Personality functioning, self-disorders and their relationship to psychotic symptoms on a continuum from mild attenuated experiences to manifest psychotic symptoms in psychotic disorders are highly relevant for psychopathology, course of illness and treatment planning in psychotic disorders, but empirical data is sparse.

This study aims at exploring personality functioning and self-disorders in individuals at ultra-high risk for psychosis (UHR) and with first-episode psychosis (FEP), compared to a clinical control group of subjects with borderline personality disorder (BPD) and healthy controls (HC).

Personality functioning was measured in 107 participants (24 UHR, 29 FEP, and 27 BPD and 27 HC) using the Structured Interview for Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS), and self-disorders were assessed using the Examination of Anomalous Self-Experience (EASE). A hierarchical cluster analysis was performed based on the seven STIPO dimensions.

Significant impairment in personality functioning was found in UHR (M = 4.29, SD = .908), FEP (M = 4.83, SD = 1.002), and BPD individuals (M=4.70, SD=.542) compared with HC (M = 1.63, SD = .565). FEP patients showed significantly worse overall personality functioning compared to UHR patients (p = .037). Patients with manifest psychosis (FEP) also exhibited significantly higher levels of self-disorders compared to BPD patients (p = .019). Self-disturbances in patients with milder forms of psychotic symptoms (UHR) were intermediate between the other diagnostic groups (FEP and BPD). Regardless of the main diagnoses, the three clusters of patients were found to differ in levels of personality functioning and self-disorder.

Impairment of personality functioning varies in different stages of psychotic disorders. The level of self-disorders may allow differentiation between manifest psychosis and borderline personality disorder. An in-depth assessment of personality functioning and self-disorders could be helpful in differentiating diagnoses, treatment planning, and establishing foci for psychotherapeutic treatment modalities.

M. Gruber: None Declared, J. Alexopoulos: None Declared, K. Feichtinger: None Declared, K. Parth: None Declared, A. Wininger: None Declared, N. Mossaheb: None Declared, F. Friedrich: None Declared, Z. Litvan: None Declared, B. Hinterbuchinger: None Declared, S. Doering: None Declared, V. Blüml Grant / Research support from: Grant / Research support from: Heigl-Foundation, Köhler-Foundation, International Psychoanalytical Association (IPA)

As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe.

Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes.

Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001).

The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.

Most studies investigating the problems and needs of schizophrenia patients’ carers include only one care-giving relative - mostly the patients’ mothers.

The compare needs of mothers and fathers of patients with schizophrenia.

101 sets of parents of patients suffering from schizophrenia were included in this study. They were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.

Compared to fathers, mothers reported significantly more often problems concerning stress due to earlier life events and burn-out. Mothers required some interventions such as individual psychoeducation or family counselling more than twice as often than fathers. Overall, mothers reported more problems and needs than fathers. The number of mothers’ problems was predicted by not living with a partner and a shorter duration of the patients’ illness (DUPI). The number of mothers’ needs was predicted by patients’ psychiatric symptoms, not living with a partner and a shorter DUPI. Among fathers we could not identify any predictors, neither for problems nor for needs.

Parents of schizophrenic patients have various problems handling their child's illness and therefore need professional support. Overall, mothers reported more problems and needs for interventions than fathers. The differences between mothers’ and fathers’ problems and needs indicate the importance of considering the carer's gender in clinical work.

Non-adherence of medication still is a major problem among patients suffering from bipolar disorders.

Previous studies focused mainly on possible side-effects, attitudes and subjective well-being. Most scales concerning this issue have been developed by psychiatric experts and based on their knowledge not on the patients points of view.

The purpose of this study was to find out what kind of drug effects the patients themselves want.

2 focus-groups with 13 patients and In-depth interviews with 15 mania patients were conducted to collect information about subjective burden and symptoms of the illness. Content analyses of the transcriptions were performed and the results were used to develop a first draft of the questionnaire.

The final German test version consists of 32 items and is called “The Subjective Mania Scale”. The study of content-validity showed that all SMS items were considered to be important by more than 50% of the sample. Test-retest reliability and sensitivity to change were evaluated. All SMS-items showed a significant change between time-point 1 and 3.

The SMS-rating scale is a feasible, reliable and valid instrument for clinical trials among mania patients.

The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.

101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.

The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).

This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.

To investigate caregiving and its consequences among fathers and mothers of the same patients suffering from schizophrenia.

101 patients as well as both parents were investigated using the “Carers' Needs Assessment for Schizophrenia”, the “Beck Depression Inventory”, the “Involvement Evaluation Questionnaire” and the “Family Problem Questionnaire”.

