Originalbeiträge (Originals). Unterscheidet sich der therapeutische Stil in altershomogenen und altersheterogenen therapeutischen Dyaden?

Does the therapeutic style differ in age-homogeneous and age-heterogeneous therapeutic dyads? BACKGROUND AND AIMS: Differences between age-homogeneous and age-heterogeneous therapeutic dyads have rarely been the subject of research.The present study aimed to investigate differences in therapeutic style (Healing and Stressful Involvement). METHOD: A sample of 527 questionnaires completed by therapists of different ages was available. Therapy style was compared between two patient groups (under 40 and over 65 years old) and three therapist groups (25-39, 40-59, ≥ 60). RESULTS: The results show in particular more stress experienced by younger therapists in the treatment of older patients, while older therapists report less stress.There were no or fewer differences in the treatment of younger patients.The regression-analytical results show that the experience of stress in the therapy of older people is associated with a greater fear of old age. CONCLUSION: Finally, some conclusions are discussed with regard to training and supervision of therapists in the treatment of older people.

[Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]. / Klinische Urteilsbildung und Beziehungskompetenz in der Psychotherapie älterer PatientInnen.

The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.

Originalbeiträge (Originals). Zur klinischen Bedeutung reduzierter Exekutivfunktionen bei älteren Patient:innen mit psychischen Erkrankungen©.

On the clinical significance of reduced executive functions in elderly patients with mental illnesses Research question: Executive functions (EF) show increasing deficits in old age.There are also numerous studies demonstrating the importance of EF in relation to depression, anxiety disorders and post-traumatic stress disorder in older patients. METHODS: The study presented examined this question in a sample of patients in a psychosomatic clinic who were in middle (< 60years) and older age (≥ 60years) (N = 150) and compared them with a psychologically non-stressed comparison sample (N = 157).The survey instrument used to assess EF was the Trail-Making Test (TMT). RESULTS: The results show age and setting differences, i. e. older as well as mentally ill subjects showed worse results; an interaction effect was also found. Associations of symptoms and EF were found only in the elderly sample, but not in the middle-aged sample. CONCLUSIONS: The results show that the importance of impaired executive functions is a clinically relevant variable in psychotherapy of the elderly.

[Physical Illness in Older Patients in the Psychosomatic Clinic]. / Körperliche Krankheit bei älteren PatientInnen in der Psychosomatischen Klinik.

So far, little is known about the number and extent of physical illnesses in older patients in psychosomatic clinics. In the present study, the number and frequency of physical illness and its relationship to psychological symptoms were investigated in a group of 150 patients in the second half of life (50 each in the age groups 40-54, 55-69 and 70). Method: The CIRS (Cumulative Illness Rating Scale), an established third-party assessment method for physical illness on 14 scales, was used to record physical illness. The results show the greatest frequency and severity of physical illness in the oldest group. In addition, physical illness was found to be more strongly related to mental illness with increasing age. In the discussion, aspects of health care policy and therapy are addressed.

[Age images of older patients with psychiatric diseases -The importance of attachment and mentalization]. / Altersbilder bei älteren Patienten mit psychischen Erkrankungen ­ Zur Bedeutung von Bindung und Mentalisierung.

Objectives: The emergence and effects of self-perception of ageing (SPA) are central gerontological research topics. SPA has an influence on numerous psychological, cognitive and physical parameters.The question of its significance for mental illness in old age, which was investigated in the present study, has so far remained in the background. Of particular interest was the connection to attachment and mentalization. Method: A clinical sample (N = 150) was compared with a non-clinical sample (N = 153). Both were divided into three age groups (40-54, 55-69 and over 70 years).The survey instruments used were the Attitude to Own Ageing subscale of the Philadelphia Geriatric Center Moral Scale (PGCMS) and a mentalizing and an attachment questionnaire (MZQ and ECR). Results:The clinical sample showed significantly lower scores in all age groups (more negative SWA), but only the non-clinical sample showed a decrease in age across the three age groups, thus the SPA became more negative. In the regression analytic evaluation, a more negative SPA was associated with an avoidant attachment orientation as well as reduced mentalizing skills. Conclusions: The results highlight the importance of SWA as a clinically and therapeutically significant variable. Finally, therapeutic implications are discussed.

