Partizipationsverhalten schizophren erkrankter Patienten in Psychoedukationsgruppen

Background

The effectiveness of psychoeducation groups for people with schizophrenia is well documented; however, there are no studies which examined patient participation behavior although this behavior might be critical for accomplishment of the therapeutic goals. This article presents newly developed 4-point Likert scale, the participation quality rating scale (PQRS), together with initial results on practicability, validity, change sensitivity, sociodemographic and clinical correlates and on the question whether participation quality might be a significant predictor of the short and long-term outcome of psychoeducation.

Patient and methods

Within the framework of the Munich Study “Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses” (COGPIP) the individual participation behavior of 97 patients with schizophrenia was examined after each psychoeducational group session (4 weeks). Individual mean PQRS scores were correlated with sociodemographic, anamnestic and clinical variables. In addition to change sensitivity the ability of the scale to predict the acquisition of illness knowledge during psychoeducation was examined as well as readmission during a 9-month follow-up period and the psychopathological endpoint (positive and negative syndrome scale, PANSS).

Results

Practicability and change sensitivity of the PQRS were found to be sufficient. Significant correlations with independently rated illness insight and medication compliance indicated a construct validity of the scale. Higher age, female sex and less pronounced psychopathological symptoms (PANSS) were associated with better participation behavior. Even patients with clearly impaired participation behavior profited from psychoeducation in that they were able to catch up with the delay with regard to illness knowledge. However, the PQRS was not a predictor of readmission during the 9-month follow-up period or of psychopathological endpoints.

Conclusions

The PQRS is qualified as a new tool for the standardized assessment of participation behavior in people with schizophrenia attending psychoeducation groups. The scale can be applied in research as well as clinical contexts in order to further improve understanding of how psychoeducation works and how this kind of supplementary therapy could become even more effective.     

Psychotherapie bei Patienten mit koronarer Herzkrankheit

Zusammenfassung Psychosomatisch-somatopsychische Interaktionen sind bei Koronarpatienten häufig und verlaufsrelevant. Seit den 1960er-Jahren kommen daher psychosoziale Interventionen zur Verbesserung von Befinden und Krankheitsverlauf zum Einsatz. Neben psychoedukativen und unspezifisch-supportiven Angeboten oder Entspannungsverfahren finden sich auch explizit psychotherapeutische Interventionen. Diese beabsichtigen einerseits, durch Reduktion von Stressbelastungen und Förderung gesundheitsbewusster Verhaltensweisen den Krankheitsverlauf zu verlangsamen. Zuletzt wurde zudem auch die Psychotherapie psychischer Komorbiditäten untersucht. Hier spielt die prognostisch relevante Depression eine besondere Rolle. In der größten Psychotherapiestudie bei Koronarpatienten, der ENRICHD-Studie, wurde bei 2481 Infarktpatienten mit Depression oder mangelnder sozialer Unterstützung eine maximal halbjährige kognitive Verhaltenstherapie eingesetzt. Diese führte zur deutlichen Besserung der Depressivität; bei hoher Spontanremissionsrate in der Kontrollgruppe blieb der Nettoeffekt jedoch bescheiden. Eine Lebensverlängerung wurde in der Interventionsgruppe nicht erreicht. Die Befundlage verlangt differenzielle Indikationsstellungen und behandlungstechnische Weiterentwicklungen der therapeutischen Konzepte bzw. die Erprobung anderer Therapieverfahren, erlaubt jedoch noch keine evidenzbasierte allgemeine Behandlungsempfehlung. Therapieentscheidungen stützen sich heute auf die Würdigung des Einzelfalls, auf gut belegte subjektiven Therapieeffekte, theoretische Annahmen über Stressbewältigungs- und Entspannungsverfahren sowie die an anderen Patientenkollektiven gewonnenen Wirksamkeitsnachweise psychotherapeutischer Verfahren. Dabei sind generell eine Beachtung der kardialen Situation und der typischen Problembereiche der koronaren Herzkrankheit (KHK) sowie eine gute Abstimmung mit den somatischen Behandlern wichtig.     

