Internistische Psychosomatik

Zusammenfassung Die psychische Komorbidität internistischer Patienten im Sinne einer ICD-Diagnose des Kapitels F beträgt mehr als 35%: Neurotische, besonders somatoforme, Schmerz-, affektive Störungen und Suchterkrankungen sind häufig. Die Liegedauer ist bei psychischer Komorbidität deutlich erhöht. Es benötigen 5% der internistischen Patienten ein psychosomatisches Konsil. Neue, komplexe Behandlungsstrategien, wie Transplantationen, Kardioverter-Defibrillatoren, Medikamentenpumpen, erfordern häufig spezifische psychosoziale Interventionen. Ältere Patienten haben Erkrankungen, die zunehmend chronifizieren und komplexer werden. Damit werden Lebensqualität und psychische Komorbidität zu zentralen Outcomevariablen der Volkskrankheiten. Das zweite große Aufgabenfeld internistischer Psychosomatik ist die Untersuchung und die Behandlung psychosomatischer Patienten im engeren Sinne (Essstörungen, Schmerz- und somatoforme Störungen), weil internistische Diagnostik und Therapie erforderlich oder die Motivation der Patienten primär somatisch ist. Organisationsmodelle reichen von Konsil-/Liaisondiensten bis zu integrierten psychosomatischen Abteilungen oder Fachabteilungen an Allgemeinkrankenhäusern. Aussichtsreiche Forschungsstrategien werden neben der Erforschung psychosomatischer Mechanismen in der Entwicklung pragmatischer Behandlungsprogramme, ihrer Überprüfung in klinischen Studien und der Versorgungsforschung gesehen. Darüber hinaus sollte eine Intensivierung nationaler und internationaler Forschungsnetze erfolgen, wenn immer möglich unter Beteiligung anderer Disziplinen, um auch im Bereich der Forschung konkurrenzfähig zu bleiben.Herrn Prof. Dr. Ernst Richard Petzold zum 65. Geburtstag gewidmet.     

The Reflecting Team approach: convergent results of two exploratory studies

This paper presents results of two exploratory investigations concerning the effectiveness of the Reflecting Team (RT) approach, conducted in Vienna and in Gottingen. Fifty-nine families/couples participated in the RT approach in the two outpatient settings. Follow-up reports from 35 families – obtained on average 15 months after closure – indicated that this model may be considered effective as well as efficient: two thirds of all clients (who made up a heterogeneous group with regard to diagnostic criteria and stage of development of the identified patient) reported symptom improvement, and about 80% said they were very satisfied; these results were obtained with a fairly small number of sessions.     

An exact and optimal standardized person test for assessing consistency with the rasch model

The Rasch model predicts that an individual's ability level is invariant over subtests of the total test, and thus, all subtests measure the same latent trait. A person test of this invariance hypothesis is discussed that is uniformly most powerful and standardized in the sense that the conditional distribution of the test statistic, given a particular level of ability, does not depend on the absolute value of the examinee's ability parameter. The test can be routinely performed by applying a computer program designed by and obtainable from the author. Finally, a suboptimal test is derived that is extremely easy to use, and an overall group test of the invariance hypothesis discussed. All tests considered do not rely on asymptotic approximations; hence, they may be applied when the test is of only moderate length and the group of examinees is small.     

Marital adaptation,divorce, and parent–infant development: A prospective study

In this prospective study of divorce in the first 4 years of life we have shown that previous marital patterns anticipate the occurrence of divorce and influence the response to that event. Most of the divorces occurred in marriages that were consistently low in satisfaction or decreased in satisfaction from birth on. The family response to the event differed. The continuing effort at conflict resolution and the fact that differing levels of adjustment are reached at different time points are suggested by these reactions. For couples with an unsatisfactory marriage from late pregnancy through the first 2 years (consistently low), the immediate and sustained impact of divorce was to enhance the parent's responsiveness to the needs of their infant and the infant's expectation of being cared for. This was not true for couples decreasing from high to lower satisfaction in their adaptation. However, by child age 4, when all families had been divorced for 1 year, divorce versus no divorce was associated with a differential positive effect on teacher Q-sort ratings of the children for both marital patterns. Children who were from families where the parents were in conflict but did not divorce were more likely to externalize control, were more often uncontrolled, and were more anti- as opposed to prosocial. The implication of these findings are discussed. © 1997 Michigan Association for Infant Mental Health     

