[Psychiatric Nursing Internship and Promotion of Specialized Training Interest]. / Psychiatrisches Pflegepraktikum und die Förderung des fachspezifischen Ausbildungsinteresses.

Qualified personnel in the field of medical psychiatry are crucial to providing comprehensive care. The importance of a nursing internship as an access point to the psychiatric field is not considered by key players. A survey conducted across German medical schools in 2012 analyzed medical care internships as viewed by medical school students. From among students surveyed, those who participated in a nursing internship, and would consider taking part in further internships within the psychiatric department ("PFJ"), were separated from those who were not sure ("PFU") or who would not ("PFN") consider further study in the field of psychiatry. The survey's conclusion was that a comparably small number of students opted for a psychiatric nursing internship based upon practical aspects of content, satisfaction, and access to nursing internships. A potential solution to the low numbers of students selecting psychiatric internships is to restructure the initial contact program that psychiatric departments use to introduce prospective medical school students to the field of psychiatry.

[Trauma and posttraumatic stress symptoms in patients in German primary care settings]. / Trauma und posttraumatische Belastungssymptome bei Patienten in deutschen Hausarztpraxen.

BACKGROUND: Primary care settings have an important gatekeeping function to detect mental diseases, including trauma and posttraumatic stress disorders. OBJECTIVES: To assess the prevalence of trauma and posttraumatic symptoms in a first sample of northeast German primary care patients and to evaluate the diagnostic sensitivity and specificity of the general practitioners. MATERIAL AND METHODS: Traumatic experiences and posttraumatic stress disorders (PTSD) were assessed with self-rating questionnaires in a sample of N = 400 patients from 3 primary care facilities. Additionally, knowledge and diagnostic accuracy of the general practitioners were evaluated. RESULTS: According to the results of the patient health questionnaire (PHQ-15) data from all patients, the majority of patients questioned showed slight to moderate stress from somatic symptoms. Of the patients with complete data 7 % (n = 25) had a complete PTSD according to the results of the questionnaire, which was also identified in the medical assessment with a sensitivity of 40 %. The stress resulting from posttraumatic symptoms was closely associated with the extent of somatic complaints. CONCLUSION: Patients with a history of trauma and posttraumatic symptoms are prevalent in primary care settings. An early diagnosis by the general practitioner can help patients to receive adequate treatment. Patients with somatoform disorders in particular should be screened for trauma and posttraumatic symptoms.

Readiness to reconcile and post-traumatic distress in German survivors of wartime rapes in 1945.

BACKGROUND: Sexual violence and wartime rapes are prevalent crimes in violent conflicts all over the world. Processes of reconciliation are growing challenges in post-conflict settings. Despite this, so far few studies have examined the psychological consequences and their mediating factors. Our study aimed at investigating the degree of longtime readiness to reconcile and its associations with post-traumatic distress within a sample of German women who experienced wartime rapes in 1945. METHODS: A total of 23 wartime rape survivors were compared to age- and gender-matched controls with WWII-related non-sexual traumatic experiences. Readiness to reconcile was assessed with the Readiness to Reconcile Inventory (RRI-13). The German version of the Post-traumatic Diagnostic Scale (PDS) was used to assess post-traumatic stress disorder (PTSD) symptomatology. RESULTS: Readiness to reconcile in wartime rape survivors was higher in those women who reported less post-traumatic distress, whereas the subscale "openness to interaction" showed the strongest association with post-traumatic symptomatology. Moreover, wartime rape survivors reported fewer feelings of revenge than women who experienced other traumatization in WWII. CONCLUSIONS: Our results are in line with previous research, indicating that readiness to reconcile impacts healing processes in the context of conflict-related traumatic experiences. Based on the long-lasting post-traumatic symptomatology we observed that our findings highlight the need for psychological treatment of wartime rape survivors worldwide, whereas future research should continue focusing on reconciliation within the therapeutic process.

Modulation of motorcortical excitability by methylphenidate in adult voluntary test persons performing a go/nogo task.

