Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Commentary on ‘mentoring and the impact of the research climate’

Conclusions First of all, I would like to commend Roberts and colleagues for taking on a difficult but very important topic. It would be valuable if someone could follow up with a broader sample of universities and laboratories — paying careful attention to possible sampling and non-sampling errors. In general, I recommend that mentors explicitly both learn and teach ethical theory and practice within the context of their scientist development programs. Finally, while it is important to emphasize sound and ethical research standards and processes in mentoring programs, this should not be at the expense of an appropriate emphasis on skills essential to professional competitiveness, such as responsible, effective publication, grant winning, and demonstrably strong performance on the grants won. Dr. Gardenier is a survey statistician at the National Center for Health Statistics of the Centers for Disease Control and Prevention. The views presented are his personal opinions only.     

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.     

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.