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No abstract

Tics are defined as involuntary, quick, sudden, and stereotypical movements or phonic productions. Despite the fact that tic suppression plays an important role for the patient's ability to cope with tic disorders, investigations of the underlying neural correlates using functional imaging focused on tic generation rather than tic suppression. We examined a patient with Gilles de la Tourette syndrome with regard to neural mechanisms of tic generation and tic suppression using fMRI. Three different conditions were compared: "tics", "tics suppressed", and "tics imitated". The comparisons of "tics" to tics suppressed" and of "tics" to "tics imitated" showed similar activation in the anterior cingulate cortex. This leads to distinct suggestions concerning the neural network involved in tic suppression. Similar mechanisms may be involved in tic suppression via mental efforts or active movements.

The present study evaluated a new integrated treatment concept offering inpatient care, acute psychiatric day hospital and outpatient treatment by the same therapeutic team. 178 patients participated in this randomized controlled trial. Data on psychopathology, global and social functioning, patient satisfaction, continuity of care and administrative data was gathered on admission, throughout the course of treatment, upon discharge and at 1-year follow-up. In addition, the physicians in charge rated the therapeutic relationship. The data analysis consists of group-wise comparisons and regression analyses (cross-tabulations and χ(2) test statistics for categorical data and Mann-Whitney U tests for continuous data). Differences between groups over time were analyzed with a series of generalized linear mixed model. The integrated care group showed a significant reduction in psychopathological impairment (20.7%) and an improvement of psychosocial functioning (36.8%). The mean number of days before re-admission was higher in the control group when compared to the integrated care group (156.8 vs. 91.5). There was no difference in the number of re-admissions and days spent in psychiatric institutions. This new approach offers a treatment model, which facilitates continuity of care. Beside it improves psychopathological outcome measures and psychosocial functioning in patients with mental illness.

STAR can serve as an important tool in research concerning the therapeutic relationship. We suggest conducting further analyses concerning the validity of the subscales in the German version.