[Mentalization ability and treatment success in psychosomatic rehabilitation]. / Mentalisierungsfähigkeit und Behandlungserfolg in der Psychosomatischen Rehabilitation.

Objectives: Psychosomatic rehabilitation clinics represent an important branch of care with good treatment results in Germany. So far, however, it is largely unclear which processes underlie the treatment successes. In the partial evaluations of the Hersfeld catamnesis study presented here, recourse is made to the construct of mentalizing ability, which has become very important in recent psychotherapy research. Methods: The mentalization ability of a large sample (N = 559) was assessed with the help of the Mentalization Questionnaire (MZQ), and psychological and somatic complaints were assessed with HEALTH-PSB scale from HEALTH-49 at three points in time, namely at admission, at discharge and in a 6-month catamnesis. Results: Both the total score of the MZQ and all subscores show significant reductions in mentalization deficits in the small effect size range, the HEALTH-PSB in the high effect size range and the catamnesis in the medium effect size range. A regression analysis shows that the reduction in mentalization deficits has a high predictive power for symptom improvement. Conclusions: The results indicate that the construct of mentalization ability is a central target variable in psychosomatic rehabilitation.

Behandlungsergebnisse in der Psychosomatischen Rehabilitation ­ Die Hersfelder Katamnesestudie.

AIM OF THE STUDY: Existing evaluation studies show the effectiveness of treatments in psychosomatic rehabilitation clinics. However, the clinics are facing new challenges, which can be attributed to the changes in the world of work, for example. At the same time, new patient groups such as older patients are coming more into focus, for whom the clinics are not yet sufficiently prepared. Against this background, an evaluation study was conducted in the Klinik am Hainberg, a psychosomatic rehabilitation clinic, to examine the changes in central dimensions of the outcome in psychosomatic medicine. METHOD: For the comparison of admission vs. discharge, data are available from a sample of 761 patients, of whom 559 still responded to the 6-month Follow-up) (73% response rate). Five modules of the HEALTH-49 were evaluated. RESULTS: In all modules, improvements were found with medium to large effect sizes at discharge, and with medium effect sizes at 6-month Follow-up. Neither age, nor gender, nor time off work had an influence on the rehabilitation outcome. Only lower education was associated with less improvement. CONCLUSIONS: The results show the effectiveness of the treatments studied. The practiced rehabilitation concept seems to be effective even for patient groups that are particularly in focus, such as those with longer work incapacity or also older patients.

Comparing Mentalizing Abilities in Older Adults with and without Common Mental Disorders.

INTRODUCTION: The concept of mentalization is of central importance not only in modern psychotherapy but also in geriatric psychotherapy. In relation to older people, deficits in some aspects of the ability to mentalize, such as the theory of mind (ToM), affect perception, and metacognitive skills, are known. However, little is known about the mentalization ability of older people with mental disorders. The aim of the present study was to investigate the mentalizing abilities of older patients with depressive and anxious symptoms. METHODS: In this study, the ability to mentalize using the Mentalization Questionnaire (MZQ), the HEALTH-49 questionnaire, Trail-Making Test (executive functions), and Reading-the-Mind-in-the-eyes-test (ToM) was studied in a clinical (n = 150) and a nonclinical comparison sample of people (n = 150) in different age groups (40-54, 55-69, ≥70). The evaluation of the data was conducted with different statistical methods, especially variance and regression analyses. RESULTS: The clinical sample of all age groups showed significantly poorer mentalizing skills than the nonclinical samples. There were large correlations to health-related aspects. Additionally, in the regression analysis, only the setting variable (clinical vs. nonclinical) had an influence on the MZQ score and neither gender, education, executive functions nor ToM had a significant influence. Age also had no effect and did not correlate with MZQ scores but did correlate negatively with ToM. CONCLUSIONS: The results show the importance of mentalization concepts for mental disorders in patients in the second half of life. There are indications of an imbalance of different aspects of mentalizing ability, especially between self- and other-related mentalizing abilities. Improving this balance could be a goal of therapeutic interventions.

[Older Patients in the Psychosomatic Clinic: Health, Attachment and Mentalisation]. / Ältere Patienten in der Psychosomatischen Klinik ­ Gesundheit, Bindung und Mentalisierung.

