Psychosomatic Treatment Research Articles

Resource activation and therapeutic success in in-patient and day-care psychosomatic treatment

The aim of the study was to examine the association between resource activation and treatment success in in-patient and day-care psychosomatic treatment. 130 patients were examined at the beginning and at the end of their in-patient or day-care psychosomatic treatment. The change of resource realization (RES[1]) and different measures of therapeutic success (SCL-90-R[2], BDI-II[3], WHO-5-Q[4], GAS[5], retrospective success evaluation [6]) were assessed using standardized questionnaires. The results demonstrated a significant trans-diagnostic change in patients' resource realization, which correlated with different measures of mental health (SCL-90-R, BDI-II, WHO-5-Q). Resource realization at the beginning of the treatment and the process of resource activation (pre-post measure of resource realization) turned out to be relevant for predicting treatment success. Furthermore, mediation analysis shows that initiation of experiences of mastery (BSPR-P[7]) seems to be effective as a mediation process. The results show that resource realization improves during psychosomatic treatment and is associated with treatment success.

Addiction patients in emergency departments

Addiction patients in emergency departments are common assignments from the rescue services. Often there are recurring images of the same patient. Patients with acute intoxications are passed from the emergency services in different constitution to the emergency department. The challenge to the treating emergency team and the infrastructure is correspondingly high. Nevertheless, the emergency treatment should include a comprehensive initial somatic and later psychosomatic treatment regim in these patients, this treatment option should always be offered and discussed again and again. Furthermore patients who are admitted to the hospital on emergency wards because of general medical or surgical problems, have in up to 10 % of cases a problematic behaviour with respect to their alcohol consumption, but are "compensated" at the time of entry. It is thus appropriate for all emergency patients who need to be hospitalized to perform a screening for a problematic alcohol consumption. there are appropriate questionnaires that take little time and can also be performed on emergency rooms, but you have to remember!

Mental distress and wish for psychosomatic treatment of patients with pulmonary hypertension

The study investigated the level of mental distress in patients with pulmonary hypertension (PH) and assessed the use of and the wish for psychosomatic treatment. A total sample of n=187 outpatients participated in the cross-sectional survey. The short form of the Patient Health Questionnaire (PHQ-D), the EuroQol (EQ-5D) and a questionnaire assessing the wish for psychosomatic treatment were applied. 50.6% of the patients exhibited depressive symptoms of varying degrees, 19.2% showed symptoms of major depression. 14.8% of the pa-tients reported panic attacks, and 7.1% demonstrated symptoms of a panic syndrome. Quality of life was low (EQ-5D VAS M=60). Experience with outpatient or inpatient psychotherapy was reported by 23.4% and 8.6% of the patients, respectively. 56.5% reported a wish for psychosomatic treatment. PH-Patients are more likely to suffer from mild or subthreshold depressive syndromes, but are very interested in psychosomatic treatment. The implementation of psychosomatic interventions into clinical practice would be desirable.

Indicators of patient care in Psychiatric and Psychosomatic Facilities (VIPP project)--a database project

In Germany a new and unique remuneration system for psychiatric and psychosomatic stationary treatments (PEPP system) was introduced in 2013 on an optional basis. From 2015 it will be mandatory for psychiatric and psychosomatic facilities. The introduction of the PEPP system brings up different questions regarding the possible incentives of the new remuneration system and its effects on the supply of psychiatric and psychosomatic treatments. To conduct these necessary analyses a reliable database is needed. The goal of the project "Indicators of patient care in Psychiatric and Psychosomatic Facilities" (VIPP project) is to gather a representative database which reflects the situation of day-to-day patient care performed by German psychiatric and psychosomatic facilities. The § 21 data set represents the basis of this database which will be complemented by other data sources (i. e., financial statements and other economic data). A number of more than 100 ,000 cases per year has already been exceeded. These case data were provided by a wide range of psychiatric hospitals, departments and universities that participate in this project. The dataset is anonymised and by pooling the data it is not possible to identify the cases of a specific clinic. Participants receive a web-based access and have the possibility to analyse the data independently. Using the examples of coding accuracy and rehospitalisation rates the variety as well as the enormous potential of this database can be demonstrated. On the base of the VIPP database valid patient care indicators can be identified and cross-sectional analyses can be conducted. From such results key data on health economic strategies can be derived and the incentives, strengths and limitations of this constantly changing system can be identified.