This study investigated the interaction between motorcortical excitability (short interval cortical inhibition, intracortical facilitation and long interval cortical inhibition), different requirement conditions [choice reaction test (CRT), attention/go/nogo], and their pharmacological modulation by methylphenidate (MPH) in normal healthy adults (n = 31) using a transcranial magnetic stimulation paradigm. MPH was administered in a dosage of 1 mg/kg body weight, maximum 60 mg. Additionally, serum level and clearance of MPH were controlled. The statistical analysis of variance revealed a significant three-way interaction of 2 (MPH) x 3 (CRT) x 6 (ISI) predicting motor evoked potential amplitudes (P = 0.032, MPH none and full dose, n = 31). In order to compare effects of dosage an additional between-subjects factor (half vs. full MPH dose) was introduced. None of the interactions involving this between-subject factor reached statistical significance. Exploring interactions with MPH only, a 3 (MPH none, half and full dose) x 3 (CRT) x 6 (ISI) analysis of variance revealed significant two-way interactions for MPH x ISI (P = 0.040) and condition x ISI (P < 0.001, n = 18). Effects observed for MPH were strongest on facilitatory processes, weaker for intracortical inhibition. In sum, MPH seems to interact via striato-thalamo-cortical pathways with original motorcortical processes (ISI), to a lesser extent with task-dependent or behavioral parameters (CRT).

Modulation of transcallosally mediated motor inhibition in children with attention deficit hyperactivity disorder (ADHD) by medication with methylphenidate (MPH).

Motor hyperactivity is one of the most outstanding symptoms of attention deficit hyperactivity disorder (ADHD) which might be caused by a disturbed inhibitory motor control. Using focal transcranial magnetic stimulation (TMS) we tested the cortico-callosal inhibition (duration and latency of the ipsilateral Silent Period, iSP) in 23 children with ADHD (mean age 11+/-2.6 years) before and on treatment with methylphenidate (MPH). iSP latency was age correlated, whereas iSP duration as well as Conners scores were age independent. Analyses of mean differences revealed a significant prolongation of iSP duration (p=0.001), shortening of iSP latency (p=0.027) and reduction of Conners score (p=0.001) under medication. Increase of iSP duration and reduction of Conners score under medication were significantly correlated (t=-9.87, p=0.016). Reduced iSP duration and prolonged iSP latency in ADHD children could be the result of a disturbed transcallosally mediated inhibition, most probable due to a combination of maturation deficits of callosal fiber tracts as well as neuronal synaptical transmission within the neuronal network between ipsilaterally stimulated cortex layer III--the origin of transcallosal motor-cortical fibers--and contralateral layer V, the origin of the pyramidal tract. MPH may indirectly improve the dysbalance between excitatory and inhibitory interneuronal activities of this neuronal network via dopaminergic modulatory effects of the striato-thalamo-cortical loop.

[Stress and progression in multiple sclerosis]. / Stress und Krankheitsverlauf der Multiplen Sklerose.

The hypothesis that stress might be connected to causation or exacerbation of multiple sclerosis has been under discussion for a long time. The current studies indicate that there is a coincidence between stress and disease progression. Besides the state of art in research different stress models will be introduced in the paper and the relations between disease, resources and coping will be discussed. Besides the influence of distressing life events on disease, the effect of illness-related characteristics on the coping behaviour will be considered in this regard. From the results of the presented studies and the described stress models it was concluded that the possibilities of stress avoiding intervention programs should be taken into account more strongly in the future.

[Axis I "illness experience and treatment preconditions" of operational psychodynamic diagnosis (OPD). Experiences in clinical practice]. / Die Achse I "Krankheitserleben und Behandlungsvoraussetzungen" der Operationalisierten Psychodynamischen Diagnostik (OPD). Erfahrungen in der klinischen Praxis.