Up to now, little is known about the group of older people treated in psychosomatic clinics, although the number of people in this age group who undergo treatment is increasing. In the study presented here, a sample of patients (age: 60 and above; n=83) from two psychosomatic clinics and a sample of clinically inconspicuous subjects (n=89) of the same age were examined. In addition to health variables, in which the group of older patients differed from the clinically inconspicuous as well as from younger patients, the connection between attachment and mentalization was examined more closely within the framework of two regression analyses. This showed that attachment-related anxiety and attachment-related avoidance were significantly more pronounced in the clinical group, but both were associated with different mentalization aspects. Based on these observations, some conclusions are drawn with regard to the treatment of older patients in psychosomatic clinics.

Theory-of-mind abilities in older patients with common mental disorders - a cross-sectional study.

OBJECTIVES: Theory-of-mind (ToM) abilities are a basic competence for social interactions and relationships. Numerous findings demonstrate ToM deficits in old age, but such findings are missing in clinical samples of older adults. METHOD: In the present study, patients treated in two clinics for common mental disorders (N = 150, distributed among the age groups 40-54, 55-69 and ≥70) were compared with a sample of people of the same age without mental disorders. The Reading the Mind in the Eyes Test (RMET) was used, in which the task is to detect mental states in the eyes, which are presented in 36 pictures. RESULTS: The two groups differed significantly from each other: the clinical samples achieved worse results than the nonclinical samples, and the older samples achieved worse results than the younger samples. In the multiple regression analysis significant beta-weights were found for executive functions, physical diseases (especially vascular diseases, in the clinical sample) and higher education. CONCLUSION: Older patients show clinically significant deficits in ToM abilities, which should be taken into account in interventions promoting ToM abilities.

[Mental illness in elderly patients - Empirical results on the theory of secondary structural deficits]. / Psychische Erkrankungen bei älteren Patienten ­ Empirische Befunde zur Theorie sekundärer Strukturdefizite.

Mental illness in elderly patients - Empirical results on the theory of secondary structural deficits Objectives: The theory of secondary structural deficits, which attributes structural deficits to age-related changes, is introduced. The following study aims at testing some elements of the theory (changes of theory of mind, ability to mentalize). Methods: Patients (N = 150, age 40-80 years) of a psychosomatic hospital participated in the study. Structural deficits were measured using the Reading-Mind-in-the-Eyes-Test (Baron-Cohen et al. 2001) and the Mentalization Questionnaire (MZQ, Hausberg et al. 2012). Influences of age as well as physical disease, trauma related stress and anxiety/depression on those structural deficits were examined. Results: Trauma related stress and physical disease (especially vascular disease) were shown to have the most associations to the structural dimensions. This influence increases with increasing age. Conclusions: The results confirm the assumptions of the presented theory in selected variables. Conclusions for modifications in geriatric psychotherapy can be derived.

[Elderly patients in psychotherapy--results of an inquiry of psychotherapists]. / Ältere Patienten in der psychotherapeutischen Praxis--Ergebnisse einer Befragung von Psychotherapeuten.

The elderly patients were underrepresented in outpatient psychotherapy, is returned in the clinical literature on the reluctance and skepticism of psychotherapists. In the study presented here, psychotherapists were asked how they perceive the elderly, the attitudes they have towards them and what factors it depends on how many older people a psychotherapist treats. Total confirmed that psychotherapists also create a very positive attitude towards older people of the day. Of particular impact in terms of how many older people treated a psychotherapist, have experience and knowledge in the age of psychotherapy. Overall, there are a number of references for arguing that the clinical field of treating the elderly gradually gains more contours.

[Motivation for psychotherapy of elderly patients in a clinic for rehabilitation - an empirical study] / Psychotherapiemotivation älterer Patienten in der Rehabilitationsklinik - Eine empirische Studie.

With the increase of elderly patients in psychosomatic clinics the question arise, what about the motivation and expectations of these patients. Here an empirical study is presented, where 189 elderly (55 years and over) and 190 younger (under 55 years) patients are included. They are analysed with different questionnaires. The elderly patients show less psychosocial attribution for their disease, less motivation and expectation for psychotherapy and a more negative accentuated attitude to psychotherapy. But the expectations especially of the elderly differ in a wide range. In a clusteranalysis three groups are separated: low, middle and high motivated patients. The older patients are over represented in the group of the low motivated patients. These older patients doesn't occure any recovery of symptoms. At last some clinical aspects, concerning this group, are discussed.