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Dieser Artikel erlautert die Entwicklung und Implementierung einer psychosomatischen Fruherkennungsmasnahme in der stationaren somatischen Versorgung. Circa jede:r sechste stationar somatisch behandelte Patient:in ist von einer psychischen Storung betroffen. Schatzungen gehen davon aus, dass nur die Halfte der Betroffenen korrekt erkannt wird. Folglich bleibt ein Grosteil der Patienten unbehandelt. Um diese Versorgungslucke zu adressieren, wurde eine psychosomatische Fruherkennungsmasnahme von einer interdisziplinaren Arbeitsgruppe entwickelt. Die Erkennung basiert auf dem Patient Health Questionnaire-4 (PHQ-4). Der PHQ-4 ist ein psychometrisch sehr gut evaluierter ultra-kurzer Screening-Fragebogen zur Erkennung von depressiven Storungen und Angststorungen. Fur die Implementierung in der stationaren Routineversorgung wurde der PHQ-4 als Formular in die elektronische Patientenakte programmiert. Dieses Formular wird beim Aufnahmegesprach durch Mitarbeitende der Pflege durchgefuhrt. Ergibt das PHQ-4 Screening-Ergebnis einen Hinweis auf das Vorliegen einer psychischen Komorbiditat und ausert der Patient Bedarf, wird automatisch ein psychosomatisches Konsil beauftragt. Die Umsetzung in die klinische Routine erfolgte auf vier internistischen sowie drei dermatologischen Stationen des Universitatsklinikums Hamburg-Eppendorf. Die in der elektronischen Patientenakte implementierte Fruherkennung ist eine minimal aufwandige, wenig zeitintensive und praktikable Methode, Patienten durch eine schnelle interdisziplinare Weiterverweisung ganzheitlich zu versorgen. Eine Evaluation der Kosten-Effektivitat, der klinischen Effizienz sowie der Akzeptanz steht noch aus.

BackgroundIn 2013, the diagnosis of somatic symptom disorder (SSD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This review aims to comprehensively synthesize contemporary evidence related to SSD.MethodsA scoping review was conducted using PubMed, PsycINFO, and Cochrane Library. The main inclusion criteria were SSD and publication in the English language between 01/2009 and 05/2020. Systematic search terms also included subheadings for the DSM-5 text sections; i.e., diagnostic features, prevalence, development and course, risk and prognostic factors, culture, gender, suicide risk, functional consequences, differential diagnosis, and comorbidity.ResultsEight hundred and eighty-two articles were identified, of which 59 full texts were included for analysis. Empirical evidence supports the reliability, validity, and clinical utility of SSD diagnostic criteria, but the further specification of the psychological SSD B-criteria criteria seems necessary. General population studies using self-report questionnaires reported mean frequencies for SSD of 12.9% [95% confidence interval (CI) 12.5–13.3%], while prevalence studies based on criterion standard interviews are lacking. SSD was associated with increased functional impairment, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Relevant research gaps remain regarding developmental aspects, risk and prognostic factors, suicide risk as well as culture- and gender-associated issues.ConclusionsStrengths of the SSD diagnosis are its good reliability, validity, and clinical utility, which substantially improved on its predecessors. SSD characterizes a specific patient population that is significantly impaired both physically and psychologically. However, substantial research gaps exist, e.g., regarding SSD prevalence assessed with criterion standard diagnostic interviews.

