Search

In der Folge sexueller Traumatisierung konnen Beschwerdebilder unterschiedlicher psychischer Storungen auftreten. Diese sind in ihrer Auspragung und im Schweregrad sehr variabel – ebenso ­unterschiedlich ist das Hilfesuchverhalten der Betroffenen. Die ­Bedurfnisse von Patienten und deren Angehorigen treffen dabei auf ein Versorgungssystem, das zergliedert und wenig ubersichtlich ist. Die Autoren dieses Beitrags unternehmen den Versuch, die Versorgungssituation fur diese Patientengruppe darzustellen und formulieren ­Optimierungsansatze.

Das Fibromyalgiesyndrom (FMS) ist charakterisiert durch u. a. chronische, multilokulare Schmerzen und psychische Auffalligkeiten. Die Rehabilitation bei Patienten mit FMS wird in Deutschland sowohl in somatisch als auch in psychosomatisch orientierten Reha-Kliniken durchgefuhrt. Ziel dieser Studie ist es, den Status quo der Zugangswege in das Rehabilita­tionssystem bei FMS-Patienten zu beschreiben sowie Pradiktoren fur die Zuordnung in die eine oder andere Indikationsgruppe zu identifizieren. Die Stichprobe setzte sich aus 197 FMS-Patientinnen aus 3 psychosomatischen (M=49,9 Jahre) und 223 FMS-Patientinnen aus 3 somatischen (M=50,2 Jahre) Reha-Kliniken zusammen. Mithilfe eines Fragebogenpakets wurden die Zugangswege in die Rehabilitation erfasst sowie verschiedene patientenseitige Merkmale erfragt. Zur Analyse der Zugangswege in die Rehabilitation erfolgten deskriptive Berechnungen. Zur Pradiktion der Gruppenzugehorigkeit wurden bivariate Korrelationen sowie binar-logistische Regressionsanalysen gerechnet. Die Zugangswege von FMS-Patientinnen zu somatischen und psychosomatischen Rehabilitationseinrichtungen waren hinsichtlich verschiedener Merkmale vergleichbar. Allerdings lagen bei psychosomatischen im Vergleich zu somatischen FMS-Rehabilitandinnen eine hohere primare Ablehnungsquote und eine langere Wartezeit zwischen Stellung und Bewilligung des Rehabilitationsantrags sowie des Rehabilitationsbeginns vor. Als pradiktive patientenseitige Merkmale fur die Zuweisung zu einer psychosomatischen Rehabilitation erwiesen sich eine ambulante psychotherapeutische Vorerfahrung sowie die subjektive Erwartung, in der Rehabilita­tion psychologische Unterstutzung zu erhalten. Fur die somatische Subgruppe erwiesen sich eine bestehende Ehe, die Rehabilitationsmotivation und subjektive Erwartungen, die korperliche Leistungsfahigkeit in der Rehabilitation zu verbessern und sich mit anderen Patienten austauschen zu konnen, als relevante Pradiktoren. Insgesamt klarten die ermittelten Pradiktoren 32% der Gesamtvarianz der Indikationsgruppe auf. Die Ergebnisse liefern erste Hinweise auf die Zugangswege von FMS-Patientinnen in das deutsche Rehabilitationssystem sowie auf Patientenmerkmale, die die Zuweisung in das jeweilige Setting der Rehabilitation pradizieren.