Prebirth marital interactions and postbirth marital development

A considerable body of research supports the general statement that “couples who before the birth of their first child are characterized by positive mutuality, partner autonomy, and the ability to confront problems and regulate negative affect are responsive to the needs of their infants, promote their autonomy and have more secure and autonomous children, as seen throughout the first 4 years of life” (Heinicke, 1995). The implications for infant mental health are profound, but more needs to be known about what specific prebirth marital qualities interact with and anticipate postbirth marital and child functioning. This is a study of the association between the nature of the couple's prebirth interaction and their marital adaptation during the first 2 years of the child's life. Linking pre- and postbirth marital functioning, the frequency of negative affect and off-task scores, as well as the inability to resolve their issues in the prebirth marital interaction, anticipated a declining or consistently low postbirth marital adaptation.     

An information-theory approach to geometry for animal groups

Animal Cognition - One of the hardest problems in studying animal behaviour is to quantify patterns of social interaction at the group level. Recent technological developments in global positioning...     

Promoting perspective coordination by dilemma discussion. The effectiveness of classroom group discussion on interpersonal negotiation strategies of 12-year-old students

Promoting social competence and social cognition is an important aim of education and socialization. According to theories of social cognitive and moral development, social cognition may be promoted by adolescent peer interaction. In this study, social cognition is theoretically conceptualized by the interpersonal negotiation strategies model of Selman which distinguishes levels of perspective coordination and steps of information processing (identification of a problem, generating negotiation strategies, selection of a strategy, evaluation). In a pre-post control group design this study investigated whether dilemma discussions among peers lead to higher individual levels of perspective coordination compared to an individualistic condition. Members of the discussion-condition exhibited higher gain scores in perspective coordination compared to the control group regarding the information processing steps generating strategies and strategy selection. In order to analyze verbal interaction in the discussion groups, an integrative coding schedule was developed. In addition, trait-like argumentative motives of the participants were assessed. The results of multilevel analyses suggest that progress in posttest-perspective coordination is mediated by the groups consensual solution of the dilemma as well as by an explanation-oriented discussion style, but only if the latter is accompanied by a trait-like subject- and consensus-oriented argumentative motive. Theoretical and practical conclusions are drawn.     

Morningness in German and Spanish students: a comparative study

Humans show pronounced individual differences in circadian orientation. Transcultural comparisons are interesting since biological (or environmental) factors together with cultural ones may contribute to differences in morningness–eveningness. We compared Spanish and German undergraduates using the Composite Scale of Morningness (CSM) to assess circadian preferences. Confirmatory and multiple groups confirmatory factor analysis were used to assess factor structure and structural invariance across countries. The results showed that a three‐factor model of morningness best characterises the CSM structure of both samples. Partial factorial invariance (factor loadings) across countries was demonstrated for the factors ‘morningness’ and ‘morning alertness’. Scores of both factors were higher in German students. Potential cultural and biological explanations for the differences are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

On how high performers keep cool brains in situations of cognitive overload

What happens in the brain when we reach or exceed our capacity limits? Are there individual differences for performance at capacity limits? We used functional magnetic resonance imaging (fMRI) to investigate the impact of increases in processing demand on selected cortical areas when participants performed a parametrically varied and challenging dual task. Low-performing participants respond with large and load-dependent activation increases in many cortical areas when exposed to excessive task requirements, accompanied by decreasing performance. It seems that these participants recruit additional attentional and strategy-related resources with increasing difficulty, which are either not relevant or even detrimental to performance. In contrast, the brains of the high-performing participants “keep cool” in terms of activation changes, despite continuous correct performance, reflecting different and more efficient processing. These findings shed light on the differential implications of performance on activation patterns and underline the importance of the interindividual-differences approach in neuroimaging research.