Introduction of performance- and day-based lump-sum remuneration for stationary psychiatric and psychosomatic treatments in Germany--analysis of incentives of the PEPP system

This paper surveys the effects of day-based lump-sum remuneration as defined by the PEPP system on the patients' length of stay and compares its incentives to the mechanisms of the German DRG system and the former remunera-tion system for stationary psychiatric and psychosomatic treatments. The analysis identifies the economically optimal length of stay defined as the profit maximising duration of treatment by comparing marginal revenues and marginal costs. Since it is economically optimal to extend the treatment until the marginal costs exceed the marginal revenues, psychiatric and psychosomatic facilities are incentivised to minimise the time gap between average duration of treatment as expected duration of treatment and the economically optimal length of stay. Compared to the German DRG system, which provides a strong incentive to reduce length of stay, the incentives set by the PEPP system imply either a reduction or an extension of treatment duration depending on the underlying cost function. If a degressive cost function is assumed, which is typical for treatments of psychiatric and psychosomatic illnesses, the economically optimal duration of treatment will be at the last upper boundary of the interval of the marginal revenue function in which the average marginal revenues exceed the average marginal costs. It is also feasible that it is economically optimal to treat the patient for as long as possible. The hospital is incentivised to extend or reduce the time of treatment to this point in time. Psychiatric and psychosomatic hospitals are able to increase their profits by reducing or extending time of treatment. Therefore these facilities have to justify the extent of treatment to the health insurance companies. Since the incentives of the PEPP system and the DRG system diverge, the results of research on supply induced demand in the DRG system cannot be transferred to the discussion about the effects of the introduction of the PEPP system. As long as the average duration of treatment as expected duration of treatment deviates from the economically optimal length of stay, policy makers should consider the options of adaptations, i. e., increase of time intervals or calculating cost weights based on variable costs combined with separate remuneration of fixed costs. The TEPP system and PEPPplus are already being discussed as adaptions or additions.

The benefit of self-help groups during and after inpatient psychosomatic treatment

The benefit of self-help groups during and after inpatient psychosomatic treatment

Non-response to therapy in acute and rehabilitative psychosomatic inpatient care - a systematic review

The study reviews the state-of-the art on failure research in acute and rehabilitative psychosomatic inpatient care. The main focus of interest lies in describing the frequency and possible predictors of unsuccessful therapeutic treatments. We systematically searched the databases MEDLINE, PsycARTICLES, PsycINFO und PSYNDEX and selected studies from the past 20 years focusing on treatment failure in the inpatient psychosomatic treatment of adult patients. A total of 31 studies were included, 15 of which allowed the extraction of predictors of non-response or deterioration. 20 %to 30%of patients leave psychotherapeutic treatment without any significant change; 5 %to 10%deteriorate during their stay.A high level of symptom distress at intake, a chronic course of the disease as well as somatoform or personality disorders are associated with non-response and deterioration. Early response to treatment and a dysfunctional therapeutic alliance are possible further predictors, whereas sociodemographic and sociomedical variables are unlikely to have a predictive validity. Hypotheses about possible predictors can be derived from the results of this review. However, the interpretation of the results is limited by the heterogeneity of the methodology and of the samples of the studies included. Nevertheless the results can be used as a basis for further hypothesis-driven research.

Behandlung eines Patienten mit Diabetes mellitus Typ 2 und einer depressiven Störung

A 65-year-old man with type 2 diabetes mellitus and unfavorable metabolic values in combination with obesity and arterial hypertension and considerable psychosocial strains presented at a psychosomatic outpatient clinic. During the course of diagnostic sessions a problematic illness behavior as well as a depressive symptomatology that had developed after the death of his wife a few years earlier became apparent. DIAGNOSIS, THERAPY, COURSE: An avoidant illness behavior and a moderate depressive episode were diagnosed. Within a low threshold psychosomatic intervention an understanding of illness could be established and psychosocial barriers of diabetes therapy were reduced. The patient was able to outline achievable goals of his diabetes treatment and began their successful implementation. Within a stepped-care approach the patient could also be motivated for an inpatient psychosomatic treatment. During the course of treatment the patient experienced a remission from his depressive symptomatology and a notable improvement of metabolic values. With the help of a close cooperation between diabetes specific and psychotherapeutic treatment in psychosomatic outpatient clinics, patients with high blood glucose levels and comorbid depression can be enabled to gain a better understanding of their illness behavior and change it in their favor.