In a selective survey, results on psychometric properties and aspects of application of the axis I, "illness experience and treatment preconditions" of the Operational Psychodynamic Diagnoses (OPD) are described. Following remarks on the role of defense and coping theories in the conceptualisation of the axis, its structure and contents are outlined. After a brief summary of findings on its interrater reliability, several aspects of validity are discussed. Results on discriminative validity show that axis I items are useful in the statistical discrimination of subsamples differing in age, clinical diagnoses, and diagnostic setting (psychotherapy outpatient vs. psychosomatic consultation-liasion services). The contribution of axis I items to prediction of treatment outcomes, moreover, reveals high degree of predictive or treatment validity. After an integrative discussion of these findings, implications of patient personality and coping behaviour for axis I ratings are highlighted as important objectives for future OPD research.

[Influence of psychotherapy motivation on the course of psychotherapy]. / Zum Einfluss der Psychotherapiemotivation auf den Psychotherapieverlauf.

The motivational characteristics of psychotherapy inpatients should be of crucial importance for treatment effectiveness. In the present study on 219 patients from two psychosomatic-psychotherapeutic treatment centers, four dimensions of motivation for psychotherapy (illness experience; lay etiology; treatment expectations; openness to psychotherapy) were assessed using the Questionnaire for the Measurement of Psychotherapy Motivation (Fragebogen zur Messung der Psychotherapiemotivation; FMP) and related to pre-post changes in symptomatology. In these analyses, psychological symptoms (SCL-90-R) as well as interpersonal problems (IIP) were considered as indicators of treatment effects. The results support the expectation that (a) a psychosocial causal attribution of illness symptoms and (b) a marked general openness to psychotherapy at the pretreatment interview predict more positive treatment outcomes. Implications of the results for the indication of pretreatment interventions are discussed.

Family support and coping with cancer: some determinants and adaptive correlates.

This paper studies the interrelationships between the coping behaviours of cancer patients and perceived amount and adequacy of family support, as well as the issue of how these predict psychosocial adjustment to cancer. Based on questionnaire data from a sample of 169 patients with cancers of various sites, three questions were considered in detail: (1) How might cognitive and behavioural modes of coping with cancer affect perceptions of support provided by one's family in terms of the amount as well as adequacy of various supportive acts? (2) Are coping modes to be considered when explaining inter-individual differences in perceived support adequacy, or can these differences be reduced to differences in amount of support? (3) Can distinct patterns of family support and coping preferences be identified and, if so, how do these patterns differ in indicators of psychosocial adjustment to cancer? Results suggest that cognitive strategies of coping may be more effective in 'mobilizing' family support than behavioural strategies. Moreover, the perceived adequacy of various support modes proves to be influenced by cognitive coping preferences independent of perceived amounts of support. Finally, results from cluster analyses point to a particular coping-support pattern identified as 'highly risky'. This pattern is characterized by generalized support deficits, strong tendencies towards rumination, and weak tendencies towards minimizing disease-related threat. The findings are discussed from an interactional perspective on support processes and with regard to implications for psychological intervention in cancer patients.

Sex-specific effects of social support on cortisol and subjective responses to acute psychological stress.

The effects of short-term social support on cortisol levels and subjective responses to acute psychological stress were investigated in healthy adults (total N = 66). In anticipation of a public-speaking task in front of an audience, subjects received either no social support ("no support") or social support from an opposite-sex stranger ("stranger") or from their boyfriend or girlfriend ("partner"). Support providers were instructed to enact both instrumental and emotional support during the 10-minute anticipation period. The results obtained suggest sex-specific effects of social support. Although men in the partner support condition showed significant attenuation of cortisol responses compared with unsupported and stranger-supported men, women showed no response decrement under stranger support. In contrast to men, women showed a tendency toward increased cortisol responses when supported by their boyfriends. The endocrine response differences between male and female subjects were unrelated to questionnaire-derived psychological variables. No sex and group differences in perceived stress, mood changes, or social desirability were observed. Although the overall level of subjective well-being throughout the experiment was elevated in the partner support condition, no sex or group differences were observed in perceived stress, well-being changes, and social desirability. Opposite to their cortisol responses, women rated both stranger and partner support attempts more favorably than did men. No significant correlations were observed between the perceived stressfulness of the situation, mood changes, and cortisol responses. These results provide preliminary evidence for sex-specific patterns of social support efficacy to acute psychological stress with respect to adrenocortical responses.