Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.     

The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

Beziehungsmuster und Beziehungskonflikte

Zusammenfassung  Die Veränderung pathogenetisch bedeutsamer Beziehungsmuster gilt als wesentliches psychotherapeutisches Behandlungsziel. Um zielgerichtete Veränderungen von Beziehungsstrukturen zu erreichen, bedarf es sowohl einer Diagnostik und Beschreibung solcher Beziehungsmuster, einer darauf zielenden Behandlungstechnik als auch einer Verlaufskontrolle und Evaluation der angestrebten Veränderungen. Nach einem Überblick über verschiedene Methoden zur Erfassung von Beziehungsmustern wird die Methode des Zentralen-Beziehungskonflikt-Themas (ZBKT) von Luborsky näher beschrieben; ausgewählte Ergebnisse der ZBKT-Forschung werden dargestellt und die Methode kritisch bewertet.

Sexualit?t und Internet

On the discussion about sexual internet activities, the professional and public discourses have been strongly polarized for a long time. Currently the trend is that online sexuality is to be seen in a differentiated and empirical manner. Next to undesired (e.g. assault by internet platform) or indirect (e.g. due to excessive pornography use by partners) confrontations with online sexuality, there is a broad spectrum of self-initiated sexual use of the internet. These are, for example reception of information sites, exchange of experiences, utilization of online sexual consultation and romantic relationships. On the other hand clinically relevant problems could accompany sexual internet use, such as cybersex addiction. Because of the mediatization in society ambulant patients in the psychotherapeutic practice are more informed about sexual internet use. For psychotherapists it is important to know the internet-specific details and the potential risks and chances for sexual behavior in order to know how to deal with the situation and if necessary to integrate the internet into the spectrum of web-based sexual therapeutic options.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Cognitive control and consistency in compliance

Abstract

The purpose of this prospective study was two-fold. First, three modes of compliance assessment were used to examine whether renal dialysis patients comply consistently across medical regimens (fluid, potassium, phosphorous, protein) and whether compliance is consistent across mode of assessment (patient self assessment, medical staff ratings, physiological data). Second. a cognitive model predicting fluid compliance was tested to see if it would generalize to predict dietary compliance and medication taking. Patients' self-control perceptions of compliance, staff assessments of compliance, and physiological data were collected prospectively for 85 end-stage renal disease (ESRD) patients. Results indicated substantial consistency across medical regimen depending on the mode of assessment; staff assessment showed the most consistency, followed by patients' self-assessments and lastly by physiological data. Despite this consistency across medical regimens, the cognitive-control model only predicted fluid compliance; the model failed to explain dietary and medication compliance. Reasons and implications for these results are discussed.     

Posttraumatische Belastungsstörung

There are some problems concerning the concepts of trauma-related disorders and especially the category of posttraumatic stress disorder (PTSD) with respect to classification, diagnosis and epidemiological findings, which can only be understood within the historical framework of the development. Even current diagnostic systems, such as the diagnostic and statistical manual of mental disorders version 4 (DSM-IV) and the international classification of diseases version 10 (ICD-10) differ in the classification of these disorders which led to higher prevalence rates being achieved with ICD-10. The diagnostic algorithms have been opened to included subsyndromal PTSD as well as complex PTSD including more severe psychiatric disorders.