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Background: Psychosomatic consultation in the workplace (PSIW) is an offer for employees who are under mental and psychosomatic strain. Core elements are early diagnosis and short-term psychotherapy with the aim of improving the care for mentally stressed employees. This article provides a characterization of patients and presents initial data on the effects of short-term psychotherapy., Materials and Methods: From 05/2016 to 12/2019, basic data were collected from all employees seeking help. Socio-demographic data, previous treatments, work ability, depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), assessment of psychological state and attitudes towards treatment options were collected by self-report before and (if applicable) after a short-term intervention., Results: A total of 672 employees from 20 companies (49% male) were mostly referred to PSIW by the company physician. Adjustment disorders and depressive disorders each accounted for almost one-third of diagnoses. A quarter of the employees presenting at PSIW were on sick leave at the time of referral. The most frequent recommendations were short-term intervention at PSIW, followed by outpatient psychotherapy. A total of 343 (51%) employees completed the questionnaires, of which 187 (55%) of them received short-term psychotherapy. The symptoms improved significantly across all scales. Satisfaction with PSIW was very high., Conclusions: PSIW is an innovative care concept in the work context, which is well accepted and effective in various sectors. Close cooperation with company stakeholders such as occupational health physicians is important for a successful outcome., Competing Interests: Die Autorinnen/Autoren geben an, dass sie für eine Klinik arbeiten, die auch eine psychosomatische Sprechstunde betreibt. Sie erhalten aber keine vom Erfolg der Sprechstunde abhängige Vergütung., (Thieme. All rights reserved.)

Work and mental health are closely interrelated. Sick leave rates due to mental illness have constantly been rising for years. Thus, not only companies but also the society as a whole have become more and more aware of the relevance of this topic.At first, various work stress models are outlined in this article. This is followed by an overview of how to classify work-related mental disorders in the ICD and DSM systems. Burnout is explained with regard to terminology, origin and adequate use in clinical practice. Furthermore, the ILO (International Labour Organization) classification of work-related mental disorders is presented. Possible intervention models for the prevention and therapy of work-related mental health problems are discussed. In addition, the most essential components of work-related psychotherapy are pointed out. Finally, corresponding guidelines are put into an international context., Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma: nein.Erklärung zu nichtfinanziellen InteressenDie Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Waiting times for the admission into a so called psychosomatic hospital in Germany prevent the necessary immediate treatment. They lead to further incapacity for work and chronic manifestation of the disease. It is reported that most psychosomatic hospitals have waiting times, but there are no studies on data on that. Therefore, it was the aim of this study to access prospectively in a defined region, how long it takes for the patients to get an outpatient preliminary talk and thereafter, how long they have to wait for their admission., Methods: 7 hospitals out of the region of South-Württemberg took part on this study, 2 of them had bigger day hospitals. Data were assessed prospectively in 2015 over 9 months, in total 916 admissions were assessed., Results: The waiting time until a preliminary talk, in which the indication for inpatient treatment was secured, was in the mean 25 days (SD=31). The waiting time after this talk until admission was 56 days (SD=47). Patients who waited for a day treatment had to wait even longer. An urgency remark, given by the therapist of the preliminary talk, as well as a private illness insurance led to shorter waiting times. The diagnosis had no influence on the waiting time., Conclusions: The waiting times are substantial and imply a burden for the patient and also for the health care system. It is recommended to assess and publish these waiting times on a regularly basis. Politics, but also the actors in the health care system should discuss if and how this deficit can be changed., Competing Interests: Alle Autoren sind in der Leitung oder als Angestellte in den beforschten Kliniken tätig. Ansonsten bestehen keine Interessenkonflikte., (© Georg Thieme Verlag KG Stuttgart · New York.)

