Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release (ACCESS trial)

The ACCESS trial examined the 12-month effectiveness of continuous therapeutic assertive community treatment (ACT) as part of integrated care compared to standard care in a catchment area comparison design in patients with schizophrenia spectrum disorders treated with quetiapine immediate release.

Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial)

To compare the 1-year cost-effectiveness of therapeutic assertive community treatment (ACT) with standard care in schizophrenia. ACT was specifically developed for patients with schizophrenia, delivered by psychosis experts highly trained in respective psychotherapies, and embedded into an integrated care system.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

Legal Integration of Islam: A Transatlantic Comparison

The status of Islam in Western societies remains deeply contentious. Countering strident claims on both the right and left, Legal Integration of Islam offers an empirically informed analysis of how four liberal democracies—France, Germany, Canada, and the United States—have responded to the challenge of integrating Islam and Muslim populations. Demonstrating the centrality of the legal system to this process, Christian Joppke and John Torpey reject the widely held notion that Europe is incapable of accommodating Islam and argue that institutional barriers to Muslim integration are no greater on one side of the Atlantic than the other. While Muslims have achieved a substantial degree of equality working through the courts, political dynamics increasingly push back against these gains, particularly in Europe. From a classical liberal viewpoint, religion can either be driven out of public space, as in France, or included without sectarian preference, as in Germany. But both policies come at a price—religious liberty in France and full equality in Germany. Often seen as the flagship of multiculturalism, Canada has found itself responding to nativist and liberal pressures as Muslims become more assertive. And although there have been outbursts of anti-Islamic sentiment in the United States, the legal and political recognition of Islam is well established and largely uncontested. Legal Integration of Islam brings to light the successes and the shortcomings of integrating Islam through law without denying the challenges that this religion presents for liberal societies.

The Think Manager-Think Male Stereotype - Malleable or Stable?

Purpose Stereotypes about leadership still represent a potent barrier to women’s advancement to leadership roles. Successful leaders are perceived to possess predominately agentic traits (e.g., assertive, dominant) that are more similar to those ascribed to men than women. This perceived incongruity of people’s beliefs about leaders and women underlies prejudice against women leaders (Eagly & Karau, 2002). Thus, an important question is whether such stereotypical beliefs about the traits of leaders, men, and women incorporate change or stability over time. Design/Methodology To examine this question, 235 Irish business students (113 men, 122 women) rated a target group’s characteristics (men, women, middle managers) as of a specific time (50 years ago, present, 50 years into the future) on gender‐stereotypical traits. Results Following Schein’s (1973) approach, intraclass correlation coefficients estimated the extent to which the stereotype of managers was similar to that of men or women. The results showed a large, significant correlation between the stereotypes about men and managers within each time condition and overall. In contrast, the women‐manager correlation was negative and nonsignificant overall. However, this negative correlation weakened from the past to the present and became positive and marginally significant for the future. Research/Practical Implications Altogether the results suggest that people perceive stereotypes about leaders to be more similar to men than to women. These perceptions may continue to function as impediments to women leaders’ advancement despite the trend over time toward femalemanager similarity. Originality/Value To our knowledge this is the first study to systematically test perceptions of change in the think manager‐think male stereotype overtime.

Peer victimisation and depressive symptoms: can specific coping strategies buffer the negative impact of cybervictimisation?

This longitudinal study investigated whether cybervictimisation is an additional risk factor for depressive symptoms over and beyond traditional victimisation in adolescents. Furthermore, it explored whether certain coping strategies moderate the impact of cybervictimisation on depressive symptoms. A total of 765 Swiss seventh graders (mean age at time-point 1 (t1) = 13.18 years) reported on the frequency of traditional and cybervictimisation, and of depressive symptoms twice in six months. At time-point 2 (t2) students also completed a questionnaire on coping strategies in response to a hypothetical cyberbullying scenario. Analyses showed that both traditional and cybervictimisation were associated with higher levels of depressive symptoms. Cybervictimisation also predicted increases in depressive symptoms over time. Regarding coping strategies, it was found that helpless reactions were positively associated with depressive symptoms. Moreover, support seeking from peers and family showed a significant buffering effect: cybervictims who recommended seeking close support showed lower levels of depressive symptoms at t2. In contrast, cybervictims recommending assertive coping strategies showed higher levels of depressive symptoms at t2.