Effectiveness of a psychosomatic day hospital treatment for the elderly: A naturalistic longitudinal study with waiting time before treatment as control condition

ObjectiveIn 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization. MethodsDesigned as a naturalistic study with waiting time before admission as a control condition, the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale. Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health questionnaire, patient perception of interpersonal problems and health care use before and after treatment. ResultsAfter treatment significant improvement (p<0.01) with moderate effect sizes (ES) was found in all variables from admission to discharge (ES from 0.3 to 0.8) and also to follow-up (ES from 0.2 to 0.6). Improvement remained stable at follow-up. Furthermore, after psychosomatic treatment a reduction in medical service usage was visible. Number of consultations (pre: 13, post: 9), number and length of hospital stays (pre: 1, 7weeks, post: 0, 3weeks) were both significantly (p<0.001) reduced six months after treatment as compared to the period six months prior to treatment. ConclusionResults indicate that the psychosomatic day hospital treatment of the elderly is successful. Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost–effect-ratio. Expanding this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly.

Werden in Österreich Patienten mit psychosomatischen Störungen ausreichend versorgt?

Quality assurance in psychosomatic medicine in Austria is currently based on a voluntary continuing medical education programme in psychosocial, psychosomatic and psychotherapeutic medicine. It is questionable whether psychosomatic care can be sufficiently provided in this manner. In addition, a broadly based proposal to create a subspecialty in psychosomatic medicine in order to facilitate quality assurance, is investigated. The necessity to reorganize psychosomatic care was explored through semi-structured qualitative interviews with experts. Data-based analyses probed the labour market of the proposed subspecialty, and the literature was reviewed to look into the cost-benefit ratio of psychosomatic treatment. All experts expressed a need to restructure psychosomatic care in Austria. Examples exist for psychosomatic treatment with an efficient cost-benefit relation in diverse medical settings. Establishing a subspecialty in Psychosomatic Medicine seems feasible and could contribute to increased quality assurance and the nationwide provision of psychosomatic care.

Why do patients with fibromyalgia complain of ear-related symptoms? Ear-related symptoms and otological findings in patients with fibromyalgia

While fibromyalgia is frequently associated with ear-related symptoms such as feeling of ear fullness, earache, and tinnitus, the pathogenesis of these ear-related symptoms in fibromyalgia patients is unknown. Here, we focused on clarifying the pathogenesis of ear fullness, a particularly common symptom observed in fibromyalgia patients. Twenty patients diagnosed with fibromyalgia on outpatient psychosomatic treatment complaining of ear-related symptoms answered our questionnaire and underwent neurotological examination, including pure tone audiometry and Eustachian tube function testing. While ear-related symptoms were significantly exacerbated after onset of fibromyalgia, we noted no correlation between the presence or absence of feeling of ear fullness and abnormal findings on neurotological examination. Given our findings, we suspect that onset of ear fullness may be associated not with abnormal findings in the middle and inner ear function tests but with other causes, such as central desensitization.

Idealtypische Interaktionsmuster psychosomatischer Patienten in stationär-geriatrischer Behandlung

Cooperation between psychosomatic and geriatric medicine is still sporadic and rarely institutionally integrated. At the same time, however, nearly half of geriatric inpatients suffer from psychopathological symptoms of clinical relevance. The patterns of interactions between patients and professionals of the geriatric team prior to a psychosomatic intervention that lead to a specific consultation are still rarely known. The aim of this paper was to identify these relational patterns, which can again occur during interaction with the psychosomatic patient. Protocols from the consultation sessions of 76 geriatric in-patients, treated over a period of 1 year, were used as the basis data for the development of interactional patterns with the systematic, qualitative method of forming ideal types by understanding. Three groups with a total of 11 interactional patterns were formed: (1) "conflictuous interaction" with patients who re-enact their inner conflicts (e.g., autonomy or conflicts on power and subjugation), (2) "the problem can not be dealt with" with patients who forget or deny and repress their mental problems in other ways, and (3) "avoiding contact" with patients who have different forms of psychosocial withdrawal. Extension of the geriatric functional diagnostic approach on interactional-psychodynamic aspects is possible and fosters a differentiated view on the psychosomatic situation of geriatric patients.

Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome

IntroductionPatients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.MethodsAs part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.ResultsOverall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01).Discussion and conclusionResults show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.

