Search

In the last decades, psychocardiological knowledge has contributed a lot to the understanding of psychosocial factors involved in the pathogenesis, course, and treatment of cardiovascular diseases. Therefore, psychological, social, and behavioral factors should be detected and addressed early on in order to prevent cardiovascular disease and/or its progression. On the other hand, cardiovascular disease is an important stressor which can lead to psychological comorbidities and thus deteriorate prognosis and quality of life. During therapy a clear, consistent, and empathic communication between professionals and patients is of importance. Up to now there is not much evidence as to the effectiveness of psychotherapeutic interventions or antidepressant medication for cardiac patients with mental comorbidities. Beyond psychosomatic basic care, combined with physical activity, severely ill patients may require multimodal inpatient care in specialized psychosomatic or psychocardiological units and continuous support with lifestyle change.

Das DKPM wurde 1974 gegründet und versteht sich als interdisziplinäre wissenschaftliche Fachgesellschaft. Die DGPM wurde 1992 mit der Einführung des Facharztes für Psychotherapeutische Medizin, später Psychosomatische Medizin und Psychotherapie gegründet. Sie hat sich 2005 mit der Allgemeinen Ärztlichen Gesellschaft für Psychotherapie (AÄGP) zusammenschlossen und vereint heute vorwiegend niedergelassene Fachärzte und Ärzte mit der Zusatzbezeichnung Psychotherapie.

Die gesundheitsbezogene Lebensqualitat (LQ) von Brustkrebspatientinnen wird wesentlich durch ihre psychische Befindlichkeit bestimmt. Bei 103 Brustkrebspatientinnen wurde die LQ in der Akutbehandlungsphase mittels EORTC-QLQ-C30, psychischer Distress durch die HADS und der psychoonkologische Versorgungswunsch an­hand einer Checkliste erhoben. ICD-10-F-Diag­nosen wurden nach klinischem Interview gestellt. Sowohl Patientinnen mit erhohtem HADS-Wert (>13) als auch solche mit einer ICD-F-­Diagnose geben in den EORTC-Skalen niedrige LQ an. Die Ergebnisse bestatigen, dass das Vorhandensein psychischer Auffalligkeiten negativ mit der LQ assoziiert ist. In einer multivariaten Varianzanalyse erwies sich das Vorliegen auffalliger HADS-Scores, nicht aber das Vorhandensein einer ICD-F-Diagnose, als unabhangig signifikanter Pradiktor der LQ. Bei der Bewertung von Screeninginstrumenten sollte nicht nur deren Trefferquote hinsichtlich Diagnosen, sondern auch ihre Relevanz fur die LQ berucksichtigt werden.

To test the possibility of predicting psychotherapy outcome by measures of cardiovascular adaptability to stress at the beginning of treatment we used a prospective, within-subject design with experimental induction of short-term stress. Cardiovascular data during induced stress (mental arithmetic, anger recall) and relaxation were assessed in 21 patients with a main diagnosis of depression at the beginning of their 12-week inpatient psychotherapy treatment. Lower change scores in blood pressure during induced stress at the beginning of therapy were significantly related to better treatment outcome, accounting for 41% of variance, even after controlling for several covariates. Furthermore, there was evidence for the impact of negative affect. Using cardiovascular stress testing as an additional area of information seems a feasible method of incorporating biological parameters in psychotherapy evaluation.

The aim of this health service research study was to investigate the change in the psychological distress of cancer in-patients. According to the structured psychooncological care program Case Management Psychoonkologie (CMP) the patients received psychological treatment during the acute cancer therapy. The CMP was implemented in routine healthcare practice of 6 hospitals. The improvement in the patient's symptoms of anxiety and depression was analyzed as an indication for the effectiveness of the CMP. In order to assess the psychological distress, quality of life, and the functional status the German version of the Hospital Anxiety and Depression Scale (HADS) and a checklist of single-item-scales were administered at hospital admission (t1), 120 days later (t2) and one year after the hospital admission (t3). According to the HADS, the pre-post effect sizes of the psychooncological care program for 258 patients were 0.35 at t2 and 0.46 at t3. The effect sizes of 1.05 at t2 and 1.38 at t3 were calculated for the sub-group of patients with high psychological distress at t1. In 34.4 % of these patients clinical significant improvements in symptoms of anxiety and depression could be identified at t2 and in 45.3 % of the cases at t3. Symptom changes were significantly influenced by the patient's age and the intensity of psychooncological interventions. Symptom improvement was most evident for patients with a high use of psychooncological care. The correlation between HADS and single Item scales is in the moderate to high range. This is an indication of improvement not only in the psychological domain but also in the quality of life and functional status one year after the beginning of cancer treatment. These findings implicate that this study is one of the first to demonstrate the potential effectiveness of structured psychooncological care interventions in routine hospital care.

The Type D personality pattern, consisting of negative affectivity and social inhibition, has been shown by Denollet et al. to predict adverse prognosis in patients with coronary heart disease. For measuring the Type D characteristics, Denollet has devised the 14 item Type D scale (DS14). In the present study, this instrument was translated into German. The validity, reliability and adequacy of the German DS14 were then tested in 2421 persons, including cardiological and psychosomatic patients as well as healthy factory workers. The results document sound psychometric properties of the scale. Cronbach's alpha was 0.87 for the negative affectivity subscale and 0.86 for social inhibition. The two-factor structure of the original instrument could be clearly replicated. The prevalence rates of the Type D pattern were lowest in cardiological patients (25 %) and highest in psychosomatic patients (62 %). The prevalence in this German sample of cardiology patients was also lower than the one observed in healthy factory workers (32.5 %) and in CHD samples reported in the literature. These group differences could not be accounted for by differences in age and sex distribution. In conclusion, the DS14 is a valid and reliable instrument that can be used for an economic evaluation of the Type D characteristics in patients and healthy persons. The possible meaningfulness of the low Type D prevalence in cardiac patients and the prognostic relevance of this pattern require further study.

Hintergrund: Die Anpassungsfahigkeit des autonomen Nervensystems als Indikator fur psychische Funktionsfahigkeit wird als Variante der Zusatzdiagnostik fur therapeutische Veranderungen dikutiert. Methode: In einer Pilotstudie wurde die kardiale Stressreaktivitat von 20 herzgesunden depressiven Patienten in der Initialphase ihrer stationaren Psychotherapie gemessen. Herzrate, Blutdruck, Pumpfunktion (SI), Barorezeptorsensitivitat (BRS) und Hochfrequenz-Herzratenvariabilitat (HF-HRV) wurden nicht-invasiv in Ruhe und bei induziertem Stress gemessen. Aus der Differenz der aggregierten Werte von Ruhe- und Stressbedingung wurde ein Reaktivitatsmas errechnet. Dieses Reaktivitatsmas wurde mit Psychotherapieerfolg (GSI-Residualwerte des SCL-90-R) und Beziehungsdisposition (RSQ-Skalen) in Relation gesetzt. Ergebnisse: Uber durchnittlich drei Monate Psychotherapie veranderte sich der mittlere GSI von 1,42 (SD 0,47) zu 0,58 (SD 0,26). BRS-Reaktivitat korrelierte signifikant mit GSI-Residualwerten (r=-.57, p