[Which kinds of distress do partners or spouses of cardiac arrhythmias patients exhibit?]

[Experience of disease, relationship and sexuality in patients with COPD]

Experience of disease, relationship and sexuality in patients with COPD Objectives: We aimed to determine the impacts of chronic obstructive pulmonary disease (COPD) on the patient's relationship and sexuality. Methods: In a multicentric study 105, 52 of them female, non-selected COPD patients who were married or in a partnership were interviewed about their partnership and sexuality. Results: Average age was 64.1 ± 9.2 years. Patients with a more severe COPD had a lower Self-Illness-Separation (SIS), i. e. they reveal significantly higher burden of suffering. Life satisfaction and satisfaction with partnership, sexuality and sexual intercourse has decreased significantly since the diagnosis (p < 0.05). Desire and frequency to be sexually active have also decreased (p < 0.001). 61 % of the respondents felt increasingly dependent from their partner. Conclusion: The results underline that patients have a stage-dependent emotional distance to their illness, the partnership develops in direction of dependency, and sexuality deteriorates with increasing severity of the COPD. The PRISM test proved to be a great way to illustrate this development and to start a conversation with the patients about it. COPD patients and their partners should be referred to the potential impact of the disease on their partnership and sexuality and should be supported in their potential solutions considering gender-specific aspects.

The well-being of relatives of patients with atrial fibrillation: a critical incident technique analysis

Background:

The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient’s condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed.

Aim:

To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations. Design and method: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF.

Results:

The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement).

Conclusion:

The well-being of relatives of patients with AF was affected depending on the patients’ well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.

[The inner coherence of psychosomatic medicine]

THE PROBLEM

The body-mind dualism of somatic medicine is resolved through the concept of psychosomatic medicine. More unspecific descriptions such as "integrative medicine" (which does not clarify what should be integrated) or the "holistic approach" (which comes close to esoterics) suggest the unity of mind, body and soul, although the term "psycho-somatic" still reflects dualistic thinking.

PAST APPROACHES

The American Psychosomatic Society has been considering a name change for years, partially to rid itself of the dualistic label, but so far these efforts have not resulted in a viable alternative. Engel's concept of biopsychosocial medicine supposes a triangular array of the body, mind, and social environment, setting body and mind into a relationship with each other and with a third party. Based on the physician-patient relationship (Balint), psychosomatic medicine can be understood in a broader sense as "relationship medicine," covering not only the use of the interpersonal relationship as a medical agent, but also a science of medicine that puts mind, body, and social environment into a theoretical framework of interrelations, with the perspective of integrating the different system levels. The translation processes among the system levels are, for example, addressed by biosemiotics (v. Uexküll).

CONSEQUENCES

Both clinical medicine and medical research, if they intend to be psychosomatic, need to take these theoretical concepts into account and utilize them practically for (team)work with patients. Together with a clear differentiation from other cultures of (para)medicine, this can serve to develop a "psychosomatic identity."

[The relationship between tinnitus, personality, and depression]

OBJECTIVE

This study examines the relationship between personality characteristics, depression symptoms, demographic profile, and the amount of the tinnitus-related distress experienced.

METHOD

121 patients suffering from tinnitus were examined by unique testing in a tinnitus-practice via three questionnaires over a period of 22 months.

RESULTS

A relationship between the severity of tinnitus-related distress and demographic profile as well as a relationship between depression symptoms and the severity of the tinnitus-related distress could be shown. Also, significant results were observed within the personality range in the areas of "impulsiveness," "aggressiveness," "demands," "physical discomfort," "health worries," und "emotionality."

DISCUSSION

Patients suffering severely from tinnitus represent a clinically relevant group for psychotherapeutic treatment. Especially persons with comorbid symptoms of depression should be screened regularly and offered additional psychotherapeutic or psychiatric treatment.

Forschung zur Versorgung von Patienten mit psychischen Störungen

Über Häufigkeit und Inhalt neuerer deutschsprachiger Arbeiten zur psychiatrischen und psychotherapeutischen Versorgungsforschung sowie den Einbezug ökonomischer Evaluationen ist wenig bekannt. Zur Beurteilung des Forschungsstandes in diesem Bereich wurden alle Originalarbeiten der Zeitschrift für Psychosomatische Medizin und Psychotherapie sowie der Psychiatrischen Praxis der Jahre 2006 und 2007 hinsichtlich ihres Beitrages zur psychiatrischen und psychotherapeutischen Versorgungsforschung sowie zur Versorgungsökonomie ausgewertet. Die Hälfte der erschienenen Originalarbeiten konnte der Versorgungsforschung zugeordnet werden. 85 % dieser Arbeiten beschäftigten sich mit der Beschreibung und Analyse der Versorgungssituation sowie mit der Evaluation von Versorgungskonzepten im Alltag. Drei Viertel der Arbeiten konnten den Teildisziplinen Bedarfs-, Inanspruchnahmeforschung und Versorgungsepidemiologie zugeordnet werden. Unter den Studien zur Versorgungsforschung fanden sich fünf gesundheitsökonomische Analysen (10 %), die in der Mehrheit Kostenstudien waren. Im Vergleich mit früheren Analysen zeigt sich ein anhaltend starkes Interesse an versorgungsbezogenen Fragestellungen im Bereich der psychiatrischen und psychotherapeutischen Versorgungsforschung. Jedoch wurde ein Mangel an Publikationen zur Entwicklung und Implementierung neuer Konzepte in der Versorgung deutlich.