Psychotherapie bei Patienten mit koronarer Herzkrankheit

Psychosomatisch-somatopsychische Interaktionen sind bei Koronarpatienten häufig und verlaufsrelevant. Seit den 1960er-Jahren kommen daher psychosoziale Interventionen zur Verbesserung von Befinden und Krankheitsverlauf zum Einsatz. Neben psychoedukativen und unspezifisch-supportiven Angeboten oder Entspannungsverfahren finden sich auch explizit psychotherapeutische Interventionen. Diese beabsichtigen einerseits, durch Reduktion von Stressbelastungen und Förderung gesundheitsbewusster Verhaltensweisen den Krankheitsverlauf zu verlangsamen. Zuletzt wurde zudem auch die Psychotherapie psychischer Komorbiditäten untersucht. Hier spielt die prognostisch relevante Depression eine besondere Rolle. In der größten Psychotherapiestudie bei Koronarpatienten, der ENRICHD-Studie, wurde bei 2481 Infarktpatienten mit Depression oder mangelnder sozialer Unterstützung eine maximal halbjährige kognitive Verhaltenstherapie eingesetzt. Diese führte zur deutlichen Besserung der Depressivität; bei hoher Spontanremissionsrate in der Kontrollgruppe blieb der Nettoeffekt jedoch bescheiden. Eine Lebensverlängerung wurde in der Interventionsgruppe nicht erreicht. Die Befundlage verlangt differenzielle Indikationsstellungen und behandlungstechnische Weiterentwicklungen der therapeutischen Konzepte bzw. die Erprobung anderer Therapieverfahren, erlaubt jedoch noch keine evidenzbasierte allgemeine Behandlungsempfehlung. Therapieentscheidungen stützen sich heute auf die Würdigung des Einzelfalls, auf gut belegte subjektiven Therapieeffekte, theoretische Annahmen über Stressbewältigungs- und Entspannungsverfahren sowie die an anderen Patientenkollektiven gewonnenen Wirksamkeitsnachweise psychotherapeutischer Verfahren. Dabei sind generell eine Beachtung der kardialen Situation und der typischen Problembereiche der koronaren Herzkrankheit (KHK) sowie eine gute Abstimmung mit den somatischen Behandlern wichtig.     

Wirksamkeit bioenergetischer Psychotherapien bei Patienten mit bekannter ICD-10-Diagnose

In this study the efficacy of Bioenergetic Analysis and Therapy (BAT) was evaluated retrospectively by means of two questionnaires. Former patients from private practice with a known ICD-10 F group diagnosis participated in the study. The SCL-90-R was modified to allow assessment of the symptoms at the beginning as well as at the end of therapy. The second questionnaire was self-constructed and contained questions about the quality of the therapeutic work, body work in general, the relationship with the therapist, and the way the therapist worked. Both questionnaires were to be answered anonymously. Eight psychotherapists (medical doctors and psychologists) served as contacts to 103 former patients; 48 patients (46.6%) returned the questionnaires. Ten patients belonged to the F3 group, 26 to the F4, and 12 to the F6 groups. All data could therefore be interpreted for each of the F groups as well as for the sum of all patients. Bioenergetic analysis and therapy reduced the symptoms according to the SCL-90-R considerably in all three F groups. Analysis of the individual symptom scales on the SCL-90-R showed high to very high symptom reduction. These were not related to the F group diagnoses. Insight gained as a result of body work produced an even greater symptom reduction independent of the ICD-10 F group diagnosis. Patients receiving BAT rated their therapy favourably and judged the relationship with the therapist as very good. The efficacy of and the satisfaction with the therapy was rated high. The formulation of a therapeutic goal at the beginning of the therapy was possibly a prerequisite for a positive outcome of the therapy. The present study confirms and complements previous efficacy studies of BAT.     

Ressourcenaktivierung bei Patienten

Background

Starting from Klaus Grawe’s draft of a general psychotherapy, the patient’s resources and resource-activating interventions have received increasing attention in empirical research.

Objective

The effectiveness of standardized writing instructions for the activation of patients’ resources before participating in internet chat aftercare groups for psychosomatic patients was examined.

Method

In a randomized controlled trial writing instruction for the activation of patients’ resources was given in 52 out of 102 internet chat aftercare sessions. The effects of this minimal intervention on the patients’ activity and the number of positive emotion words expressed during the chat session were examined. Additionally, the effects on patients’ self-esteem, attachment, orientation, control and well-being after the group sessions were assessed.

