Little is known about the physical co-morbidity in mentally ill living in psychiatric and social health care facilities with regard to variation, causes, risk factors and prevention strategies. Aim of this study was to determine patients’ and professionals’ perceptions, attitudes and thoughts of

1. (i) co-morbid physical health problems and illness,

2. (ii) risk factors and causes of somatic problems and

3. (iii) prevention measures across Europe.

A total of 52 focus groups in 14 European countries were conducted. Participants were recruited from psychiatric and social health care facilities. Data were content analyzed deductively and inductively.

The physical health problems that were often mentioned were weight problems, diabetes, cardiovascular and gastrointestinal problems, problems of the circulatory system, and general aches and pains. Regarding the causes of somatic problems and illnesses, focus groups repeatedly emphasized side-effects from medications. Besides treatment-related factors, country-specific aspects also were mentioned, mainly in the field of the living environment. Findings concerning “prevention” demonstrated the greatest distinctions between the participant groups, particularly with regard to the implementation and realization of health promotion interventions. Discussions revealed that patients preferred active learning (hands-on experiences) coupled with group classes for education and social support.

Focus groups identified behavioural, environmental and iatrogenic health risks. Efforts need to be directed toward interventions for physical illness prevention and health promotion on the background of the heterogeneity of mental disorders and the multitude of physical problems, and need to be based on an understanding of residents’ cultural beliefs and life situations.

Little is known about the physical co-morbidity in mentally ill living in psychiatric and social health care facilities with regard to variation, causes, risk factors and prevention strategies. Aim of this study was to determine patients’ and professionals’ perceptions, attitudes and thoughts of (i) co-morbid physical health problems and illness, (ii) risk factors and causes of somatic problems and (iii) prevention measures across Europe.

A total of 52 focus groups in 14 European countries were conducted. Participants were recruited from psychiatric and social health care facilities. Data were content analyzed deductively and inductively.

The physical health problems that were often mentioned were weight problems, diabetes, cardiovascular and gastrointestinal problems, problems of the circulatory system, and general aches and pains. Regarding the causes of somatic problems and illnesses, focus groups repeatedly emphasized side-effects from medications. Besides treatment-related factors, country-specific aspects also were mentioned, mainly in the field of the living environment. Findings concerning “prevention” demonstrated the greatest distinctions between the participant groups, particularly with regard to the implementation and realization of health promotion interventions. Discussions revealed that patients preferred active learning (hands-on experiences) coupled with group classes for education and social support.

Focus groups identified behavioural, environmental and iatrogenic health risks. Efforts need to be directed toward interventions for physical illness prevention and health promotion on the background of the heterogeneity of mental disorders and the multitude of physical problems, and need to be based on an understanding of residents’ cultural beliefs and life situations.

Collecting prospective data on medication adherence, course of illness, course of treatment, cost effectiveness and quality of life among patients with schizophrenia under the German health system.

The ELAN study was conducted as a multi-centre, non-interventional observation study. 374 patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-10 F2) who had been discharged with a medication of quetiapine (N=183), olanzapine (N=91) or risperidone (N=100) were included. Follow-up interviews were conducted after 6,12,18 and 24 months. Applied instruments comprised PANSS, MARS-S, EPS-M, AIMS-S, GAF, ZST and a questionnaire for quality of life.

For each follow-up, at least 80% of the original sample could be included. After two years, between 39% and 43% of patients continued to take the drug prescribed at discharge. Only between 4% and 7% of patients received no neuroleptic treatment in the last 6 months, respectively. The variety of drugs used increased during the course. Only small differences could be found regarding the defined outcome measures (PANSS, GAF, rehospitalisation rate) and side effects. Changes in medication were mostly due to insufficient efficacy or side effects. Doctor's recommendations had an important influence on patients’ decisions.

Under conditions of routine treatment, medication adherence was much greater and differences between drugs were smaller than reported in randomised controlled clinical trials. Taking into account the low sample selection bias and the small percentage of lost-to-follow-up subjects, this study provides some new insight into routine clinical treatment and outcomes in patients with schizophrenia.

People with a mental disorder are at increased risk for physical illness and therefore their risk of premature death is raised. An unhealthy lifestyle, living conditions, medication side-effects and a lack of physical health monitoring are regarded as the main causes of high somatic morbidity. But up to now only little research has addressed the physical co-morbidity in mentally ill. At present, there are no specific policies to improve the health status of residents in mental health care facilities.

Against this background a multi-disciplinary network of experts from 15 European countries was set up. Working together with researchers, stakeholders, professionals, networks, practitioners, and relevant organizations, the HELPS network developed a “physical health promotion toolkit” for routine application in a wide range of mental health care facilities across Europe. The HELPS toolkit intends to empower patients and staff to identify the most relevant risk factors in their specific context and subsequently select the most appropriate action out of a range of defined health promoting interventions. In doing so, the toolkit takes into account the heterogeneity of mental disorders, the high number of somatic problems, aspects of lifestyle, environment, medical care system, personal goals of patients and their motivation for health behavior.

The poster presents the HELPS toolkit. It illustrates the individual components of the tool and the processes of its implementation and evaluation. First results of the pilot study concerning the feasibility of the toolkit will be presented and discussed.

Intensification of outpatient psychiatric care may improve the care quality in community but also increase the total care costs in the first period as well as reduce in-patient cumulative length of stay over the medium term.

We investigate the economic and clinical effects of establishing of a psychiatric outpatient-service in a South-Bavarian catchment area one year before and one year after establishing.

