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.     

Kreuzvalidierung der Kurzform des Kindheitsfragebogens

Objectives

Existing questionnaires about parent-child relationships usually assess love and control only. The childhood questionnaire (CQ) offers a more differentiating alternative.

Methods

In a sample of approximately 1,400 patients and more than 500 controls the CQ was reduced from 22 to 11 scales and the number of items of each scale was shortened to 5.

Results

The shortened scales of the CQ also showed good reliability and item characteristics, as well as plausible intercorrelations.

Conclusion

By the use of 66 out of the former 128 items, the shortened version of the CQ assesses three further important dimensions in the parent-child relationship of adults towards their parents in childhood besides love and control: punishment, ambition and role reversal. Beside this, parental separation, divorce and job status as well as various parameters of the socio-economic status (e.g. educational, occupational and financial) of the parents can be assessed.     

Politische und soziale Verantwortung von Psychotherapeuten

Psychotherapists should always continuously remind themselves what role they and/or representatives of their discipline played and still play in various political contexts. Under these aspects the following general categories can be suitable for orientation: 1) general political participation, 2) application of specific psychotherapeutic perspectives for understanding of cultural, social and political processes and 3) development of possible activity perspectives from a psychotherapeutic viewpoint. The psychotherapeutic view of social processes and the possible resulting activity perspectives are a consequence of observation of the interplay between exactly these social processes and their deposition in the individual.     

Stressbew?ltigung

Training for coping with stress as the core instrument of prevention of stress-related disorders at the individual level is characterized within the framework of prominent theoretical concepts of stress and derived from these. Response-focused, situation-focused and relational definitions of stress as well as the main results of stress research are described. The cognitive-transactional stress theory and the concept of coping are then outlined in their main features and control of stressor exposition, problem-focused coping, cognitive reappraisal, emotion-focused coping and mobilization of social support are characterized as main targets and modes of intervention in coping skills group programs. General aspects of such programs, selected findings on effectiveness and methodological considerations regarding the evaluation are then depicted. It is concluded that training of individual coping skills should be supplemented by preventive intervention at the institutional or organizational level.     

Dyadische Planungsintervention nach Prostatektomie

Background

Prostate cancer is one of the most prevalent forms of cancer in men. One treatment for localized prostate cancer is radical prostatectomy. Patients and partners have to deal with stressors associated with the diagnosis, the surgery and its consequences (e.g. incontinence). Dyadic planning prepares for the coping process with illness consequences in order to enhance self-regulation and reduce anxiety. Dyadic planning means generating plans together with a partner specifying when, where and how the target person wants to initiate a health behavior.

Patients and methods

In this longitudinal randomized controlled trial (RCT) 112 prostatectomy patients and their spouses were invited to participate in a dyadic planning intervention. Participants were randomly allocated to a dyadic pelvic floor exercise (pfe) planning group or one of three control groups (i.e., individual pfe planning, dyadic or individual nutrition planning). Patients and partners received questionnaires at baseline, 2 weeks and 6 months after surgery.

Results

Patients in the dyadic pfe planning group reported higher dyadic pfe planning 2 weeks after surgery than patients in the nutrition planning groups. No such differential effects were found in partners. Additionally, there were no group differences in patient reports on anxiety 6 months after surgery, whereas partners in the dyadic pfe planning group reported lower anxiety levels compared to partners in the individual pfe planning group. Self-reported pfe planning did not, however, mediate the effects of the intervention on partners?? anxiety.

Conclusion

Economical dyadic planning interventions may not only support change of health-relevant behaviour in target persons but also emotional adjustment of their partners.     

Psychotherapie in Westdeutschland nach 1945

Protagonists during the formation of post-World War II medical psychotherapy (e.g. Ernst Speer, Berthold Kihn) had been involved in Nazi selection and ??hereditary health?? policies and continued to express related attitudes and views in the post-war period. To contextualize and analyze these findings, the broader institutional structures and dynamics in psychotherapy before and after 1945 are described. It is argued that for gaining attention, acceptance and resources, psychotherapy and psychiatry are much more dependent on the specific political and economic contexts than somatic medical disciplines, due to the focus on experiences and behavior of human beings. This is related to the fact that such political and economic contexts are themselves bound to anthropological conceptions and norms of behavior. In a further step three paradigms of dealing with the Nazi past are identified for post-World War II psychotherapy and psychiatry: the isolation paradigm, the continuity paradigm and the localizing-complex paradigm.     

Neurobiologische Grundlagen psychotherapeutischer Verfahren

In the last few years the investigation of the neurobiological basis of psychotherapeutic treatments has gained importance. Therapy-associated functional changes have been studied in a number of different psychiatric diseases. It has been shown that diseases with a central role of emotions (e.g. depression, anxiety disorders, borderline personality disorder) often demonstrate dysfunctions in brain areas that are linked to emotional regulation. Psychotherapeutic interventions can lead to a kind of normalization of brain responses in these areas (e.g. amygdala, ventromedial prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex). In addition, therapy-associated transformations were also demonstrated in areas which are related to attention processes and visual perception. Other studies have aimed at finding neurobiological parameters that can be used to predict a therapeutic outcome or to choose between various therapeutic strategies. For instance, in depression, the amygdala and the anterior cingulate cortex are assumed to play a major role. Altogether, knowledge on the neurobiological basis of psychotherapeutic procedures is limited. A comparatively small number of studies and several methodological problems (e.g. small sample sizes, insufficient control groups, variability of methods used) make it difficult to propose reliable statements.     

Kultursensible Diagnostik in Forschung und Praxis

Nearly one fifth of the German population are migrants of the first and second generation. Evidence-based knowledge about mental health of migrants, their health care needs and the actual mental health care situation of this population is limited. Psychometric instruments are helpful for the assessment of mental disorders. Although a culture-sensitive approach in diagnostics is necessary it is often neglected in research as well as in clinical practice. This article describes culture-specific and linguistic challenges and specifies specific communication problems. In most cases psychometric instruments are not developed simultaneously in different languages but are translated later on. After translation psychometric instruments should be culturally validated and adapted with respect to linguistic, cultural and metric equivalence. The article gives an overview about the different aspects of equivalence and explains these aspects on the example of the PHQ-9.