{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:58:01Z","timestamp":1785455881897,"version":"3.56.0"},"reference-count":69,"publisher":"Georg Thieme Verlag KG","funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und\n                        Forschung","doi-asserted-by":"crossref","award":["FKZ: 01EE2303C to Alkomiet Hasan"],"award-info":[{"award-number":["FKZ: 01EE2303C to Alkomiet Hasan"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacopsychiatry"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Previous studies suggest a problem in the care of long-term patients in\n                        psychiatry, i.e., patients with long hospitalizations and no indication for\n                        acute inpatient treatment. Long stays are often associated with treatment\n                        resistance, for which evidence-based guideline recommendations exist for\n                        patients with schizophrenia. The aim of this study is to assess and\n                        characterize long-term patients in German psychiatric clinics and analyze\n                        the implementation of guideline recommendations for treatment-resistant\n                        schizophrenia.<\/jats:p>\n                  <jats:p>An anonymous online questionnaire was distributed to the management of 218\n                        acute psychiatric clinics in Germany. The survey covered structural\n                        characteristics of the clinic, the number and diagnoses of long-term\n                        patients, and the implementation of guideline recommendations for patients\n                        with treatment-resistant schizophrenia.<\/jats:p>\n                  <jats:p>At the time of the survey, two-thirds of the responding clinics were treating\n                        long-term patients. Over 60% (n=45) of these patients had a diagnosis\n                        from the schizophrenia spectrum, with an average length of stay of 267 days.\n                        A total of 82.2% of patients with schizophrenia received antipsychotic\n                        therapy, 53% received clozapine, and 15.6% received electroconvulsive\n                        therapy. The most common reason for not receiving clozapine and\n                        electroconvulsive therapy was lack of consent.<\/jats:p>\n                  <jats:p>The survey confirms the unresolved problem of long-term patients in acute\n                        psychiatric clinics. In addition to demands for improved care structures for\n                        people with severe and chronic mental illnesses, the quality of acute\n                        psychiatric treatment (guideline adherence) must also be questioned. From an\n                        ethical viewpoint, short-term nonvoluntary measures aimed at restoring\n                        capacity to consent need to be weighed up against long-term or even\n                        permanent detention.<\/jats:p>","DOI":"10.1055\/a-2899-9948","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:03:29Z","timestamp":1785452609000},"source":"Crossref","is-referenced-by-count":0,"title":["Guideline adherence in patients with long-term\n                    schizophrenia in Germany: Focus on clozapine and electroconvulsive\n                    therapy"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5707-7602","authenticated-orcid":false,"given":"Berend","family":"Malchow","sequence":"first","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Germany","place":["G\u00f6ttingen"],"department":["Department of Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul-Fabian","family":"M\u00fchl","sequence":"first","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Germany","place":["G\u00f6ttingen"],"department":["Department of Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Belz","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsmedizin G\u00f6ttingen, Niedersachsen, Germany","place":["G\u00f6ttingen"],"department":["Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Bramesfeld","sequence":"additional","affiliation":[{"name":"Hannover Medical School, Institute for Epidemiology, Social Medicine\n                    and Health Systems Research, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Wagner","sequence":"additional","affiliation":[{"name":"University of Augsburg Faculty of\n                    Medicine, Germany","place":["Augsburg"],"department":["Department of Psychiatry, Psychotherapy and Psychosomatics,"]},{"name":"University of Augsburg, Germany","place":["Augsburg"],"department":["Evidence-based Psychiatry and Psychotherapy, Faculty of\n                    Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Wiltfang","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Germany","place":["G\u00f6ttingen"],"department":["Department of Psychiatry and Psychotherapy"]},{"name":"German Centre for Neurodegenerative Diseases (DZNE), Germany","place":["G\u00f6ttingen"]},{"name":"Neurosciences and Signalling Group, Institute of Biomedicine (iBiMED),\n                    Department of Medical Sciences, University of Aveiro, Portugal","place":["Aveiro"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alkomiet","family":"Hasan","sequence":"additional","affiliation":[{"name":"University of Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Psychiatry, Psychotherapy and Psychosomatics of the\n                    University Augsburg"]},{"name":"German Centre for Mental Health (DZPG), Germany","place":["Augsburg"],"department":["Munich\/Augsburg site"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zilles-Wegner","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Germany","place":["G\u00f6ttingen"],"department":["Department of Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","first-page":"169","article-title":"Heavy users of inpatient services: A comparison of diagnostic subgroups","volume":"28","author":"H Rittmannsberger","year":"2014","journal-title":"Neuropsychiatr"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1176\/ps.46.12.1247","article-title":"A review of studies of heavy users of psychiatric services","volume":"46","author":"S Kent","year":"1995","journal-title":"Psychiatr Serv"},{"key":"ref3","first-page":"213","article-title":"The strandet Ill: Long-term-inpatients in psychiatric hospitals and\n                    departments","volume":"49","author":"A Bramesfeld","year":"2022","journal-title":"Psychiatr Prax"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1055\/a-2307-5236","article-title":"Discharged, but where to? 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sample","volume":"235","author":"S Nykanen","year":"2016","journal-title":"Psychiatry Res"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/acps.13111","article-title":"How and when to use clozapine","volume":"141","author":"J M Rubio","year":"2020","journal-title":"Acta Psychiatr Scand"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"MY20096AH1C","DOI":"10.4088\/JCP.MY20096AH1C","article-title":"Treatment-resistant schizophrenia: Definition, predictors, and\n                    therapy options","volume":"82","author":"C U Correll","year":"2021","journal-title":"J Clin Psychiatry"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/acps.13280","article-title":"An evaluation of the variation and underuse of clozapine in the United\n                    Kingdom","volume":"143","author":"E Whiskey","year":"2021","journal-title":"Acta Psychiatr Scand"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/YCO.0000000000000871","article-title":"The ever-growing case for clozapine in the treatment of schizophrenia: An\n                    obligation for psychiatrists and psychiatry","volume":"36","author":"R A Bittner","year":"2023","journal-title":"Curr Opin Psychiatry"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.schres.2023.09.002","article-title":"An expert review of clozapine in Eastern European countries: Use, regulations\n                    and pharmacovigilance","volume":"268","author":"M Sagud","year":"2024","journal-title":"Schizophr Res"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/acps.12742","article-title":"International trends in clozapine use: A study in 17 countries","volume":"136","author":"C J Bachmann","year":"2017","journal-title":"Acta Psychiatr 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and statement of\n                    the German Association for Psychiatry, Psychotherapy and Psychosomatics\n                    (DGPPN)]","volume":"96","author":"D Zilles-Wegner","year":"2025","journal-title":"Nervenarzt"},{"key":"ref58","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.psychres.2017.01.042","article-title":"Effectiveness of electroconvulsive therapy in patients with treatment resistant\n                    schizophrenia: A retrospective study","volume":"249","author":"S Grover","year":"2017","journal-title":"Psychiatry Res"},{"key":"ref59","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.schres.2023.11.008","article-title":"A systematic review of clozapine for aggression and violence in patients with\n                    schizophrenia or schizoaffective disorder","volume":"268","author":"J Faden","year":"2024","journal-title":"Schizophr 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