Beurteilerübereinstimmung von Psychotherapie-Gutachtern

The access to outpatient psychotherapy in Germany is regulated by an application and expert opinion procedure in a peer-review system. In an external assessment procedure, the application of each patient is considered concerning the existence of a mental disorder, a positive prognosis as well as the adequacy of the chosen therapy rationale. The present paper examines the reliability of this procedure by reanalysing the data from three studies on interrater agreement in the expert opinions about psychoanalytic/psychodynamic therapy, behaviour therapy or child and youth behaviour therapy. In the study of Rudolf et al. (2002) 48 experts re-examined two already assessed cases, in the studies of Sulz et al. (2003) as well as Sulz and Peterander (2004) each of 30 and respectively 7 experts had judged five non selected or seven selected applications. The interrater agreement was calculated using the kappa coefficient by Fleiss for the agreement among many raters, which tests the observed agreement probability against the expected agreement probability that would occur by chance. The level of agreement among the experts differs between 46% and 70%. With the chosen method it is mostly not possible to show that there is a significant higher agreement than by chance. The generalizability of the results to the usual assessment procedure is discussed as well as their potential for the advancement of the application procedure and expert peer-review system.     

Systemische Therapie bei Störungen des Erwachsenenalters

Background

Systemic therapy is a scientifically acknowledged form of psychotherapy in the US and many European countries, but not yet in Germany.

Method

All randomized (or parallelized) controlled trials (RCT) evaluating systemic couples/family/individual therapy with adult index patients published in English, German or Spanish up to the end of 2004 were identified via data base searches and cross-references in other meta-analyses and reviews. A meta-analysis of the identified RCT was performed.

Results

28 RCT (43 publications) evaluating systemic therapy with adult index patients suffering from clinical disorders (ICD-10) were identified. Systemic therapy is efficacious with regard to substance disorders, mental/social factors interacting with somatic disorders, schizophrenia, depression and eating disorders. The results are stable across follow-up periods of up to 5 years.

Conclusion

According to the criteria of the German Scientific Advisory Board Psychotherapy (Wissenschaftlicher Beirat Psychotherapie) there seems to be good evidence for the efficacy of systemic therapy in at least four fields of application of adult psychotherapy.     

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.     

Standards der sozialmedizinischen Leistungsbegutachtung in der Psychosomatischen Medizin und Psychotherapie

Sociomedical problems are playing an increasingly important role in both psychosomatic medicine and psychotherapy and in psychiatry. The present article examines the standards relating to content and method in sociomedical assessments, primarily in the discipline of psychosomatic medicine and psychotherapy. The focus is on the assessment of performance, highlighting the fact that performance and performance deficits cannot primarily be derived from the medical diagnosis; instead, psychosocial variables that influence the processes of dealing with disease in particular affect the actual performance status. The article pays particular attention to aspects that aggravate or dissimulate performance competence. Finally, the principles of integrating the various findings and results that are incorporated into the assessment report are outlined.     

Prevalence of poor psychological morbidity following a minor road traffic accident (RTA): The clinical implications of a prospective longitudinal study

Few Road Traffic Accident (RTA) victims have their psychological needs attended to in hospital or afterwards. We conducted a small-scale preliminary investigation exclusively focussing on the prevalence of poor psychological morbidity following minor road traffic accidents (RTAs). Participants (N?=?50) completed assessments one-month after their minor RTA and (N?=?39) at 4-months follow-up. The identification of clinically significant anxiety, depression and post traumatic stress disorder (PTSD) in this minor RTA sample supports both evidence reported elsewhere and our specific predictions. Seven (14%) participants at baseline and five (12.8%) at follow-up met diagnostic criteria for PTSD. The clinical implications for identifying and meeting the psychological needs of minor RTA victims are discussed in the context of cognitive behavioural conceptualizations of mental disorder.     

Prolonged exposure therapy for chronic combat-related PTSD: a case report of five veterans

Prolonged exposure (PE) therapy has been found efficient in reducing posttraumatic stress disorder (PTSD) symptoms mostly among rape victims, but has not been explored in combat-related PTSD. Five patients with severe chronic PTSD, unresponsive to previous treatment (medication and supportive therapy) are described. Patients were evaluated with the PTSD Symptom Scale-Interview, and Beck Depression Inventory, before and after 10-15 sessions of PE therapy. All five patients showed marked improvement with PE, with a mean decrease of 48% in PTSD Symptom Scale-Interview score and 69% in Beck Depression Inventory score. Moreover, four patients maintained treatment gains or kept improving 6-18 months after the treatment. The results suggest that PE was effective in reducing combat-related chronic PTSD symptoms.