OBJECTIVE The diagnostic criteria of somatic symptom disorder (SSD) emphasize that somatic symptoms receive disease value once they are accompanied by excessive thoughts, feelings, or behaviors. The main objective of this study was to examine what constitutes excessiveness in psychological reactions to somatic complaints and how excessive symptom-related behavior influences self-reported health status and health care utilization. METHODS A national, representative general population survey was performed between January and March 2016 in Germany, including 2395 individuals older than 13 years. Self-report questionnaires (Somatic Symptom Scale-8, Somatic Symptom Disorder-B Criteria Scale) were used to operationalize the SSD criteria. Group differences in the daily amount of time dedicated to physical complaints were analyzed between individuals with and without SSD. Stepwise linear regression analyses were performed to predict general mental and physical health status, and health care utilization. RESULTS There was a significant effect of group (SSD yes/no) in daily time spent on symptoms, after controlling for age, sex, depression, and anxiety (F(1,2336) = 447.53, p < .001). The SSD group (n = 213) reported an average of 4 hours, whereas individuals without SSD reported 30 minutes. Results of the regression analyses showed that the combination of somatic symptoms and symptom-related psychological features is predictive of worsened self-reported physical and mental health status, and increased health care utilization. CONCLUSIONS A range of 3 to 4 hours per day spent on dealing with physical complaints seems indicative of excessiveness. If, during a clinical consultation, a patient reports such a large amount of time, a more comprehensive clinical examination of SSD should follow.

Objective Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients views on routine screening for depression in cardiac practice. Methods This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. Results We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. Conclusion We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.

Mental health-related stigma is common and inhibits help-seeking. It triggers fears of devaluation and can add to the burden of a mental disorder. To counter the consequences of mental health-related stigma, its sound assessment is crucial. Therefore, we developed a new measure, the Stigma-9 Questionnaire (STIG-9), and evaluated its psychometric properties and applicability in patients with mental disorders. Item development was based on the modified labelling theory, psychometric reasoning, and discussion with focus groups including patients and clinicians. Data from 919 consecutive patients from an outpatient clinic for mental disorders (69% female, mean age 41 (SD = 14) years) was used to psychometrically evaluate the measure. The STIG-9 consists of nine items assessing cognitive, behavioural and affective aspects of perceived mental health-related stigma. Higher scores indicate stronger expectations of negative societal beliefs, feelings, and behaviours towards ‘mentally ill’ people. Confirmatory factor analysis revealed a single factor structure. The scale showed high internal consistency. Male gender, social impairment and higher levels of psychopathology corresponded with higher STIG-9 scores. The STIG-9 is a new, theory-grounded, patient-oriented and psychometrically promising self-report measure of perceived mental health-related stigma. It is brief, comprehensive, and appears to be well accepted by patients with mental disorders.

OBJECTIVE Prior studies investigated objective somatic consequences of eating disorders whereas research on subjective somatic symptom severity, that is, profiles of subjective burden of somatic symptoms in patients with anorexia (AN) and bulimia nervosa (BN), is sparse. METHODS Somatic symptom severity (Patient Health Questionnaire-15) was investigated in a cross-sectional consecutive sample of outpatients with AN or BN. Using regression and mediation analyses, effects of somatic symptom severity on days of sick leave during the last 2 weeks and quality of life were examined. RESULTS Compared with AN-outpatients (n = 90, MBMI = 17.2, Mage = 27.9 years, 95% female), BN-outpatients (n = 63, MBMI = 21.8, Mage = 29.0 years, 93% female) reported a significantly higher somatic symptom severity (p = 0.016). Increased somatic symptom severity predicted days of sick leave during the last 2 weeks (p = 0.036) and physical quality of life (p =

A high proportion of cardiac patients suffers from depression, which is an antecedent for suicidal ideation. This study identifies clinical vulnerabilities for suicidal ideation in cardiac patients.The primary outcome of the study was severity of suicidal ideation as measured with the Patient Health Questionnaire (PHQ-9) item No. 9. Covariates were demographics, cardiac characteristics (i.e., Canadian Cardiovascular Society angina rating of chest pain and New York Heart Association rating of shortness of breath), depression (PHQ-8,i.e., PHQ-9 minus item No. 9), anxiety (Generalized Anxiety Disorder-7, GAD-7), somatic symptoms (PHQ-15), illness perception (Brief-Illness Perception Questionnaire), and health-related quality of life (EuroQol-5D, EQ 5D).Data from 1,976 patients were analysed. At least 14% (95% CI [12%, 16%]) of patients indicated suicidal ideations within the last 2 weeks. Bivariate analyses yielded associations between suicidal ideation and higher levels of depression severity, anxiety severity, somatic symptom burden, chest pain, shortness of breath, negative illness perceptions, reduced health-related quality of life, and a higher probability of living alone (all p 0.001). A multivariable ordinal regression revealed depression severity and anxiety severity to show the highest associations with suicidal ideation (ORThis study identified several clinical vulnerabilities of suicidal ideation. The results stress the importance of screening for suicidal ideation in clinical practice.