AIM OF THE STUDY The aim of the current study was the identification of predictors for a successful transfer of progressive relaxation (PR) into clinical and daily life. Furthermore the development of tension-related symptoms dependening of the frequency of continuous practise was detected. METHODS 411 patients of a psychosomatic rehabilitation clinic attended a 6-h-course of progressive relaxation and were interviewed at 3 different times by a modified version of the "diagnostisches und evaluatives Instrumentarium fur Entspannungstraining und Entspannungstherapie (ET-EVA)": at the beginning of therapy (T1), at discharge (T2) and 3 months after discharge by postal service (T3). After 3 months 274 patients (78.3%) sent the completed questionnaires back. The frequency of exercising by at least once a week was defined as successful. To detect the extent of symptom improvement, difference values between the different measuring times and effect sizes were calculated. To identify predictors of the frequency of daily practise, bivariate correlations and linear regression were used. RESULTS 69.4% of the patients continued the exercises successfully beyond the course. The improved experience of relaxation directly after the program (r=-0.184; p

The objective of this prospective study was to evaluate the impact of exercise capacity, mental disorders, and hemodynamics on quality-of-life (QoL) parameters in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Sixty-three patients with invasively diagnosed PAH (n = 48) or CTEPH (n = 15) underwent a broad panel of assessments, including cardiopulmonary exercise testing (CPET), 6-minute walking distance (6-MWD), World Health Organization functional class (WHO-FC), and assessment of hemodynamics. QoL was evaluated by the 36-item Medical Outcome Study Short Form Health Survey Questionnaire (SF-36). Exercise capacity, hemodynamics, age, gender, and mental disorders (anxiety and depression) were assessed for association with QoL subscores by uni- and multivariate regression analyses. Exercise capacity, WHO-FC, oxygen therapy, symptoms of right heart failure, right atrial pressure, and mental disorders were significantly associated with QoL (p

Zusammenfassung Fragestellung: Die Klassifikation und Therapie von Patienten mit chronischen Schmerzen in mehreren Korperregionen ohne hinreichend erklarenden somatischen Krankheitsfaktor ist umstritten. Das diagnostische Etikett "Fibromyalgiesyndrom" (FMS) wird von einigen Vertretern psychosozialer Facher und der Allgemeinmedizin abgelehnt. Methode: Zusammenfassung der wichtigsten Empfehlungen der aktuellen S3-Leitlinien zum FMS und zu nicht-spezifischen/funktionellen/somatoformen Korperbeschwerden. Ergebnisse: Das FMS ist eine funktionelle Storung, bei der psychosoziale Faktoren in Entstehung und Verlauf bei derMehrheit der Patienten eine wesentliche Rolle spielen. Die Diagnose eines FMS kann anhand des typischen Beschwerdebildes und durch Ausschluss somatischer Differenzialdiagnosen ohne Tender Point Untersuchung anhand der 2010 modifizierten diagnostischen Kriterien des American College of Rheumatology gestellt werden. Aus psychosomatischer Sicht sollte eine Einordnung nach Schweregrad vorgenommen wer...

Objectives PTSD prevalence rates in cardiac and cancer patients greatly vary probably due to diverging samples, designs and assessments. Aim of this study was therefore to compare prevalence rates of PTSD as well as instruments assessing PTSD in different cardiac and cancer patient groups. Methods A total of 274 cardiac and cancer patients were examined with the Post-Traumatic Stress Scale 10 (PTSS-10) and the Impact of Event Scale — revised (IES-R). Presence of PTSD was validated by Structured Clinical Interview for DSM-IV (SCID). Results Diagnostic criteria for the existence of PTSD were met by 29.2% of all patients via PTSS-10, by 7.6% in IES-R and by 4.8% in SCID, indicating substantial discrepancy among assessments. This is further underlined by the moderate correlation between self-reports and poor agreement with the standardised interview. Conclusion A structured interview is the “gold standard” for diagnosing PTSD in cardiac and cancer patients. Questionnaires can be used as screening instruments when they reliably assess trauma-related diagnostic criteria. Further studies are necessary to clarify the specifics of trauma criteria in medical setting.

