ABSTRACT
Objectives: In Germany, the office-based psychosomatic medicine with focus on acute care offers psychosomatic treatment besides primary care by general practitioners and regular psychotherapy. The aim of this study is to determine specific characteristics of these innovative office-based practices. Methods: In a qualitative cross-sectional study, twelve board-certified specialists in psychosomatic medicine, practicing office-based psychosomatic medicine were surveyed by means of semi-structured telephone-interviews. After transcription and coding in MAXQDA 2020, a content analysis was conducted. Results: The innovative practice model was characterized by high numbers of initial contacts in walk-in or pre-planned consultation hours. Besides regular psychotherapy long-term and low-threshold treatment was offered. Physician assistants organised the workflow and administrative tasks. For settlement the EBM-number psychosomatic interview or short-term treatment was used. Focusses were set on somatopsychic and socio-medical treatment and consultant support. Psychotherapy often was realised in form of group sessions by integrating behavioural and psychodynamic psychotherapy. Discussion: The innovative psychosomatic practice model with focus on acute care shows an independent profile. A treatment based on medical understanding of complex somatic disease processes can be provided to somatopsychic patients. Future studies should compare this practice model to psychosomatic practices receiving a treatment by guideline psychotherapy. Conclusions: In Germany, the practices of psychosomatic medicine with a focus on acute care closes an increasing gap in psychosomatic care and augments treatment possibilities, especially for elderly and multimorbid patients.
Subject(s)
Psychosomatic Medicine , Psychotherapy, Psychodynamic , Humans , Aged , Cross-Sectional Studies , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/therapy , Psychophysiologic Disorders/psychology , Psychotherapy , Referral and Consultation , GermanyABSTRACT
Long-term effectiveness of psychodynamic inpatient therapy on depressive disorders - Catamnestic- Results of the STOP-D-Study Objectives: Depression is one of the most common disorders with a rate of recurrence between 60-75 %. The effectiveness of psychodynamic therapy is well-proven, but there is still a lack of studies proving the long-term effectiveness of inpatient treatment on depressive symptom load. Methods: After psychodynamic inpatient treatment in a psychodynamically oriented psychosomatic hospital unit, the reduction in general and depressive symptom load (e. g. BDI, HAMD, SCL-90-R) was evaluated by a six-month follow up design. The study was set up as naturalistic multicenter intervention study including a female follow-up sample (N = 291; age 25-45 years). Results: The symptom improvement reached by the inpatient treatment remained stable at the follow-up survey. Patients treated with antidepressant medication showed stronger depressive symptom load at discharge and follow-up survey compared to patients without antidepressant medication. Sociodemographic variables and a comorbid personality disorder were not associated with increased drop-out rates, but depressive symptom load and a premature ending of the treatment. Conclusions: The obtained results demonstrate the long-term effectiveness of inpatient psychodynamic psychotherapy. Further studies about the influence of post-hospital psychotherapy and medical treatment as well as patient satisfaction seem necessary.
Subject(s)
Depressive Disorder/psychology , Depressive Disorder/therapy , Inpatients/psychology , Psychotherapy, Psychodynamic , Adult , Depression/complications , Depression/psychology , Depression/therapy , Depressive Disorder/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Disorders/complications , Time Factors , Treatment OutcomeABSTRACT
Objectives Depression is one of the most common illnesses. The effectiveness of psychodynamic psychotherapy on depressive symptom load has been demonstrated. However, for patients suffering from comorbid personality disorder (PD) a decreased benefit has been reported, as well as fewer rates of remission and extended duration of remission. However, findings are inconsistent. The objective of this study was to determine potential differences in therapy-outcome comparing female patients with and without comorbid PD. Method Including female inpatients aged between 25-45 years (N=377) in a psychodynamic treatment, the dissenting outcome on depressive symptom load (among others BDI; HAMD) as well as psychodynamic variables (IPO) by patients with and without comorbid PD were analysed within a naturalistic multicenter intervention study (STOP-D). Data were collected in 15 psychodynamically oriented psychosomatic hospital units in Germany, based on self- and external-assessment instruments. Results Under comparable therapy-doses, female patients with and without comorbid PD benefit significantly from psychodynamic inpatient treatment. By equivalent baseline severity of clinical symptoms patients without comorbid PD show larger effect sizes in all inventories than patients with comorbid PD. Discussion Although the benefit is lower for depressed patients with comorbid personality disorder, the positive effect of inpatient psychodynamic psychotherapy is statistically and clinically significant in both groups. Influences of further comorbid symptoms and confounding symptoms between depression and PD, which were difficult to control, are possible. Further studies are necessary. Conclusion Although patients with comorbid PD benefit significantly from the inpatient treatment, a special therapeutic design seems to be indicated for these patients.
Subject(s)
Depression/complications , Depression/therapy , Personality Disorders/complications , Personality Disorders/therapy , Psychotherapy, Psychodynamic , Adult , Depression/psychology , Female , Humans , Inpatients , Middle Aged , Personality Disorders/psychology , Treatment OutcomeABSTRACT
OBJECTIVES: While the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy. METHODS: This paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2). RESULTS: Our findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder. CONCLUSION: Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.