运用叙事医学培养精神科专科医师人文素质

21世纪医学从生物治疗到身心综合治疗的转向提示现代精神科专科医师需要“既懂病，又懂人”，临床实践中医患之间的摩擦与日俱增不乏与医生的人文素养有关。鉴于精神科患者的特殊性，在临床实践中需要精神科专科医师具备更高的人文素养。在精神科专科医师规范化培训过程中，通过开展“第一人称叙事”练习和医学人文教育等形式，使专科医师受到我院百年进步文化的浸渍，对人文精神有更为深刻的认识。 From biological treatment to psychosomatic treatment, the involving changes are supposed to company with higher humanistic spirit, especially for modern psychiatrists, just as the saying “not only understand the disease, but also understand people”. In recent years, there are more and more misunderstandings between doctors and patients, even though the reasons are complex, lack of humanity may be one of them. So, we prompt the humanities of psychiatric residency by the excise of “the first-person narratives” which is derived from narrative medicine and humanity education in the process of standardized training of psychiatric residency. Through these applications, the residents could under the atmosphere of the century culture of our hospital and the direction of humanity experts and have a deeper understanding of humanistic spirit.

Evaluation of a salutogenetic concept for inpatient psychosomatic treatment.

The increase of psychosomatic disorders due to cultural changes requires enhanced therapeutic models. This study investigated a salutogenetic treatment concept for inpatient psychosomatic treatment, based on data from more than 11000 patients of a psychosomatic clinic in Germany. The clinic aims at supporting patients' health improvement by fostering values such as humanity, community, and mindfulness. Most of patients found these values realized in the clinical environment. Self-assessment questionnaires addressing physical and mental health as well as symptom ratings were available for analysis of pre-post-treatment effects and long-term stability using one-year follow-up data, as well as for a comparison with other clinics. With respect to different diagnoses, symptoms improved in self-ratings with average effect sizes between 0.60 and 0.98. About 80% of positive changes could be sustained as determined in a 1-year follow-up survey. Patients with a lower concordance with the values of the clinic showed less health improvement. Compared to 14 other German psychosomatic clinics, the investigated treatment concept resulted in slightly higher decrease in symptoms (e.g., depression scale) and a higher self-rated mental and physical improvement in health. The data suggest that a successfully implemented salutogenetic clinical treatment concept not only has positive influence on treatment effects but also provides long-term stability.

H-MR Spectroscopy of the Anterior Cingulated Cortex: Usefulness in the Prediction of Patients That Will Benefit from a Cognitive Behavioural Therapy in the Treatment of Chronic Pain

Anterior cingulated cortex (ACC) is involved in “the state in which patients do not care much about pain despite its presence” which is a goal of psychosomatic treatment. To investigate the absolute concentration of N-acetylaspartate (NAA) in the anterior cingulated cortex (ACC) as predictors of patients that may benefit from cognitive behavioural therapy in the treatment of chronic pain. Proton magnetic resonance spectroscopy (1H-MRS) was performed with a 1.5 T MR system on a voxel in the bilateral ACC in 85 chronic pain patients and 20 age-matched normal control subjects. Eighteen out of 24 (75.0%) patients whose NAA concentration decreased significantly in the ACC, respectively, compared to the mean NAA concentration of the normal control subjects, needed cognitive behavioural therapy. Our results suggest that decreased NAA concentration in the ACC is associated with the necessity of cognitive behavioural therapy. 1H-MRS may serve as a useful non-invasive tool for evaluating chronic pain patients.

运用叙事医学培养精神科专科医师人文素质&lt;br&gt;The Application of Narrative Medicine in the Cultivation of Humanity Spirit in the Training of Psychiatric Residency

21世纪医学从生物治疗到身心综合治疗的转向提示现代精神科专科医师需要“既懂病，又懂人”，临床实践中医患之间的摩擦与日俱增不乏与医生的人文素养有关。鉴于精神科患者的特殊性，在临床实践中需要精神科专科医师具备更高的人文素养。在精神科专科医师规范化培训过程中，通过开展“第一人称叙事”练习和医学人文教育等形式，使专科医师受到我院百年进步文化的浸渍，对人文精神有更为深刻的认识。 From biological treatment to psychosomatic treatment, the involving changes are supposed to company with higher humanistic spirit, especially for modern psychiatrists, just as the saying “not only understand the disease, but also understand people”. In recent years, there are more and more misunderstandings between doctors and patients, even though the reasons are complex, lack of humanity may be one of them. So, we prompt the humanities of psychiatric residency by the excise of “the first-person narratives” which is derived from narrative medicine and humanity education in the process of standardized training of psychiatric residency. Through these applications, the residents could under the atmosphere of the century culture of our hospital and the direction of humanity experts and have a deeper understanding of humanistic spirit.

