as usual.

Measurements of psychopathology, social functioning, and psychological functions (Rorschach and WAIS) showed that the group of patients who were treated by the intervention methods did better than the group who received the Treatment as usual. Preliminary 5 years data will also be indicated.

After two years patients receiving integrated treatment and the psychodynamic treatment will do better than the group of patients getting Treatment as usual. Integrated treatment is superior compared with the two other modes of treatment. After five years only minor advantages of adding psychodynamic treatment to Treatment as usual can be shown on the general symptom and social functioning scales.

Investigations in the premorbid and early phases of psychosis are important for enhancing early intervention programmes. The purpose of the present study was to examine premorbid functioning in a large sample of individuals admitted to their first treatment for psychosis.

184 first-episode psychotic patients participated in the study. The relationship between premorbid adjustment, initial presentation and one-year outcome was examined using Premorbid Adjustment Scale (PAS), Positive and Negative Symptoms Scale (PANSS) and Global Assessment of Functioning (GAF). Social and academic dimension of PAS was analysed. Cluster analyses were used to identify patterns of premorbid adjustment over four developmental periods.

A poorer premorbid adjustment was consistently related to more negative symptoms at initial presentation and more negative symptoms and poorer social functioning at one-year outcome. PAS contributed to outcome at one year independent of initial presentation. No relationship between premorbid adjustment and DUP was found and DUP was associated only with positive symptoms at one year. A stable-poor and a deteriorating premorbid adjustment course lead to a similar poorer initial presentation and poorer outcome at one year compared to a stable-good premorbid adjustment. The social dimension seems to contribute more importantly to outcome than the academic dimension.

The results support a heterogenetic view of schizophrenia where premorbid adjustment and DUP could be understood as influencing different rather independent pathological domains. The findings point to a possible need for early intervention in case of social maladjustment, independent of later transition to psychosis.