Psychosoziale Versorgungsforschung

Health is of high value. Therefore, an effective and efficient care is a widely accepted societal objective. Correspondingly, health service research in general and for the psychosocial area in particular receives increasing attention from politics, health and pension insurance companies and professional organisations. These stakeholders promote health service research with considerable financial means. The various promotional programs are described and their implications are discussed. The relationship between content, purposes and methodology for the definition of research in health care is clarified. Finally, current research questions are exemplified by five key topics.     

Psychosomatische Aspekte des Diabetes mellitus

The term “diabetes mellitus” describes a group of endocrinological diseases characterised by hyperglycemia. The treatment is demanding for patients in terms of self-management and self-responsibility, and some patients need not only medical but psychological support as well. This article reviews essential psychological aspects of diabetes, starting with factors affecting adherence to diabetes treatment. The main part describes epidemiology and interactions between anxiety disorders, eating disorders and depression in patients with diabetes. Treatment recommendations are derived from current knowledge in accordance with evidence-based treatment guidelines.     

Ökonomisierung und Psychotherapie

Former fundamental social structures are disappearing and, especially by the economization and industrialization of medicine, the self-understanding of patients, doctors and hospitals has changed. From these developments psychotherapy gets into a strange area of tension, not only in the society as a whole, but also within medicine: on the one hand psychotherapy is needed more than ever, but on the other hand it finds itself in an outsider position. Thereby, the reality constructions of patients and psychotherapists are affected as well, mostly gradually, so that the consequences for the relationship between psychotherapists and patients escape attention. Dealing with these problems in a considered and transparent manner can avoid damaging the therapeutic work.     

Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

Both predator and prey: emotional arousal in threat and reward

This research examined the psychophysiology of emotional arousal anticipatory to potentially aversive and highly pleasant outcomes. Human brain reactions (event-related potentials) and body reactions (heart rate, skin conductance, the probe startle reflex) were assessed along motivational gradients determined by apparent distance from sites of potential punishment or reward. A predator-prey survival context was simulated using cues that signaled possible money rewards or possible losses; the cues appeared to loom progressively closer to the viewer, until a final step when a rapid key response could ensure reward or avoid a punishing loss. The observed anticipatory response patterns of heightened vigilance and physiological mobilization are consistent with the view that the physiology of emotion is founded on action dispositions that evolved in mammals to facilitate survival by dealing with threats or capturing life-sustaining rewards.     

Stimulus frequency influences spontaneous perceptual reversals in ambiguous apparent motion

The temporal integration of continuous sensory information into a temporally extended percept becomes evident in spontaneous reversals of ambiguous apparent motion. To study the temporal relation of spontaneous percept reversals and temporal stimulus properties, we systematically varied presentation frequency in an ambiguous-apparent-motion paradigm. Moreover, we triggered percept reversals in a manner that was not consciously perceived by manipulating the duration of single frames. We found that the reversal rate depended on the stimulus frequency (with higher frequencies resulting in faster percept reversals) and that we could externally trigger perceptual reversals. Our findings support the idea that spontaneous reversals of ambiguous apparent motion are influenced by bottom-up effects at early processing levels. The paradigm allows for specific contrasts of spontaneous and externally triggered (but otherwise identical) perceptual reversals and, by this means, for further study of the underlying mechanisms.     

Jugendgewalt als Lebensbewältigungsprozess

Aggression und Gewalt bei Jugendlichen stilisieren sich zum Sinnbild für unsere „kranke Gesellschaft“. Was sich bei jüngeren Jugendlichen noch – oft als Lausbuben-Verhalten bagatellisiertes – Herumschubsen und Rangeln im Pausenhof ?u?ert, tritt in Form von Bullying und Mobbing immer st?rker zutage. Jugendliche, die trinken, stehlen, Drogen zu sich nehmen, Mitschüler oder Gruppenmitglieder bedrohen und Gegenst?nde ?ffentlichen Gutes besch?digen etc., stehen auf der Tagesordnung. Selbst Erpressung von Mitschülern ist kein Einzeldelikt mehr.     

Harbour seals (<Emphasis Type="Italic">Phoca vitulina</Emphasis>) can steer by the stars

Offshore orientation in marine mammals is still a mystery. For visual orientation during night-time foraging and travelling in the open seas, seals cannot rely on distant terrestrial landmarks, and thus might use celestial cues as repeatedly shown for nocturnally migrating birds. Although seals detect enough stars to probably allow for astronavigation, it was unclear whether they can orient by the night sky. The widely accepted cognitive mechanism for bird night-time orientation by celestial cues is a time-independent star compass with learned geometrical star configurations used to pinpoint north as the rotational centre of the starry sky while there is no conclusive evidence for a time-compensated star compass or true star navigation. Here, we present results for two harbour seals orienting in a custom made swimming planetarium. Both seals learned to highly accurately identify a lodestar out of a pseudo-randomly oriented, realistic projection of the northern hemisphere night sky. Providing the first evidence for star orientation capability in a marine mammal, our seals’ outstanding directional precision would allow them to steer by following lodestars of learned star courses, a celestial orientation mechanism that has been known to be used by Polynesian navigators but has not been considered for animals yet.