Objective The comorbidity of somatic, anxious and depressive syndromes occurs in half of all primary care cases. As research on this overlap of syndromes in the general population is scarce, the present study investigated the prevalence of the overlapping syndromes and their association with health care use. Method A national general population survey was conducted between June and July 2012. Trained interviewers contacted participants face-to-face, during which, individuals reported their health care use in the previous 12 months. Somatic, anxious and depressive syndromes were assessed using the Somatic Symptom Scale–8 (SSS-8), Generalized Anxiety Disorder-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2) respectively. Results Out of 2510 participants, 236 (9.4%) reported somatic (5.9%), anxious (3.4%) or depressive (4.7%) syndromes, which were comorbid in 86 (3.4%) cases. The increase in the number of syndromes was associated with increase in health care visits (no syndrome: 3.18 visits vs. mono syndrome: 5.82 visits vs. multi syndromes: 14.16 visits, ( F (2,2507) = 149.10, p 2 = 3.4%), anxious (semi-partial r 2 = 0.82%) or depressive (semi-partial r 2 = 0.002%) syndrome, the syndrome overlap (semi-partial r 2 = 6.6%) explained the greatest part of variance of health care use ( change_in R 2 = 11.2%, change_in F (3,2499) = 112.81, p Conclusions The overlap of somatic, anxious and depressive syndromes is frequent in the general population but appears to be less common compared to primary care populations. To estimate health care use in the general population the overlap of somatic, anxious and depressive syndromes should be considered.

Emotions have a considerable impact on eating behaviour; however, research addressing emotion regulation in obesity is rare. The present study is the first to investigate the association between emotional suppression and overeating in individuals with overweight. In total, 314 participants including 190 individuals with obesity filled in a cross-sectional online survey, which assessed emotional suppression, eating behaviour and psychopathology. A hierarchical linear regression analysis was conducted to identify factors associated with overeating. Individuals with obesity reported more frequent overeating compared with individuals without obesity. The habitual use of emotional suppression was associated with more overeating; however, this link was moderated by increased body mass index (BMI). The results suggest that suppression of emotional expression contributes to overeating and is maladaptive especially in individuals with obesity. Further research should longitudinally investigate the predictive value of emotional suppression on overweight, as the training of emotion regulation could contribute to treating obesity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Weight bias often results in the social exclusion of individuals with obesity. The direct, short-term psychological effects of social exclusion in obesity have not been investigated yet. This study experimentally tests whether social exclusion elicits stronger negative emotions in individuals with obesity compared to normal-weight controls. Specifically, we test whether social exclusion has a specific impact on shame. In total, N = 299 individuals (n = 130 with body mass index [BMI] ≤ 30 and n = 169 with BMI N 30) were randomly assigned to a social exclusion condition or a control condition that was implemented with an online Cyberball paradigm. Before and after, they filled out questionnaires assessing state emotionality. Social exclusion increased negative emotionality in both groups compared to the control condition (p b 0.001) according to a multivariate ANOVA. However, the interaction of group and social exclusion was also significant (p = 0.035) and arose from a significant, specific increase of shame in the group with obesity during social exclusion (p b 0.001, Cohen's d = 0.7). When faced with social exclusion, individuals with obesity do not respond with more intensive negative emotions in general compared to controls, but with a specific increase in shame. As social exclusion is frequent in individuals with obesity, psychological interventions focussing shame-related emotional distress could be crucial.

