Ingo Schäfer

The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of earl...

Objective. To examine how patients with schizophrenia spectrum disorders view psychiatric research and what influences their readiness to participate. Methods. A sample of 83 patients with schizophrenia spectrum disorders was examined using a specific self-report questionnaire designed for the purpose of the study. Results. Most patients (97%) approved at least "a little" of psychiatric research in general. There was a tendency to approve of psychosocial rather than biological research subjects (e.g., research on the role of traumatic life events was approved by 95% of patients as compared to 72% in the case of genetics and 76% in the case of medication studies). Reasons to participate were mainly altruistic, only a minority found that monetary incentives were important. Another important reason was to improve individual chances of recovery. A large majority (95%) found it important to get sufficient information prior to the start but also to receive the results of the study. Conclusion. Patients' capability of critically appraising psychiatric research as well as their role in the research process should inform future research to ensure a more cooperative practice.

The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.

ABSTRACT Zusammenfassung Zielsetzung: Analyse von Bedingungsfaktoren für die Umsetzung von alkoholbezogenen Interventionen in der hausärztlichen Praxis. Methode: Fragebogengestützte Befragung von 229 Hausärzten sowie leitfadengestützte Fokusgruppeninterviews mit 29 Hausärzten. Die Fokusgruppenteilnehmer wurden aus der teilnehmenden Grundgesamtheit randomisiert. Ergebnisse: Standardisierte Methoden zur Früherkennung von Patienten mit Alkoholproblemen kommen in der hausärztlichen Praxis kaum zur Anwendung. Die Umsetzung von alkoholbezogenen Maßnahmen korreliert mit den bisherigen Erfahrungen des Arztes sowie der patientenseitigen Motivation. Als strukturelle Barrieren werden fehlende zeitliche/finanzielle Ressourcen, fehlende Eigenqualifikation und die mangelnde Kooperation mit dem Suchthilfesystem angegeben. Vorhandene Fortbildungsangebote werden anscheinend nur unzureichend wahrgenommen. Schlussfolgerung: Diese Studie zeigt die Komplexität der patientenseitigen, arztbezogenen und strukturellen Gründe, die eine flächendeckende Umsetzung von alkoholbezogenen Interventionen in der hausärztlichen Praxis verhindern. Modelle zur Verbesserung der Versorgungssituation von Menschen mit Alkoholproblemen in der hausärztlichen Praxis müssen die Bedarfe an Qualifikation, Vernetzung und Finanzierung berücksichtigen. Abstract Aim: Analysis of factors influencing the implementation of alcohol-related interventions in primary care. Methods: Cross-sectional survey of 229 general practitioners (GPs). Focus group interviews with 29 GPs. Focus group members were recruited randomly from the total sample. Results: Standardized methods for screening patients with alcohol-related problems are hardly used. The implementation of alcohol-related interventions correlated with the GP' experiences and patients' motivation. Structural barriers included lack of time and financial resources, lack of cooperation with addiction services and lack of personal qualification. Current training opportunities are seemingly little known. Conclusion: This study demonstrates the complexity of patient-, physician- and system-related barriers, which hinder a widespread implementation of alcohol-related interventions in primary care. Future efforts have to take into account general practitioners' needs for qualification, networking and financing to improve the primary care situation for persons with alcohol-related problems.

ABSTRACT Objectives: Owing to the limited knowledge of the effect of cocaine use on the outcome of opioid dependence, a long-term follow-up study was conducted to assess the importance of cocaine use in the long-term course. Methods: A representative sample of 350 opioid-dependent patients in treatment was studied over a 4-year period using the European version of the Addiction Severity Index. The sample was split into 2 groups according to cocaine use at baseline: 1 group with regular cocaine use and 1 group with irregular or no cocaine use. Results: The group of regular cocaine using opioid-dependent patients had a significantly higher severity of dependence and a higher need for treatment at baseline compared to those with irregular or no cocaine use. At the 4-year follow-up examination no differences were found between the 2 groups. Conclusions: The lack of evidence of long-term effects weakens the predictive value of the negative effect of cocaine use on outcome.