The Hamburg-Model of Integrated Care for Patients with Psychosis: Part 1

Objective: The "Hamburg model" designates an integrated care model for severely ill patients with psychotic disorders financed by the health insurance system in accordance with § 140 SGB V.Methods: It comprises comprehensive and long-term treatment within a regional network of the psychosis center of the University Medical Center Hamburg-Eppendorf (UKE) and private psychiatrists. The treatment model consists of therapeutic assertive community treatment (ACT) provided by a highly specialized treatment team and need-adapted in- and outpatient care.Results and conclusions: The present article summarizes the disease- and treatment-specific rationales for the model development as well as the model structure and treatment contents. The article further summarizes the effectiveness and efficiency results of a study comparing the Hamburg model and treatment as usual (without ACT) within a 12-month follow-up study (ACCESS trial).

Experimental induction of psychotherapeutically relevant emotional states

Background: Emotion research in neuroscience targets brain structures and processes involved in discrete emotion categories (e.g. anger, fear, sadness) or dimensions (e.g. valence, arousal, approach-avoidance), and usually relies on carefully controlled experimental paradigms with standardized and often simple emotion-eliciting stimuli like e.g. unpleasant pictures. Emotion research in clinical psychology and psychotherapy is often interested in very subtle differences between emotional states, e.g. differences within emotion categories (e.g. assertive, self-protecting vs. rejecting, protesting anger or specific grief vs. global sadness), and/or the biographical, social, situational, or motivational contexts of the emotional experience, which are desired to be minimized in experimental neuroscientific research. Objective: In order to facilitate the experimental and neurophysiological investigation of psychotherapeutically relevant emotional experiences, the present study aims at developing a priming procedure to induce specific, therapeutically and biographically relevant emotional states under controlled experimental conditions. Methodology: N = 50 participants who reported negative feelings towards another close person were randomly assigned to 2 different conditions. They fulfilled 2 different sentence completion tasks that were supposed to prime either ‘therapeutically productive’ or ‘therapeutically unproductive’ emotional states and completed an expressive writing task and several self-report measures of specific emotion-related constructs. The sentence completion task consisted in max. 22 sentence stems drawn from psychotherapy patients’ statements that have been shown to be typical for productive or unproductive therapy sessions. The subjects of the present study completed these sentence stems with regard to their own negative feelings towards the close person. Results: There were a substantial inter-individual variability concerning the number of completed sentences, and significant correlations between number of completed sentences and problem activation in both conditions. No differences were observed in general mood or problem activation between both groups after priming. Descriptively, there were differences between groups concerning emotion regulation aspects. Significant differences between groups in resolution of negative feelings towards the other person were found. Discussion: The results point in the expected direction, however the small sample sizes (after exclusion of several subjects) and low power hinder the detection of convincing significant effects. More data is needed in order to evaluate the efficacy of this emotional priming procedure.

Treatment for outpatients with comorbid schizophrenia and substance use disorders: a review

Aims: This review provides evidence of which interventions need to be part of effective outpatient integrated treatment for patients with comorbid schizophrenia and substance use disorders. Methods: A total of 14 randomized controlled trials were included. Effect sizes are provided to assess the magnitude of the treatments’ efficacy. Results: Despite the studies’ heterogeneity, we can conclude that certain programs (e.g., Behavioral Treatment for Substance Abuse in Schizophrenia) and specific interventions (e.g., motivational interviewing, family interventions) seem to be effective. Moreover, programs integrating multiple interventions are more likely to be positively related to better outcomes than single interventions. Finally, the lack of difference between effect sizes of assertive community treatment compared to case management suggests that a lower caseload is not necessary for positive treatment outcomes. Conclusion: Integrated treatment seems advantageous, although effect sizes are mostly modest. More homogeneous and qualitative sound studies are needed.