Objective The Patient Health Questionnaire—15 (PHQ-15) is a frequently used questionnaire to assess somatic symptom burden. Recently, the Somatic Symptom Scale—8 (SSS-8) has been published as a short version of the PHQ-15. This study examines whether the instruments' psychometric properties and estimates of symptom burden are comparable. Methods Psychosomatic outpatients (N = 131) completed the PHQ-15, the SSS-8 and other questionnaires (PHQ-9, GAD-7, WI-7, SF-12). Item characteristics and measures of reliability, validity, and symptom severity were determined and compared. Results The reliabilities of the PHQ-15 and SSS-8 were α = 0.80 and α = 0.76, respectively and both scales were highly correlated (r = 0.83). The item characteristics were comparable. Both instruments showed the same pattern of correlations with measures of depression, anxiety, health anxiety and health-related quality of life (r = 0.32 to 0.61). On both scales a 1-point increase was associated with a 3% increase in health care use. The percentile distributions of the PHQ-15 and the SSS-8 were similar. Using the same thresholds for somatic symptom severity (5, 10, and 15 points), both instruments identified nearly identical subgroups of patients with respect to health related quality of life. Conclusion The PHQ-15 and the SSS-8 showed similar reliability and validity but the comparability of severity classifications needs further evaluation in other populations. Until then we recommend the use of the previously established thresholds. Overall, the SSS-8 performed well as a short version of the PHQ-15 which makes it preferable for assessment in time restricted settings.

Identification of risk factors for decline in health status by profiling illness perceptions before and one year after heart valve replacement surgery.Prospective data from N=225 consecutively admitted first time valve replacement patients was assessed before and one year after surgery. Patients were asked about their illness perceptions (Illness Perception Questionnaire-Revised) and mood state (Hospital Anxiety and Depression Scale). Health status was defined by quality of life (Short-Form 36) and New York Heart Association (NYHA) class. Cluster analyses were conducted to identify illness perception profiles over time. Predictors of health status after surgery were analyzed with multivariate methods.Patients were grouped according to the stability and nature (positive, negative) of their illness perception profile over one year. One year after surgery patients holding a negative illness perception profile showed a lower physical quality of life and were diagnosed in a higher New York Heart Association class than patients changing to positive and patients with stable positive illness perceptions (P.001). Over and above biological determinants, post-surgery physical quality of life and NYHA class were both predicted by pre-surgery illness perception profiles (P.05).Patients going for heart valve replacement surgery can be easily categorized into illness perception profiles that predict health status one year after surgery. These patients could benefit from early screening as negative illness perceptions are modifiable risk factors.

Background: Non pharmacological crisis intervention for immediate panic in anxiety disorders or more complex disturbances are furthermore a therapeutic challenge. Method: In an inpatient setting in 100 consecutive crisis situations (73 patients) there were after informed consent randomly offered or 5 min decelerbreathing (6 circles of respiration in one minute, expiration 6 s, inspiration 4 s), using a vibrating device, or a method of self-regulation by means of a slight swinging (SURE — somatic universal regulative exercise, derived from a Sufi-meditation-technique for 5 min) or standard appeasing talk by nurses or medication on demand. We asked in a cross over setting which of the procedures would be the most helpful. To estimate actual anxiety the STAI was used for state anxiety. Results: There was a significant decrease of state anxiety in all 4 treatment conditions. With no significant differences except comparing talking down and the respiration technique with an advantage in the respiration group (Wilkoxon Test for related samples; mean of improvement 10 points, SD 8, in the Group using themedication, 8 points, SD 7, the Descelerbreather, 4 points, SD 4, in the talk-group and the SURE group). Conclusion: The model of stepped care – in this situation – study caused – randomly – is a practicable strategy for crisis intervention. Standards are at the moment talking and if not sufficient pharmacological treatment e.g. with lorazepam. We can broaden the spectrum with respiration oriented techniques – not only in the case of hyperventilation – or movement based self-centering meditation.