Subject(s)
Depressive Disorder/therapy , Hospitalization , Psychotherapy, Psychodynamic/methods , Adult , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Combined Modality Therapy , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Germany , Humans , Middle Aged , Personality Disorders/diagnosis , Personality Disorders/psychology , Personality Disorders/therapy , Personality Inventory , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Psychophysiologic Disorders/therapy , Treatment OutcomeSubject(s)
Delusions/ethnology , Emigrants and Immigrants/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Psychotropic Drugs , Schizophrenia/ethnology , Schizotypal Personality Disorder/ethnology , Substance-Related Disorders/ethnology , Cross-Cultural Comparison , Cross-Sectional Studies , Cultural Diversity , Delusions/diagnosis , Delusions/epidemiology , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Emigrants and Immigrants/psychology , Germany , Health Surveys , Humans , Multilingualism , Reproducibility of Results , Schizophrenia/diagnosis , Schizophrenia/epidemiology , Schizotypal Personality Disorder/diagnosis , Schizotypal Personality Disorder/epidemiology , Socioeconomic Factors , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Utilization Review/statistics & numerical dataABSTRACT
OBJECTIVE: The aim of the study was to investigate whether dimensional traits of personality disorder and other aspects of personality had an influence on perceived help and stress by the subsettings of a multimodal psychodynamic inpatient psychotherapy. METHODS: 89 patients of a psychodynamic psychotherapy clinic were investigated. Symptom severity was measured using SCL-R-90 symptom check list and BSS (Impairment Score). A questionnaire for patients' assessment of perceived help and stress by each subsetting of the therapy program was administered weekly. Personality assessment included (1) personality traits related to specific personality disorder as defined by SCID-II interview and questionnaire, (2) interpersonal problems as measured by the IIP, (3) self-related affiliation as measured by SASB-INTREX questionnaire (Introjekt), and (4) psychotrauma as determined by the Childhood Trauma Questionnaire (CTQ). Therapy outcome measures were: change of SCL-90-R, change of BSS, perceived change in VEV. RESULTS: Perceived help and stress by the total setting, by inpatient group therapy and by fellow patients were shown to be primarily influenced by personality traits related to DSM-IV clusters of personality disorders, particularly by Cluster-A-related traits. Interpersonal dominance and trauma history had an influence as well. CONCLUSION: Perceived help and stress by subsettings of inpatient psychotherapy can be predicted on the basis of several aspects of personality.
Subject(s)
Hospitalization , Mental Disorders/therapy , Mood Disorders/therapy , Patient Satisfaction , Personality Disorders/therapy , Psychoanalytic Therapy , Psychotherapy, Group , Somatoform Disorders/therapy , Stress, Psychological/psychology , Adaptation, Psychological , Adult , Female , Group Processes , Group Structure , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Mood Disorders/diagnosis , Mood Disorders/psychology , Personality Assessment , Personality Disorders/diagnosis , Personality Disorders/psychology , Physician-Patient Relations , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Stress, Psychological/complications , Treatment OutcomeABSTRACT
The aim of this study is to explore symptoms and personality traits of patients from two Psychosomatic University Departments, one in Düsseldorf (West Germany) and the other in Magdeburg (East Germany), suffering from anxiety disorders and depression. 560 unselected outpatients with anxiety disorders and depression were examined with the Symptom-Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-D). The ratio of these two diagnostic groups in relation to the total number of outpatients in both clinics was analysed. The results show a higher rate of Anxiety disorders in the East German group and a higher rate of depressed patients in the West German group. Both diagnostic groups differ in certain scales of SCL-90-R and IIP-D. These profiles are mainly stable against cultural (East-West) influences. The SCL-90-R and IIP-D should be used to develop diagnostic profiles of the discussed syndromes. Social and cultural influences of patients' self ratings should be taken into account.
Subject(s)
Anxiety Disorders/psychology , Depressive Disorder/psychology , Personality , Adult , Data Collection , Female , Germany, East , Germany, West , Humans , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
The present study aimed to assess the effect of psychological screening of medical inpatients using the Symptom Check List, SCL-90-R. A sample of 630 medical inpatients who were referred to a psychosomatic consultation-liaison service was assessed using the SCL-90-R. A clinical interview was conducted with all assessed patients. Patients referred to the consultation-liaison service showed high psychological distress. 73% of the subjects were classed as cases using the International Classification of Diseases (10th Revision) criteria and psychological impairment. The screening characteristics of the SCL-90-R were not as good as those reported for other outpatient samples. The SCL-90-R appears to have been valuable for the consultation-liaison service since subjects with mental disorders scored significantly higher on almost all the scales than subjects without mental disorders. The questionnaire can serve as a useful tool for understanding patients' current status regarding mental health problems.
Subject(s)
Psychophysiologic Disorders/diagnosis , Referral and Consultation , Surveys and Questionnaires , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Reproducibility of Results , Severity of Illness IndexABSTRACT
Whereas the efficacy of inpatient treatment in socalled psychosomatic rehabilitation clinics in Germany has been well researched and documented, studies involving large samples on the efficacy of inpatient treatment in acute hospitals are lacking. A multicentered retrospective study involving clinics for psychotherapy at three separate universities was conducted on a sample of n=495. The patients were treated on an inpatient basis between April 1990 and July 1998 in one of the clinics. The predominant approach to treatment of these clinics was psychodynamic. Other approaches such as behavioral therapy are integrated. In addition to sociodemographic variables clinical data (SCL-90-R, IIP, BSS, ICD-Diagnosis) at admission and discharge were collected. A follow-up study was not conducted. With an average effect size of 0.84 in terms of clinical scales the results demonstrate good efficacy of inpatient treatment. Effect sizes were high on the depression, obsessive-compulsive and anxiety scale of the SCL-90-R, and were low on the phobia subscale. By self report 55% of all patients indicated they had markedly improved, 22% indicated no change and 6% stated they were worse. 17% of all patients were below the chosen cut-off point of the GSI. Patients with a low level of education took benefit as well from the offered therapy. There was no clear relationship between effect size and length of hospital stay. This may be due to the particular setting of a university clinic.