BACKGROUND The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinaren Vereinigung fur Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Heart-focused anxiety is a common phenomenon that is related to psychological disorders and cardiac diseases. We investigated heart-focused anxiety in the general population and provided standard values using the Cardiac Anxiety Questionnaire (CAQ). Furthermore, we assessed the reliability of the CAQ and investigated the influence of social variables on heart-focused anxiety. The questionnaire was applied to 2,396 individuals (age range: 18–92; mean age 49 ± 17, 50% male). Three aspects of heart-focused anxiety (fear, attention, and avoidance) were captured by the CAQ. To test the influence of age, gender, and social factors, we performed analyses of variance, correlative statistics, and regression analyses. Heart-focused anxiety showed a linear increase with age (P

Based on a recent diagnostic proposal for adjustment disorders a self-report assessment was developed. The current study reports validation results. Psychometric properties were examined using two different samples of 687 patients with cardiac arrhythmias and 86 patients from a psychosomatic outpatient clinic. Besides evaluating the internal structure and re-test reliability, associations with quality of life, general anxiety and depression, symptoms of posttraumatic stress disorder and coping strategies were analyzed. The factor analysis confirmed the three postulated factors: intrusion, avoidance and failure to adapt. The internal consistencies for these three scales were between α = 0.74 and 0.91. The re-rest reliability of the scales for a six-week period lay between r(tt) = 0.61 and 0.84. Medium-sized correlations were found between the scales with general anxiety and depression as well as posttraumatic stress disorder. Furthermore, the scales correlated with emotion-oriented and somewhat with proactive coping, but not with task-oriented or avoidance-oriented coping strategies. It is concluded that the self-report on adjustment disorders enables new possibilities to investigate further previously under-researched adjustment disorders.

The article presents an operationalized and manualized approach for the assessment of the capability of performance. This manual has been conceptualized and tested empirically by a multicentric and interdisciplinary workgroup. It is basically oriented to the “International Classification of Functioning” (ICF; WHO), which is well accepted for assessing the course of chronic diseases and the consequences for the individual. It is especially widely applied in the context of rehabilitation. The different diagnostic levels of the manual and their operationalization are outlined. Furthermore, the first results concerning reliability, content validity, applicability and practicability are described and questions on the areas of application of the instrument are discussed.

Objective Type-D personality—negative affectivity and social inhibition—are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. Methods One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). Results Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery. Conclusion Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

The aim of the study was to record patients’ symptoms of anxiety, depression and post-traumatic stress, as well as their subjective experience of illness, with different forms of radiotherapy and for different indications. The question is to be answered of whether more invasive techniques such as stereotactic radiotherapy involve greater stress or whether the psychological stress instead tends to be caused by the underlying disorder itself. Questionnaires were given to 240 patients after conventional radiotherapy for a malignant underlying disorder, to 80 with a benign disorder, and to 67 patients following stereotactic radiotherapy. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to measure anxiety and depression; the Post-Traumatic Symptom Scale (PTSS-10) was used to measure symptoms related to post-traumatic stress disorder (PTSD), and there were questions about patients’ subjective experience of radiotherapy. 28% of all patients scored in the pathologic or borderline anxiety range; 26% were in the pathologic or borderline depression range. 22% of patients were above the diagnostic cutoff for the PTSS-10. No differences were evident between the three groups in terms of anxiety and stress-related symptoms. Women were significantly (p = 0.001) more severely affected by symptoms of PTSD and anxiety than men. No gender differences could be proven in terms of depression. In the HADS-D, patients with a benign underlying disorder had significantly (p < 0.05) lower depression values than the two other groups studied. Patients who had undergone stereotactic radiotherapy did not demonstrate higher values for anxiety, depression or PTS symptoms than patients treated with conventional radiotherapy. From the results submitted here it cannot be assumed that this form of treatment leads to an increased incidence of traumatic stress or even post-traumatic stress disorder (PTSD). All in all, it is the type of underlying disorder (malignant/benign), which affects the extent of psychological stress experienced by patients following radiotherapy.