The mean number of days fathers lived together with the patients was not significant from that of the mothers, but the average duration (hours per week) of contact with the patient was significantly higher for mothers than for fathers. Among 40% of the sample, fathers and mothers spend an equal amount of time caring for the patient. Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed some interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Mothers reported overall higher numbers of problems and needs for intervention than fathers. The overall score of caregivers' involvement did not differ significantly between fathers and mothers. The mothers' objective burden was significantly higher than the fathers' objective burden, but parents did not show differences concerning subjective burden. Using the “Beck Depression Inventory”, mothers were more often depressed than fathers.

This study shows that often fathers and mothers spend an equal amount of time caring for the patient. The differences found between mothers and fathers should be considered when planning services for family caregivers.

The aim of the study was to explore how many physicians intended to be psychiatrists and how many of those physicians practising as psychiatrists originally desired this area of expertise

For this cross-sectional survey, a self-administered questionnaire with 12 items was sent to all licensed physicians (n = 8127), based on the register of the Vienna Medical Chamber in June 2000

2736 respondents (34%) completed the questionnaire validly. 50.3% (m: 43.2%; f: 58.6%) of all physicians in Vienna did not achieve their desired subject, whilst 86% of psychiatrists did so. These study results represent the highest percentage compared to other medical specialisations. Further, 6% of all physicians (m: 5%; f: 7%) initially defined psychiatry as their desired medical career regardless whether they attained this specialty later on or not. An average of 9% of all physicians changed their minds about their preferred specialty during their training.

Compared with other specialties the average number of physicians who practice a specialty different from the one desired is low in psychiatry. We think that this fact constitutes a favourable aspect with regard to recruitment of graduates for specialty training in psychiatry. Data found in this survey are similar to other studies conducted in German speaking countries, when focussing on psychiatry as desired career.

Depression is among the main risk factors for suicide. The Geriatric Depressions Scale (GDS-30, GDS-15) is depression screening instrument specifically developed for the elderly.

To provide a systematic review of the screening accuracy of both GDS versions.

An electronic search was performed using Medline, Embase, Cinahl, Psyndex and Cochrane library. The selection and examination of papers was done by two reviewers independently. The following studies were excluded: number of depression cases less than 10, no clear case criterion, phone version, psychiatric samples.

Of 173 papers which were read and examined, only 42 papers were included. For both GDS versions similar mean validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using pooled samples we could not find significant differences between the two versions of the GDS. Using comparative studies based on identical samples, both GDS versions showed significantly better validity indices than the “Yale-1-question” screen, but did not differ from the CES-D. Frequently, essential information about research methods was not given. When methods were reported, the differing methods (e.g. concerning blinding, cut-off values, sampling procedures) limit the comparability of primary studies.

In general, the GDS seems to be sufficient for depression screening. While early recognition of depression is essential for identifying persons at risk for suicide, the GDS does not explicitly focus on this problem.

Originally, the General Health Questionnaire (= GHQ) was designed to detect mental disorders among general medical outpatients and in community. The aim of the present survey is to compare the criterion validity indices of three different GHQ versions among general hospital inpatients when using different scoring methods.

The GHQ-30 was filled in by inpatients prior to the research interview. For psychiatric case-identifiation the Clinical Interview Schedule was performed by three research psychiatrists.

The final sample consisted of 993 inpatients. When comparing the three different GHQ-versions, no significant differences were found in OMR and ROC-AUC as well as in sensitivity (0,612–0,701) and specificity (0,601–0759). When comparing the four scoring methods no significant differences were found in sensitivity. By contrast, OMR and specificity showed better indices for the 20 item and 12 item GHQ versions when using the bimodal and modified Lickert scoring method. Further, the Lickert scoring method showed no significant differences to the other scoring methods for the GHQ-30, where as the modified Lickert and the bimodal method showed lower OMR and higher specificity compared to the chronic method.

Due to the results of this survey, the future use of the chronic scoring method for the GHQ has to be questioned when used for general hospital inpatients.

The aim of the present study was to analyse the problems and needs for interventions among caregivers of patients with schizophrenia who were the first time in contact with psychiatric services.

93 family caregivers of schizophrenia patients and 93 schizophrenia patients were investigated during the first contact with psychiatric services. The ‘Carer’s Needs Assessment for Schizophrenia” (CNA-S) and PANNS were used for investigation.

The most frequent problems of caregivers of first contact patients with schizophrenia were insufficient information on psychiatric disorder and concerns about the patient’s future. Further, the intervention ‘individual psychoeducation” was needed significantly more often among caregivers of first contact patients than among those having been previously in contact with psychiatric services.

Carers being the first time in contact with psychiatric services need some specific interventions significantly more often than later.

Short nocturnal sleep impairs morning glucose tolerance, and this effect is thought to involve the lack of slow-wave sleep (SWS).

So far, it has not been examined in humans whether the influence of poor sleep on morning glucose tolerance may emerge when non-SWS sleep is lacking.

To compare the influence of one night of slow-wave sleep suppression (SWSS) with that of one night of non-SWS suppression (NSWSS) on morning glucose tolerance in humans.

