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.     

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.     

Editorial

Ohne Zusammenfassung