All admitted patients in a psychiatric acute ward corresponding to the catchment area of the new outpatient- service are registered one year before establishing (2007, n = 145) and one year after (2009, n = 167). Associations between clinical, demographic and economical variables were investigated by means of multivariate regression analysis. Control variables are sex, age and psychiatric diagnostic groups.

Cumulative length of stay (b = −1.72, p = 0.68) and number of admissions (b = −0.10; p = 0.28) decreased, but not significantly. In-patient as well as global care costs remains the same. Costs of prescribed psychopharmacological drugs (b = 54.4; p = 0.36) and outpatient psychiatric care (b = 67.8; p = 0.15) increase obviously, but not significantly.

Additional implementation of an outpatient-service is not related to increase of service use costs. We found out, that in the first year there is a demand increasing effect. The effects on in-patient parameters and diagnosis groups have to be observed for the following years.

Given that parental mental diseases affect the whole family system, a family centered support and help system seems appropriate for families with a mentally ill mother/father. However, the majority of mental health services do not integrate interventions for the family system into psychiatric treatment programs.

To introduce a counselling and support service for families with a mentally ill parent (FIPS) that has been established at a psychiatric hospital serving a large catchments area. Preliminary results of a qualitative study that focused on the clients’ family background as well as on their reasons for utilising the service and service satisfaction will be presented.

Factors that impact the family system are considered and brought to a concept for counselling and support service for families with a mentally ill parent. Problem-focused interviews with 14 clients (mentally ill parents and relatives) of the counselling service for families were subjected to content analysis.

Most clients came to the counselling centre because of worries that the parent's mental illness might negatively affect children's well-being. Mentally ill mothers described their daily lives as utterly burdensome and also reported strong feelings of guilt towards their children. The concept of FIPS includes psychoeducation, social therapy, case management and family therapy. Clients assessed the counselling service as helpful and reported some significant changes.

Admission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.

Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n = 54) and control groups (n = 46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3.

Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P < 0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P = 0.013) and T3 (difference: −8584.10€, P = 0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.

Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Severe mental illness is associated with increased risk of premature death due to chronic somatic diseases. Patients with severe mental illness receive less medical care regarding these problems, than others, and that it is not well defined with whom the responsibility of treating their physical health problems lies.

There is a need for lifestyle interventions and focus on physical health in patients with severe mental illness. The patients' and staff perspective upon the problems and possibilities of change is important.

To investigate physical health problems and their causes as well as possibilities for preventing and treating them, as experienced by the staff and patients.

Focus Group Discussions with patients and staff respectively, from three out-patient clinics treating patients with schizophrenia or substance use disorder comorbid to another psychiatric disorder.

The paramount physical health problems are weight issues, cardiovascular diseases and bad physical shape in general. The main causes are lifestyle, the mental disorder and organisational issues. Possibilities for prevention and treatment includes: a case-manger, binding communities with like-minded. Furthermore less fragmentation of the treatment system and implementation of focus upon physical health into daily practice in psychiatry.

To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. There is a need for a change in clinical practice and implementation of routines regarding physical health, supported by the managements.

To identify possible change patterns or robustness in sources of meaning in family caregivers of pre-terminal patients after onset of support at home by an outreach palliative nursing team during a survey period of three months.

One hundred caregivers of terminally ill patients were included in a prospective observational trial. The Sources of Meaning and Meaning in Life Questionnaire (SoMe) was administered at four points of measurement: T0 (immediately before onset of palliative care); T1 (one week after T0); T2 (one month after T0); T3 (three months after T0). Descriptive statistics, random effects regression analyses; multivariate linear and quadratic regression models were performed for the full (n = 100) as well as for the reduced sample (n = 24).

Growth curve analyses reveal significant parabolic changes for the dimension “order” and for the subscales “social commitment”, “tradition”, “morality”, and “fun”. All other dimensions or subscales remained stable during the time of the study. Cross-sectional multivariate regression models (T0) showed negative associations of some dimensions with patients’ age and psychological burden of the family caregiver while psychological burden of patients was found to be positively associated with some dimensions. No significant effects of interaction variables with time (linear and quadratic).

With few exceptions, family carers seem to keep a stable sense of meaning in life during the final stage of their relatives’ terminal illness. Particular associations between sources of meaning and age of patients as well as psychological burden both of patients and carers have to be taken into consideration in support planning.

The authors have not supplied their declaration of competing interest.

Metabolic syndrome (MetS) parameters are: elevated waist circumference (WC), triglycerides (TG), fasting glucose (FBG) and blood pressure (BP) and reduced high-density lipoprotein cholesterol (HDL). MetS parameters are associated with poor cognition and this association should be studied in the context of other factors. In particular, factors that are involved in maintaining poor lifestyle choices – MetS is largely a lifestyle illness. One factor important to consider is cognitive insight – an individual's ability to be flexible in how you think about yourself and others and to question your own thoughts.

To conduct an exploratory cross-sectional study investigating the influence of cognitive insight on the relationship between MetS parameters and cognition in non-psychiatric individuals.

To explore the nature of the relationship between cognition and MetS parameters and test whether cognitive insight moderates the association.

Our sample consisted of n = 156 participants with mixed-ancestry. Correlations between MetS parameters and cognition were tested. ANOVA was used to test interaction effects and logistic regression was done to test the predictive power of selected factors.

BP correlated with attention, delayed memory, and RBANS total scale score. The BCIS self-certainty subscale moderated the relationship between BP and immediate memory and attention. Age and BCIS self-certainty were the only predictors of elevated BP.

Good cognitive insight act as protective factor and reduce the impact of elevated BP on cognition. Cognitive insight may be a predictor of elevated BP.

The authors have not supplied their declaration of competing interest.