Results

Patients reported higher levels of self-esteem, orientation, control and well-being after chat sessions with a resource-activating intervention. No differences between intervention and control groups were detected on the text-based variables activity and number of positive emotion words.

Conclusions

Standardized minimal interventions for the activation of patients’ resources seem to be promising for enhancing the effectiveness of therapeutic Internet chat groups.     

Schemaorientierte Psychotherapie mit forensischen Patienten

A total of 19 forensic patients with the diagnosis of a personality disorder participated in a schema-oriented psychotherapy (SOPT) over a period of approximately 2 years. Treatment was carried out in three groups which were separated according to diagnoses from clusters B and C of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders text revision (DSM-IV-TR). The control group of 19 forensic patients received treatment as usual and were paralleled for relevant forensic variables. The SOPT was implemented to raise patient awareness for their maladapted schemas and to modify the associated dysfunctional coping strategies. On the basis of differentiated individual case concepts, therapeutic interventions were carried out at cognitive and behavioral levels. Furthermore, activating therapeutic methods were implemented during treatment sessions to actualize maladapted schemas on an emotional level and to enhance awareness. Treatment effects were assessed by standardized self-rating, staff rating and objective measures. The results showed more positive changes for the schema-oriented treatment groups in comparison to the control group. In contrast staff rating for patients in the control group showed a clear deterioration of the clinical features.     

Psychotherapeutische Kurzintervention bei somatisierenden Patienten im Krankenhaus

The manual describes the psychotherapeutic procedure for somatizing patients who are admitted to hospital for diagnostics and therapy of unclear physical complaints. An essential goal of the psychotherapeutic interventions is to achieve an understanding for the disease, in which body, psyche and social relationships are experienced as interrelated. By addressing the health fears and subjective concepts about the onset and maintenance of his physical complaints, the patient feels that he is being taken seriously and understood. Connections between physical symptoms and the suppression of undesirable affects like anger, rage and disappointment are verbalized and understood in greater depth, based on body perception exercises and a symptom diary. The positive experience of understanding and symptom relief obtained in the psychotherapeutic sessions is used for the main goal of the intervention: to motivate the (out- and in-)patient for a regular psychotherapy. Experience up to now has shown that three to five sequential sessions of about 45–60 minutes suffice to attain this therapy goal. Implementation is most successful within an established consultant or liaison service in close cooperation with the ward doctors.     

Erwachsenenschutz bei dementen Patienten aus rechtlicher Sicht

Das 2. Erwachsenenschutz-Gesetz brachte 2017 eine gewisse Neupositionierung in Bezug auf nicht entscheidungsfähige Patienten. Im neuen Recht liegt es wie bisher am Arzt selbst, die Entscheidungsfähigkeit zu beurteilen. Vor Einschalten eines Vertreters greift eine spezielle Unterstützungspflicht (Beiziehung einer Vertrauensperson), um eine Entscheidungsfähigkeit doch noch zu erlangen. Ansonsten erfolgt – abgesehen von Fällen einer Gefahr in Verzug – die Aufklärung gegenüber dem Vertreter des Patienten, der eine allfällige Einwilligung zu erteilen hat. Eine gerichtliche Zustimmung ist grundsätzlich nicht mehr einzuholen.     

Psychosoziale Interventionen bei Patientinnen mit Brustkrebs

Breast cancer patients are subject not only to physical strain but also to substantial psychological and social stress as well as major threats and challenges.The paper presented gives an overview of the research status on psychosocial interventions to support patients in their coping endeavours.Psychosocial basic care of women with breast cancer is performed by the physicians treating oncologically and includes information fitting patients' information needs,and responding to their emotional stress.Evaluated training and educational programs are available for physicians to enhance their psychosocial competence.Psychosocial basic care is completed by psychoeducational interventions.In 20–30% of women with breast cancer, there is a need for a special psychotherapeutic treatment.Especially, supportive and cognitive-behavioral therapies in an individual or a group setting contribute to a reduction of anxiety and depression. Even anticipated side-effects of somatic treatments can be diminished by psychotherapy. Research in the field supports that there is a need for broad integration of psychosocial interventions into disease management programs for women suffering from breast cancer.