Suchttherapie bei abhängigen Ärzten

Background

International studies indicate an increased incidence of substance abuse disorders among physicians. This article investigates specific variables in the work field and describes existing treatment programs.

Patients and methods

In a cross-sectional study 107 physicians with and 468 without substance abuse disorders were compared. Two highly developed treatment programs in Germany and Canada are described.

Results

The high work-load associated with the medical work environment leads to reduced performance and social isolation. Treatment programs for addicted physicians work with the concept of ?help before restriction“. The abstinence rate of the 5-year Canadian program is over 90%.

Conclusions

As a form of prevention, medical students should be systematically informed about work-related stress in the medical profession. Structured treatment programs should be implemented nationwide. The expert team ?Risk of addiction in physicians“ of the German Addiction Foundation, whose members are authors of this article, may be a small step in this direction.     

Emotion und Psychotherapie

Considering the fact that all psychic disturbances are emotional disturbances as well, we develop based on our research on the modular structure of the emotional system a systematisation of the disturbance-specific concatenation of these modules within the patient’s social relationships. Subsequently, we discuss treatment possibilities and contraindications for each clinical empirically validated constellation. We describe a fundamental mechanism of affect induction keeping the disturbances alive and transporting them to the next generation. We conclude in stating that treatment recommendations focusing on a standard algorithm of handling the emotions system fail because there is no general indication for such enterprises.     

Overgeneral memory and suppression of trauma memories in post-traumatic stress disorder

The study investigated the relationship between the suppression of trauma memories and overgeneral memory in 42 assault survivors with and without PTSD. Overgeneral memory (OGM) was assessed with a standard autobiographical memory test (AMT). Participants completed two further AMTs under the instructions to either suppress or not suppress assault memories, in counterbalanced order. Participants with PTSD retrieved fewer and more general memories when following the suppression instruction than participants without PTSD, but not under the control instruction. OGM correlated with PTSD symptom severity, and measures of cognitive avoidance. The results are discussed with reference to current theories of overgeneral memory and its possible relationship with PTSD.     

Nice wor_ if you can get the wor_: subliminal semantic and form priming in fragment completion

Two experiments investigated subliminal semantic and form priming in a word-completion task. Visual gap-words with a dominant and a subordinate solution were preceded by form-related or by semantically related words, which were briefly presented and sandwich-masked. Priming of the subordinate solution was assessed in Experiment 1, relative to a neutral condition. Both solutions were primed in Experiment 2. In the absence of conscious prime recognition, both semantic and form primes reliably increased the probability with which the primed solution was given. With our variant of fragment-completion, response priming can be ruled out as explanation. Moreover, effects were already present at first presentation, excluding an interpretation in terms of partial awareness due to massive repetition. The data demonstrate automatic activation at both form and semantic levels in the absence of conscious awareness.     

Optimism, pessimism, and change of psychological well-being in cancer patients

Whereas most previous studies have assessed optimism/pessimism as a unidimensional construct, there is increasing awareness that optimism and pessimism may represent two partially independent dimensions. In this study, the role of optimism and pessimism for the maintenance of psychological well-being was assessed in 161 newly diagnosed cancer patients. Before the start of chemotherapy, more positive affect balance was associated with higher optimism and lower pessimism. Over the course of 9 months following diagnosis, pessimism predicted negative change in affect balance, whereas no effect of optimism appeared. Higher levels of perceived side-effects of chemotherapy were associated with negative change in affect balance. However, an interaction effect of perceived side-effects with pessimism indicated that this was only the case in patients with above-median levels of pessimism. The conclusion is drawn that it may be more important to be less pessimistic than to be optimistic when diagnosed with cancer.     

Different types—Different rights

Drawing on a social construction theory of ownership in biological material this paper discusses which differences in biological material might motivate differences in treatment and ownership rights. The analysis covers both the perspective of the person from whom the material originates and that of the potential recipient. Seven components of bundles of rights, drawing on the analytical tradition of Tony Honoré, and their relationship to various types of biological material are investigated. To exemplify these categories the cases of a heart, a kidney, stem cells and hair are used.     

The Ethics of NIMBY Conflicts

NIMBY (Not In My Backyard) refers to an oppositional attitude from local residents against some risk generating facility that they have been chosen to host either by government or industry. The attitude is claimed to be characteristic of someone who is positive to a facility but who wants someone else to be its host. Since siting cannot be provided if everyone has this attitude, society ends up in a worse situation. The attitude is claimed to be egoistic and irrational. Here it is argued that the NIMBY critique rests on questionable assumptions about the rightness of weighing total benefit against total cost. This weighing-principle will sometimes have to yield so that the rights of individuals can be acknowledged.

Editorial

Ohne Zusammenfassung