Psycho-mental stressors and increased perceived stress in workplace settings may determine the onset and course of stress-related mental and psychosomatic disorders. For the description of psycho-mental stressors three distinct models have widely been used in the analyses of the matter: the Demand-Control-Model by Karasek and Theorell, the Effort-Reward-Imbalance Model by Siegrist, and the Model of Organisational Justice.The interactional or social dimension in work-place settings can be seen as a cross-sectional dimension to the above mentioned models. Here, social conflicts and mobbing, as specific forms of interactional problems, are of importance.Besides measures of primary prevention which can be derived from applying the above mentioned models, attention is paid increasingly to secondary and tertiary preventive measures in work-place settings. Concepts such as the psychosomatic consultation-hour within the context of workplace showed to be effective measures for the early detection of people at risk or early stages of e. g. stress-related psychosomatic disorders.Furthermore, step-wise reintegration of members of the work-force play an important role within the effort to retain the ability to work and the workplace of individuals who suffered from stress-related mental disorders, as it has to be stressed that working and social interactions at the workplace may well be a resource that enhances and stipulates psycho-mental well-being and mental health.This CME-Article describes the above mentioned models and discusses selected perspectives of preventive measures to avoid stress-related mental disorders in members of the work-force., (© Georg Thieme Verlag KG Stuttgart · New York.)

Difficulties in the assessment of patients with somatoform disorders and a claim for social security benefits or invalidity pensioning pose a considerable challenge to the medical community. Within the process of delivering a medical expert's opinion, psychiatric and psychological factors often are underestimated. There are ample recommendations to apply specific criteria within the medical expert's report, but there are no empirical studies confirming that these criteria are really used and prognostically valuable. Especially, despite the growing numbers of psychosomatic in-patients and the thereby heightened socioeconomic importance, there are nearly no catamnestic studies which sufficiently evaluate the results of psychotherapy in the specific group of patients with somatoform disorders and a pending desire for financial compensation alone. The rare available data provides a nearly disastrous impression of psychotherapy results in this patient group. This review article highlights important problems of this special patient group and provides some suggestions concerning the further handling of the addressed issues.

This article discusses modern theories about the influence of developmental factors on the genesis of alexithymia and about its influence on maturing neurobiological structures. Against this background it becomes clear that core concepts of psychodynamic psychotherapy, like the concept of a unconscious level of experience, are confirmed by modern neurobiological research. Thus, modern psychosomatic research should strive to validate clinical core concepts by the use of empirical studies which also consider neurobiological parameters.

The purpose of this study was to assess whether alexithymia is a risk factor for autonomic dysregulation in cervical dystonia (spasmodic torticollis, ST). Alexithymia was assessed by an authorized German version of the TAS-20. In a first step, we recruited 10 ST-patients with high alexithymia scores (> 62; M = 69.2, SD = 3.0) and compared them with 10 ST-patients with low alexithymia scores (< 35; M = 28.7, SD = 4.3) on physiological and subjective responses to a cognitive and an emotional laboratory stressor. High-alexithymic ST-patients generally showed increased levels of autonomic arousal (higher SCL, more NS.SCF and lower T; 0.016 /= 57 vs. low

Within the last decade cost-effectiveness assumes a much more strategic perspective in the rationing of care that is taking place due to evidently increasingly limited financial resources and managed-care driven protocols. As universities and general hospitals face this increasing pressure to justify services within their facilities, consultation-liaison (C/L) programs need to carefully address and evaluate the financial base of the services they provide. Overlooking or neglecting the financial aspects of C/L-services has already resulted in the closure or service reduction of C/L-programs throughout the United States. Whereas a result of that development interest in cost-effectiveness research is considerable in the US and GB and has produced some good evidence for the impact of psychosocial problems on the outcome and cost of medical care, nearly no such studies come from the German-speaking countries. The present article reviews the worldwide existing literature concerning cost-effectiveness analyses of C/L-work and attempts to guide the reader through the currently available methods for cost-effectiveness research. As a conclusion we propose somatisation syndromes as one patient group. There the development of appropriate treatment regiments is vital both concerning clinical and socioeconomical aspects.