16 normal-weight students [age 20–30 years] participated in a counterbalanced fashion in three experimental conditions: regular sleep, SWSS, and NSWSS. The suppression of sleep was performed by means of an acoustic tone (562 Hz) with gradually rising intensity. Glucoregulatory parameters were measured upon an oral glucose tolerance test (OGTT) the next morning.

Following the oral glucose load, the serum insulin and plasma glucose responses were significantly greater after the nocturnal suppression of SWS, as compared with those after NSWSS and regular sleep, respectively (P < 0.03). In contrast, such effects did not emerge when comparing the NSWSS and regular sleep conditions (P > 0.27).

One night of SWSS is linked to an impaired glucoregulatory response to an oral glucose load. Since NSWSS, compared to regular sleep, did not influence the postprandial serum insulin and plasma glucose response, our data suggest that lacking slow wave sleep may be the driving force that underlies the association between poor sleep and impaired daytime glucose tolerance.

Most studies on the consequences of psychiatric illnesses for caregiver relatives of patients involve only one relative, predominantly a parent and most often the patient’s mother. Studies that focus on the gender-specific differences between caregiver relatives are very sparse. In order to rule out possible differences in the level of burden depending on the particular patient both parents of the same patients were included in this study.

To analyse the differences in the level of burden put on mothers and fathers of patients diagnosed with schizophrenia according to ICD-10. To analyse the correlation between the unmet needs of caregivers and the level of burden put on them.

Both parents of 101 patients with schizophrenia were included in this study. The different aspects of caregivers’ burden were assessed by means of the 'Involvement Evaluation Questionnaire”. Unmet needs of caregivers were assessed with the 'Carers’ Needs Assessment for Schizophrenia”.

Mothers showed significantly higher scores in the dimensions 'Tensions” and 'Urging” than fathers. Multiple linear regression analysis showed positive correlation between unmet needs and the level of burden in both mothers and fathers.

Unmet needs of caregiving parents of patients suffering from schizophrenia are in correlation with higher levels of burden. The differences between mothers and fathers in the level of burden indicate the importance of considering the caregiver´s gender in clinical work.

Alcohol dependence is a complex psychiatric disorder.

To investigate the role of temperament on the course of alcohol dependence.

To further investigate the role of temperaments in alcohol dependent patients and to analyse the differences in relevant clinical features in correlation with the different temperament distributions.

The patients‘case files of 116 alcohol dependent patients, according to ICD-10 and DSM-IV-TR, admitted to the Vienna General Hospital between 02/08 and 03/09, were examined retrospectively. The brief-TEMPS-M auto-questionnaire was used to assess the temperamental distribution. The dimensions of alcohol dependence have been assessed using the Lesch Alcoholism Typology, a computerized structured interview. The potential effect of temperamental scores on various outcomes describing the course of illness is investigated using multi-variable regression models.

Cyclothymic score was the only temperament which significantly influenced the age of onset of alcohol abuse and age of onset of alcohol dependence. Backward selection among temperaments exhibits depressive temperament as most important effect regarding the likelihood of suicide-attempts in the patient‘s case history and anxious temperament as most important effect regarding having psychiatric treatment focusing on alcohol dependence prior to current in- or outpatient stay.

Dominant cyclothymic, but also depressive and anxious temperament, seem to be negative predictors for the course of illness in alcohol dependence.

Worldwide, Mycobacterium chimaera infections have been linked to contaminated aerosols from heater-cooler units (HCUs) during open-heart surgery. These infections have mainly been associated with the 3T HCU (LivaNova, formerly Sorin). The reasons for this and the risk of transmission from other HCUs have not been systematically assessed.

Prospective observational study.

University Hospital Basel, Switzerland.

Continuous microbiological surveillance of 3 types of HCUs in use (3T from LivaNova/Sorin and HCU30 and HCU40 from Maquet) was initiated in June 2014, coupled with an epidemiologic workup. Monthly water and air samples were taken. Construction design was analyzed, and exhausted airflow was measured.

Mycobacterium chimaera grew in 8 of 12 water samples (66%) and 22 of 24 air samples (91%) of initial 3T HCUs in use, and in 2 of 83 water samples (2%) and 0 of 41 (0%) air samples of new replacement 3T HCUs. Moreover, 7 of 12 water samples (58%) and 0 of 4 (0%) air samples from the HCU30 were positive, and 0 of 64 (0%) water samples and 0 of 50 (0%) air samples from the HCU40 were positive. We identified 4 relevant differences in HCU design compared to the 3T: air flow direction, location of cooling ventilators, continuous cooling of the water tank at 4°C, and an electronic alarm in the HCU40 reminding the user of the next disinfection cycle.

All infected patients were associated with a 3T HCU. The individual HCU design may explain the different risk of disseminating M. chimaera into the air of the operating room. These observations can help the construction of improved devices to ensure patient safety during cardiac surgery.

Infect Control Hosp Epidemiol 2018;834–840