Veränderungen der Krankheitsrepräsentationen und der Lebensqualität bei Patienten im Verlauf einer stationären psychosomatischen Behandlung

This article concerns the change of illness representations during the course of psychotherapeutic-psychosomatic treatment. It studies the predictive value of pretreatment illness representations and how they change with respect to quality of life. In a pre-post measurement design, data were collected from 199 patients at pretreatment and from 172 patients at posttreatment. The instruments used were the Illness Perception Questionnaire and the World Health Organisation Quality of Life Questionnaire. Patients were on average 41 years old and had spent on average 44 days in the hospital. 76 % of them were women. Patients reported a significant enhancement of their symptoms and a reduction of perceived consequences. The illness representations of timeline and perceived control predicted altogether 11 % of the increase in quality of life. This increase also corresponds to a reduction of perceived consequences and an increase of control. Results point toward the importance of illness representations for patients regarding psychosomatic treatment. Therefore, consideration of illness representations during therapeutic interventions could increase quality of life.

Specific Job Anxiety in Comparison to General Psychosomatic Symptoms at Admission, Discharge and Six Months after Psychosomatic Inpatient Treatment

Objective: Job anxiety is a severe problem in many patients with chronic mental disorders, as it usually results in specific participation problems in the workplace and long-term sick leave. The aim of this study was to explore the development of sick leave in dependence on general psychosomatic complaints and job anxiety from admission to a psychosomatic inpatient treatment until 6 months after discharge. Method: A convenience sample of 91 patients, suffering from multiple mental disorders, filled in self-rating questionnaires on job anxiety (Job Anxiety Scale) and on general psychosomatic symptom load (Symptom Checklist-90-Revised) at the beginning, the end, and 6 months after discharge from an inpatient psychosomatic treatment. Additionally, sick leave status and employment status were assessed before and 6 months after the treatment. Results: 15.4% of 91 patients were on sick leave before inpatient treatment and at follow-up (SS group), 20.9% were fit for work at intake and follow-up (FF group), 6.6% were fit for work initially and on sick leave later (FS group), and 57.1% on sick leave first and working at follow-up (SF group). In regard to general psychosomatic complaints, there were initially high scores on the SCL, a marked reduction during inpatient treatment, and a bouncing back to initial levels at follow-up for all 4 patient groups. SS and FS patients showed the highest scores at intake and follow-up. Concerning job anxiety, SS patients had the highest scores at all three assessments, while FF patients had significantly lower scores, with only low variation between assessments. SF patients started with comparatively high scores of job anxiety, which even increased before reentering work, but decreased in the follow-up period when they were confronted with work again. FS patients started low (like the FF patients) at intake, reduced their job anxiety further till discharge, but increased to higher scores at follow-up. Conclusions: General psychosomatic symptom load and job anxiety show a different course during treatment and are differently related to sick leave. General psychosomatic symptom load can be understood as a measure of the degree of the chronic illness status, whereas job anxiety reflects specific additional context-related problems, i.e. problems with work. A core finding is that job anxiety is related to work avoidance, but work exposure may reduce job anxiety. This has direct consequences for putting patients on sick leave or not.

Physical and psychosocial impact of acne in adult females

Background:Acne, the most common problem that presents to dermatologists, can persist beyond teen years. Although its physical and psychosocial impact is studied in teen years, it is poorly understood in the Indian adult population.Aim:To study the physical and psychosocial impact of acne in adult females.Settings and Design:This exploratory study was done in the university setting.Materials and Methods:Eleven adult, unmarried females, between the age group of 18 and 25 years, having (mild-to-moderate), acne, for two consecutive years, were interviewed using a semi-structured clinical interview of the Skindex, a quality-of-life measure for patients with skin disease, developed by Chren et al., along with some open-ended questions. Both qualitative and quantitative analysis was done to analyze the data.Results:The results indicated a higher level of emotional and social impairment, in terms of the feelings of physical discomfort, anger, and the intermingling impact of these, among the participants.Conclusions:Acne is a common problem among adults and appears to have a considerable impact on the mental health, therefore, for the treatment to be successful, a sympathetic approach by doctors and significant others, with the basic psychosomatic treatment, are necessary.