OBJECTIVES: The aim of this cross-sectional study was to explore the psychological and physical well-being of patients with chest pain depending on availability cardiological disease (coronary heart disease, different cardiological disease, no cardiological disease, unclear diagnose). METHODS: In a total of 383 cardiological outpatients, anxiety and depression (HADS) as well as physical complaints (B-L) were assessed. RESULTS: For half of the outpatients, no cardiological diagnose was found that explained the symptoms of chest pain. In comparison to the general population, outpatients with various cardiological symptoms exhibited a lower psychological and physical well-being independent of availability cardiological disease. 50.9% of the outpatients showed elevated anxiety scores, 35.2% showed elevated depression scores and 71.7% felt impaired by physical complaints. In comparison to males, females were more anxious and exhibited a lower physical well-being. In general, physical impairment increased with age, while anxiety decreased. CONCLUSIONS: The present study discovered a very high psychological comorbidity in cardiological outpatients with chest pain that underlines the necessity of an integrated psychosomatic care regardless of clinical finding. In order to understand the symptom of chest pain it is not indicated to differentiate between cardiologically vs. psychologically ill patients.

Hintergrund Eine symptombasierte Diagnose des Fibromyalgiesyndroms (FMS) ohne „Tender-Point-Uberprufung“ ist fur die arztliche Primarversorgung sinnvoll. Wir uberpruften, ob die symptombasierte Diagnose eines FMS auf die Symptome Gliederschmerzen sowie Mudigkeit/Erschopfung gegrundet werden kann.

Wachsende Evidenz fur eine Interaktion zwischen dem Ausbruch und dem Voranschreiten einer Vielzahl von kardialen Erkrankungen mit psychosozialen Faktoren hat die Klinische Kommission der DGK dazu bewogen, ein Positionspapier zu diesem Gegenstandsbereich anzuregen. In einem formalisierten Expertenrating wurden von den 10 teilnehmenden Experten die fur die Fragestellung relevanten Subdisziplinen, in denen gegenwartig eine kritische Masse umsetzungsrelevanten psychokardiologischen Wissens vorhanden ist, ermittelt, die Evidenz zusammengetragen und bewertende Schlussfolgerungen fur die Praxis gezogen. Komorbide psychosoziale Parameter im Kontext der koronaren Herzerkrankung (KHK) erreichten die groste Aufmerksamkeit mit I-A-Empfehlungen fur ein Depressionsscreening im Vorfeld und Verlauf der KHK; der Notwendigkeit zur Einbeziehung psychosozialer Konzepte in Strategien zur Verkurzung der Prahospitalzeit sowie fur die Empfehlung einer routinemasigen (Mit-)Behandlung psychosozialer Belastungsfaktoren in der Sekundarpravention der KHK. Eine weitere I-A-Empfehlung konnte fur die Einbeziehung psychologischer Belastungsfaktoren in die Bewertung von Therapieverlaufen von ICD-Patienten ausgesprochen werden. Weitere relevante Aufgabenfelder beziehen sich auf die Herzinsuffizienz und das Verhalten bei Herzoperationen. Insgesamt ist die Evidenzbasierung fur die therapeutische Umsetzung schwacher als fur Diagnostik und Fruherkennung. Das Positionspapier formuliert eine Reihe von konkreten Anwendungsfeldern mit hoher Prioritat fur die Einbeziehung psychosozialer Faktoren in die kardiologische Praxis, die eine leitlinienkonforme Evidenz aufweisen. Forschungsdefizite existieren weiterhin fur die Bewertung der Wirksamkeit von psychotherapeutischen Konzepten bei kardialen Patienten. Curricula fur die Vermittlung von (psycho)diagnostischer, kommunikativer und differenzialdiagnostischer Kompetenz mussen rasch entwickelt werden, um eine Transmission des aktuellen Wissensstandes in die Alltagspraxis zu ermoglichen.

Background A guideline for the treatment of fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. Methods A systematic literature search including all controlled studies evaluating multicomponent therapy (MT) was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. Results MT is superior to control groups or routine treatment (evidence level 1A) and should be offered to FMS patients (recommendation strength A). Conclusions Future studies should consider medication, other co-therapies and comorbidities. MT programs tailored to FMS subgroups should be tested.